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1.
Medicine (Baltimore) ; 99(45): e23081, 2020 Nov 06.
Artículo en Inglés | MEDLINE | ID: mdl-33157975

RESUMEN

Few studies have clarified the use of complementary therapies (CTs) in France. The main objective of this preliminary study was to evaluate knowledge of CTs in 4 representative groups of patients: patients suffering from cancer, patients presenting with a chronic noncancerous disease, chronic dialysis patients and nonchronic or cancerous patients needing surgery.A formalized questionnaire was designed by 2 psychologists, an oncologist and an anesthesiologist in charge of the Pain Clinic and Support Care Unit. One-hundred eleven patients were enrolled, and all agreed to complete the questionnaire.Eighty (72%) patients did not know the term "complementary therapies" (patients who were "not aware of CTs"), and 24 (21.6%) patients knew the term "complementary therapies" (patients who were "aware of CTs"), while 7 patients were not sure of the meaning. There were no differences between aware and unaware patients in gender (P = .27), age (P = .24), level of education (p = 0.24) or professional occupation (P = .06). Knowledge about CTs was significantly different among the different categories of patients (P = .03), with the only statistically significant difference between groups being between oncologic patients receiving ambulatory chemotherapy and patients presenting with a chronic noncancerous disease (P = .004).This preliminary study clearly highlights that patients and health caregivers are not aware of CTs and that there is a need for better communication about CTs.


Asunto(s)
Terapias Complementarias/estadística & datos numéricos , Conocimientos, Actitudes y Práctica en Salud , Utilización de Procedimientos y Técnicas/estadística & datos numéricos , Centros de Atención Terciaria/estadística & datos numéricos , Anciano , Femenino , Francia , Humanos , Masculino , Persona de Mediana Edad , Autoinforme
2.
J Pregnancy ; 2020: 3631808, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32695513

RESUMEN

Background: Obstructed or prolonged labor is a major cause of maternal deaths. Prolonged and obstructed labor contributed to 13% of global maternal deaths which can be reduced by proper utilization of a partograph during labor. Obstetric caregivers' use of the partograph during labor has paramount importance in identifying any deviation during labor. Even though partograph use is influenced by different factors as obtained from the literatures, the magnitude of partograph utilization and the factors associated with its use are not well determined in the health facilities of Wolaita Zone. Objective: To assess the magnitude of partograph utilization and factors that affect its utilization among obstetric caregivers in public health facilities of Wolaita Zone, Ethiopia, 2017. Methods: An institution-based cross-sectional study was conducted on obstetric caregivers. A pretested and structured questionnaire was used to collect data. Data was entered to EpiData version 3.01 and exported to SPSS version 23.0 for further analysis. Logistic regression analyses were used to see the association of different variables. Result: A total of 269 obstetric caregivers participated in the study. Among those who were utilizing the partograph, 193 (71.7%) routinely used it for all laboring mothers and 76 (28.3%) of participants reported that they do not routinely utilize it. Greater number of service years (AOR = 4.93, 95% CI: 1.53-15.88), on-the-job training (AOR = 0.16, 95% CI: 0.06-0.43), good knowledge (AOR = 3.35, 95% CI: 1.61-6.97), and favorable attitude towards partograph utilization (AOR = 2.99, 95% CI: 1.28-7.03) were significantly associated with partograph utilization. Conclusion and Recommendation. Partograph utilization among obstetric caregivers in the public health facilities was good. Greater years of work experience, in-service training, having good knowledge, and favorable attitude towards partograph utilization among obstetric caregivers independently determined partograph utilization. Provision of on-the-job training to make obstetric caregivers improve knowledge and skill on partograph utilization, maintaining caregivers' retention to decrease turnover by providing different incentives to more experienced obstetric care providers, and establishing favorable attitude could improve the proper use of the tool.


Asunto(s)
Monitoreo Fetal/métodos , Monitoreo Fetal/estadística & datos numéricos , Personal de Salud/estadística & datos numéricos , Trabajo de Parto , Complicaciones del Trabajo de Parto/prevención & control , Utilización de Procedimientos y Técnicas/estadística & datos numéricos , Competencia Clínica , Estudios Transversales , Etiopía/epidemiología , Femenino , Instituciones de Salud/estadística & datos numéricos , Conocimientos, Actitudes y Práctica en Salud , Personal de Salud/educación , Humanos , Embarazo , Encuestas y Cuestionarios
3.
Am J Kidney Dis ; 76(5): 696-709.e1, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-32730812

