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1.
Medicine (Baltimore) ; 99(15): e19655, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32282715

RESUMEN

Endovascular treatment of arterial injuries with stent-graft is a reliable alternative approach in patients not suitable for embolization or at high risk for surgery. The aim of our study was to evaluate the efficacy and the safety of the BeGraft stent-graft, a low-profile balloon expandable covered stent, for emergency endovascular treatment of iatrogenic arterial injuries.Between August 2015 and September 2018, 34 consecutive patients (mean age 71 ±â€Š12 years, 9 females) underwent implantation of BeGraft stent-grafts for iatrogenic arterial injuries (22 active bleedings, 11 pseudoaneurysms, and 1 enteric-iliac fistula). The primary endpoints were technical and clinical success and rates of major and minor complications. The secondary endpoint was the patency of the device during the follow-up. Imaging follow-up was performed by duplex ultrasound and/or computed tomography angiography (according to lesion site/target vessel), at 1-6-12-15 and 24 months.In all 34 patients (100%), the lesion or the defect was effectively excluded with a cumulative amount of 42 stent-grafts. The clinical success was documented in 30/34 patients (88.2%). Neither device- or procedure-related deaths, or major complications occurred. A minor complication was reported in 1 patient (2.9%), successfully treated during the same procedure. Thirty (88.2%) patients were available for a mean follow-up time of 390 ±â€Š168 days (minimum 184, maximum 770), with no observed loss of patency, yielding a 100% Kaplan-Meier cumulative survival patency function. The percentage of patent patients was 30/30 at 6 months, 22/22 at 12 months, and 5/5 at 15 months.Endovascular treatment of iatrogenic arterial injuries with the BeGraft stent-graft is minimally invasive and effective, with good patency rate at midterm follow-up.


Asunto(s)
Embolización Terapéutica/métodos , Tratamiento de Urgencia/normas , Enfermedad Iatrogénica/epidemiología , Lesiones del Sistema Vascular/terapia , Anciano , Anciano de 80 o más Años , Aneurisma Falso/epidemiología , Aneurisma Falso/terapia , Oclusión con Balón/métodos , Procedimientos Endovasculares/métodos , Femenino , Hemorragia/epidemiología , Hemorragia/terapia , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Stents/efectos adversos , Resultado del Tratamiento , Fístula Vascular/epidemiología , Fístula Vascular/terapia , Grado de Desobstrucción Vascular
2.
West J Emerg Med ; 21(2): 365-373, 2020 Feb 25.
Artículo en Inglés | MEDLINE | ID: mdl-32191195

RESUMEN

INTRODUCTION: Since 2013, the First Care Provider (FCP) model has successfully educated the non-medical population on how to recognize life-threatening injuries and perform interventions recommended by the Committee for Tactical Emergency Casualty Care (C-TECC) and the Hartford Consensus in the disaster setting. Recent programs, such as the federal "Stop The Bleed" campaign, have placed the emphasis of public training on hemorrhage control. However, recent attacks demonstrate that access to wounded, recognition of injury, and rapid evacuation are equally as important as hemorrhage control in minimizing mortality. To date, no training programs have produced a validated study with regard to training a community population in these necessary principles of disaster response. METHODS: In our study, we created a reproducible community training model for implementation into prehospital systems. Two matched demographic groups were chosen and divided into "trained" and "untrained" groups. The trained group was taught the FCP curriculum, which the Department of Homeland Security recognizes as a Stop the Bleed program, while the untrained group received no instruction. Both groups then participated in a simulated mass casualty event, which required evaluation of multiple victims with varying degree of injury, particularly a patient with an arterial bleed and a patient with an airway obstruction. RESULTS: The objective measures in comparing the two groups were the time elapse until their first action was taken (T1A) and time to their solution of the simulation (TtS). We compared their times using one-sided t-test to demonstrate their responses were not due to chance alone. At the arterial bleed simulation, the T1A for the trained and untrained groups, respectively, were 34.75 seconds and 111 seconds (p-value = .1064), while the TtS were 3 minutes and 33 seconds in the trained group and eight minutes in the untrained groups (physiologic cutoff) (p-value = .0014). At the airway obstruction simulation, the T1A for the trained and untrained groups, respectively, were 20.5 seconds and 43 seconds (p-value = .1064), while the TtS were 32.6 seconds in the trained group and 7 minutes and 3 seconds in the untrained group (p-value = .0087). Simulation values for recently graduated nursing students and a local fire department engine company (emergency medical services [EMS]) were also given for reference. The trained group's results mirrored times of EMS. CONCLUSION: This study demonstrates an effective training model to civilian trauma response, while adhering to established recommendations. We offer our model as a potential solution for accomplishing the Stop The Bleed mission while advancing the potential of public disaster response.


