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1.
Medicine (Baltimore) ; 98(41): e17479, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593111

RESUMO

BACKGROUND: Community-acquired pneumonia (CAP) is a potentially life-threatening condition. The aim of this study is to investigate the stratified and prognostic value of admission lactate and severity scores (confusion, urea >7 mmol/L, respiratory rate ≥30/min, blood pressure <90 mm Hg systolic and/or ≤60 mm Hg diastolic, and age ≥65 years [CURB65], pneumonia severity index [PSI], sequential organ failure assessment [SOFA], qSOFA) in patients with CAP in emergency department. METHODS: Adult patients diagnosed with CAP admitted between January 2017 and January 2019 were enrolled and divided into severe CAP (SCAP) group and nonSCAP (NSCAP) group according to international guidelines, death group, and survival group according to 28-day prognosis. Predicting performance of parameters above was compared using receiver operating characteristic curves and logistic regression model. Cox proportional hazard regression model was used to identify variables independently associated with 28-day mortality. RESULTS: A total of 350 patients with CAP were enrolled. About 196 patients were classified as SCAP and 74 patients died after a 28-day follow-up. The levels of CURB65, PSI, SOFA, qSOFA, and admission lactate were higher in the SCAP group and death group. SOFA showed advantage in predicting SCAP, while qSOFA is superior in predicting 28-day mortality. The combination of SOFA and admission lactate outperformed other combinations in predicting SCAP, and the combination of qSOFA and lactate showed highest superiority over other combinations in predicting 28-day mortality. CONCLUSION: The SOFA is a valuable predictor for SCAP and qSOFA is superior in predicting 28-day mortality. Combination of qSOFA and admission lactate can improve the predicting performance of single qSOFA.


Assuntos
Infecções Comunitárias Adquiridas/mortalidade , Ácido Láctico/sangue , Escores de Disfunção Orgânica , Admissão do Paciente/estatística & dados numéricos , Pneumonia/mortalidade , Idoso , Idoso de 80 Anos ou mais , Infecções Comunitárias Adquiridas/sangue , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Modelos Logísticos , Masculino , Pneumonia/sangue , Prognóstico , Curva ROC , Estudos Retrospectivos
2.
Acta Gastroenterol Belg ; 82(3): 397-400, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31566327

RESUMO

BACKGROUND AND AIMS: Early prediction of severe acute pancreatitis (SAP)would be helpful for triaging patients to the appropriate level of care and intervention. The aim of this study is to compare the performance of the Change in Amylase And Body mass index (CAB) score and BISAP score for predicting SAP. PATIENTS AND METHODS: A total of 406 with AP were enrolled. The age, gender, body mass index(BMI), blood urea nitrogen determined at the time of admission and serum amylase determined on day 1 and day 2 after hospitalization were collected and analyzed statistically. RESULTS: Multivariable analysis confirmed that blood urea nitrogen (OR 1.06; 95%CI 1.03-1.09) and percentage change in amylase day 2 (OR 0.75; 95%CI 0.65-0.87) were independently associated with development of SAP. No statistically significant association was observed between BMI (OR 1.04; 95%CI 0.951.13) and severity of acute pancreatitis. The area under the receiver operating characteristic curve for Body mass index (BMI), percentage change in amylase day 2, BISAP score and CAB score were 0.57±0.05, 0.68±0.04, 0.84±0.03 and0.53±0.05, respectively. CONCLUSION: BISAP is more accurate for predicting the severity of acute pancreatitis than the CAB score.