RESUMEN

RATIONALE & OBJECTIVE: During the coronavirus disease 2019 (COVID-19) pandemic, New York encountered shortages in continuous kidney replacement therapy (CKRT) capacity for critically ill patients with acute kidney injury stage 3 requiring dialysis. To inform planning for current and future crises, we estimated CKRT demand and capacity during the initial wave of the US COVID-19 pandemic. STUDY DESIGN: We developed mathematical models to project nationwide and statewide CKRT demand and capacity. Data sources included the Institute for Health Metrics and Evaluation model, the Harvard Global Health Institute model, and published literature. SETTING & POPULATION: US patients hospitalized during the initial wave of the COVID-19 pandemic (February 6, 2020, to August 4, 2020). INTERVENTION: CKRT. OUTCOMES: CKRT demand and capacity at peak resource use; number of states projected to encounter CKRT shortages. MODEL, PERSPECTIVE, & TIMEFRAME: Health sector perspective with a 6-month time horizon. RESULTS: Under base-case model assumptions, there was a nationwide CKRT capacity of 7,032 machines, an estimated shortage of 1,088 (95% uncertainty interval, 910-1,568) machines, and shortages in 6 states at peak resource use. In sensitivity analyses, varying assumptions around: (1) the number of pre-COVID-19 surplus CKRT machines available and (2) the incidence of acute kidney injury stage 3 requiring dialysis requiring CKRT among hospitalized patients with COVID-19 resulted in projected shortages in 3 to 8 states (933-1,282 machines) and 4 to 8 states (945-1,723 machines), respectively. In the best- and worst-case scenarios, there were shortages in 3 and 26 states (614 and 4,540 machines). LIMITATIONS: Parameter estimates are influenced by assumptions made in the absence of published data for CKRT capacity and by the Institute for Health Metrics and Evaluation model's limitations. CONCLUSIONS: Several US states are projected to encounter CKRT shortages during the COVID-19 pandemic. These findings, although based on limited data for CKRT demand and capacity, suggest there being value during health care crises such as the COVID-19 pandemic in establishing an inpatient kidney replacement therapy national registry and maintaining a national stockpile of CKRT equipment.


Asunto(s)
Lesión Renal Aguda , Defensa Civil , Terapia de Reemplazo Renal Continuo/métodos , Infecciones por Coronavirus , Enfermedad Crítica , Necesidades y Demandas de Servicios de Salud/organización & administración , Unidades de Cuidados Intensivos/provisión & distribución , Pandemias , Neumonía Viral , Reserva Estratégica/métodos , Lesión Renal Aguda/etiología , Lesión Renal Aguda/terapia , Betacoronavirus , Defensa Civil/métodos , Defensa Civil/organización & administración , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Enfermedad Crítica/epidemiología , Enfermedad Crítica/terapia , Humanos , Modelos Teóricos , Neumonía Viral/complicaciones , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Utilización de Procedimientos y Técnicas/estadística & datos numéricos , Medición de Riesgo/métodos , Estados Unidos/epidemiología
4.
Saudi Med J ; 41(7): 698-702, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32601636

RESUMEN

OBJECTIVES: To determine the ultrasound guidance for central venous catheter (USG-CVC) placement rate of emergency physicians (EPs) in Kingdom of Saudi Arabia. METHODS: A cross-sectional survey study regarding the respondents' demographic profiles, formal and informal training in USG-CVC placement, experiences, and attitudes towards the procedure was emailed to all EPs registered with the Saudi Commission for Health Specialties (SCFHS) between October and December 2018. RESULTS: In total, 234/350 SCFHS-registered EPs completed the survey; the response rate was 66.9%. Most respondents (70.5%) were board-certified in emergency medicine (EM). Ninety percent indicated that US device for CVC placement assistance was available. Most EPs (78.2%) had performed USG-CVC placement; the US usage rate correlated significantly with recent graduation from residency (p=0.048). In total, 83.3% received formal training during residency. Of the 234 respondents, 53.8% felt extremely comfortable with CVC placement with USG and 19.7% without USG (p less than 0.01). Nevertheless, most respondents desired further USG-CVC training. CONCLUSION: Despite existing evidence and a consensus on its superiority over the landmark technique, USG-CVC placement has not been adopted by a small proportion of EPs into clinical practice. Formal training, education, and institutional provision of permanent onsite US machines may address any barriers.


Asunto(s)
Cateterismo Venoso Central/métodos , Cateterismo Venoso Central/estadística & datos numéricos , Catéteres Venosos Centrales , Medicina de Emergencia , Internado y Residencia/estadística & datos numéricos , Médicos , Utilización de Procedimientos y Técnicas/estadística & datos numéricos , Cirugía Asistida por Computador/métodos , Cirugía Asistida por Computador/estadística & datos numéricos , Ultrasonografía Intervencional/métodos , Ultrasonografía Intervencional/estadística & datos numéricos , Ultrasonografía , Estudios Transversales , Femenino , Humanos , Masculino , Arabia Saudita/epidemiología , Cirugía Asistida por Computador/educación , Encuestas y Cuestionarios
5.
BMJ Open Respir Res ; 7(1)2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-32624495

RESUMEN

The aim of this case series is to describe and evaluate our experience of continuous positive airway pressure (CPAP) to treat type 1 respiratory failure in patients with COVID-19. CPAP was delivered in negative pressure rooms in the newly repurposed infectious disease unit. We report a cohort of 24 patients with type 1 respiratory failure and COVID-19 admitted to the Royal Liverpool Hospital between 1 April and 30 April 2020. Overall, our results were positive; we were able to safely administer CPAP outside the walls of a critical care or high dependency unit environment and over half of patients (58%) avoided mechanical ventilation and a total of 19 out of 24 (79%) have survived and been discharged from our care.