Asunto(s)
Servicios Médicos de Urgencia , Socorristas , Tratamiento de Urgencia , Hemorragia/terapia , Incidentes con Víctimas en Masa , Consenso , Educación , Servicios Médicos de Urgencia/métodos , Tratamiento de Urgencia/normas , Humanos
5.
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
6.
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
8.
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
11.
Aten. prim. (Barc., Ed. impr.) ; 51(5): 269-277, mayo 2019. tab
Artículo en Español | IBECS | ID: ibc-180875

RESUMEN

Objetivo: Explorar la percepción acerca de la presencia de familiares durante la reanimación cardiopulmonar (RCP) en pacientes adultos, de los propios pacientes y familiares, enfermeras y médicos. Diseño: Se desarrolló un estudio cualitativo exploratorio y un análisis temático. Emplazamiento: Atención Primaria, Atención Hospitalaria y Servicio de Emergencias del Servicio Vasco de Salud. Participantes: La selección de los participantes se realizó a través de muestreo intencional. Se desarrollaron 4 grupos de discusión: uno de pacientes y familiares, 2 de enfermeras y uno de médicos. Método: Se realizó un análisis temático. Se utilizaron técnicas de triangulación entre investigadores e investigador-informante. Se utilizó el programa informático Open Code 4.1. Resultados: Se identificaron 3 categorías significativas: impacto de la actuación en la familia; peso de la responsabilidad ética y legal; poder, lugar donde sucede la parada y supuestos culturales. Conclusiones: La RCP es un constructo social influido por los valores de los contextos socioculturales específicos. En este estudio, los pacientes y familiares describieron temor y resistencia a presenciar la RCP. Por su parte, los profesionales sanitarios consideran que su decisión reviste complejidad, siendo necesario valorar cada caso de forma independiente e integrando a pacientes y familiares en la toma de decisiones. Como líneas de investigación futuras sería recomendable profundizar sobre la experiencia subjetiva de familiares que hayan presenciado la RCP y el impacto de los elementos contextuales y socioculturales en sus percepciones


Objective: To determine the perception of nurses, doctors, patients and family or relatives being present during cardiopulmonary resuscitation (CPR) in adult patients. Design: A qualitative exploratory study and thematic analysis were developed. Site: Primary Care, Hospital Care and Emergency Service of the Basque Health Service. Participants.The selection of the participants was made through intentional sampling. Four focus groups were developed: one of patients and family, 2 of nurses, and one of physicians. Method: Thematic analysis was performed. Triangulation techniques were used between investigators and investigator-participant member. The Open code 4.1 statistics software was used. Results: Three significant categories were identified: the impact on the family; the weight of ethical and legal responsibility; power, place of death, and cultural assumptions. Conclusions: CPR is a social construct influenced by values which are situated in specific socio-cultural contexts. In this study, patients and family members describe the fear and resistance to being present during CPR. Health professionals consider that their decision is complex, and each case must be assessed independently, and patients and relatives must be integrated into decision-making. Future research should explore in greater depth the subjective experience of relatives who have witnessed CPR and the impact of contextual and sociocultural elements from the perspectives of relatives


