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1.
Scand Cardiovasc J ; 58(1): 2373085, 2024 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38957077

RESUMO

Objectives. The prevalence of patients with prior stroke is increasing globally. Accordingly, there is a need for up-to-date evidence of patient-related prognostic factors for stroke recurrence, post stroke myocardial infarction (MI) and death based on long-term follow-up of stroke survivors. For this purpose, the RIALTO study was established in 2004. Design. A prospective cohort study in which patients diagnosed with ischemic stroke (IS) or transient ischemic attack (TIA) in three Copenhagen hospitals were included. Data were collected from medical records and by structured interview. Data on first stroke recurrence, first MI and all-cause death were extracted from the Danish National Patient Registry and the Danish Civil Registration System. Results. We included 1215 patients discharged after IS or TIA who were followed up by register data from April 2004 to end of 2018 giving a median follow-up of 3.5-6.9 years depending on the outcome. At the end of follow-up 406 (33%) patients had been admitted with a recurrent stroke, 100 (8%) had a MI and 822 (68%) had died. Long-term prognostic predictors included body mass index, diabetes, antihypertensive and lipid lowering treatment, smoking, a sedentary lifestyle as well as poor self-rated health and psychosocial problems. Conclusions. Long-term risk of recurrent stroke and MI remain high in patients discharged with IS or TIA despite substantial improvements in tertiary preventive care in recent decades. Continued attention to the patient risk profile among patients surviving the early phase of stroke, including comorbidities, lifestyle, and psychosocial challenges, is warranted.


Assuntos
Ataque Isquêmico Transitório , AVC Isquêmico , Infarto do Miocárdio , Alta do Paciente , Recidiva , Sistema de Registros , Humanos , Masculino , Feminino , Ataque Isquêmico Transitório/mortalidade , Ataque Isquêmico Transitório/diagnóstico , Ataque Isquêmico Transitório/epidemiologia , Idoso , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/epidemiologia , Dinamarca/epidemiologia , Fatores de Risco , Fatores de Tempo , Pessoa de Meia-Idade , Estudos Prospectivos , Medição de Risco , AVC Isquêmico/mortalidade , AVC Isquêmico/diagnóstico , AVC Isquêmico/epidemiologia , Prognóstico , Idoso de 80 Anos ou mais , Causas de Morte
2.
Rev Bras Enferm ; 77Suppl 1(Suppl 1): e20230402, 2024.
Artigo em Inglês, Português | MEDLINE | ID: mdl-38958356

RESUMO

OBJECTIVE: To assess the quality of care transition from hospital to home for COVID-19 patients. METHOD: A cross-sectional study conducted at a University Hospital in Southern Brazil, involving 78 patients discharged after COVID-19 hospitalization. Data collection was performed via telephone using the Brazilian version of the Care Transitions Measure (CTM-15). Data were analyzed using descriptive and analytical statistics. RESULTS: The mean quality of care transition was 70.8 on a scale ranging from zero to 100, indicating moderate quality of care transition. The highest score was attributed to factor 1, "Preparation for self-management," and the lowest to factor 4, "Care Plan." CONCLUSIONS: It is important to enhance communication and support provided to patients during the transition process, especially regarding understanding prescribed medications and the development of clear care plans.


Assuntos
COVID-19 , Hospitais Universitários , Qualidade da Assistência à Saúde , SARS-CoV-2 , Humanos , COVID-19/terapia , COVID-19/epidemiologia , Brasil , Estudos Transversais , Hospitais Universitários/organização & administração , Masculino , Feminino , Pessoa de Meia-Idade , Qualidade da Assistência à Saúde/normas , Adulto , Idoso , Alta do Paciente/normas , Inquéritos e Questionários
3.
PLoS One ; 19(7): e0302681, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38985795

RESUMO

RATIONALE: A common strategy to reduce COPD readmissions is to encourage patient follow-up with a physician within 1 to 2 weeks of discharge, yet evidence confirming its benefit is lacking. We used a new study design called target randomized trial emulation to determine the impact of follow-up visit timing on patient outcomes. METHODS: All Ontario residents aged 35 or older discharged from a COPD hospitalization were identified using health administrative data and randomly assigned to those who received and did not receive physician visit follow-up by within seven days. They were followed to all-cause emergency department visits, readmissions or death. Targeted randomized trial emulation was used to adjust for differences between the groups. COPD emergency department visits, readmissions or death was also considered. RESULTS: There were 94,034 patients hospitalized with COPD, of whom 73.5% had a physician visit within 30 days of discharge. Adjusted hazard ratio for all-cause readmission, emergency department visits or death for people with a visit within seven days post discharge was 1.03 (95% Confidence Interval [CI]: 1.01-1.05) and remained around 1 for subsequent days; adjusted hazard ratio for the composite COPD events was 0.97 (95% CI 0.95-1.00) and remained significantly lower than 1 for subsequent days. CONCLUSION: While a physician visit after discharge was found to reduce COPD events, a specific time period when a physician visit was most beneficial was not found. This suggests that follow-up visits should not occur at a predetermined time but be based on factors such as anticipated medical need.