Assuntos
Amilases/sangue , Nitrogênio da Ureia Sanguínea , Índice de Massa Corporal , Pancreatite/diagnóstico , Índice de Gravidade de Doença , Doença Aguda , Biomarcadores/sangue , Humanos , Pancreatite/classificação , Pancreatite/patologia , Admissão do Paciente/estatística & dados numéricos , Valor Preditivo dos Testes , Prognóstico , Curva ROC , Estudos Retrospectivos
3.
Isr Med Assoc J ; 21(10): 686-691, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31599512

RESUMO

BACKGROUND: C-reactive protein (CRP) blood level is associated with clinical outcomes of several diseases. However, the independent predictive role of CRP in the heterogeneous population of patients admitted to internal medicine wards is not known. OBJECTIVES: To determine whether single CRP levels at admission independently predicts clinical outcome and flow of patients in general medicine wards. METHODS: This study comprised 275 patients (50.5% female) with a mean age of 68.25 ± 17.0 years, hospitalized with acute disease in a general internal medicine ward. The association between admission CRP levels and clinical outcomes including mortality, the need for mechanical ventilation, duration of hospitalization, and re-admission within 6 months was determined. RESULTS: A significant association was found between CRP increments of 80 mg/L and risk for the major clinical outcomes measured. The mortality odds ratio (OR) was 1.89 (95% confidence interval (95%CI, 1.37-2.61, P < 0.001), mechanical ventilation OR 1.67 (95%CI, 1.10-2.34, P = 0.006), re-admission within 6 months OR 2.29 (95%CI, 1.66-3.15 P < 0.001), and prolonged hospitalization >7 days OR 2.09 (95%CI, 1.59-2.74, P < 0.001). Lower increments of10 mg/L in CRP levels were associated with these outcomes although with lower ORs. Using a stepwise regression model for admission CRP levels resulted in area under the receiver operating characteristics curves between 0.70 and 0.76 for these outcomes. CONCLUSIONS: A single admission CRP blood level is independently associated with major parameters of clinical outcomes in acute care patients hospitalized in internal medicine wards.


Assuntos
Proteína C-Reativa/análise , Hospitalização/estatística & dados numéricos , Medicina Interna/métodos , Avaliação de Resultados da Assistência ao Paciente , Doença Aguda , Adulto , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Admissão do Paciente/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Valor Preditivo dos Testes , Prognóstico , Respiração Artificial/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
5.
Ann R Coll Surg Engl ; 101(7): 487-494, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31362520

RESUMO

INTRODUCTION: Acute pancreatitis is a common surgical emergency. Identifying variations in presentation, incidence and management may assist standardisation and optimisation of care. The objective of the study was to document the current incidence management and outcomes of acute pancreatitis against international guidelines, and to assess temporal trends over the past 20 years. METHODS: A prospective four-month audit of patients with acute pancreatitis was performed across the Wessex region. The Atlanta 2012 classifications were used to define cases, severity and complications. Outcomes were recorded using validated systems and correlated against guideline standards. Case ascertainment was validated with clinical coding and hospital episode statistics data. RESULTS: A total of 283 patient admissions with acute pancreatitis were identified. Aetiology included 153 gallstones (54%), 65 idiopathic (23%), 29 alcohol (10%), 9 endoscopic retrograde cholangiopancreatography (3%), 6 drug related (2%), 5 tumour (2%) and 16 other (6%). Compliance with guidelines had improved compared with our previous regional audit. Results were 6.5% mortality, 74% severity stratification, 23% idiopathic cases, 65% definitive treatment of gallstones within 2 weeks, 39% computed tomography within 6-10 days of severe pancreatitis presentation and 82% severe pancreatitis critical care admission. The Atlanta 2012 severity criteria significantly correlated with critical care stay, length of stay, development of complications and mortality (2% vs 6% vs 36%, P < 0.0001). CONCLUSIONS: The incidence of acute pancreatitis in southern England has risen substantially. The Atlanta 2012 classification identifies patients with severe pancreatitis who have a high risk of fatal outcome. Acute pancreatitis management is seen to have evolved in keeping with new evidence and updated clinical guidelines.