Asunto(s)
Presión de las Vías Aéreas Positiva Contínua/métodos , Infecciones por Coronavirus , Pandemias , Neumonía Viral , Utilización de Procedimientos y Técnicas/estadística & datos numéricos , Unidades de Cuidados Respiratorios , Insuficiencia Respiratoria , Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/terapia , Vías Clínicas/tendencias , Femenino , Humanos , Masculino , Registros Médicos/estadística & datos numéricos , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Consumo de Oxígeno , Neumonía Viral/epidemiología , Neumonía Viral/fisiopatología , Neumonía Viral/terapia , Unidades de Cuidados Respiratorios/métodos , Unidades de Cuidados Respiratorios/organización & administración , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/mortalidad , Insuficiencia Respiratoria/fisiopatología , Insuficiencia Respiratoria/terapia , Análisis de Supervivencia , Reino Unido/epidemiología
6.
Nihon Koshu Eisei Zasshi ; 67(6): 380-389, 2020.
Artículo en Japonés | MEDLINE | ID: mdl-32612078

RESUMEN

Objective In recent years, the long-term use of media (including the Internet, video games, and social networking services) at a young age has been regarded as a problem. It has been pointed out that prolonged media usage may have an undesirable effect on the growth of adolescents from the physical, mental, and social perspectives. Junior and senior high school students are in a particularly important period of self-management of the basic lifestyle habits acquired thus far. Additionally, they must cultivate the ability to interact appropriately with media used daily. In this study, we investigated the relationship between the time expended on media usage and lifestyle habits among junior and senior high school students.Methods A sample of 1,633 students was extracted from all junior and senior high schools in Fukushima City. Principals of the schools distributed a self-administered questionnaire to their students. In total, 1,589 responses were obtained; as surveys of 30 students were missing values for gender and grade, they were excluded from the analysis, and data from 1,559 respondents were ultimately analyzed. A binomial logistic regression analysis was performed to examine the relationship between an independent variable (media usage time) and dependent variables (subjective health, lifestyle habits, and drinking and smoking experience) while controlling for gender and grade.Results Among junior high students, media usage for more than three hours was significantly related to "no breakfast," "no exercise habits," "irregular sleep," "lack of rest," and "feeling stressed." Among high school students, media usage for three hours or more was significantly related to "poor subjective health status," "eating only one or two meals a day," "no breakfast," "low food diversity," "obesity," "no exercise habits," "irregular sleep," "late bedtime," "waking up late," "drinking," and "smoking."Conclusion Our findings indicate that three or more hours of daily media usage is related to unhealthy lifestyles in terms of sleeping, eating, physical activity, drinking, and smoking. Junior and senior high school students who responded to the survey indicated that prolonged usage was also adversely related to their subjective health. Because the overuse of media is associated with students' lifestyles and health, it is important to develop an educational system that helps junior and senior high school students use media properly.


Asunto(s)
Medios de Comunicación/estadística & datos numéricos , Internet/estadística & datos numéricos , Estilo de Vida , Redes Sociales en Línea , Utilización de Procedimientos y Técnicas/estadística & datos numéricos , Instituciones Académicas , Estudiantes/psicología , Juegos de Video/estadística & datos numéricos , Adolescente , Consumo de Bebidas Alcohólicas/epidemiología , Actitud Frente a la Salud , Niño , Educación en Salud , Humanos , Fumar/epidemiología , Factores de Tiempo
7.
In Vivo ; 34(3 Suppl): 1695-1699, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32503831

RESUMEN

BACKGROUND/AIM: Coronavirus is an ongoing pandemic challenging health systems worldwide. The aim of this report was to evaluate the effectiveness of lockdown in different countries, highlighting the performance of Greek society and authorities. METHODS: We analyzed publicly available data from the "Worldometer". We evaluated the efficacy of lockdown at one month after implementation. Delta Days (DD) referred to the difference in the days of reaching 1 case/million people to the adoption of lockdown. RESULTS: Higher healthcare expenditure as % of the national GDP was not correlated with better 30-day mortality outcomes. DD index was significantly correlated to the incidence of COVID-19 per million people at 30 days (p-value=0.001). The correlation between DD and 30-day mortality was not statistically significant (p-value=0.087). CONCLUSION: Early lockdown was proven to be the appropriate policy to limit the spread of COVID-19. Greece was a success story in preventing spread despite limited resources.


Asunto(s)
Infecciones por Coronavirus/prevención & control , Política de Salud , Pandemias/prevención & control , Neumonía Viral/prevención & control , Cuarentena , Técnicas de Laboratorio Clínico/estadística & datos numéricos , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/economía , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/transmisión , Salud Global , Grecia/epidemiología , Gastos en Salud/estadística & datos numéricos , Recursos en Salud/economía , Humanos , Incidencia , Pandemias/economía , Neumonía Viral/economía , Neumonía Viral/mortalidad , Neumonía Viral/transmisión , Utilización de Procedimientos y Técnicas/estadística & datos numéricos , Evaluación de Programas y Proyectos de Salud , Cuarentena/estadística & datos numéricos , Asignación de Recursos
8.
Indian J Gastroenterol ; 39(2): 176-185, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32483692

