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1.
Talanta ; 233: 122596, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34215084

RESUMO

Detection of explosives at trace levels is crucial for security purposes because of increasing worldwide terrorist threats at public places. Previously, a hollow cathode discharge (HCD) ion source has been fabricated for detection of explosives. Recently, the HCD ion source has been modified for a dual pressures operating system and coupled to a linear ion trap MS to analyze explosives simultaneously. Here, trinitrotoluene (TNT), nitroglycerin (NG), pentaerythritol tetranitrate (PETN) and 1,3,5-trinitroperhydro-1,3,5-triazine (RDX) were taken as model explosive compounds and the mass spectra were recorded in the negative mode ionization. At the higher ion source pressure (~28.0-30.0 Torr), NG, PETN and RDX gave adduct ions with the NO3- ion while TNT showed the [TNT + NO3-HNO2]- (m/z 242) simultaneously. However, NG and PETN did not give any ion signals at the lower ion source pressure (~0.8-1.0 Torr) while TNT exhibited its molecular ion, [TNT]-• (m/z 227), as a major ion through electron attachment and RDX showed fragment ions that followed electron capture dissociation concurrently. The modified HCD ion source exhibited better sensitivity in simultaneous detection and quantification of the explosives. The NO3- and NO2- as reagent ions in the air HCD plasma form stable adduct ions with the NG, PETN and RDX even with TNT at the higher temperature (140-200 °C). The formation of the NO3-, NO2- in the HCD plasma also causes the formation of [TNT-H]- (m/z 226) at the higher ion source pressure. The inner metallic surface of the hollow tube assists the Birch reduction type reaction that results in the formation of hydride ion of the TNT, [TNT + H]- (m/z 228). No significant difference in the spectral pattern for simultaneous and individual measurements for the explosives was observed at the higher ion source pressure. Therefore, it may conclude that the present modified HCD ion source can be used for simultaneous detection and quantification of the explosive compounds at trace and/or ultra-trace levels using air as a carrier gas.


Assuntos
Substâncias Explosivas , Tetranitrato de Pentaeritritol , Trinitrotolueno , Eletrodos , Humanos , Alta do Paciente
2.
Respir Res ; 22(1): 203, 2021 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-34243776

RESUMO

BACKGROUND: Thousands of Coronavirus Disease 2019 (COVID-19) patients have been discharged from hospitals Persistent follow-up studies are required to evaluate the prevalence of post-COVID-19 fibrosis. METHODS: This study involves 462 laboratory-confirmed patients with COVID-19 who were admitted to Shenzhen Third People's Hospital from January 11, 2020 to April 26, 2020. A total of 457 patients underwent thin-section chest CT scans during the hospitalization or after discharge to identify the pulmonary lesion. A total of 287 patients were followed up from 90 to 150 days after the onset of the disease, and lung function tests were conducted about three months after the onset. The risk factors affecting the persistence of pulmonary fibrosis were identified through regression analysis and the prediction model of the persistence of pulmonary fibrosis was established. RESULTS: Parenchymal bands, irregular interfaces, reticulation and traction bronchiectasis were the most common CT features in all COVID-19 patients. During the 0-30, 31-60, 61-90, 91-120 and > 120 days after onset, 86.87%, 74.40%, 79.56%, 68.12% and 62.03% patients developed with pulmonary fibrosis and 4.53%, 19.61%, 18.02%, 38.30% and 48.98% patients reversed pulmonary fibrosis, respectively. It was observed that Age, BMI, Fever, and Highest PCT were predictive factors for sustaining fibrosis even after 90 days from onset. A predictive model of the persistence with pulmonary fibrosis was developed based-on the Logistic Regression method with an accuracy, PPV, NPV, Sensitivity and Specificity of the model of 76%, 71%, 79%, 67%, and 82%, respectively. More than half of the COVID-19 patients revealed abnormal conditions in lung function after 90 days from onset, and the ratio of abnormal lung function did not differ on a statistically significant level between the fibrotic and non-fibrotic groups. CONCLUSIONS: Persistent pulmonary fibrosis was more likely to develop in patients with older age, higher BMI, severe/critical condition, fever, a longer viral clearance time, pre-existing disease and delayed hospitalization. Fibrosis developed in COVID-19 patients could be reversed in about a third of the patients after 120 days from onset. The pulmonary function of less than half of COVID-19 patients could turn to normal condition after three months from onset. An effective prediction model with an average area under the curve (AUC) of 0.84 was established to predict the persistence of pulmonary fibrosis in COVID-19 patients for early diagnosis.