Assuntos
Cuidados Críticos/métodos , Cálculos Biliares/terapia , Auditoria Médica/estatística & dados numéricos , Pancreatite/epidemiologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Consumo de Bebidas Alcoólicas/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Cuidados Críticos/normas , Inglaterra/epidemiologia , Feminino , Cálculos Biliares/complicações , Humanos , Incidência , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Pancreatite/diagnóstico , Pancreatite/etiologia , Pancreatite/terapia , Admissão do Paciente/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Estudos Prospectivos , Índice de Gravidade de Doença , Taxa de Sobrevida , Resultado do Tratamento , Adulto Jovem
6.
Crit Care Resusc ; 21(3): 200-211, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31462207

RESUMO

OBJECTIVE: To provide a contemporary description of the demographics, characteristics and outcomes of critically ill Indigenous patients in Australia. DESIGN, SETTING AND PARTICIPANTS: Retrospective database review using the Australian and New Zealand Intensive Care Society Adult Patient Database for intensive care unit (ICU) admissions in 2017-18. Characteristics of critically ill Indigenous patients were compared with non-Indigenous patients. MAIN OUTCOME MEASURES: Primary outcome was hospital mortality. Secondary outcomes examined demographics and resource use. RESULTS: Per capita, Indigenous Australians were overrepresented in the intensive care. They were younger (51 v 66 years), more likely to be admitted from outer regional, rural and remote settings (59% v 15%), more likely to require emergency admission (81% v 59%), and had higher rates of mechanical ventilation (35% v 32%; P < 0.01 for all). Indigenous patients were over-represented in the diagnostic categories of sepsis (15% v 9%), trauma (7% v 5%), and respiratory illness (17% v 15%), and had higher rates of ICU re-admission (7% v 5%; P < 0.01 for all). There was no difference in either unadjusted (7.9% for each; P = 0.96) or adjusted (odds ratio, 1.1; 95% CI, 1.0-1.2) in-hospital mortality. CONCLUSION: Indigenous patients, especially young Indigenous patients, were disproportionately represented in Australian ICUs, particularly for sepsis. The high level of acute illness and high proportion of emergency admissions could be interpreted as representing delayed presentation, which, with a higher re-admission rate, suggest access barriers to health care may exist. Nevertheless, there was no mortality gap between Indigenous and non-Indigenous Australians during a hospital admission for critical illness.


Assuntos
Cuidados Críticos/estatística & dados numéricos , Serviços de Saúde do Indígena/estatística & dados numéricos , Mortalidade Hospitalar/etnologia , Hospitalização/estatística & dados numéricos , Unidades de Terapia Intensiva/estatística & dados numéricos , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Adulto , Distribuição por Idade , Austrália , Estado Terminal , Diagnóstico Tardio , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Estudos Retrospectivos , Adulto Jovem
7.
Am Surg ; 85(7): 733-737, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31405418

RESUMO

Several models exist to predict trauma center need in the prehospital setting; however, there is lack of simple clinical tools to predict the need for ICU admission and mortality in trauma patients. The aim of our study was to develop a simple clinical tool that can be used with ease in the prehospital or emergency setting and can reliably predict the need for ICU admission and mortality in trauma patients. We abstracted one year of National Trauma Data Bank for all patients aged ≥ 18 years. Transferred patients and those dead on arrival were excluded. Patient demographics, injury parameters, vital signs, and Glasgow Coma Scale (GCS) were recorded. Our primary outcome measures were mortality and ICU admission. Logistic regression analysis was performed using three variables (age > 55 years, shock index (SI) > 1, and GCS score) to determine the appropriate weights for predicting mortality. Appropriate weights derived from regression analysis were used to construct a simple SI, age, and GCS (SAG) score, and associated mortality and ICU admissions were calculated for three different risk groups (low, intermediate, and high). A total of 281,522 patients were included. The mean age was 47 ± 20 years, and 65 per cent were male. The overall mortality rate was 2.9 per cent, and the rate of ICU admission was 28.7 per cent. The SAG score was constructed using weights derived from regression analysis for age ≤ 55 years (4 points), SI < 1 (3 points), and GCS (3-15 points). The median [IQR] SAG score was 21 [18-22]. The area under the receiver operating curve [95% Confidence Interval (CI)] of the SAG score for predicting mortality and ICU admission was 0.873 [0.870-0.877] and 0.644 [0.642-0.647], respectively. Each 1-point increase in the SAG score was associated with 18 per cent lower odds of mortality (odds ratio [95% CI]: 0.822 [0.820-0.825]) and 10 per cent lower odds of ICU admission (odds ratio [95% CI]: 0.901 [0.899-0.902]). The SAG score is a simple clinical tool derived from variables that can be assessed with ease during the initial evaluation of trauma patients. It provides a rapid assessment and can reliably predict mortality and need for ICU admission in trauma patients. This simple tool may allow early resource mobilization possibly even before the arrival of the patient.


