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1.
Emergencias (Sant Vicenç dels Horts) ; 32(1): 49-56, feb. 2020. tab, graf
Artigo em Espanhol | IBECS-Express | ID: ibc-ET2-3437

RESUMO

Objetivo. Evaluar la efectividad, en relación al retorno a circulación espontánea, la supervivencia al alta y la supervivencia al alta con buen estado neurológico, del acceso intraóseo frente al acceso venoso en la resucitación en parada cardiaca extrahospitalaria. Método. Se realiza una revisión sistemática y metanálisis en las bases de datos Medline (PubMed), Embase, Web of Science y Cochrane Library. Se incluyeron estudios observacionales y ensayos clínicos registrados en las bases de datos mencionadas desde el 1 de enero de 1950 hasta el 31 de mayo de 2019, en los que la población incluida fueran pacientes adultos en situación de parada cardiaca extrahospitalaria y que tuvieran canalizado un acceso intraóseo o intravenoso. La evaluación del riesgo de sesgo se realizó mediante la herramienta de evaluación de sesgo de Cochrane y la herramienta GRADE. Resultado. Se identificaron 434 referencias de las que 5 se incluyen en la síntesis cualitativa y cuantitativa. El acceso intraóseo se relaciona con una peor tasa de retorno a circulación espontánea [OR 0,69 (IC 95%: 0,57-0,83), p = 0,02, I2 = 65%] y una peor supervivencia al alta hospitalaria [OR 0,65 (IC 95%: 0,51-0,83); p < 0,01, I2 = 30%] en comparación con el acceso venoso. Conclusiones. El acceso intraóseo en pacientes en situación de parada cardiaca extrahospitalaria se relaciona con peores resultados en términos de retorno a circulación espontánea y supervivencia al alta hospitalaria


Objective. To evaluate the efficacy of intraosseous access versus venous access in out-of-hospital cardiac arrest in terms of return of spontaneous circulation (ROSC) and survival to hospital discharge with or without favorable neurologic status. Methods. Systematic review and meta-analysis of articles indexed in MEDLINE (PubMed), Embase, the Web of Science, and the Cochrane Library. Other terms adapted to the language of each index were also used. We included observational studies and clinical trials published from January 1, 1950, to May 31, 2019, if the study population included adult patients in cardiac arrest outside the hospital and in whom an intraosseous or intravenous catheter was inserted. Risk of bias was evaluated with the Cochrane and GRADE (Grading of Recommendations Assessment, Development and Evaluation) tools. Results. We identified 434 papers to include in the qualitative review and 5 studies for meta-analysis. Intraosseous access was related to a lower rate of ROSC (odds ratio [OR], 0.69; 95% CI, 0.57-0.83; P = .02; I2 = 65%) and worse survival to discharge (OR, 0.65; 95% CI, 0.51-0.83); P<.01, I2 = 30%). Conclusion. Intraosseous access in out-of-hospital cardiac arrest is related to poorer outcomes in terms of ROSC and survival at hospital discharge

4.
Emergencias ; 32(1): 49-56, 2020 Feb.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-31909913

RESUMO

OBJECTIVES: To evaluate the efficacy of intraosseous access versus venous access in out-of-hospital cardiac arrest in terms of return of spontaneous circulation (ROSC) and survival to hospital discharge with or without favorable neurologic status. MATERIAL AND METHODS: Systematic review and meta-analysis of articles indexed in MEDLINE (PubMed), Embase, the Web of Science, and the Cochrane Library. Other terms adapted to the language of each index were also used. We included observational studies and clinical trials published from January 1, 1950, to May 31, 2019, if the study population included adult patients in cardiac arrest outside the hospital and in whom an intraosseous or intravenous catheter was inserted. Risk of bias was evaluated with the Cochrane and GRADE (Grading of Recommendations Assessment, Development and Evaluation) tools. RESULTS: We identified 434 papers to include in the qualitative review and 5 studies for meta-analysis. Intraosseous access was related to a lower rate of ROSC (odds ratio [OR], 0.69; 95% CI, 0.57-0.83; P=.02; I2=65%) and worse survival to discharge (OR, 0.65; 95% CI, 0.51-0.83); P<.01, I2=30%). CONCLUSION: Intraosseous access in out-of-hospital cardiac arrest is related to poorer outcomes in terms of ROSC and survival at hospital discharge.