Assuntos
Serviço Hospitalar de Emergência , Alta do Paciente , Readmissão do Paciente , Doença Pulmonar Obstrutiva Crônica , Humanos , Doença Pulmonar Obstrutiva Crônica/terapia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Alta do Paciente/estatística & dados numéricos , Masculino , Feminino , Idoso , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Fatores de Tempo , Idoso de 80 Anos ou mais , Ontário/epidemiologia , Seguimentos , Adulto , Hospitalização/estatística & dados numéricos
4.
Am J Manag Care ; 30(7): 310-314, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38995829

RESUMO

OBJECTIVES: Medicare Advantage (MA) members referred to home health after inpatient hospitalization may or may not receive these services for a variety of member- and health care system-related reasons. Our objective was to compare outcomes among MA members referred to home health following hospitalization who receive home health services vs those who do not. STUDY DESIGN: Retrospective quasi-experimental study. METHODS: Following acute hospitalization, members with discharge orders to receive home health services between January 2021 and October 2022 were identified in a medical claims database consisting of MA beneficiaries. Members who received services within 30 days of discharge were balanced using inverse propensity score weighting on member- and admission-related covariates with a comparator group of members who did not receive services. Primary outcomes included mortality and readmissions in the ensuing 30, 90, and 180 days. Secondary outcomes included emergency department visits, primary care visits, and per-member per-month costs. RESULTS: The home health-treated group consisted of 2115 discharges, and the untreated group consisted of 761 discharges. The treated group experienced lower mortality at 30 days (2% vs 3%, respectively; OR, 0.58; 95% CI, 0.36-0.92), 90 days (8% vs 10%; OR, 0.77; 95% CI, 0.60-0.98), and 180 days (11% vs 14%; OR, 0.81; 95% CI, 0.65-0.99). The treated group also experienced higher readmissions at 30 days (13% vs 10%; OR, 1.26; 95% CI, 1.01-1.60), 90 days (24% vs 16%; OR, 1.69; 95% CI, 1.39-2.05), and 180 days (33% vs 24%; OR, 1.52; 95% CI, 1.29-1.79). CONCLUSION: MA members referred to home health after acute hospitalization who did not receive home health services had higher mortality.


Assuntos
Serviços de Assistência Domiciliar , Medicare Part C , Readmissão do Paciente , Encaminhamento e Consulta , Humanos , Medicare Part C/estatística & dados numéricos , Estados Unidos , Masculino , Feminino , Estudos Retrospectivos , Idoso , Serviços de Assistência Domiciliar/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Idoso de 80 Anos ou mais , Mortalidade/tendências , Hospitalização/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos
5.
BMC Health Serv Res ; 24(1): 789, 2024 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-38982360

RESUMO

BACKGROUND: To ensure a safe patient discharge from hospital it is necessary to transfer all relevant information in a discharge summary (DS). The aim of this study was to evaluate a bundle of measures to improve the DS for physicians, nurses and patients. METHODS: In a double-blind, randomized, controlled trial, four different versions of DS (2 original, 2 revised) were tested with physicians, nurses and patients. We used an evaluation sheet (Case report form, CRF) with a 6-point Likert scale (1 = completely agree; 6 = strongly disagree). RESULTS: In total, 441 participants (physicians n = 146, nurses n = 140, patients n = 155) were included in the study. Overall, the two revised DS received significant better ratings than the original DS (original 2.8 ± 0.8 vs. revised 2.1 ± 0.9, p < 0.001). Detailed results for the main domains are structured DS (original 1.9 ± 0.9 vs. revised 2.2 ± 1.3, p = 0.015), content (original 2.7 ± 0.9 vs revised 2.0 ± 0.9, p < 0.001) and comprehensibility (original 3.8 ± 1.2vs. revised 2.3 ± 1.2, p < 0.001). CONCLUSION: With simple measures like avoiding abbreviations and describing indications or therapies with fixed contents, the DS can be significantly improved for physicians, nurses and patients at the same time. TRIAL REGISTRATION: First registration 13/11/2020 NCT04628728 at www. CLINICALTRIALS: gov , Update 15/03/2023.