Assuntos
Mortalidade Hospitalar , Escala de Gravidade do Ferimento , Unidades de Terapia Intensiva/estatística & dados numéricos , Índices de Gravidade do Trauma , Ferimentos e Lesões/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Admissão do Paciente/estatística & dados numéricos , Análise de Regressão , Estudos Retrospectivos , Ferimentos e Lesões/mortalidade , Adulto Jovem
8.
Rev Assoc Med Bras (1992) ; 65(7): 1015-1020, 2019 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-31389516

RESUMO

OBJECTIVE: To review systematically the influence of admission criteria on the mortality of elderly patients under intensive therapy. METHODS: We performed a search on the PUBMED and BIREME databases by using the MeSH and DeCS terms "intensive care units", "patient admission", and "aged" in Portuguese, English, and Spanish. Only prospective and retrospective cohort studies were included. We analyzed the severity score, type of hospital admission, quality of life, co-morbidities, functionality, and elderly institutionalization. RESULTS: Of the 1,276 articles found, thirteen were selected after evaluation of the inclusion and exclusion criteria. It was observed that the severity score, functionality, and co-morbidities had an impact on mortality. It was not possible to determine which severity score was more suitable. CONCLUSION: We suggest that analysis of functionality, co-morbidities, and severity scores should be conducted to estimate the elderly mortality in relation to the admission to intensive care units.


Assuntos
Mortalidade Hospitalar , Unidades de Terapia Intensiva/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Admissão do Paciente/normas , Fatores Etários , Comorbidade , Humanos , Qualidade de Vida , Índice de Gravidade de Doença
10.
Ann R Coll Surg Engl ; 101(7): 479-486, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31155901

RESUMO

INTRODUCTION: We aimed to enhance the emergency general surgical service in our high-volume centre in order to reduce four-hour target breaches, to expedite senior decision making and to avoid unnecessary admissions. MATERIALS AND METHODS: The aggregation of marginal gains theory was applied. A dual consultant on-call system was established by the incremental employment of five emergency general surgeons with a specialist interest in colorectal or oesophagogastric surgery. A surgical ambulatory care unit, which combines consultant-led clinical review with dedicated next-day radiology slots, and a dedicated working week half-day gastrointestinal urgent theatre session were instituted to facilitate ambulatory care pathways. RESULTS: The presence of two consultant surgeons being on call during weekday working hours decreased the four-hour target breaches and allowed consultant presence in the surgical ambulatory care clinic and the gastrointestinal urgent theatre list. Of 1371 surgical ambulatory care clinic appointments within 30 months, 1135 (82.7%) avoided a hospital admission, corresponding to savings of £309,752 . The coordinated functioning of the surgical ambulatory care clinic and the gastrointestinal urgent theatre list resulted in statistically significantly reduced hospital stays for patients operated for abscess drainage (gastrointestinal urgent theatre median 11 hours (interquartile range 3, 38) compared with emergency median 31 hours (interquartile range 24, 53), P < 0.001) or diagnostic laparoscopy/appendicectomy (gastrointestinal urgent theatre median 52 hours (interquartile range 41, 71) compared with emergency median 61 hours (interquartile range 43, 99), P = 0.005). Overnight surgery was reduced with only surgery that was absolutely necessary occurring out of hours. CONCLUSION: The expansion of the 'traditional' on-call surgical team, the establishment of the surgical ambulatory care clinic and the gastrointestinal urgent theatre list led to marginal gains with a reduction in unnecessary inpatient stays, expedited decision making and improved financial efficiency.