5.
Emergencias (Sant Vicenç dels Horts) ; 31(4): 261-269, ago. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-182768

RESUMO

Objetivo: Evaluar, en términos de mortalidad y estado funcional, la eficacia y seguridad de la administración de ácido tranexámico (TXA) en los pacientes que sufren un traumatismo grave en los servicios de urgencias y emergencias. Metodo: Revisión sistemática y metaanálisis. Las bases de datos consultadas fueron Medline, Embase, The Cochrane Library, Web of Science y TheClinicalTrials.gov. Se incluyeron ensayos clínicos publicados entre el 1 de enero de 2008 y el 1 de agosto de 2018 en los que participaran pacientes que sufrían un traumatismo y a los que se les administró TXA en las primeras 8 horas tras este. Se extrajeron variables clínicas relacionadas con los pacientes y con la intervención. Las variables de resultado principales fueron la mortalidad y el estado funcional. Resultados: Se incluyeron 5 ensayos clínicos para la revisión sistemática y 4 para el metanálisis (20.697 pacientes). Se detectó una disminución de la mortalidad (OR 0,89 [IC 95% 0,83-0,96]; p = 0,004; I2 = 0%) y un mejor estado funcional (OR 0,60 [IC 95% 0,39-0,94]; p = 0,02; I2 = 0%) tras la administración de TXA en estos pacientes en comparación con placebo. Por el contrario, se encontró una estancia en la unidad de cuidados intensivos más larga (diferencia de medias 2,55 días [IC 95% 0,04-5,06]; p = 0,05; I2 = 0%). Conclusiones: La administración de TXA disminuye la mortalidad de los pacientes con traumatismo grave y mejora su estado funcional


Objective: The aim of this systematic review and meta-analysis was to evaluate the efficacy (mortality and functional status) and safety of emergency department (ED) use of tranexamic acid (TXA) in patients with severe trauma. Methods: MEDLINE, Embase, the Cochrane Library, the Web of Science, and ClinicalTrials.gov were searched to find relevant clinical trials published between January 1, 2008, and 1 August, 2018. The selected trials included trauma patients who received infusions of TXA within 8 hours. We extracted patient-related clinical variables and treatment variables. The main outcomes were mortality and functional status. Results: Five clinical trials were included in the systematic review. Four of them (20 697 patients) were included in the metaanalysis. We found that TXA versus placebo was associated with lower mortality (OR, 0.89 [95% CI, 0.83-0.96]; P = .004; I2 = 0%) and better functional status (OR, 0.60 [95% CI, 0.39-0.94]; P = .02; I2 = 0%). However, intensive care unit stays were longer in patients administered TXA (mean difference, 2.55 days [95% CI, 0.04-5.06 days]; P = .05; I2 = 0%). Conclusions: ED infusion of TXA decreases mortality after severe trauma and improves patients' functional status


Assuntos
Humanos , Ácido Tranexâmico/administração & dosagem , Ferimentos e Lesões/tratamento farmacológico , Serviços Médicos de Emergência , Resultado do Tratamento , Ácido Tranexâmico/uso terapêutico , Indicadores de Morbimortalidade , Hospitalização/tendências , Tempo de Internação/estatística & dados numéricos , Escala de Resultado de Glasgow
6.
Emergencias ; 31(4): 261-269, 2019.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-31347807

RESUMO

OBJECTIVES: The aim of this systematic review and meta-analysis was to evaluate the efficacy (mortality and functional status) and safety of emergency department (ED) use of tranexamic acid (TXA) in patients with severe trauma. MATERIAL AND METHODS: MEDLINE, Embase, the Cochrane Library, the Web of Science, and ClinicalTrials.gov were searched to find relevant clinical trials published between January 1, 2008, and 1 August, 2018. The selected trials included trauma patients who received infusions of TXA within 8 hours. We extracted patient-related clinical variables and treatment variables. The main outcomes were mortality and functional status. RESULTS: Five clinical trials were included in the systematic review. Four of them (20 697 patients) were included in the metaanalysis. We found that TXA versus placebo was associated with lower mortality (OR, 0.89 [95% CI, 0.83-0.96]; P = .004; 2 = 0%) and better functional status (OR, 0.60 [95% CI, 0.39-0.94]; P = .02; I2 = 0%). However, intensive care unit stays were longer in patients administered TXA (mean difference, 2.55 days [95% CI, 0.04-5.06 days]; P = .05; I2 = 0%). CONCLUSION: ED infusion of TXA decreases mortality after severe trauma and improves patients' functional status.

7.
Clin Nurs Res ; : 1054773819843627, 2019 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-31007041

RESUMO

The aim of this study was to determine which factors are related to Accidents and Emergency Unit (AEU) use by the elderly Spanish population. Observational analysis of the 2014 European Survey of Health in Spain (ESHS-2014; N = 6,520) and the 2017 Spanish Health Survey (SHS-2017; N = 7,024) was employed. About one third (4,095, 30.2%) of the sample used the AEU, and they were primarily women (32.6%). Comorbidity ( p = .01), presence of physical limitation in the prior 6 months to the survey, and a history of several diseases ( p < .001)-as in diabetes ( p < .001), osteoarthritis ( p < .001), and chronic bronchitis, emphysema, or chronic obstructive pulmonary disease ( p < .001)-were associated with AEU visits in both surveys. Female sex and several cardiovascular diseases were only significant in the ESHS-2014. In the SHS-2017, depressive status was an independent risk factor. This epidemiological data allow a better understanding of the use of AEU, suggesting indications for the care process.