RESUMEN

BACKGROUND: Evidence supports therapeutic drug monitoring (TDM) in improving efficacy and cost-effectiveness of anti-TNF therapy in inflammatory bowel disease (IBD). Data on perceptions and barriers to TDM use are limited and no data are available from India. Our objective was to assess clinicians' attitudes and barriers to TDM use in IBD. METHODS: A 16-question survey was distributed to members of the Indian Society of Gastroenterology. Information on clinician characteristics, demographics, use and barriers towards TDM with anti-TNFs was collected. Logistic regression was used to predict factors influencing TDM use. RESULTS: Two hundred and forty-two respondents participated (92.5% male); 83% were consultant gastroenterologists. Of 104 respondents meeting inclusion criteria (treating > 5 IBD patients and at least 1 with an anti-TNF per month), complete responses were available for 101 participants. TDM was utilized by 20% (n = 20) of respondents. Of them, 89.5% (n = 17) used TDM for secondary loss of response; 73.7% (n = 14) for primary non-response and 5.3% (n = 1) proactively. Barriers to TDM use were cost (71.2%), availability (67.8%), time lag in results (58.7%) and the perception that TDM is time-consuming (45.7%). Clinicians treating > 30 IBD patients were more likely to check TDM (OR = 4.9, p = 0.02). Of 81 respondents not using TDM, 97.5% (n = 79) would do so if all the barriers were removed. CONCLUSION: Significant barriers to TDM use were availability, cost and time lag for results. If these barriers were removed, almost all the clinicians would use TDM at least reactively and 25% would use proactively. There is an urgent need to address these barriers and optimize anti-TNF therapy for optimal outcomes.


Asunto(s)
Monitoreo de Drogas , Enfermedades Inflamatorias del Intestino/tratamiento farmacológico , Infliximab/uso terapéutico , Utilización de Procedimientos y Técnicas/estadística & datos numéricos , Encuestas y Cuestionarios , Inhibidores del factor de Necrosis Tumorales/uso terapéutico , Adulto , Anciano , Análisis Costo-Beneficio , Monitoreo de Drogas/estadística & datos numéricos , Femenino , Humanos , India/epidemiología , Enfermedades Inflamatorias del Intestino/economía , Infliximab/economía , Masculino , Persona de Mediana Edad , Factores de Tiempo , Inhibidores del factor de Necrosis Tumorales/economía
9.
Stroke ; 51(7): 1991-1995, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-32438895

RESUMEN

BACKGROUND AND PURPOSE: The purpose of the study is to analyze how the coronavirus disease 2019 (COVID-19) pandemic affected acute stroke care in a Comprehensive Stroke Center. METHODS: On February 28, 2020, contingency plans were implemented at Hospital Clinic of Barcelona to contain the COVID-19 pandemic. Among them, the decision to refrain from reallocating the Stroke Team and Stroke Unit to the care of patients with COVID-19. From March 1 to March 31, 2020, we measured the number of emergency calls to the Emergency Medical System in Catalonia (7.5 million inhabitants), and the Stroke Codes dispatched to Hospital Clinic of Barcelona. We recorded all stroke admissions, and the adequacy of acute care measures, including the number of thrombectomies, workflow metrics, angiographic results, and clinical outcomes. Data were compared with March 2019 using parametric or nonparametric methods as appropriate. RESULTS: At Hospital Clinic of Barcelona, 1232 patients with COVID-19 were admitted in March 2020, demanding 60% of the hospital bed capacity. Relative to March 2019, the Emergency Medical System had a 330% mean increment in the number of calls (158 005 versus 679 569), but fewer Stroke Code activations (517 versus 426). Stroke admissions (108 versus 83) and the number of thrombectomies (21 versus 16) declined at Hospital Clinic of Barcelona, particularly after lockdown of the population. Younger age was found in stroke admissions during the pandemic (median [interquartile range] 69 [64-73] versus 75 [73-80] years, P=0.009). In-hospital, there were no differences in workflow metrics, angiographic results, complications, or outcomes at discharge. CONCLUSIONS: The COVID-19 pandemic reduced by a quarter the stroke admissions and thrombectomies performed at a Comprehensive Stroke Center but did not affect the quality of care metrics. During the lockdown, there was an overload of emergency calls but fewer Stroke Code activations, particularly in elderly patients. Hospital contingency plans, patient transport systems, and population-targeted alerts must act concertedly to better protect the chain of stroke care in times of pandemic.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus , Hospitales Especializados/organización & administración , Hospitales Urbanos/organización & administración , Pandemias , Neumonía Viral , Accidente Cerebrovascular/terapia , Enfermedad Aguda , Distribución por Edad , Infecciones por Coronavirus/epidemiología , Servicios Médicos de Urgencia/estadística & datos numéricos , Servicio de Urgencia en Hospital , Capacidad de Camas en Hospitales/estadística & datos numéricos , Hospitales Especializados/estadística & datos numéricos , Hospitales Urbanos/normas , Humanos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Neuroimagen/estadística & datos numéricos , Aceptación de la Atención de Salud , Admisión del Paciente/estadística & datos numéricos , Neumonía Viral/epidemiología , Utilización de Procedimientos y Técnicas/estadística & datos numéricos , Asignación de Recursos , España/epidemiología , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/cirugía , Trombectomía/estadística & datos numéricos , Resultado del Tratamiento
10.
AJR Am J Roentgenol ; 215(2): 420-424, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32452692