Assuntos
COVID-19/virologia , Pulmão/virologia , Alta do Paciente , Fibrose Pulmonar/virologia , SARS-CoV-2/patogenicidade , Adolescente , Adulto , COVID-19/complicações , COVID-19/diagnóstico , China , Feminino , Interações Hospedeiro-Patógeno , Humanos , Pulmão/diagnóstico por imagem , Pulmão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Fibrose Pulmonar/diagnóstico por imagem , Fibrose Pulmonar/fisiopatologia , Testes de Função Respiratória , Fatores de Tempo , Tomografia Computadorizada por Raios X , Adulto Jovem
3.
Sci Rep ; 11(1): 13733, 2021 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-34215803

RESUMO

To determine the proportion of patients with COVID-19 who were readmitted to the hospital and the most common causes and the factors associated with readmission. Multicenter nationwide cohort study in Spain. Patients included in the study were admitted to 147 hospitals from March 1 to April 30, 2020. Readmission was defined as a new hospital admission during the 30 days after discharge. Emergency department visits after discharge were not considered readmission. During the study period 8392 patients were admitted to hospitals participating in the SEMI-COVID-19 network. 298 patients (4.2%) out of 7137 patients were readmitted after being discharged. 1541 (17.7%) died during the index admission and 35 died during hospital readmission (11.7%, p = 0.007). The median time from discharge to readmission was 7 days (IQR 3-15 days). The most frequent causes of hospital readmission were worsening of previous pneumonia (54%), bacterial infection (13%), venous thromboembolism (5%), and heart failure (5%). Age [odds ratio (OR): 1.02; 95% confident interval (95% CI): 1.01-1.03], age-adjusted Charlson comorbidity index score (OR: 1.13; 95% CI: 1.06-1.21), chronic obstructive pulmonary disease (OR: 1.84; 95% CI: 1.26-2.69), asthma (OR: 1.52; 95% CI: 1.04-2.22), hemoglobin level at admission (OR: 0.92; 95% CI: 0.86-0.99), ground-glass opacification at admission (OR: 0.86; 95% CI:0.76-0.98) and glucocorticoid treatment (OR: 1.29; 95% CI: 1.00-1.66) were independently associated with hospital readmission. The rate of readmission after hospital discharge for COVID-19 was low. Advanced age and comorbidity were associated with increased risk of readmission.


Assuntos
COVID-19/terapia , Readmissão do Paciente , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , COVID-19/complicações , COVID-19/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Estudos Retrospectivos , Fatores de Risco , SARS-CoV-2/isolamento & purificação
4.
Isr Med Assoc J ; 23(7): 420-425, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34251124

RESUMO

BACKGROUND: Syncope is a common reason for emergency department (ED) visits; however, the decision to admit or discharge patients after a syncopal episode remains challenging for emergency physicians. Decision rules such as the Boston Syncope Criteria have been developed in an attempt to aid clinicians in identifying high-risk patients as well as those who can be safely discharged, but applying these rules to different populations remains unclear. OBJECTIVES: To determine whether the Boston Syncope Criteria are valid for emergency department patients in Israel. METHODS: This retrospective cohort convenience sample included patients who visited a tertiary care hospital in Jerusalem from August 2018 to July 2019 with a primary diagnosis of syncope. Thirty-day follow-up was performed using a national health system database. The Boston Syncope Criteria were retrospectively applied to each patient to determine whether they were at high risk for an adverse outcome or critical intervention, versus low risk and could be discharged. RESULTS: A total of 198 patients fulfilled the inclusion criteria and completed follow-up. Of these, 21 patients had either an adverse outcome or critical intervention. The rule detected 20/21 with a sensitivity of 95%, a specificity of 66%, and a negative predictive value of 99. CONCLUSIONS: The Boston Syncope Criteria may be useful for physicians in other locations throughout the world to discharge low-risk syncope patients as well as identify those at risk of complications.


Assuntos
Regras de Decisão Clínica , Tomada de Decisão Clínica/métodos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Seleção de Pacientes , Medição de Risco , Síncope , Idoso , Procedimentos Clínicos , Bases de Dados Factuais/estatística & dados numéricos , Feminino , Humanos , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Admissão do Paciente/normas , Alta do Paciente/normas , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco/métodos , Medição de Risco/normas , Síncope/diagnóstico , Síncope/epidemiologia , Síncope/etiologia , Síncope/terapia
6.
Artigo em Russo | MEDLINE | ID: mdl-34283527