Assuntos
Letramento em Saúde , Humanos , Método Duplo-Cego , Masculino , Feminino , Áustria , Pessoa de Meia-Idade , Adulto , Segurança do Paciente , Alta do Paciente , Sumários de Alta do Paciente Hospitalar/normas , Idoso , Assistência Centrada no Paciente
6.
Acta Dermatovenerol Croat ; 32(1): 33-38, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38946185

RESUMO

Introduction Telogen effluvium (TE) is a common sequela of SARS-CoV-2 infection. Existing studies are highly heterogeneous. We aimed to assess the prevalence of TE in a cohort of patients with severe disease hospitalized for acute COVID-19. Methods This prospective cohort study was conducted at the University Clinic of Dermatology, part of the COVID-19 University Hospital Network throughout the pandemic. The acute phase data were extracted from electronic hospital records. Details about hair loss were obtained at two follow-up points, 3 and 6 months after hospital discharge, using telephone interviews. Results A total of 77 patients were successfully followed up, and 40 (48.8%) were male. The mean age was 55.91, SD=10,588. Overall, 68.8% of patients reported TE. Among these, 52.8% reported early onset, and 50.9% reported moderate hair loss. 11 (20.7%) reported complete hair regrowth within three months, and an additional 32 (60.3%) reported complete regrowth within six months. 4 (7.5%) patients have chronic TE. Female sex (p<0.0001), anemia (p=0.019), hypoproteinemia (p=0.037), and severe pneumonia (p=0.004) were associated with TE. Age, fever, SpO2, CRP levels, in-hospital complications, and raised D-dimers were not associated with TE. Discussion Our study confirmed a high prevalence of COVID-19-associated TE in hospitalized patients. Anemia and hypoalbuminemia were associated with TE, shedding new light on the possible pathogenesis. COVID-19-associated TE occurs earlier than classic TE and has a good prognosis in most patients. However, chronic ТЕ was reported by 7.5%. Even a small incidence of long-term sequelae during a pandemic could have substantial health consequences.


Assuntos
COVID-19 , Humanos , Masculino , COVID-19/epidemiologia , Feminino , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto , Alta do Paciente , Idoso , Alopecia/epidemiologia , Alopecia/etiologia , Prevalência , Estudos de Coortes , SARS-CoV-2
7.
Health Aff (Millwood) ; 43(7): 970-978, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38950291

RESUMO

Although emergency department (ED) and hospital overcrowding were reported during the later parts of the COVID-19 pandemic, the true extent and potential causes of this overcrowding remain unclear. Using data on the traditional fee-for-service Medicare population, we examined patterns in ED and hospital use during the period 2019-22. We evaluated trends in ED visits, rates of admission from the ED, and thirty-day mortality, as well as measures suggestive of hospital capacity, including hospital Medicare census, length-of-stay, and discharge destination. We found that ED visits remained below baseline throughout the study period, with the standardized number of visits at the end of the study period being approximately 25 percent lower than baseline. Longer length-of-stay persisted through 2022, whereas hospital census was considerably above baseline until stabilizing just above baseline in 2022. Rates of discharge to postacute facilities initially declined and then leveled off at 2 percent below baseline in 2022. These results suggest that widespread reports of overcrowding were not driven by a resurgence in ED visits. Nonetheless, length-of-stay remains higher, presumably related to increased acuity and reduced available bed capacity in the postacute care system.


Assuntos
COVID-19 , Serviço Hospitalar de Emergência , Tempo de Internação , Medicare , Estados Unidos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Serviço Hospitalar de Emergência/tendências , Humanos , COVID-19/epidemiologia , Medicare/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Tempo de Internação/tendências , Idoso , Feminino , Pandemias , Masculino , Alta do Paciente/estatística & dados numéricos , Alta do Paciente/tendências , SARS-CoV-2 , Hospitalização/estatística & dados numéricos , Hospitalização/tendências , Número de Leitos em Hospital/estatística & dados numéricos , Planos de Pagamento por Serviço Prestado/tendências , Aglomeração , Visitas ao Pronto Socorro
8.
Br J Community Nurs ; 29(7): 326-334, 2024 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-38963274