RESUMEN

OBJECTIVE. The purpose of this study was to analyze recent trends in abdominal imaging utilization in the Medicare population. MATERIALS AND METHODS. Medicare Part B databases for 2004-2016 were reviewed, and all Current Procedural Terminology codes pertaining to noninvasive imaging of the abdomen and pelvis were identified. Codes were grouped into six categories: CT and CT angiography (CTA), MRI and MR angiography (MRA), ultrasound, radionuclide imaging, radiography, and gastrointestinal fluoroscopy. Annual utilization rates per 1000 Medicare beneficiaries were calculated. Medicare physician specialty codes were used to identify studies performed by radiologists versus nonradiologist physicians. Reimbursements were determined. RESULTS. Total abdominal imaging utilization decreased from 558.0 examinations per 1000 Medicare beneficiaries in 2004 to 441.9 in 2016 (-20.8%). CT and CTA examinations increased by 22.5% from 2004 to 2010, followed by a sharp drop in 2011 caused by code bundling. From 2011 to 2016, CT and CTA use increased by only 7.2%. Radiography utilization decreased from 129.6 examinations per 1000 Medicare beneficiaries in 2004 to 91.5 in 2016 (-29.4%). Radionuclide studies decreased from 14.0 to 9.5 (-32.1%), and gastrointestinal fluoroscopy decreased from 37.8 examinations to 22.5 (-40.5%). Utilization of ultrasound increased slightly (1.5%), whereas MRI and MRA utilization sharply increased on a percentage basis (81.2%). Reimbursements peaked in 2009 at $1.704 billion, dropped substantially in 2011 because of code bundling, and remained relatively stable thereafter. The radiologists' market share of abdominal imaging was approximately 87% in both 2004 and 2016. CONCLUSION. Abdominal imaging utilization rates have declined in recent years, in part due to code bundling, but also largely because of a decrease in the use of abdominal radiography, gastrointestinal fluoroscopy, and nuclear imaging. Reimbursements have also declined. This study also showed that most of the abdominal imaging was performed by radiologists.


Asunto(s)
Abdomen/diagnóstico por imagen , Utilización de Procedimientos y Técnicas/estadística & datos numéricos , Diagnóstico por Imagen/estadística & datos numéricos , Humanos , Medicare Part B , Factores de Tiempo , Estados Unidos
11.
Updates Surg ; 72(1): 179-184, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32141046

RESUMEN

Little is known about how robot technology is employed by surgeons in minimally invasive surgery (MIS). We evaluated the needs of established robotic surgeons and of those who are new to this technology. A survey was designed and sent electronically to MIS surgeons. Questions included fellowship training, area of expertise, experience with robotic simulation and in clinical use, mentorship, likelihood of switching to a different approach, and expectations for the robot. Descriptive analysis was conducted using STATA/MP 15.1. 189 interviewees self-identified as hernia surgeons. 73.8% had additional fellowship, with majority practicing for 3-6 years (54%). Nearly 40% were MIS surgeons (N = 73), followed by general surgery (34.4%), and bariatrics (13.8%). 146 interviewees (77.7%) have used the daVinci® in clinical scenarios. Among robotic surgeons, majority were performing less than ten robotic cases per month. Inguinal hernia repairs were the leading procedures (49%), followed by foregut-related (19.5%), and colorectal-related surgeries (17.5%). Nearly 40% of surgeons stated inguinal hernia repairs to be the most often performed procedure using the robot. Nearly 40% of open and laparoscopic hernia surgeons are willing to adopt robotic-assisted procedures for their inguinal hernia repairs. Level 1 evidence (47.9%) and cost (24.1%) were the most pressing needs for robotic research. Majority of interviewees have used the daVinci® in clinical settings. Hernia repair remains the primary application of the robot in general surgery, among specialized surgeons. Over 40% of hernia surgeons are interested in switching to robotic technology over its open or laparoscopic counterparts.


Asunto(s)
Hernia Inguinal/cirugía , Herniorrafia/estadística & datos numéricos , Procedimientos Quirúrgicos Mínimamente Invasivos/estadística & datos numéricos , Utilización de Procedimientos y Técnicas/estadística & datos numéricos , Procedimientos Quirúrgicos Robotizados/estadística & datos numéricos , Cirujanos/estadística & datos numéricos , Herniorrafia/métodos , Humanos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Procedimientos Quirúrgicos Robotizados/métodos , Encuestas y Cuestionarios
12.
J Pediatr ; 220: 116-124.e3, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32171561

RESUMEN

OBJECTIVE: To evaluate whether differences in pediatric tonsillectomy use by race/ethnicity and type of insurance were impacted by the American Academy of Otolaryngology-Head and Neck Surgery's 2011 tonsillectomy clinical practice guidelines. STUDY DESIGN: We included children aged <15 years from Florida or South Carolina who underwent tonsillectomy in 2004-2017. Annual tonsillectomy rates within groups defined by race/ethnicity and type of health insurance were calculated using US Census data, and interrupted time series analyses were used to compare the guidelines' impact on utilization across groups. RESULTS: The average annual tonsillectomy rate was greater among non-Hispanic white children (66 procedures per 10 000 children) than non-Hispanic black (38 procedures per 10 000 children) or Hispanic children (41 procedures per 10 000 children) (P < .001). From the year before to the year after the guidelines' release, tonsillectomy use decreased among non-Hispanic white children (-11.1 procedures per 10 000 children), but not among non-Hispanic black (-0.9 procedures per 10 000 children) or Hispanic children (+3.9 procedures per 10 000 children) (P < .05). Use was greater among publicly than privately insured children (75 vs 52 procedures per 10 000 children, P < .001). The guidelines were associated with a reversal of the upward trend in use seen in 2004-2010 among publicly insured children (-5.5 procedures per 10 000 children per year, P < .001). CONCLUSIONS: Tonsillectomy use is greatest among white and publicly insured children. However, the American Academy of Otolaryngology-Head and Neck Surgery's 2011 clinical practice guideline statement was associated with an immediate decrease and change in use trends in these groups, narrowing differences in utilization by race/ethnicity and type of insurance.