Assuntos
Instituições de Assistência Ambulatorial/organização & administração , Cuidados Críticos/organização & administração , Serviço Hospitalar de Emergência/organização & administração , Hospitais com Alto Volume de Atendimentos , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Adulto , Idoso , Instituições de Assistência Ambulatorial/economia , Consultores , Serviço Hospitalar de Emergência/economia , Inglaterra , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Admissão do Paciente/estatística & dados numéricos , Jornada de Trabalho em Turnos/estatística & dados numéricos , Centro Cirúrgico Hospitalar/economia , Centro Cirúrgico Hospitalar/organização & administração , Procedimentos Cirúrgicos Operatórios/economia , Carga de Trabalho/estatística & dados numéricos , Adulto Jovem
11.
Soins Psychiatr ; 40(322): 22-25, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31229142

RESUMO

Faced with the growing number of requests for the admission of patients with chronic psychiatric pathologies, a nursing home in Port-Louis has created the 'Normandie' unit to accomodate these residents. The special feature of the support provided and the organisation of the day-to-day routine requires caregivers to adopt a specific approach.


Assuntos
Transtornos Mentais/enfermagem , Casas de Saúde/organização & administração , Idoso , França , Humanos , Admissão do Paciente/estatística & dados numéricos
12.
Hosp Top ; 97(2): 60-65, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31050309

RESUMO

The objective of study was to evaluate the prevalence of malnutrition and associated factors in cardiac patients in the north of Iran. This cross-sectional study was done on 430 cardiac patients, who were admitted to the only heart hospital in the north of Iran. The malnutrition status was assessed based on "Malnutrition Universal Screening Tool" (MUST). The data was analyzed using SPSS software. The mean age of patients was 63.5 ± 12.67 years. The commonest cause of hospitalization was acute coronary syndrome. 31.4% patients had history of admission in the past 12 months. The prevalence of malnutrition was 14%, 7.7%, and 6.3% had medium and high risk of malnutrition, respectively. Patients with history of one time admission were 2.7 times more likely to be malnourished. The odds ratio for more than one time of hospital admission was 3.54. Malnutrition is likely to be present when the cardiac patients are admitted to hospital in Gilan province, in northern Iran.


Assuntos
Cardiopatias/complicações , Desnutrição/classificação , Idoso , Estudos Transversais , Feminino , Humanos , Irã (Geográfico) , Masculino , Desnutrição/etiologia , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Estado Nutricional , Razão de Chances , Admissão do Paciente/normas , Admissão do Paciente/estatística & dados numéricos , Prevalência , Fatores de Risco
13.
Rev Lat Am Enfermagem ; 27: e3136, 2019 Apr 29.
Artigo em Português, Inglês, Espanhol | MEDLINE | ID: mdl-31038630

RESUMO

OBJECTIVE: to analyze the time trend of surgical admissions by the Unified Health System according to hospital stay, costs and mortality by subgroups of surgical procedures in Brazil. METHOD: ecological study of time series. The variables surgical hospitalization, permanence, cost and mortality were obtained from the Department of Informatics of the Unified Health System. The trend analysis used the polynomial regression model. RESULTS: in nine years, 37,565,785 surgical admissions were recorded. The mean duration of surgical admissions was constant (p = 0.449); the mean stay (3.8 days) was decreasing and significant (p <0.01); the mean cost (389.16 dollars) and mortality (1.63%) were increasing and significant (p <0.01). In subgroups of eye, thoracic, oncological and other surgeries, the temporal evolution of surgeries was increasing and significant (p <0.05). In contrast, endocrine glands, digestive tract, genitourinary, breast, reconstruction and buco-maxillofacial surgeries showed a significant trend of decline (p <0.05). In the other subgroups, the trend was constant. CONCLUSION: evidence shows the trend of surgical admissions in the last decade in the country and provide subsidies for the efficient elaboration of public policies, planning and management towards universal coverage in surgical care.


