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Anticancer Res ; 40(1): 305-313, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31892581


BACKGROUND: Cancer-associated thrombosis (CAT), the second leading cause of death in patients with cancer can be treated with low molecular weight heparin (LMWH) according to guidelines. PATIENTS AND METHODS: A multicenter prospective observational study was carried out to record anti-thrombotic treatment practice, assess thrombosis recurrence and bleeding, and identify potential risk factors. Adult patients from 18 Oncology Departments throughout Greece were followed-up for 12 months. RESULTS: A total of 120 patients with CAT receiving anticoagulant treatment were enrolled (35% incidental); 85% were treated for more than 6 months, 95.8% were treated with tinzaparin and smaller percentages with other agents. Thrombosis recurred in three patients and there was minor bleeding in four patients. Bleeding was associated with high body mass index (>35 kg/m2), trauma history, renal insufficiency and bevacizumab use. CONCLUSION: Incidental thrombosis contributes significantly to CAT burden. Long-term use of LMWH seems to be effective and safe. Several risk factors associated with bleeding should be considered during anti-coagulation therapy planning.

Neoplasias/complicações , Trombose/etiologia , Trombose/terapia , Feminino , Hemorragia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Fatores de Risco
Australas Emerg Nurs J ; 15(4): 219-28, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23217655


BACKGROUND: There are many Emergency Department (ED) demand management systems that include advanced practice emergency nursing roles. The aim of this study is to examine and compare three advanced emergency nursing practice roles: ED Fast Track, Clinical Initiatives Nurse (CIN) and Rapid Intervention and Treatment Zone (RITZ). METHOD: A descriptive exploratory approach was used to conduct this study at an urban district hospital in Melbourne, Australia. The study participants were patients managed in each of the three systems with advanced practice emergency nursing roles: Fast Track, CIN and RITZ. RESULTS: There were a total of 551 patients: 195 Fast Track patients, 163 CIN managed patients and 193 RITZ patients. CIN managed patients were older (p<0.001), with higher levels of clinical urgency (p<0.001), and higher hospital admission rates (p<0.001). CIN managed patients had shorter waiting time for nursing care (p=0.001) and lower incidence of medical assessment within the time associated with their triage category (p<0.0001). ED LOS for discharged patients was significantly longer for CIN managed patients (p<0.001). CIN managed patients had a significantly higher incidence of electrocardiography (p<0.001), blood glucose measurement (p<0.001), intravenous cannulation (p<0.001), pathology testing (p<0.001), and analgesia administration (p<0.001) when compared to Fast Track and RITZ patients. CONCLUSIONS: Advanced practice roles in emergency nursing can have different applications in the ED context. Clarity about role intent and scope of practice is important and should inform educational preparation and teams within which these roles operate.

Prática Avançada de Enfermagem/organização & administração , Eficiência Organizacional , Enfermagem em Emergência/organização & administração , Serviço Hospitalar de Emergência/organização & administração , Profissionais de Enfermagem/organização & administração , Papel do Profissional de Enfermagem , Doença Aguda/enfermagem , Adolescente , Adulto , Prática Avançada de Enfermagem/métodos , Competência Clínica , Procedimentos Clínicos , Enfermagem em Emergência/métodos , Serviço Hospitalar de Emergência/normas , Feminino , Hospitais Urbanos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Pesquisa em Administração de Enfermagem , Inovação Organizacional , Equipe de Assistência ao Paciente , Alta do Paciente/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde , Triagem , Vitória , Listas de Espera , Adulto Jovem
Int J Nurs Pract ; 18(1): 60-7, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22257332


The impact of emergency nursing roles in demand management systems is poorly understood. The aim of this study was to evaluate emergency nurses' role in a specific emergency department (ED) demand management system: rapid intervention and treatment zone (RITZ). A descriptive exploratory approach was used. Data were collected from audit of 193 randomly selected patient records and 12 h of clinical practice observation. The median age of participants was 31 years, 51.8% were males and 99.5% were discharged home. Nurse qualifications or seniority had no significant effect on waiting time or length of stay (LOS). There were disparities between documented and observed nursing practice. The designation and qualifications of RITZ nurses made little difference to waiting times and ED LOS. Specific documentation and communication systems for areas of the ED that manage large numbers of low complexity patients warrant further research.