RESUMO

OBJECTIVE: To develop a method for early (24 hrs after intervention) prognosis of functional outcome at discharge in patients after endovascular thrombectomy (EVT) in anterior cerebral circulation based on NIHSS. MATERIAL AND METHODS: A retrospective analysis of endovascular treatment in 362 acute stroke patients (189 men, 173 women, median age 69 years) with anterior circulation large vessel occlusion was performed in the regional vascular centers of St. Petersburg. RESULTS: The original scale (S10-10) developed for prognosis of functional outcome at discharge is based on total scores on 3 patterns: NIHSS 24 hrs after EVT (10 and less - 1, greater than 10 - 2), NIHSS improvement 24 hrs (greater than 10 - 0, 1-10 - 1, 0 and less - 2), older than 78 yr - 1. According to the total score, 5 grades are determined: 1 (good, mRs 0-2 75%, mRs 3-5 25%, mRs 6 0%), 2 (favorable, mRs 0-2 66%, mRs 3-5 26%, mRs 6 8%), 3 (unfavorable, mRs 0-2 14%, mRs 3-5 68%, mRs 6 18%), 4 (unfavorable with high mortality, mRs 0-2 1%, mRs 3-5 52%, mRs 6 47%), 5 (highly negative, mRs 0-2 0%, mRs 3-5 16%, mRs 6 84%). S10-10 greater than 2 indicates unfavorable prognosis. The scale allows accurate prognosis of functional outcome at discharge (AUC 0.89; AUC 0.84 in a validation cohort) and length of in-patient staying and time to death for S10-10 greater than 2. CONCLUSION: Accurate prognosis of functional outcome at discharge can be done 24 hrs after EVT in anterior cerebral circulation based on the widely used neurological scale (NIHSS) taking into account patient age.


Assuntos
Isquemia Encefálica , Procedimentos Endovasculares , Acidente Vascular Cerebral , Idoso , Artéria Carótida Primitiva , Feminino , Humanos , Masculino , Alta do Paciente , Prognóstico , Estudos Retrospectivos , Acidente Vascular Cerebral/cirurgia , Trombectomia , Resultado do Tratamento
7.
Bone Joint J ; 103-B(7 Supple B): 116-121, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34192915

RESUMO

AIMS: Total hip arthroplasty (THA) using the direct anterior approach (DAA) is undertaken with the patient in the supine position, creating an opportunity to replace both hips under one anaesthetic. Few studies have reported simultaneous bilateral DAA-THA. The aim of this study was to characterize a cohort of patients selected for this technique by a single, high-volume arthroplasty surgeon and to investigate their early postoperative clinical outcomes. METHODS: Using an institutional database, we reviewed 643 patients who underwent bilateral DAA-THA by a single surgeon between 1 January 2010 and 31 December 2018. The demographic characteristics of the 256 patients (39.8%) who underwent simultaneous bilateral DAA-THA were compared with the 387 patients (60.2%) who underwent staged THA during the same period of time. We then reviewed the length of stay, rate of discharge home, 90-day complications, and readmissions for the simultaneous bilateral group. RESULTS: Patients undergoing simultaneous bilateral DAA-THA had a 3.5% transfusion rate, a 1.8 day mean length of stay, a 98.1% rate of discharge home, and low rates of 90-day infection (0.39%), dislocation (0.39%), periprosthetic fracture (0.77%), venous thromboembolism (0%), haematoma (0.39%), further surgery (0.77%), and readmission (0.77%). These patients were significantly younger (mean 58.2 years vs 62.5 years; p < 0.001), more likely to be male (60.3% vs 46.5%; p < 0.001), and with a trend towards having a lower mean BMI (27.8 kg/m2 vs 28.4 kg/m2; p = 0.071) than patients who underwent staged bilateral DAA-THA. CONCLUSION: Patients selected for simultaneous bilateral DAA-THA in a single surgeon's practice had a 3% rate of postoperative transfusion and a low rate of complications, readmissions, and discharge to a rehabilitation facility. Simultaneous bilateral DAA-THA appears to be a reasonable and safe form of treatment for patients with bilateral symptomatic osteoarthritis of the hip when undertaken by an experienced arthroplasty surgeon with appropriate selection criteria. Cite this article: Bone Joint J 2021;103-B(7 Supple B):116-121.


Assuntos
Artroplastia de Quadril/métodos , Seleção de Pacientes , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Prótese de Quadril , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Alta do Paciente/estatística & dados numéricos , Posicionamento do Paciente , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia
8.
Bone Joint J ; 103-B(7 Supple B): 103-110, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34192916

RESUMO

AIMS: Due to the opioid epidemic in the USA, our service progressively decreased the number of opioid tablets prescribed at discharge after primary hip (THA) and knee (TKA) arthroplasty. The goal of this study was to analyze the effect on total morphine milligram equivalents (MMEs) prescribed and post-discharge opioid repeat prescriptions. METHODS: We retrospectively reviewed 19,428 patients undergoing a primary THA or TKA between 1 February 2016 and 31 December 2019. Two reductions in the number of opioid tablets prescribed at discharge were implemented over this time; as such, we analyzed three periods (P1, P2, and P3) with different routine discharge MME (750, 520, and 320 MMEs, respectively). We investigated 90-day refill rates, refill MMEs, and whether discharge MMEs were associated with represcribing in a multivariate model. RESULTS: A discharge prescription of < 400 MMEs was not a risk factor for opioid represcribing in the entire population (p = 0.772) or in opioid-naïve patients alone (p = 0.272). Procedure type was the most significant risk factor for narcotic represcribing, with unilateral TKA (hazard ratio (HR) = 5.62), bilateral TKA (HR = 6.32), and bilateral unicompartmental knee arthroplasty (UKA) (HR = 5.29) (all p < 0.001) being the highest risk for refills. For these three procedures, there was approximately a 5% to 6% increase in refills from P1 to P3 (p < 0.001); however, there was no significant increase in refill rates after any hip arthroplasty procedures. Total MMEs prescribed were significantly reduced from P1 to P3 (p < 0.001), leading to the equivalent of nearly 500,000 fewer oxycodone 5 mg tablets prescribed. CONCLUSION: Decreasing opioids prescribed at discharge led to a statistically significant reduction in total MMEs prescribed. While the represcribing rate did not increase for any hip arthroplasty procedure, the overall refill rates increased by about 5% for most knee arthroplasty procedures. As such, we are now probably prescribing an appropriate amount of opioids at discharge for knee arthroplasty procedure, but further reductions may be possible for hip arthroplasty procedures. Cite this article: Bone Joint J 2021;103-B(7 Supple B):103-110.