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Chaperones Médicos/normas , Reanimación Cardiopulmonar/normas , Paro Cardíaco/terapia , Tratamiento de Urgencia/normas , Discusiones Bioéticas/normas , Percepción Social , Miedo , Actitud del Personal de Salud , Investigación Cualitativa , Grupos Focales/métodos
12.
World J Emerg Surg ; 14: 15, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30976292

RESUMEN

Background: The prognostic role of what a surgeon observes in the abdomen of patients with complicated intra-abdominal infection (cIAI) is largely unknown. The aim of this prospective study was to systemically analyze components of the intra-abdominal view (IAV) and their association to severe complicated intra-abdominal sepsis (SCIAS) or mortality. Methods: The study cohort consisted of adult patients with cIAI. The operating surgeon filled a paper form describing the intra-abdominal view. Demographics, operative details, and preoperative physiological status were collected. Descriptive, univariate, and multivariate statistical analyses were performed, and a new score was developed based on regression coefficients. The primary outcome was a composite outcome of SCIAS or 30-day mortality, in which SCIAS was defined as organ dysfunctions requiring intensive care unit admission. Results: A total of 283 patients were analyzed. The primary outcome was encountered in 71 (25%) patients. In the IAV, independent risk factors for the primary outcome were fecal or bile as exudate (odds ratio (OR) 1.98, 95% confidence interval 1.05-3.73), diffuse peritonitis (OR 2.15, 1.02-4.55), diffuse substantial redness of the peritoneum (OR 5.73, 2.12-15.44), and a non-appendiceal source of cIAI (OR 11.20, 4.11-30.54). Based on these factors, an IAV score was developed and its performance analyzed. The area under the receiver operating characteristic for the IAV score was 0.81. The IAV score also correlated significantly with several outcomes and organ dysfunctions. Conclusions: The extent of peritonitis, diffuse substantial redness of the peritoneum, type of exudate, and source of infection associate independently with SCIAS or mortality. A high IAV score associates with mortality and organ dysfunctions, yet it needs further external validation. Combining components of IAV into comprehensive scoring systems for cIAI patients may provide additional value compared to the current scoring systems. Trial registration: The study protocol was retrospectively registered on April 4, 2016, right after the first enrolled patient at Clinicaltrials.gov database (NCT02726932).


Asunto(s)
Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Infecciones Intraabdominales/diagnóstico , Infecciones Intraabdominales/cirugía , Pronóstico , Anciano , Índice de Masa Corporal , Estudios de Cohortes , Tratamiento de Urgencia/métodos , Tratamiento de Urgencia/normas , Femenino , Humanos , Infecciones Intraabdominales/fisiopatología , Modelos Logísticos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Estudios Prospectivos , Curva ROC , Estudios Retrospectivos , Factores de Riesgo , Estadísticas no Paramétricas
13.
PLoS One ; 14(4): e0213719, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30958834

RESUMEN

OBJECTIVE: To assess the existing knowledge and skills relating to Emergency Obstetrics Care (EMOC) among health providers in eight referral maternity hospitals in Nigeria. STUDY DESIGN: A cross-sectional study of skilled health providers (doctors, nurses and midwives) working in the hospitals during the period. SETTING: Six general hospitals (4 in the south and 2 in the north), and two teaching hospitals (both in the Northern part) of the country. POPULATION: All skilled providers offering EMOC services in the hospitals during the study. METHODS: A pre-tested self-administered questionnaire was used to obtain information relating to socio-demographic characteristics, the respondents' knowledge and skills in offering specific EMOC services (as compared to standard World Health Organization recommendations), and their confidence in transferring the skills to mid-level providers. Data were analyzed with univariate, bivariate, binary and multinomial logistic regression analyses. Main outcome measures: knowledge and skills in EMOC services by hospital and overall. RESULTS: A total of 341 health providers (148 doctors and 193 nurses/midwives) participated in the study. Averagely, the providers scored less than 46% in a composite EMOC knowledge score, with doctors scoring considerable higher than the nurses/midwives. Similarly, doctors scored higher than nurses/midwives in the self-reporting of confidence in carrying out specific EMOC functions. Health providers that scored higher in knowledge were significantly more likely to report confidence in performing specific EMOC functions as compared to those with lower scores. The self-reporting of confidence in transferring clinical skills was also higher in those with higher EMOC knowledge scores. CONCLUSION: The knowledge and reported skills on EMOC by health providers in referral facilities in Nigeria was lower than average. We conclude that the in-service training and re-training of health providers should be included in national policy and programs that address maternal mortality prevention in referral facilities in the country. TRIAL REGISTRATION: Nigeria Clinical Trials Registry 91540209.