Asunto(s)
Seguro de Salud , Utilización de Procedimientos y Técnicas/estadística & datos numéricos , Tonsilectomía/estadística & datos numéricos , Adolescente , Afroamericanos , Niño , Preescolar , Estudios Transversales , Grupos Étnicos , Grupo de Ascendencia Continental Europea , Femenino , Florida , Hispanoamericanos , Humanos , Masculino , Guías de Práctica Clínica como Asunto , Estudios Retrospectivos , South Carolina
13.
Updates Surg ; 72(2): 503-512, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32219731

RESUMEN

The aim of this study was to evaluate the trend in use, feasibility and safety of laparoscopy in a single level 1 European trauma centre. Laparoscopy in abdominal trauma is gaining acceptance as a diagnostic and a therapeutic tool as it reduces surgical invasiveness and may reduce post-operative morbidity. All trauma patients who underwent a laparoscopic procedure between January 2013 and December 2017 were retrospectively analysed. A sub-analysis of isolated abdominal trauma was also performed. There has been a significant increase in the use of this technique in the considered time period. A total of 40 patients were included in the study: 17 diagnostic laparoscopies and overall 32 therapeutic laparoscopies. Conversion rate was 15%. All patients were hemodynamically stable. The majority of patients were younger than 60 years, with an ASA score of I-II and sustained a blunt trauma. Mean ISS score was 17. Colon and diaphragm were the most commonly laparoscopically diagnosed injuries, while splenectomy was the most common operation. The average operating time was 106 min. There were no missed injuries, no SSI, no re-interventions and no mortality related to the surgical procedure. The average length of stay was 14 days. No significant difference was found in the isolated abdominal trauma group. Laparoscopy is an emergent safe and effective technique for both diagnostic and therapeutic purposes in selected stable abdominal penetrating or blunt trauma patients. However, these results need to be put in relation with the level of the centre and the expertise of the surgeon.


Asunto(s)
Traumatismos Abdominales/cirugía , Laparoscopía/métodos , Laparoscopía/tendencias , Procedimientos Quirúrgicos Mínimamente Invasivos/tendencias , Utilización de Procedimientos y Técnicas/estadística & datos numéricos , Utilización de Procedimientos y Técnicas/tendencias , Cirujanos , Centros Traumatológicos , Traumatismos Abdominales/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Europa (Continente) , Estudios de Factibilidad , Femenino , Humanos , Laparoscopía/estadística & datos numéricos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Morbilidad , Tempo Operativo , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/prevención & control , Estudios Retrospectivos , Seguridad , Adulto Joven
14.
Am J Surg ; 220(3): 706-713, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32008720

RESUMEN

BACKGROUND: The Michigan Appropriate Perioperative (MAP) criteria provide guidance regarding urinary catheter use. For Category A (e.g., laparoscopic cholecystectomy), B (e.g., hemicolectomy), and C (e.g., abdominoperineal resection) procedures, recommendations are to avoid catheter, remove POD 0 or 1, and remove POD 1-4, respectively. We applied MAP criteria to statewide registry data to identify improvement targets. METHODS: Retrospective cohort study of risk-adjusted catheter use and duration for appendectomy, cholecystectomy, and colorectal resections in 2014-2015 from 64 Michigan hospitals. RESULTS: 5.5% of 13,032 Category A cases used urinary catheters, including 26.9% of open appendectomies. 94.5% of 1,624 Category B cases used catheters (31.2% remained after POD 1). 98.3% of 700 Category C cases used catheters (4.6% remained POD5+). Variation in duration of use persisted after risk adjustment. CONCLUSIONS: Perioperative urinary catheter use was appropriate for most simple abdominal procedures, but duration of use varied in all categories.


Asunto(s)
Utilización de Procedimientos y Técnicas/estadística & datos numéricos , Utilización de Procedimientos y Técnicas/normas , Cateterismo Urinario/estadística & datos numéricos , Cateterismo Urinario/normas , Adulto , Anciano , Apendicectomía , Colecistectomía , Estudios de Cohortes , Procedimientos Quirúrgicos del Sistema Digestivo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto , Estudios Retrospectivos
15.
Updates Surg ; 72(2): 513-525, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32088854

RESUMEN

As the world population is aging rapidly, emergency abdominal surgery for acute abdomen in the elderly represents a global issue, both in developed and developing countries. Data regarding all the elderly patients who underwent emergency abdominal surgery from January 2017 to December 2017 at 36 Italian surgical departments were analyzed with the aim to appraise the contemporary reality regarding the use of emergency laparoscopy for acute abdomen in the elderly. 1993 patients were enrolled. 1369 (68.7%) patients were operated with an open technique; whereas, 624 (31.3%) underwent a laparoscopic operation. The postoperative morbidity rate was 32.6%, with a statically significant difference between the open and the laparoscopic groups (36.2% versus 22.1%, p < 0.001). The reported mortality rate was 8.8%, with a statistically significant difference between the open and the laparoscopic groups (11.2% versus 2.2%, p < 0.001). Our results demonstrated that patients in the ASA II (58.1%), ASA III (68.7%) and ASA IV (88.5%) groups were operated with the traditional open technique in most of the cases. Only a small percentage of patients underwent laparoscopy for perforated gastro-duodenal ulcer repair (18.9%), adhesiolyses with/without small bowel resection (12.2%), and large bowel resection (10.7%). Conversion to open technique was associated with a higher mortality rate (11.1% versus 2.2%, p < 0.001) and overall morbidity (38.9% versus 22.1%, p = 0.001) compared with patients who did not undergo conversion. High creatinine (p < 0.001) and glycaemia (p = 0.006) levels, low hemoglobin levels (p < 0.001), oral anticoagulation therapy (p = 0.001), acute respiratory failure (p < 0.001), presence of malignancy (p = 0.001), SIRS (p < 0.001) and open surgical approach (p < 0.001) were associated with an increased risk of postoperative morbidity. Regardless of technical progress, elderly patients undergoing emergency surgery are at very high risk for in-hospital complications. A detailed analysis of complications and mortality in the present study showed that almost 9% of elderly patients died after surgery for acute abdomen, and over 32% developed complications.