Assuntos
Hospitalização/economia , Programas Nacionais de Saúde/economia , Procedimentos Cirúrgicos Operatórios/economia , Brasil/epidemiologia , Custos e Análise de Custo , Hospitalização/estatística & dados numéricos , Humanos , Tempo de Internação , Programas Nacionais de Saúde/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/mortalidade
14.
Chin J Traumatol ; 22(3): 125-128, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30956066

RESUMO

PURPOSE: To examine the relationships between emergency department length of stay (EDLOS) with hospital length of stay (HLOS) and clinical outcome in hemodynamically stable trauma patients. METHODS: Prospective data collected for 2 years from consecutive trauma patients admitted to the trauma resuscitation bay. Only stable blunt trauma patients with appropriate trauma triage criteria requiring trauma team activation were included in the study. EDLOS was determined short if patient spent less than 2 h in the emergency department (ER) and long for more than 2 h. RESULTS: A total of 248 patients were enrolled in the study. The mean total EDLOS was 125 min (range 78-180). Injury severity score (ISS) were significantly higher in the long EDLOS group (17 ± 13 versus 11 ± 9, p < 0.001). However, when leveled according to ISS, there were no differences in mean in diagnostic workup, admission rate to intensive care unit (ICU) or HLOS between the short and long EDLOS groups. CONCLUSION: EDLOS is not a significant parameter for HLOS in stable trauma patients.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Tempo de Internação , Avaliação de Resultados da Assistência ao Paciente , Ferimentos e Lesões , Unidades de Terapia Intensiva/estatística & dados numéricos , Israel , Admissão do Paciente/estatística & dados numéricos , Fatores de Tempo , Índices de Gravidade do Trauma
15.
Healthc Q ; 21(4): 48-53, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30946655

RESUMO

The twin challenges of bed boarding and "hallway medicine" have emerged in recent years as key healthcare issues. Many hospitals, challenged with increasing demand and limited resources, have tried to find efficiencies within their operations. One such strategy is that of early morning discharges and expedited bed turnaround times. We conducted a retrospective study within three high-volume hospitals in the Greater Toronto Area looking at discharge times of in-patients and transfer times of admitted, Emergency Department (ED)-boarded patients. We discovered a consistent pattern of late-in-the-day discharges, and even later-in-the-day transfers of boarded ED patients, indicating that this may be a potential source of increased efficiency for overburdened hospitals.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitais Comunitários/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Transferência de Pacientes/estatística & dados numéricos , Ocupação de Leitos , Aglomeração , Humanos , Ontário , Admissão do Paciente/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Tempo
16.
Artigo em Inglês | MEDLINE | ID: mdl-30934957

RESUMO

Environmental variables can regulate behavior in healthy subjects. Recently, some authors investigated the role of meteorological variables in bipolar patients with an impact on both the onset and course of bipolar disorder (BD). The aim of this study was to investigate the impact of meteorological variables and other indexes in bipolar hospitalized patients. We examined all patients admitted to the Psychiatric Inpatient Unit of San Luigi Gonzaga Hospital, Orbassano (Turin, Italy) from September 2013 to August 2015, collecting several socio-demographic and clinical characteristics. Seven hundred and thirty patients were included. Compared to the day of admission of control individuals, patients with BD were admitted on a day that presented higher minimum, medium, and maximum temperature, higher maximum humidity, higher solar radiation, and higher hours of sunshine. After logistic regression analysis, admissions to the emergency psychiatric ward due to a primary diagnosis of BD were associated with maximum temperature and solar radiation. The current study provides a novel perspective on the question surrounding seasonal mood patterns in patients with BD. A greater awareness of all possible precipitating factors is needed to inform self-management and psycho-educational programs as well as to improve resilience regarding affective recurrences in the clinical practice.