Serviço Hospitalar de Emergência/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde , Recursos Humanos de Enfermagem no Hospital/provisão & distribução , Inovação Organizacional , Eficiência Organizacional , Serviço Hospitalar de Emergência/organização & administração , Recursos Humanos de Enfermagem no Hospital/organização & administração , Queensland , Estudos de Tempo e Movimento
Emerg Med J ; 28(5): 416-21, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-20660904


BACKGROUND: The aim of this study was to examine reported incidents affecting Emergency Department (ED) episodes of care. METHODS: A retrospective audit of ED patients was carried out in an urban district hospital in Melbourne, Australia from 1 January 2008 to 31 December 2008. The main outcome measure was presence or absence of reported patient-related incident(s) during ED care. RESULTS: There were 984 patient-related incidents (n=984) during 2008.The most common incidents were related to patient behaviour (66.4%), patient management (10.1%) and medications (6.5%). Patients whose ED care involved reported incident(s) were older, had higher triage categories, longer length of ED stay and were more likely to need hospital admission or leave at their own risk. Eighteen per cent of reported incidents occurred in patients aged 65 years and over. Incidents affecting older patients were more likely to be related to breach of skin integrity, patient management, diagnosis and patient identification, and less likely to involve patient behaviour. CONCLUSIONS: Reported incident(s) occurred in 0.47% of ED episodes of care. Differences in personal and clinical characteristics of patients whose ED care involved reported incident(s) highlights the need for better understanding of incidents occurring in the ED in order to improve systems for high-risk patients.

Serviço Hospitalar de Emergência , Doença Iatrogênica/epidemiologia , Erros Médicos/estatística & dados numéricos , Gestão de Riscos/organização & administração , Cuidado Periódico , Feminino , Pesquisa sobre Serviços de Saúde , Hospitais Urbanos , Humanos , Masculino , Auditoria Administrativa , Estudos Retrospectivos , Medição de Risco , Gestão da Segurança/organização & administração , Gestão da Qualidade Total , Vitória/epidemiologia
Emerg Med J ; 27(11): 838-42, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-20581389


OBJECTIVE: To examine the effect of clinician designation on emergency department (ED) fast track performance. DESIGN AND SETTING: A retrospective audit of patients managed in the fast track area of an ED in metropolitan Melbourne, Australia. PARTICIPANTS: Patients triaged to ED fast track from 1 January 2008 to 31 December 2008 (n=8714). MAIN OUTCOME MEASURES: Waiting times in relation to Australasian triage scale (ATS) recommendations and ED length of stay (LOS) for non-admitted patients were examined for each clinician group. RESULTS: Compliance with ATS waiting time recommendations was highest (82.5%) for emergency nurse practitioners/candidates and lowest (48.2%) for junior medical officers. Median ED LOS was less than 3 h for non-admitted patients, and 85.8% of non-admitted fast track patients (n=6278) left the ED within 4 h. Patients managed by emergency nurse practitioners/candidates had the shortest ED LOS (median 1.7 h) and patients managed by junior medical officers and locum medical officers the longest ED LOS (median 2.7 h) (χ(2)=498.539, df=6, p<0.001). CONCLUSIONS: Clinician designation does impact on waiting times and, to a lesser extent, ED LOS for patients managed in ED fast track systems. Future research should focus on obtaining a better understanding of the relationship between clinician expertise, time-based performance measures and quality of care indicators.

Medicina de Emergência/normas , Enfermagem em Emergência/normas , Serviço Hospitalar de Emergência/normas , Fidelidade a Diretrizes/normas , Indicadores de Qualidade em Assistência à Saúde , Tempo para o Tratamento/normas , Adulto , Austrália , Auditoria Clínica , Eficiência Organizacional , Fidelidade a Diretrizes/estatística & dados numéricos , Hospitais Urbanos , Humanos , Tempo de Internação/estatística & dados numéricos , Corpo Clínico/normas , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Tempo , Triagem/métodos