8.
Women Health ; 59(9): 985-996, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30880631

RESUMO

Domestic accidents pose serious threats to the independence of the elderly. We explored associations between domestic accidents and gender, socioeconomic, medical, and environmental factors using data from the European Health Survey 2014 for elderly Spanish female and male nationals. Records of 5960 participants (mean age ± SD: 75.9 ± 7.6 years), 59.8% of whom were women, were examined. Domestic accidents occurred in 460 (7.1%) seniors, predominately in women (78.5%). Age (adjusted odds ratio [aOR]: 1.02 [95% confidence interval [CI]: 1.00-1.03, p = .003], female gender (aOR 2.04 [95% CI 1.60-2.60, p < .001]), difficulty managing 12 stairs (reference: none) (some: aOR 2.03 [95% CI 1.53-2.68, p < .001]; much: aOR 2.88 [95% CI 2.15-3.87, p < .001]; inability: aOR 3.09 [95% CI 2.14-4.45, p < .001]), and depressive symptoms severity (reference: absent) (mild: aOR 1.44 [95% CI 1.10-1.89, p = .008]; moderate: aOR 1.91 [95% CI 1.35-2.71, p < .001];. Very severe: aOR 2.53 [95% CI 1.72-3.71, p < .001]; extremely severe: aOR 2.38 [95% CI 1.45-3.93, p = .001]) were independently associated with domestic accidents. Severity of depressive symptoms was the most prominent feature for women, while inability to manage 12 stairs was the most prominent for men. Our results suggest important gender differences in factors associated with domestic accidents that are relevant to intervention and preventive programs.

9.
Vaccine ; 35(51): 7095-7100, 2017 12 18.
Artigo em Inglês | MEDLINE | ID: mdl-29122385

RESUMO

BACKGROUND: Influenza is a major public health problem. Achieving 65% coverage in people over 65 years old is a health policy priority in Spain. OBJECTIVE: To determine the coverage of influenza vaccination in Spain in 2014 for people over 65 years and to analyze the factors associated with coverage and its progression between 2009 and 2014. METHODS: A descriptive cross-sectional study was conducted that included 18,442 non-institutionalized individuals over 65 years who had participated in the National Health Survey in Spain in 2011 and in the European Health Survey in Spain in 2009 and 2014. Socio-demographic variables, health variables, and influenza vaccination data were used. A logistic regression analysis was performed to determine the variables associated with anti-influenza vaccination. RESULTS: Influenza vaccination coverage has declined from 2009 (74.5%) to 2014 (57.4%). There are significant differences in the vaccination coverage among the different Spanish autonomous communities in the different years studied. Influenza vaccination was associated with males, low social class, and low level of education. There is greater participation in other preventive measures, such as assessing blood pressure, blood glucose, and cholesterol, than in influenza vaccination. CONCLUSIONS: Fewer people over 65 years old than recommended by the WHO participated in the influenza vaccination campaign in Spain in 2014. This coverage declined progressively from 2009 to 2014.


Assuntos
Vacinas contra Influenza/administração & dosagem , Influenza Humana/epidemiologia , Influenza Humana/prevenção & controle , Cobertura Vacinal/estatística & dados numéricos , Vacinação/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Escolaridade , Feminino , Inquéritos Epidemiológicos , Humanos , Influenza Humana/virologia , Masculino , Prevalência , Fatores Sexuais , Fatores Socioeconômicos , Espanha/epidemiologia
10.
Rev Lat Am Enfermagem ; 24: e2821, 2016 12 08.
Artigo em Inglês, Português, Espanhol | MEDLINE | ID: mdl-27982306

RESUMO

Objective: evaluate the effectiveness of epinephrine used during cardiac arrest and its effect on the survival rates and neurological condition. Method: systematic review of scientific literature with meta-analysis, using a random effects model. The following databases were used to research clinical trials and observational studies: Medline, Embase and Cochrane, from 2005 to 2015. Results: when the Return of Spontaneous Circulation (ROSC) with administration of epinephrine was compared with ROSC without administration, increased rates were found with administration (OR 2.02. 95% CI 1.49 to 2.75; I2 = 95%). Meta-analysis showed an increase in survival to discharge or 30 days after administration of epinephrine (OR 1.23; 95% IC 1.05-1.44; I2=83%). Stratification by shockable and non-shockable rhythms showed an increase in survival for non-shockable rhythm (OR 1.52; 95% IC 1.29-1.78; I2=42%). When compared with delayed administration, the administration of epinephrine within 10 minutes showed an increased survival rate (OR 2.03; 95% IC 1.77-2.32; I2=0%). Conclusion: administration of epinephrine appears to increase the rate of ROSC, but when compared with other therapies, no positive effect was found on survival rates of patients with favorable neurological status.