Asunto(s)
Competencia Clínica/normas , Parto Obstétrico/normas , Mortalidad Materna , Médicos/normas , Adulto , Anciano , Servicios Médicos de Urgencia/normas , Tratamiento de Urgencia/normas , Femenino , Accesibilidad a los Servicios de Salud , Maternidades/normas , Humanos , Persona de Mediana Edad , Nigeria/epidemiología , Enfermeras Obstetrices , Obstetricia/normas , Embarazo
14.
Lancet ; 393(10187): 2213-2221, 2019 06 01.
Artículo en Inglés | MEDLINE | ID: mdl-31030986

RESUMEN

BACKGROUND: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. METHODS: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. FINDINGS: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96-1·28). INTERPRETATION: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. FUNDING: National Institute for Health Research Health Services and Delivery Research Programme.


Asunto(s)
Procedimientos Quirúrgicos del Sistema Digestivo/mortalidad , Tratamiento de Urgencia/mortalidad , Mejoramiento de la Calidad , Anciano , Anciano de 80 o más Años , Análisis por Conglomerados , Vías Clínicas/normas , Procedimientos Quirúrgicos del Sistema Digestivo/normas , Tratamiento de Urgencia/normas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Programas y Proyectos de Salud , Medicina Estatal/normas , Medicina Estatal/estadística & datos numéricos , Análisis de Supervivencia , Reino Unido
15.
BMC Emerg Med ; 19(1): 14, 2019 01 24.
Artículo en Inglés | MEDLINE | ID: mdl-30678636

RESUMEN

BACKGROUND: Prehospital emergency care has developed rapidly during the past decades. The care is given in a complex context which makes prehospital care a potential high-risk activity when it comes to patient safety. Patient safety in the prehospital setting has been only sparsely investigated. The aims of the present study were 1) To investigate the incidence of adverse events (AEs) in prehospital care and 2) To investigate the factors contributing to AEs in prehospital care. METHODS: We used a retrospective study design where 30 randomly selected prehospital medical records were screened for AEs each month in three prehospital organizations in Sweden during a period of one year. A total of 1080 prehospital medical records were included. The record review was based on the use of 11 screening criteria. RESULTS: The reviewers identified 46 AEs in 46 of 1080 (4.3%) prehospital medical records. Of the 46 AEs, 43 were classified as potential for harm (AE1) (4.0, 95% CI = 2.9-5.4) and three as harm identified (AE2) (0.3, 95% CI = 0.1-0.9). However, among patients with a life-threatening condition (priority 1), the risk of AE was higher (16.5%). The most common factors contributing to AEs were deviations from standard of care and missing, incomplete, or unclear documentation. The most common cause of AEs was the result of action(s) or inaction(s) by the emergency medical service (EMS) crew. CONCLUSIONS: There were 4.3 AEs per 100 ambulance missions in Swedish prehospital care. The majority of AEs originated from deviations from standard of care and incomplete documentation. There was an increase in the risk of AE among patients who the EMS team assessed as having a life-threatening condition. Most AEs were possible to avoid.