Assuntos
Analgésicos Opioides/administração & dosagem , Artroplastia de Quadril , Artroplastia do Joelho , Dor Pós-Operatória/tratamento farmacológico , Padrões de Prática Médica/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Prescrições de Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Morfina/administração & dosagem , Alta do Paciente , Estudos Retrospectivos
9.
Nutrients ; 13(6)2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34208391

RESUMO

BACKGROUND: The COVID-19 lockdown may have negatively impacted the treatment of obesity. This study aimed to assess the effect of COVID-19 lockdown in patients with obesity treated with intensive residential cognitive behavioral therapy (CBT-OB). METHODS: This retrospective case-control study analyzed 129 patients with severe obesity who experienced COVID-19 lockdown in the 6 months after discharge from intensive residential CBT-OB, comparing their outcomes on weight loss, binge-eating episodes, and general health status with those in a sample of patients matched by gender, age, and body mass index given the same treatment before the COVID-19 outbreak as control. Patients were assessed at baseline and by phone interview 6-month follow-up. RESULTS: Both groups had lost more than 9% of their baseline bodyweight and reported a significant decrease in binge-eating episodes and similar general health status at 6-month follow-up. However, control patients achieved a significantly greater weight loss than those who experienced lockdown, although half of lockdown patients reported persisting with CBT-OB procedures after their discharge. CONCLUSION: Patients with obesity treated with CBT-OB and exposed to COVID-19 lockdown, despite achieving lower weight loss than non-exposed patients, had a healthy weight loss at 6-month follow-up and comparable reduction in binge-eating behaviors.


Assuntos
COVID-19 , Terapia Cognitivo-Comportamental , Controle de Doenças Transmissíveis , Obesidade/terapia , Pandemias , Alta do Paciente , Perda de Peso , Adulto , Idoso , Transtorno da Compulsão Alimentar , Índice de Massa Corporal , Estudos de Casos e Controles , Feminino , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/psicologia , Tratamento Domiciliar , Estudos Retrospectivos , SARS-CoV-2 , Isolamento Social , Resultado do Tratamento , Programas de Redução de Peso
10.
BMC Musculoskelet Disord ; 22(1): 611, 2021 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-34243746

RESUMO

BACKGROUND: Although many people with chronic low back pain (LBP) improve following conservative treatment, one in five will experience worsening symptoms after discharge from treatment and seek health care again. The current LBP clinical care pathway in many health services lacks a well-integrated, systematic approach to support patients to remain physically active and self-manage their symptoms following discharge from treatment. Health coaching can support people to improve physical activity levels and may potentially reduce health care utilisation for LBP. The primary aim of this study is to evaluate the effect of introducing a coordinated support system (linking hospital outpatient physiotherapy services to a public health coaching service) at discharge from LBP treatment, on the future use of hospital, medical, and health services for LBP, compared with usual care provided at discharge. METHODS: Three hundred and seventy-four adults with chronic non-specific LBP will be recruited from the outpatient physiotherapy departments of public hospitals in New South Wales, Australia. Participants will be individually randomised to a support system (n = 187) or usual care group (n = 187). All participants will receive usual care provided at discharge from treatment. Participants allocated to the support system will also receive up to 10 telephone-based health coaching sessions, delivered by the Get Healthy Service®, over a 6-month period. Health coaches will monitor and support participants to improve physical activity levels and achieve personal health-related goals. The primary outcome is the total number of encounters with hospital, medical, and health services for LBP, at 12 months from baseline. A within-trial economic evaluation will quantify the incremental costs and benefits of the support system from a health system perspective, to support reimbursement decision making. DISCUSSION: This study will establish the effect of a coordinated support system, introduced at discharge from treatment, on the future use of hospital, medical, and health services for LBP and various health outcomes. CONCLUSION: Innovative community-driven solutions to support people with chronic LBP after discharge from treatment are urgently needed. Study findings will help inform health care policy and clinical practice in Australia. TRIAL REGISTRATION: Prospectively registered on the Australian New Zealand Clinical Trials Registry ( ACTRN12620000889954 ) on 10/09/2020.