RESUMO

BACKGROUND: Collaboration is a key factor influencing the quality and safety in patients transition between sectors. However, specific collaborative practices may give rise to conflict between hospital nurses and community nurses. AIMS: To gain a deeper understanding of collaborative practices which have the potential to fuel tension in collaboration between hospital nurses and community nurses during discharge of older patients from hospital to homecare. METHODS: A meta-ethnography approach was used in this study and a systematic literature search was conducted in 2022. RESULTS: Five themes were identified in the analysis. These themes revealed how uncertainty, limited confidence in information and personal attitude in communication may fuel tension between hospital nurses and community nurses. Tensions arising from a negative loop emerged because of uncertainty, causing a growing rift between hospital nurses and community nurses, leaving them as opponents rather than collaborators. The authors suggest that policy makers and managers can break this loop by underpinning shared policies and awareness of common objectives.


Assuntos
Serviços de Assistência Domiciliar , Alta do Paciente , Humanos , Idoso , Comportamento Cooperativo , Recursos Humanos de Enfermagem Hospitalar/psicologia , Enfermagem em Saúde Comunitária , Antropologia Cultural , Atitude do Pessoal de Saúde
9.
Age Ageing ; 53(7)2024 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-38970302

RESUMO

BACKGROUND: Discharging older adult patients from the hospital poses risks due to their vulnerable conditions, complex instructions and limited health literacy. Insufficient information about medication side effects adds to patient concerns. To address this, a post-discharge information summary system was developed. While it has shown positive impacts, concerns exist regarding implementation fidelity. OBJECTIVE: This study employed a theory-driven approach to understand health providers' perspectives on effective implementation. METHOD: Individual semi-structured interviews were conducted via telephone with nurses, doctors and pharmacists from local public hospitals. All interviews were audio-recorded and transcribed verbatim. Theoretical Domains Framework (TDF) was applied for direct content analysis. Belief statements were generated by thematic synthesis under each of the TDF domains. RESULTS: A total of 98 participants were interviewed. Out of the 49 belief statements covering eight TDF domains, 19 were determined to be highly relevant to the implementation of the post-discharge information summary system. These TDF domains include knowledge, skills, social/professional role and identity, beliefs about consequences, intentions, memory, attention and decision processes, environmental context and resources and social influences. CONCLUSION: Our study contributes to the understanding of determinants in implementing discharge interventions for older adult patients' self-care. Our findings can inform tailored strategies for frontline staff, including aligning programme rationale with stakeholders, promoting staff engagement through co-creation, reinforcing positive programme outcomes and creating default settings. Future research should employ rigorous quantitative designs to examine the actual impact and relationships among these determinants.


Assuntos
Alta do Paciente , Pesquisa Qualitativa , Autogestão , Humanos , Feminino , Masculino , Idoso , Conhecimentos, Atitudes e Prática em Saúde , Entrevistas como Assunto , Atitude do Pessoal de Saúde , Pessoa de Meia-Idade , Educação de Pacientes como Assunto
10.
J Patient Rep Outcomes ; 8(1): 70, 2024 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-38995437

RESUMO

BACKGROUND: Patients with COVID-19 often experience severe long-term sequelae. This study aimed to assess resilience and Quality of Life (QoL) of patients who underwent mechanical ventilation due to COVID-19, one year after discharge. METHODS: This cross-sectional study enrolled patients who received mechanical ventilation for severe COVID-19 and were assessed one-year post-discharge. Participants completed a structured questionnaire via telephone comprising the Connor-Davidson Resilience Scale (CD-RISC) and the Post-COVID-19 Functional Status scale (PCFS). To establish the association between QoL and resilience, Spearman correlations were calculated between the PCFS and the CD-RISC. Linear regression models were adjusted to evaluate which factors were associated with QoL, with the total score of PCFS as the dependent variable. RESULTS: A total of 225 patients were included in the analysis. The CD-RISC had a median score of 83 (IQR 74-91). The PCFS results showed that 61.3% (n = 138) of the patients were able to resume their daily activities without limitations. Among them, 37.3% (n = 84) were classified as Grade 0 and 24% (n = 54) as Grade 1. Mild and moderate functional limitations were found in 33.7% of the patients, with 24.8% (n = 56) classified as Grade 2 and 8.8% (n = 20) as Grade 3. Severe functional limitations (Grade 4) were observed in 4.8% (n = 11) of the patients. High CD-RISC scores were associated with lower levels of PCFS score (p < 0.001). CONCLUSIONS: In this cohort of critically ill patients who underwent mechanical ventilation due to COVID-19, 38% of patients experienced a significant decline in their QoL one year after hospital discharge. Finally, a high level of resilience was strongly associated with better QoL one year after discharge.