Asunto(s)
Servicios Médicos de Urgencia/estadística & datos numéricos , Tratamiento de Urgencia/efectos adversos , Errores Médicos/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Servicios Médicos de Urgencia/normas , Tratamiento de Urgencia/normas , Falla de Equipo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Seguridad del Paciente , Estudios Retrospectivos , Factores de Riesgo
16.
Hosp Pract (1995) ; 47(1): 42-45, 2019 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-30409047

RESUMEN

BACKGROUND: Rapid response teams (RRTs) improve mortality by intervening in the hours preceding arrest. Implementation of these teams varies across institutions. SETTING AND DESIGN: Our health-care system has two different RRT models at two hospitals: Hospital A does not utilize a proactive rounder while Hospital B does. We studied the patterns of RRT calls at each hospital focusing on the differences between night and day and during nursing shift transitions. RESULTS: The presence of proactive surveillance appeared to be associated with an increased total number of RRT calls with more than twice as many calls made at the smaller Hospital B than Hospital A. Hospital B had more calls in the daytime compared to the nighttime. Both hospitals showed a surge in the night-to-day shift transition (7-8am) compared to the preceding nighttime. Hospital A additionally showed a surge in calls during the day-to-night shift transition (7-8pm) compared to the preceding daytime. CONCLUSIONS: Differences in the diurnal patterns of RRT activation exist between hospitals even within the same system. As a continuously learning system, each hospital should consider tracking these patterns to identify their unique vulnerabilities. More calls are noted between 7-8am compared to the overnight hours. This may represent the reestablishment of the 'afferent' arm of the RRT as the hospital returns to daytime staffing and activity. Factors that influence the impact of proactive rounding on RRT performance may deserve further study.


Asunto(s)
Tratamiento de Urgencia/normas , Paro Cardíaco/terapia , Equipo Hospitalario de Respuesta Rápida/normas , Unidades de Cuidados Intensivos/normas , Cuidados Nocturnos/normas , Hospitalización/estadística & datos numéricos , Humanos
17.
Eur J Cancer Care (Engl) ; 28(2): e12974, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30520179

RESUMEN

INTRODUCTION: Recent worldwide advances in cancer therapies have resulted in an increased number of people receiving chemotherapy in ambulatory care settings. In Spain, emergency departments are the single point of entry to acute inpatient services and they play a pivotal role in the management of chemotherapy complications. Little research exists in patterns of emergency department utilisation by oncology patients with chemotherapy-related complications. However, it is important for the oncology patients and the healthcare system to gain understanding in the disease pathway and the organisational factors influencing the quality of care. METHODS: This critical review's main aims were to describe the clinical characteristics of patients who presented to an emergency department after chemotherapy treatment as reported in international literature; to map reported patterns of care in emergency department access; and quality of care exploring the management of febrile neutropenic patients described in the literature, against best practice guidelines. RESULTS: The search strategy yield 701 articles from MEDLINE, TROVE and SCOPUS and 26 were included. The review combines systematic reviews, observational, cross-sectional case-control studies and randomised control trials. CONCLUSION: All articles showed areas and opportunities for improvement in the management of this population, especially with regard to time from triage to antibiotic administration in febrile neutropenic patients.


Asunto(s)
Antineoplásicos/efectos adversos , Servicio de Urgencia en Hospital/estadística & datos numéricos , Neoplasias/tratamiento farmacológico , Antibacterianos/uso terapéutico , Servicio de Urgencia en Hospital/normas , Tratamiento de Urgencia/métodos , Tratamiento de Urgencia/normas , Métodos Epidemiológicos , Utilización de Instalaciones y Servicios , Neutropenia Febril/inducido químicamente , Neutropenia Febril/tratamiento farmacológico , Humanos , Aceptación de la Atención de Salud/estadística & datos numéricos , Mejoramiento de la Calidad , Tiempo de Tratamiento
18.
Emerg Med Australas ; 31(1): 105-111, 2019 02.
Artículo en Inglés | MEDLINE | ID: mdl-30472768

RESUMEN

OBJECTIVES: To summarise recent developments in emergency care in Kiribati, a developing Pacific Island nation. Multiple donor countries and agencies have partnered in this process. Changes in medical training, staffing models and planned infrastructure developments are all described, with a particular focus on a recent emergency nurse training programme. METHODS: A bespoke nurse education course was developed by external clinical nurse specialists in collaboration with local administrators and clinicians, incorporating WHO Basic Emergency Care course. The nine-day course was delivered to 18 nurses, over a 3-week period to accommodate rostering requirements. Pre- and post-course assessment was undertaken. RESULTS: Quantitative assessment improved from 87.11 ± 7.46 (mean ± SD) to 94.89 ± 5.95 (t = 5.45, P < 0.001). Qualitative scenario-based assessment confirmed marked improvement. CONCLUSIONS: A multifaceted development strategy has proven essential for progression in emergency care. Nurse education is an essential component of this, and the existing model has potential for other similar nations.