Assuntos
Dor Lombar , Tutoria , Adulto , Austrália , Hospitais Públicos , Humanos , Dor Lombar/diagnóstico , Dor Lombar/terapia , New South Wales , Alta do Paciente , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
11.
BMC Health Serv Res ; 21(1): 678, 2021 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-34243769

RESUMO

BACKGROUND: Reducing the economic impact of hip fractures (HF) is a global issue. Some efforts aimed at curtailing costs associated with HF include rehabilitating patients within primary care. Little, however, is known about how different rehabilitation settings within primary care influence patients' subsequent risk of institutionalization for long-term care (LTC). This study examines the association between rehabilitation setting (outside an institution versus short-term rehabilitation stay in an institution, both during 30 days post-discharge for HF) and risk of institutionalization in a nursing home (at 6-12 months from the index admission). METHODS: Data were for 612 HF incidents across 611 patients aged 50 years and older, who were hospitalized between 2008 and 2013 in Oslo, Norway, and who lived at home prior to the incidence. We used logistic regression to examine the effect of rehabilitation setting on risk of institutionalization, and adjusted for patients' age, gender, health characteristics, functional level, use of healthcare services, and socioeconomic characteristics. The models also included fixed-effects for Oslo's boroughs to control for supply-side and unobserved effects. RESULTS: The sample of HF patients had a mean age of 82.4 years, and 78.9 % were women. Within 30 days after hospital discharge, 49.0 % of patients received rehabilitation outside an institution, while the remaining 51.0 % received a short-term rehabilitation stay in an institution. Receiving rehabilitation outside an institution was associated with a 58 % lower odds (OR = 0.42, 95 % CI = 0.23-0.76) of living in a nursing home at 6-12 months after the index admission. The patients who were admitted to a nursing home for LTC were older, more dependent on help with their memory, and had a substantially greater increase in the use of municipal healthcare services after the HF. CONCLUSIONS: The setting in which HF patients receive rehabilitation is associated with their likelihood of institutionalization. In the current study, patients who received rehabilitation outside of an institution were less likely to be admitted to a nursing home for LTC, compared to those who received a short-term rehabilitation stay in an institution. These results suggest that providing rehabilitation at home may be favorable in terms of reducing risk of institutionalization for HF patients.


Assuntos
Assistência ao Convalescente , Fraturas do Quadril , Idoso , Idoso de 80 Anos ou mais , Feminino , Fraturas do Quadril/epidemiologia , Humanos , Institucionalização , Pessoa de Meia-Idade , Noruega/epidemiologia , Alta do Paciente
12.
Rev Bras Enferm ; 74Suppl 2(Suppl 2): e202000992, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34287500

RESUMO

OBJECTIVE: To analyze the planning and implementation of the care offered by nurses to elders with coronary disease during the hospital-house transition. METHODS: Qualitative research that used the Transitions Theory as a theoretical reference. The participants were 12 nurses who work in a hospital that specializes in cardiology, in the city of Salvador-BA. A semistructured interview was carried out from January to February 2018, and the data was analyzed using the Content Analysis technique. RESULTS: Transition care takes place on the day of discharge. The presence of the family was found to be a facilitator; low adherence, poor financial situations, the low educational levels inhibited its implementation. The rehospitalization is an indicator of the results of the transition of care. FINAL CONSIDERATIONS: The planning and implementation of transition care is not effective. It must provide safety in the management of self-care in the home of elders with coronary disease and their families.


Assuntos
Doença da Artéria Coronariana , Enfermeiras e Enfermeiros , Cuidado Transicional , Idoso , Doença da Artéria Coronariana/terapia , Humanos , Alta do Paciente , Pesquisa Qualitativa
13.
Rev Lat Am Enfermagem ; 29: e3440, 2021.
Artigo em Inglês, Português, Espanhol | MEDLINE | ID: mdl-34287539

RESUMO

OBJECTIVE: to analyze the evolution of self-care in hospitalized patients with decompensated heart failure, between the first return after hospital discharge (T0) and three months after this assessment (T1). METHOD: an observational, analytical and longitudinal study carried out in the cardiology outpatient clinics of two public hospitals in Ribeirão Preto, São Paulo. The sociodemographic and clinical data were collected through interviews and consultation of medical records. Self-care was assessed using the Brazilian version of the Self-Care of Heart Failure Index-SCHFI instrument. The data were analyzed by means of the Student's t test and paired distribution (McNemar) with a significance level of 0.05. RESULTS: we verified an increase in the mean scores of the three subscales of SCHFI (Maintenance, Management and Confidence), when comparing the values of T0 and T1, these differences being statistically significant (p<0.001). When comparing the positive changes in self-care actions over these months, we found statistically significant changes in the Maintenance (6 out of 10 items), Management (5 out of 6 items) and Confidence (4 out of 6 items) subscales. CONCLUSION: self-care for heart failure improved in the period between the first return after discharge and the end of three months of follow-up. Further studies are needed to verify the variables associated with improved self-care after hospitalization.