Assuntos
Epinefrina/uso terapêutico , Parada Cardíaca/tratamento farmacológico , Humanos , Resultado do Tratamento , Vasopressinas/uso terapêutico
11.
Rev. latinoam. enferm. (Online) ; 24: e2821, 2016. tab, graf
Artigo em Inglês | LILACS | ID: biblio-960930

RESUMO

abstract Objective: evaluate the effectiveness of epinephrine used during cardiac arrest and its effect on the survival rates and neurological condition. Method: systematic review of scientific literature with meta-analysis, using a random effects model. The following databases were used to research clinical trials and observational studies: Medline, Embase and Cochrane, from 2005 to 2015. Results: when the Return of Spontaneous Circulation (ROSC) with administration of epinephrine was compared with ROSC without administration, increased rates were found with administration (OR 2.02. 95% CI 1.49 to 2.75; I2 = 95%). Meta-analysis showed an increase in survival to discharge or 30 days after administration of epinephrine (OR 1.23; 95% IC 1.05-1.44; I2=83%). Stratification by shockable and non-shockable rhythms showed an increase in survival for non-shockable rhythm (OR 1.52; 95% IC 1.29-1.78; I2=42%). When compared with delayed administration, the administration of epinephrine within 10 minutes showed an increased survival rate (OR 2.03; 95% IC 1.77-2.32; I2=0%). Conclusion: administration of epinephrine appears to increase the rate of ROSC, but when compared with other therapies, no positive effect was found on survival rates of patients with favorable neurological status.


resumo Objetivo: avaliar a efetividade da adrenalina na parada cardíaca e seu efeito na sobrevivência e no estado neurológico. Métodos: revisão sistemática da literatura científica com meta-análise utilizando um modelo de efeitos aleatórios. Revisão em Medline, Embase e Cochrane, desde 2005 até 2015 de ensaios clínicos e estudos observacionais. Resultados: observou-se aumento nas taxas de retorno de circulação espontânea com a administração de adrenalina (OR 2,02; 95% IC 1,49-2,75; I2=95%) comparadas com a não administração de adrenalina. A meta-análise mostrou um aumento da sobrevivência na alta ou depois de 30 dias da administração de adrenalina (OR 1,23; 95% IC 1,05-1,44; I2=83%). Quando estratificados por ritmos desfibrilháveis e não desfibrilháveis apareceu um aumento da sobrevivência nos ritmos não desfibrilháveis (OR 1,52; 95% IC 1,29-1,78; I2=42%). Também observou-se um incremento de sobrevivência na alta ou depois de 30 dias, quando administrada a adrenalina antes de 10 minutos, isto comparado com administração tardia (OR 2,03; 95% IC 1,77-2,32; I2=0%). Conclusão: a administração de adrenalina parece incrementar a taxa de retorno da circulação espontânea, mas não se tem encontrado um efeito positivo nas taxas de sobrevivência nem nas taxas de pacientes com estado neurológico favorável, em comparação com outras terapias.


resumen Objetivo: evaluar la efectividad de la adrenalina en el paro cardíaco y su efecto en la supervivencia y en el estado neurológico. Métodos: revisión sistemática de la literatura científica con metaanálisis utilizando un modelo de efectos aleatorios. Revisión en Medline, Embase y Cochrane, desde 2005 hasta 2015, de ensayos clínicos y estudios observacionales. Resultados: se observó aumento en las tasas de retorno de circulación espontánea cuando administrada adrenalina (OR 2,02; 95% IC 1,49-2,75; I2=95%) comparada con la no administración de adrenalina. El metaanálisis mostró un aumento de la supervivencia al alta hospitalaria o a los 30 días cuando administrada adrenalina (OR 1,23; 95% IC 1,05-1,44; I2=83%). La estratificación por ritmos desfibrilables y no desfibrilables mostró un aumento de la supervivencia en ritmos no desfibrilables (OR 1,52; 95% IC 1,29-1,78; I2=42%). También, se observó un incremento en la supervivencia al alta hospitalaria o a los 30 días en la administración de adrenalina antes de 10 minutos comparada con la administración tardía (OR 2,03; 95% IC 1,77-2,32; I2=0%). Conclusión: la administración de adrenalina parece incrementar la tasa de retorno de circulación espontánea, pero no se ha encontrado un efecto positivo en tasas de supervivencia ni en tasas de pacientes con estado neurológico favorable, en comparación con otras terapias.


Assuntos
Humanos , Epinefrina/uso terapêutico , Parada Cardíaca/tratamento farmacológico , Vasopressinas/uso terapêutico , Resultado do Tratamento
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