Assuntos
Transtorno Bipolar/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Unidade Hospitalar de Psiquiatria/estatística & dados numéricos , Luz Solar , Temperatura Ambiente , Adulto , Transtorno Bipolar/psicologia , Feminino , Humanos , Umidade , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Energia Solar
17.
J Forensic Leg Med ; 65: 9-14, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31029004

RESUMO

BACKGROUND: There is sparse literature regarding K-9 (legal intervention) dog bites. It was the purpose of this study to analyze the demographics of K-9 dog bites using a national data base. METHODS: This was a retrospective study of prospectively collected data from National Electronic Injury Surveillance System - All Injury Program for years 2005-2013. Patients with dog bites were identified and those due to legal intervention were analyzed. Statistical analyses were performed with SUDAAN 11.0.01™ software. A p < 0.05 was considered statistically significant. RESULTS: There were an estimated 32, 951 K-9 dog bite ED visits, accounting for 1.1% of all ED dog bite visits. The K-9 group was nearly all male (95.0 vs 52.1%) and more commonly Black (42.0 vs 13.0%) compared to the non K-9 group. Bites to the head/neck and upper extremity were less frequent and lower extremity bites more frequent in the K-9 group; K-9 bites more commonly occurred outside the home. Within the K-9 group, the proportion of White patients increased with increasing age and smaller hospital size. Patients seen in small and medium size hospitals were in the middle age ranges, while those in the very young and >64 years of age were only seen at large hospitals. The average annual incidence of K-9 dog bites seen in the ED for US was 2.43 per 100,000 males with no changes over time. CONCLUSIONS: In the US, 1.1% of all ED visits for dog bites are due to K-9 intervention with no change in incidence, even though this study spanned the time when it was encouraged to change K-9 intervention; from "find and bite" to "find and bark". The K-9 dog bite patient is nearly always male, more commonly Black, occurred away from home, and has a 3.7% hospital admission rate. Bites to the head/neck are less common compared to the non K-9 dog bite group.


Assuntos
Mordeduras e Picadas/epidemiologia , Cães , Polícia , Adolescente , Adulto , Distribuição por Idade , Animais , Grupos de Populações Continentais/estatística & dados numéricos , Bases de Dados Factuais , Serviço Hospitalar de Emergência , Feminino , Tamanho das Instituições de Saúde/estatística & dados numéricos , Humanos , Incidência , Extremidade Inferior/lesões , Masculino , Pessoa de Meia-Idade , Admissão do Paciente/estatística & dados numéricos , Estudos Retrospectivos , Distribuição por Sexo , Estados Unidos/epidemiologia , Adulto Jovem
18.
J Laryngol Otol ; 133(5): 386-389, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30967160

RESUMO

OBJECTIVE: Acute tonsillitis represents a significant proportion of admissions to ENT departments nationally. Given current hospital pressures, it is vital to look for safe alternatives to admission. This study explores the safe management of patients in an ambulatory medical unit, without the need for admission. METHODS: A retrospective review of 48 patients' notes was carried out. Following the development and implementation of a guideline for acute tonsillitis, a prospective re-audit of 41 patients was carried out, measuring length of stay, overnight admissions and re-admissions. RESULTS: The rate of overnight admission following implementation of the guideline fell from 0.75 to 0.29, and average length of stay dropped from 19.2 to 9.5 hours. There were two re-admissions in each cycle of the audit, which represents a non-significant increase. CONCLUSION: The tonsillitis guideline has significantly reduced admissions and length of stay. Re-admissions remain low, demonstrating that this is a safe and cost-effective intervention.


