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1.
Nutrients ; 13(7)2021 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-34371859

RESUMO

Almost two in three patients who are aged 75 years and older and scheduled for surgery for colorectal cancer (CRC) are undernourished. Despite evidence that perioperative nutritional management can improve patients outcomes, international guidelines are still insufficiently applied in current practice. In this stepped-wedge cluster-randomized study of five surgical hospitals, we included 147 patients aged 70 years or older with scheduled abdominal surgery for CRC between October 2013 and December 2016. In the intervention condition, an outreach team comprising a geriatrician and a dietician visited patients and staff in surgical wards to assist with the correct application of guidelines. Evaluation, diagnosis, and prescription (according to nutritional status) were considered appropriate and strictly consistent with guidelines in 39.2% of patients in the intervention group compared to only 1.4% in the control group (p = 0.0002). Prescription of oral nutritional supplements during the perioperative period was significantly improved (41.9% vs. 4.1%; p < 0.0001). However, there were no benefits of the intervention on surgical complications or adverse events. A possible benefit of hospital stay reduction will need to be confirmed in further studies. This study highlights the importance of the implementation of quality improvement interventions into current practice for the perioperative nutritional management of older patients with CRC.


Assuntos
Avaliação Geriátrica/métodos , Desnutrição/terapia , Terapia Nutricional/métodos , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios/métodos , Idoso , Idoso de 80 Anos ou mais , Neoplasias Colorretais/complicações , Neoplasias Colorretais/fisiopatologia , Neoplasias Colorretais/cirurgia , Suplementos Nutricionais , Feminino , Humanos , Masculino , Desnutrição/complicações , Política Nutricional , Terapia Nutricional/normas , Estado Nutricional , Complicações Pós-Operatórias/etiologia , Cuidados Pré-Operatórios/normas , Período Pré-Operatório , Melhoria de Qualidade , Resultado do Tratamento
2.
Clinics (Sao Paulo) ; 63(4): 457-64, 2008 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-18719755

RESUMO

BACKGROUND: The aim of this study was to determine the occurrence rate, demographics, clinical characteristics, and outcomes of patients with severe sepsis admitted to the emergency department. METHODS: A prospective study evaluating all patients admitted to the emergency department unit in a public hospital of tertiary complexity in a six-month period was conducted. During this period, the emergency team was trained to diagnose sepsis. Patients who met the diagnostic criteria for severe sepsis were followed until their discharge from the hospital. RESULTS: A total of 5,332 patients were admitted to the emergency department, and 342 met the criteria for severe sepsis/septic shock. The median (interquartile range) age of patients was 74 (65-84) years, and 52.1% were male. The median APACHE II and SOFA scores at diagnosis were 19 (15-25) and 5 (3-7), respectively. The median number of dysfunctional organ systems per patient was 2 (1-3). The median hospital length of stay was 10 (4.7-17) days, and the hospital mortality rate was 64%. Only 31% of the patients were diagnosed by the emergency department team as septic. About 33.5% of the 342 severe sepsis patients admitted to the emergency department were referred to an ICU, with a median time delay of 24 (12-48) hours. Training improved diagnosis and decreased the time delay for septic patients in arriving at the ICU. CONCLUSIONS: The occurrence rate of severe sepsis in the emergency department was 6.4%, and the rate of sepsis diagnosed by the emergency department team as well as the number of patients transferred to the ICU was very low. Educational campaigns are important to improve diagnosis and, hence, treatment of severe sepsis.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Sepse/epidemiologia , APACHE , Idoso , Brasil/epidemiologia , Feminino , Mortalidade Hospitalar , Hospitais Estaduais , Humanos , Incidência , Masculino , Equipe de Assistência ao Paciente , Prognóstico , Estudos Prospectivos , Sepse/diagnóstico , Sepse/mortalidade , Análise de Sobrevida , Fatores de Tempo
3.
Clinics ; 63(4): 457-464, 2008. graf, tab
Artigo em Inglês | LILACS | ID: lil-489654

RESUMO

BACKGROUND: The aim of this study was to determine the occurrence rate, demographics, clinical characteristics, and outcomes of patients with severe sepsis admitted to the emergency department. METHODS: A prospective study evaluating all patients admitted to the emergency department unit in a public hospital of tertiary complexity in a six-month period was conducted. During this period, the emergency team was trained to diagnose sepsis. Patients who met the diagnostic criteria for severe sepsis were followed until their discharge from the hospital. RESULTS: A total of 5,332 patients were admitted to the emergency department, and 342 met the criteria for severe sepsis/septic shock. The median (interquartile range) age of patients was 74 (65-84) years, and 52.1 percent were male. The median APACHE II and SOFA scores at diagnosis were 19 (15-25) and 5 (3-7), respectively. The median number of dysfunctional organ systems per patient was 2 (1-3). The median hospital length of stay was 10 (4.7-17) days, and the hospital mortality rate was 64 percent. Only 31 percent of the patients were diagnosed by the emergency department team as septic. About 33.5 percent of the 342 severe sepsis patients admitted to the emergency department were referred to an ICU, with a median time delay of 24 (12-48) hours. Training improved diagnosis and decreased the time delay for septic patients in arriving at the ICU. CONCLUSIONS: The occurrence rate of severe sepsis in the emergency department was 6.4 percent, and the rate of sepsis diagnosed by the emergency department team as well as the number of patients transferred to the ICU was very low. Educational campaigns are important to improve diagnosis and, hence, treatment of severe sepsis.


Assuntos
Idoso , Feminino , Humanos , Masculino , Serviço Hospitalar de Emergência/estatística & dados numéricos , Sepse/epidemiologia , APACHE , Brasil/epidemiologia , Mortalidade Hospitalar , Hospitais Estaduais , Incidência , Equipe de Assistência ao Paciente , Prognóstico , Estudos Prospectivos , Análise de Sobrevida , Sepse/diagnóstico , Sepse/mortalidade , Fatores de Tempo
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