Assuntos
Insuficiência Cardíaca , Autocuidado , Brasil , Insuficiência Cardíaca/terapia , Hospitais , Humanos , Estudos Longitudinais , Pacientes Ambulatoriais , Alta do Paciente
14.
Nutrients ; 13(7)2021 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-34209229

RESUMO

Background & Aims: SARS-CoV2 infection is associated with an increased risk of malnutrition. Although there are numerous screening and nutritional management protocols for malnutrition, only few studies have reported nutritional evolution after COVID-19. The objectives of this study were to describe the evolution of nutritional parameters between admission and 30 days after hospital discharge, and to determine predictive factors of poor nutritional outcome after recovery in adult COVID-19 patients. Methods: In this observational longitudinal study, we report findings after discharge in 91 out of 114 patients initially admitted for COVID-19 who received early nutritional management. Nutritional status was defined using GLIM criteria and compared between admission and day 30 after discharge. Baseline predictors of nutritional status at day 30 were assessed using logistic regression. Results: Thirty days after discharge, 28.6% of patients hospitalized for COVID-19 were malnourished, compared to 42.3% at admission. Half of malnourished patients (53%) at admission recovered a normal nutritional status after discharge. Weight trajectories were heterogeneous and differed if patients had been transferred to an intensive care unit (ICU) during hospitalization (p = 0.025). High oxygen requirement during hospitalization (invasive ventilation p = 0.016 (OR 8.3 [1.6-61.2]) and/or oxygen therapy over 5 L/min p = 0.021 (OR 3.2 [1.2-8.9]) were strong predictors of malnutrition one month after discharge. Conclusions: With early nutritional management, most patients hospitalized for COVID-19 improved nutritional parameters after discharge. These findings emphasize the importance of nutritional care in COVID-19 patients hospitalized in medicine departments, especially in those transferred from ICU.


Assuntos
COVID-19/dietoterapia , Hospitalização , Desnutrição/epidemiologia , Estado Nutricional , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Unidades de Terapia Intensiva , Modelos Logísticos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Avaliação Nutricional , Terapia Nutricional/métodos , Oxigenoterapia/estatística & dados numéricos , Alta do Paciente , Fatores de Risco , SARS-CoV-2 , Índice de Gravidade de Doença
15.
Am J Phys Med Rehabil ; 100(8): 725-729, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34257184

RESUMO

ABSTRACT: The coronavirus disease 2019 has been reported to cause various serious neurological sequelae. However, there is little information available about the impact of the disease and its complications on patients' functional status and their postacute needs. Hence, this study was performed to address the current gap in knowledge about the function and postacute needs of those with neurological complications of coronavirus disease 2019. A prospective chart review was completed for 319 patients admitted with coronavirus disease 2019 between March 4 and May 1, 2020. Primary outcomes included rate of new functional decline, discharge location, need for outpatient physical/occupational/speech therapy, need for durable medical equipment at discharge, and presence of dysphagia at discharge. Patients with neurological complications were compared with patients without neurological complications. Two hundred ninety-six cases were included in the final analysis, and 81 (27.4%) of these patients experienced neurological complications. Results indicated that hospitalized coronavirus disease 2019 patients with neurological complications exhibit a significantly longer length of stay, higher frequency of functional decline, higher mortality rate, and more frequent discharge to a subacute rehabilitation facility (all P < 0.0001). The findings of this study are expected to better prepare patients, providers, and health systems for the postacute needs of those with coronavirus disease 2019 and neurological complications.


Assuntos
COVID-19/complicações , Doenças do Sistema Nervoso/reabilitação , Doenças do Sistema Nervoso/virologia , Adulto , Idoso , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Alta do Paciente , Estudos Prospectivos , Recuperação de Função Fisiológica , SARS-CoV-2 , Cuidados Semi-Intensivos
16.
JSLS ; 25(2)2021.
Artigo em Inglês | MEDLINE | ID: mdl-34248337