Asunto(s)
Abdomen Agudo/cirugía , Endoscopía Gastrointestinal/métodos , Endoscopía Gastrointestinal/estadística & datos numéricos , Laparoscopía/métodos , Laparoscopía/estadística & datos numéricos , Utilización de Procedimientos y Técnicas/estadística & datos numéricos , Abdomen Agudo/mortalidad , Factores de Edad , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Urgencias Médicas , Endoscopía Gastrointestinal/mortalidad , Femenino , Humanos , Italia/epidemiología , Laparoscopía/mortalidad , Masculino , Morbilidad , Complicaciones Posoperatorias/epidemiología , Pronóstico , Estudios Prospectivos , Riesgo
16.
Radiol Med ; 125(6): 595-599, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32048156

RESUMEN

In recent years, the increasing prescription of diagnostic imaging has been noted, due to advances in imaging technology and the development of defensive medicine. Overuse of diagnostic imaging significantly impacts the quality and costs of health care. Therefore, the purpose of this study was to quantify overprescription and investigate its causes through the evaluation of head computer tomography (CT) scan prescriptions. In this study, a set of 100 requests of CT scans was collected and analysed by three experts in guidelines and scientific evidences, evaluating prescription appropriateness. Then, the rate of overprescription was quantified and its causes identified as incorrect adoption of guidelines indications (32%) and as defensive medicine (6%). Therefore, in order to reduce inappropriate investigations, the findings of the present study suggest that the reduction in overprescription could be reached through the improvement of training of health personnel and the propagation of a no-blame culture aimed at minimizing defensive medicine.


Asunto(s)
Traumatismos Craneocerebrales/diagnóstico por imagen , Utilización de Procedimientos y Técnicas/estadística & datos numéricos , Tomografía Computarizada por Rayos X/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Servicio de Urgencia en Hospital , Femenino , Humanos , Italia , Masculino , Persona de Mediana Edad , Adulto Joven
17.
Respir Med ; 162: 105877, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-32056675

RESUMEN

BACKGROUND AND OBJECTIVE: Home mechanical ventilation (HMV) is used in heterogeneous conditions underlying chronic hypercapnic respiratory failure, but there are sparse data on long-term clinical outcomes. The aim was to systematically analyse the time and the circumstances of death on HMV. METHODS: All-cause mortality data of HMV patients were prospectively collected between 2008 and 2018 in a large tertiary centre. Data were categorised into diagnostic groups including neuromuscular disease (NMD), chest wall disease (CWD), chronic obstructive pulmonary disease (COPD), obesity hypoventilation syndrome (OHS), overlap syndrome of COPD and OSA (overlap) and other group. The primary outcome was time-to-death from initiation of HMV. RESULTS: 1210 deaths were recorded over a 10-year period. Median time-to-death was 19.5 [6-55] months and differed between groups (Kruskal Wallis p < 0.001). CWD (98.5 [23.5-120] months) and slowly progressive NMD (64.5 [28-120] months) had the longest time-to-death on HMV, while OHS (33 [13-75] months) and overlap syndrome (30.5 [14.5-68.5] months) had a longer median time-to-death than COPD (19.5 [7-42.5] months) and motor neurone disease (7 [3-14] months). Daily adherence to HMV of greater than 4 h/night was associated with better outcomes (10 [3-24] vs. 30 [10-76] months; p < 0.001). 43% with confirmed location of death died outside the hospital. CONCLUSIONS: The time-to-death on home mechanical ventilation varies widely across disease groups with chronic respiratory failure and seems to be associated with daily usage time. TRIAL REGISTRATION: researchregistry.com UIN: researchregistry4122.


Asunto(s)
Respiración Artificial/mortalidad , Insuficiencia Respiratoria/mortalidad , Anciano , Enfermedad Crónica , Estudios de Cohortes , Femenino , Servicios de Atención de Salud a Domicilio , Humanos , Masculino , Persona de Mediana Edad , Cooperación del Paciente , Utilización de Procedimientos y Técnicas/estadística & datos numéricos , Factores de Tiempo
18.
Otolaryngol Head Neck Surg ; 162(4): 554-558, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31959051