Assuntos
Instituições de Assistência Ambulatorial/normas , Assistência Ambulatorial/normas , Implementação de Plano de Saúde/métodos , Guias de Prática Clínica como Assunto , Tonsilite/terapia , Doença Aguda , Adulto , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Auditoria Médica , Admissão do Paciente/estatística & dados numéricos , Estudos Prospectivos , Estudos Retrospectivos
19.
Soc Psychiatry Psychiatr Epidemiol ; 54(7): 871-881, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30895353

RESUMO

OBJECTIVES: Compared with the majority population, those from minority ethnic groups in the UK are more likely to be admitted compulsorily during a first episode of psychosis (FEP). We investigated whether these disparities in pathways in to care continue. METHODS: We analysed data from two first episode psychosis studies, conducted in the same geographical area in south London 15 years apart: the Aetiology and Ethnicity in Schizophrenia and Other Psychosis (AESOP) and the Clinical Record Interactive Search-First Episode Psychosis (CRIS-FEP) studies. The inclusion/exclusion criteria for case ascertainment for first episode psychosis were identical across the two studies. We performed multivariable logistic regression to estimate odds of compulsory admission by ethnic group, controlling for confounders. PARTICIPANTS: Two hundred sixty-six patients with first episode psychosis, aged 18-64 years, who presented to mental health services in south London in 1997-1999 and 446 with FEP who presented in 2010-2012. RESULTS: When the two samples  were compared, ethnic differences in compulsory admission appear to have remained the same for black African patients, i.e. three times higher than white British in both samples: AESOP (adj. OR = 3.96; 95% CI = 1.80-8.71) vs. CRIS-FEP (adj. OR = 3.12; 95% CI = 1.52-6.35). Black Caribbean patients were three times more likely to be compulsorily admitted in AESOP (adj. OR = 3.20; 95% CI = 1.56-6.54). This was lower in the CRIS-FEP sample (adj. OR = 1.68; 95% CI = 0.71-3.98) and did not meet conventional levels for statistical significance. CONCLUSION: Ethnicity is strongly associated with compulsory admissions at first presentation for psychosis with evidence of heterogeneity across groups, which deserves further research.


Assuntos
Grupos Étnicos/estatística & dados numéricos , Serviços de Saúde Mental/estatística & dados numéricos , Grupos Minoritários/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Transtornos Psicóticos/etnologia , Adolescente , Adulto , Grupo com Ancestrais do Continente Africano/psicologia , Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Grupos Étnicos/psicologia , Grupo com Ancestrais do Continente Europeu/psicologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Modelos Logísticos , Londres , Masculino , Pessoa de Meia-Idade , Grupos Minoritários/psicologia , Esquizofrenia/etnologia , Adulto Jovem
20.
Epidemiology ; 30(3): 365-370, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30882402

RESUMO

BACKGROUND: Opioid misuse is a major public health issue in the United States and in particular the state of Ohio. However, the burden of the epidemic is challenging to quantify as public health surveillance measures capture different aspects of the problem. Here, we synthesize county-level death and treatment counts to compare the relative burden across counties and assess associations with social environmental covariates. METHODS: We construct a generalized spatial factor model to jointly model death and treatment rates for each county. For each outcome, we specify a spatial rates parameterization for a Poisson regression model with spatially varying factor loadings. We use a conditional autoregressive model to account for spatial dependence within a Bayesian framework. RESULTS: The estimated spatial factor was highest in the southern and southwestern counties of the state, representing a higher burden of the opioid epidemic. We found that relatively high rates of treatment contributed to the factor in the southern part of the state, whereas relatively higher rates of death contributed in the southwest. The estimated factor was also positively associated with the proportion of residents 18-64 years of age on disability and negatively associated with the proportion of residents reporting white race. CONCLUSIONS: We synthesized the information in the opioid-associated death and treatment counts through a spatial factor model to estimate a latent factor representing the consensus between the two surveillance measures. We believe this framework provides a coherent approach to describe the epidemic while leveraging information from multiple surveillance measures.


Assuntos
Analgésicos Opioides/envenenamento , Overdose de Drogas/mortalidade , Overdose de Drogas/terapia , Admissão do Paciente/estatística & dados numéricos , Vigilância da População/métodos , Adolescente , Adulto , Teorema de Bayes , Humanos , Pessoa de Meia-Idade , Ohio/epidemiologia , Análise Espacial , Adulto Jovem
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