RESUMO

Background and Objectives: Operating-room procedures canceled due to the COVID-19 pandemic depleted hospital revenue and potentially worsened patient outcomes through disease progression. Despite safeguards to resume elective procedures, patients remain apprehensive of contracting COVID-19 during hospitalization and recovery. We investigated symptomatic COVID-19 infection in patients undergoing operating-room procedures during the spring 2020 outbreak in Fairfield County, CT, a heavily affected New York Metropolitan area. Methods: We retrospectively analyzed 419 operating-room patients in Danbury and Norwalk Hospitals between 3/16/20 and 5/19/20. COVID-19 infection was assessed through test results or documented well-being within 2 weeks postdischarge. Variables studied were procedure classification, length of stay, and discharge disposition. Postprocedural COVID-19 infection was analyzed using binomial tests comparing rates to state-mandated infection data. Results: Six patients developed COVID-19 after 212 urgent-elective and 207 emergent procedures. Overall postprocedural infection risk was equivalent to community infection risk (P > .05). No infections occurred in 1-2 day stays or urgent-elective procedures with discharge home (both P < .05). Discharges home reduced the risk to one-sixth of community spread (P = .03). Risk of infection doubled in hospitalizations > 5 days (P = .05) and quadrupled in discharges to extended care facilities (P = .01). Discussion: Operating-room procedures did not increase the risk of symptomatic COVID-19 infection during an outbreak. Urgent-elective and emergent procedures during further outbreaks appear safe when anticipating short stays with discharges home. When anticipating prolonged hospitalization or discharges to facilities, appropriate delay of urgent-elective procedures may minimize risk of infection.


Assuntos
COVID-19/epidemiologia , Infecção Hospitalar/epidemiologia , Transmissão de Doença Infecciosa/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Alta do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Idoso , Idoso de 80 Anos ou mais , COVID-19/transmissão , Connecticut/epidemiologia , Infecção Hospitalar/virologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Salas Cirúrgicas , Complicações Pós-Operatórias/virologia , Estudos Retrospectivos , SARS-CoV-2
17.
BMC Med ; 19(1): 163, 2021 07 14.
Artigo em Inglês | MEDLINE | ID: mdl-34256745

RESUMO

BACKGROUND: Few studies had described the health consequences of patients with coronavirus disease 2019 (COVID-19) especially in those with severe infections after discharge from hospital. Moreover, no research had reported the health consequences in health care workers (HCWs) with COVID-19 after discharge. We aimed to investigate the health consequences in HCWs with severe COVID-19 after discharge from hospital in Hubei Province, China. METHODS: We conducted an ambidirectional cohort study in "Rehabilitation Care Project for Medical Staff Infected with COVID-19" in China. The participants were asked to complete three physical examinations (including the tests of functional fitness, antibodies to SARS-CoV-2 and immunological indicators) at 153.4 (143.3, 164.8), 244.3 (232.4, 259.1), and 329.4 (319.4, 339.3) days after discharge, respectively. Mann-Whitney U test, Kruskal-Wallis test, t test, one-way ANOVA, χ2, and Fisher's exact test were used to assess the variance between two or more groups where appropriate. RESULTS: Of 333 HCWs with severe COVID-19, the HCWs' median age was 36.0 (31.0, 43.0) years, 257 (77%) were female, and 191 (57%) were nurses. Our research found that 70.4% (114/162), 48.9% (67/137), and 29.6% (37/125) of the HCWs with severe COVID-19 were considered to have not recovered their functional fitness in the first, second, and third functional fitness tests, respectively. The HCWs showed improvement in muscle strength, flexibility, and agility/dynamic balance after discharge in follow-up visits. The seropositivity of IgM (17.0% vs. 6.6%) and median titres of IgM (3.0 vs. 1.4) and IgG (60.3 vs. 45.3) in the third physical examination was higher than that in the first physical examination. In the third physical examination, there still were 42.1% and 45.9% of the HCWs had elevated levels of IL-6 and TNF-α, and 11.9% and 6.3% of the HCWs had decreased relative numbers of CD3+ T cells and CD4+ T cells. CONCLUSION: The HCWs with severe COVID-19 showed improvement in functional fitness within 1 year after discharge, active intervention should be applied to help their recovery if necessary. It is of vital significance to continue monitoring the functional fitness, antibodies to SARS-CoV-2 and immunological indicators after 1 year of discharge from hospital in HCWs with severe COVID-19.


Assuntos
Anticorpos Antivirais/sangue , Teste Sorológico para COVID-19 , COVID-19 , Teste de Esforço , Pessoal de Saúde/estatística & dados numéricos , SARS-CoV-2/imunologia , Adulto , COVID-19/epidemiologia , COVID-19/imunologia , COVID-19/fisiopatologia , COVID-19/reabilitação , Teste Sorológico para COVID-19/métodos , Teste Sorológico para COVID-19/estatística & dados numéricos , China/epidemiologia , Teste de Esforço/métodos , Teste de Esforço/estatística & dados numéricos , Feminino , Seguimentos , Estado Funcional , Humanos , Interleucina-6/sangue , Masculino , Alta do Paciente/estatística & dados numéricos , Índice de Gravidade de Doença , Fator de Necrose Tumoral alfa/sangue
18.
Drug Discov Ther ; 15(3): 156-161, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34234065