RESUMEN

OBJECTIVE: Congenital ear anomalies are associated with congenital cardiac and renal defects. Renal ultrasounds, electrocardiogram, and echocardiogram can be utilized for diagnosis of these concurrent defects. No standard of care exists for the workup of patients with microtia. The goals of this study were to describe the utilization of diagnostic testing for cardiac and renal anomalies and to identify their prevalence in patients with microtia. STUDY DESIGN: Case series with chart review. SETTING: Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center. SUBJECTS AND METHODS: This study is an Institutional Review Board-approved retrospective review of consecutive patients born between 2002 and 2016 who were diagnosed with microtia and seen in the otolaryngology clinic at a tertiary care children's hospital. Demographics, sidedness and grade of microtia, comorbid diagnoses, and details of renal and cardiovascular evaluations were recorded. Factors associated with retroperitoneal ultrasound and cardiac testing were assessed with logistic regression. RESULTS: Microtia was present in 102 patients, and 98 patients were included as they received follow-up. Microtia was associated with craniofacial syndrome in 34.7% of patients. Renal ultrasound was performed in 64.3% of patients, and 12.9% of patients with ultrasounds had renal aplasia. Cardiac workup (electrocardiogram or echocardiogram) was completed in 60.2% of patients, and of this subset, 54.2% had a congenital heart defect. CONCLUSION: Diagnostic testing revealed renal anomalies and cardiac defects in patients with isolated microtia at a higher rate than in the general population. This suggests the need for further evaluation of the role of routine screening in patients with microtia.


Asunto(s)
Anomalías Múltiples/diagnóstico , Microtia Congénita/complicaciones , Cardiopatías Congénitas/complicaciones , Cardiopatías Congénitas/diagnóstico , Riñón/anomalías , Anomalías Múltiples/epidemiología , Adolescente , Niño , Preescolar , Técnicas y Procedimientos Diagnósticos/estadística & datos numéricos , Femenino , Cardiopatías Congénitas/epidemiología , Humanos , Lactante , Recién Nacido , Masculino , Prevalencia , Utilización de Procedimientos y Técnicas/estadística & datos numéricos , Estudios Retrospectivos
19.
Am J Surg ; 220(2): 482-488, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-31932078

RESUMEN

BACKGROUND: There are concerns about overuse of abdominopelvic-computed tomography (CTAP) in pediatric blunt abdominal trauma (BAT) given malignancy risks. This study evaluates how an evidence-based algorithm affected CTAP and hospital resource use for hemodynamically stable children with BAT. MATERIALS AND METHODS: This is a retrospective cohort study of hemodynamically stable pediatric BAT patients one year before and after algorithm implementation. We included children less than or equal to 14 years of age treated in a Level I pediatric trauma center. We compared CTAP rates before and after algorithm implementation. RESULTS: There were 65 in the pre- and 50 in the post-algorithm implementation group, and CTAPs decreased by 27% (p = 0.02). The unadjusted and adjusted odds ratio of receiving a CTAP after algorithm implementation were 0.3 (95% CI 0.1-0.6) and 0.2 (95% CI 0.1-0.7), respectively. There were no significant missed injuries in the post cohort. ED length of stay (LOS) decreased by 53 min (p = 0.03). CONCLUSIONS: An evidence-based algorithm safely decreased CTAPs for pediatric BAT with no increase in hospital resource utilization.


Asunto(s)
Traumatismos Abdominales/diagnóstico por imagen , Traumatismos Abdominales/fisiopatología , Algoritmos , Hemodinámica , Utilización de Procedimientos y Técnicas/estadística & datos numéricos , Tomografía Computarizada por Rayos X/estadística & datos numéricos , Heridas no Penetrantes/diagnóstico por imagen , Heridas no Penetrantes/fisiopatología , Niño , Preescolar , Estudios de Cohortes , Medicina Basada en la Evidencia , Femenino , Humanos , Masculino , Estudios Retrospectivos
20.
Clin Ter ; 170(1): e89-e98, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31916427

RESUMEN

Introduction: Uveal melanoma is the most common intraocular tumor in the adult population. It can affect any part of the uveal tract: the iris, ciliary body, and choroid. Historically, enucleation has been the mainstay of treatment for primary melanoma. In the last decade, however, radiotherapy has acquired an increasingly important role and has now become our first-line modality. However, it is still widely debated what is the most effective radiotherapy technique for this tumor. Purpose to perform a literature review on the utility of radiotherapy for primary ocular melanoma and determine the most effective radiotherapy technique Materials and Methods: We included all systematic and narrative reviews on the topic, published between September 2007 and November 2017 on PubMed and SCOPUS. Two independent reviewers assessed the eligibility criteria for each article using the PRISMA checklist. The methodological quality of narrative and systematic reviews was evaluated with the INSA and AMSTAR checklists, respectively Results: Our study analyzed a total of 23 studies, including 18 narrative reviews and 5 systematic reviews. Radiotherapy with Brachytherapy, Proton Therapy, SRS/SRT with gamma knife and cyber knife, are the most common choices for the treatment of primary ocular melanoma. These techniques allow for excellent lesion spread control, eye, and vision conservation, and improve overall patients' quality of life. Among the narrative reviews, the highest INSA score was 5/7, the lowest 2/7, the mean was 3.83/7 and median was 4/7. Among the systematic reviews, the highest AMSTAR score was 9/12, the lowest 4/12, the mean 5.6/7 and median 4/7 Conclusion: The number of studies available on this topic is scarce. Among those published, the methodological quality is modest, as assessed with the INSA and AMSTAR checklists. As a result, we are not able to determine what the most effective radiotherapy technique is


Asunto(s)
Neoplasias del Ojo/radioterapia , Melanoma/radioterapia , Utilización de Procedimientos y Técnicas/estadística & datos numéricos , Radioterapia/métodos , Radioterapia/estadística & datos numéricos , Enfermedades de la Úvea/radioterapia , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad
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