Asunto(s)
Medicina de Emergencia/tendencias , Enfermería de Urgencia/educación , Tratamiento de Urgencia/normas , Educación Médica/métodos , Educación Médica/organización & administración , Educación Médica/normas , Educación en Enfermería/métodos , Educación en Enfermería/organización & administración , Educación en Enfermería/normas , Evaluación Educacional/métodos , Enfermería de Urgencia/normas , Tratamiento de Urgencia/métodos , Humanos , Micronesia
19.
Am J Emerg Med ; 37(6): 1037-1043, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-30177266

RESUMEN

OBJECTIVES: To describe recent trends in advanced imaging and hospitalization of emergency department (ED) syncope patients, both considered "low-value", and examine trend changes before and after the publication of American College Emergency Physician (ACEP) syncope guidelines in 2007, compared to conditions that had no changes in guideline recommendations. METHODS: We analyzed 2002-2015 National Hospital Ambulatory Medical Care Survey data using an interrupted-time series with comparison series design. The primary outcomes were advanced imaging among ED visits with principal diagnosis of syncope and headache and hospitalization for ED visits with principal diagnosis of syncope, chest pain, dysrhythmia, and pneumonia. We adjusted annual imaging and hospitalization rates using survey-weighted multivariable logistic regression, controlling for demographic and visit characteristics. Using adjusted outcomes as datapoints, we compared linear trends and trend changes of annual imaging and hospitalization rates before and after 2007 with aggregate-level multivariable linear regression. RESULTS: From 2002 to 2007, advanced imaging rates for syncope increased from 27.2% to 42.1% but had no significant trend after 2007 (trend change: -3.1%; 95%CI -4.7, -1.6). Hospitalization rates remained at approximately 37% from 2002 to 2007 but declined to 25.7% by 2015 (trend change: -2.2%; 95%CI -3.0, -1.4). Similar trend changes occurred among control conditions versus syncope, including advanced imaging for headache (difference in trend change: -0.6%; 95%CI -2.8, 1.6) and hospitalizations for chest pain, dysrhythmia, and pneumonia (differences in trend changes: 0.1% [95%CI -1.9, 2.0]; -0.9% [95%CI -3.1, 1.3]; and -1.2% [95%CI -5.3, 2.9], respectively). CONCLUSIONS: Before and after the release of 2007 ACEP syncope guidelines, trends in advanced imaging and hospitalization for ED syncope visits had similar changes compared to control conditions. Changes in syncope care may, therefore, reflect broader practice shifts rather than a direct association with the 2007 ACEP guideline. Moreover, utilization of advanced imaging remains prevalent. To reduce low-value care, policymakers should augment society guidelines with additional policy changes such as reportable quality measures.


Asunto(s)
Diagnóstico por Imagen/tendencias , Síncope/diagnóstico , Adolescente , Adulto , Anciano , Niño , Preescolar , Diagnóstico por Imagen/métodos , Servicio de Urgencia en Hospital/organización & administración , Servicio de Urgencia en Hospital/estadística & datos numéricos , Tratamiento de Urgencia/normas , Tratamiento de Urgencia/estadística & datos numéricos , Tratamiento de Urgencia/tendencias , Femenino , Guías como Asunto , Hospitalización/tendencias , Humanos , Masculino , Persona de Mediana Edad , Calidad de la Atención de Salud/normas , Calidad de la Atención de Salud/estadística & datos numéricos , Síncope/terapia , Estados Unidos
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