RESUMO

A variable proportion of patients develop persistent/prolonged symptoms of Coronavirus Disease 2019 (COVID-19) infection (long COVID). We aimed to study the clinical predictors of persistent symptoms in patients with mild COVID-19 at 30 days post discharge (long COVID-19). We also tried to identify symptom clusters among mild COVID-19 patients. Fifty-seven patients admitted at a tertiary care centre after a positive RT-PCR report over a period of 2 months, were enrolled in the study. Details of presentation, history of illness, laboratory investigations and disease outcomes were recorded from documented medical records and discharge slip. The patients were contacted (telephonically) at 30 days after discharge and enquired regarding persistent symptoms, if any. Follow up data at 30 days post-discharge was available for 53 patients. Among them, the most common persistent symptom was fatigue (22.6%), followed by cough (9.4%) and myalgias (7.5%). There was a significant association of persistent symptoms with diarrhoea at presentation [OR 14.26 (95% CI 2.30-142.47; p = 0.009] and gap between symptom onset and admission [OR 1.40 (95% CI 1.08-1.93; p = 0.020] on multivariate logistic regression analysis. On cluster analysis, three phenotypes of mild COVID-19 were identified, which may have implications on monitoring and management. There appears to be a positive association of diarrhoea as a presenting manifestation and gap between symptom onset and admission with the persistence of symptoms classified as long COVID-19, even in mild illness. We also identified multiple phenotypes of mild COVID-19 illness, which warrant further exploration.


Assuntos
COVID-19/fisiopatologia , Centros de Atenção Terciária/organização & administração , Adulto , COVID-19/epidemiologia , COVID-19/virologia , Feminino , Seguimentos , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Alta do Paciente , SARS-CoV-2/isolamento & purificação , Estudos de Tempo e Movimento , Adulto Jovem
19.
Nutrients ; 13(7)2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34202303

RESUMO

This cross-sectional study investigated the proportion of patients' recovery from sarcopenia status and the relationship between improvement in sarcopenia (IS) and function and discharge outcome in hospitalized patients with stroke. This study included patients with stroke, aged 65 years or more, with a diagnosis of sarcopenia, who were admitted to a convalescent rehabilitation ward. Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia 2019 criteria. Patients were divided according to the presence or absence of sarcopenia at discharge: IS group and non-improvement in sarcopenia (NIS) group. Among the 227 participants (mean age: 80.5 years; 125 females), 30% (69/227) of the patients were in the IS group, while 70% (158/227) were in the NIS group. The IS group showed a higher Functional Independence Measure (FIM) than the NIS group (median 112 vs. 101, p = 0.003). The results demonstrated that IS was independently associated with higher FIM (partial regression coefficient, 5.378; 95% confidence interval (CI), 0.709-10.047). The IS group had higher odds of home discharge than the NIS group (odds ratio, 2.560; 95% CI, 0.912-7.170). In conclusion, recovery from sarcopenia may be associated with better function in patients with stroke.


Assuntos
Estado Funcional , Estado Nutricional , Sarcopenia/reabilitação , Reabilitação do Acidente Vascular Cerebral/estatística & dados numéricos , Acidente Vascular Cerebral/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Razão de Chances , Alta do Paciente , Recuperação de Função Fisiológica , Sarcopenia/complicações , Sarcopenia/fisiopatologia , Acidente Vascular Cerebral/complicações , Reabilitação do Acidente Vascular Cerebral/métodos , Resultado do Tratamento
20.
J Clin Neurosci ; 90: 94-98, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34275588

RESUMO

OBJECTIVE: This study aimed to investigate the value of Barthel, PLAN, and NIHSS scores for predicting death in the 5-year follow-up after patients with AIS are discharged and find a simple and convenient predictive scale. METHODS: Data were prospectively collected from 678 patients with AIS. Patients' death after 5 years of follow-up was considered the final event. The predictors of death were examined through single-factor and multivariate analysis. The receiver operating characteristic curve (ROC) of the patients' Barthel, PLAN, and NIHSS scores was drawn, and the area under the curve (AUC) was calculated. Differences in the predictive power of the three scales were compared using MedCalc. The goodness of fit between predictive and actual models was evaluated with the Hosmer-Lemeshow method. RESULTS: Multivariate analysis suggested that the BI score was an independent predictor of death from AIS in the 5-year follow-up. The Barthel, PLAN, and NIHSS scale scores predicted the 5-year mortality AUC values of AIS were 0.687 [95% CI, (0.649-0.722)], 0.621 [95% CI, (0.583-0.659)], 0.637 [95% CI, (0.599-0.674)], the Hosmer-Lemeshow test revealed P > 0.05, indicating that the three models had a good fit. In pairwise comparison, the AUC value of the BI score was significantly greater than that of the NIHSS scores (Pc = 0.0189). BI and PLAN scores were very close to statistical significance (Pc = 0.0513). However, PLAN and NIHSS scores had no significant differences (Pc = 1.7493). CONCLUSION: Simple BI scores had a high predictive value for the death of Chinese patients with AIS within 5 years.


Assuntos
AVC Isquêmico/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Taxa de Sobrevida
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