Assuntos
COVID-19 , Alta do Paciente , Qualidade de Vida , Resiliência Psicológica , Respiração Artificial , Humanos , COVID-19/psicologia , Qualidade de Vida/psicologia , Masculino , Feminino , Estudos Transversais , Pessoa de Meia-Idade , Idoso , SARS-CoV-2 , Inquéritos e Questionários
11.
BMJ Open Qual ; 13(3)2024 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-39009462

RESUMO

BACKGROUND: Compassionate discharges (ComD), commonly known as rapid discharges, are urgent one-way discharges for critically ill hospitalised patients with death expected within hours or less than 7 days, to die at their place of choice-usually in their own home. Challenges abound in this time-sensitive setting when multiple parties must work together to prepare medically unstable patients for discharge, yet healthcare staff are largely unaware of the process, resulting in delays. METHODS: Process mapping, an Ishikawa diagram and a Pareto chart were used to identify barriers, which included timely acquisition of home equipment and medication and poor communication among stakeholders. In May 2020, the Quality Improvement (QI) team embarked on a pilot project to reduce family caregiver anxiety and delays in the ComD process while maintaining a success rate above 90% over a 12-month period. INTERVENTIONS: Three Plan-Do-Study-Act (PDSA) cycles were used to refine a ComD resource package that was developed; this consisted of a checklist, a kit and caregiver resources. This was to support nurses, doctors and families during this difficult and emotional transition. Items in the ComD resource package were revised iteratively based on user feedback, with further data collected to measure its usefulness. RESULTS: The 12-month ComD success rate over 3 PDSA cycles were 88.9%, 94.2% and 96.7%, respectively, after each cycle. There was a consistent reduction in the level of family anxiety before and after caregiver training and resources. Reasons for failed ComD included acute clinical deterioration or delays in obtaining home oxygen support. CONCLUSION: The ComD resource package allowed collaborative work across different disciplines, strengthening the safety and utility of ComD and allowing patients to die in their place of choice. These are ubiquitous across settings; this QI problem is thus relevant beyond our local institution.


Assuntos
Alta do Paciente , Melhoria de Qualidade , Humanos , Alta do Paciente/estatística & dados numéricos , Alta do Paciente/normas , Projetos Piloto , Empatia , Estado Terminal/psicologia , Estado Terminal/terapia , Assistência Terminal/métodos , Assistência Terminal/normas
12.
BMC Gastroenterol ; 24(1): 225, 2024 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-39009983

RESUMO

BACKGROUND/OBJECTIVES: The Oakland score was developed to predict safe discharge in patients who present to the emergency department with lower gastrointestinal bleeding (LGIB). In this study, we retrospectively evaluated if this score can be implemented to assess safe discharge (score ≤ 10) at WellStar Atlanta Medical Center (WAMC). METHODS: A retrospective cohort study of 108 patients admitted at WAMC from January 1, 2020 to December 30, 2021 was performed. Patients with LGIB based on the ICD-10 codes were included. Oakland score was calculated using 7 variables (age, sex, previous LGIB, digital rectal exam, pulse, systolic blood pressure (SBP) and hemoglobin (Hgb)) for all patients at admission and discharge from the hospital. The total score ranges from 0 to 35 and a score of ≤ 10 is a cut-off that has been shown to predict safe discharge. Hgb and SBP are the main contributors to the score, where lower values correspond to a higher Oakland score. Descriptive and multivariate analysis was performed using SPSS 23 software. RESULTS: A total of 108 patients met the inclusion criteria, 53 (49.1%) were female with racial distribution was as follows: 89 (82.4%) African Americans, 17 (15.7%) Caucasian, and 2 (1.9%) others. Colonoscopy was performed in 69.4% patients; and 61.1% patients required blood transfusion during hospitalization. Mean SBP records at admission and discharge were 129.0 (95% CI, 124.0-134.1) and 130.7 (95% CI,125.7-135.8), respectively. The majority (59.2%) of patients had baseline anemia and the mean Hgb values were 11.0 (95% CI, 10.5-11.5) g/dL at baseline prior to hospitalization, 8.8 (95% CI, 8.2-9.5) g/dL on arrival and 9.4 (95% CI, 9.0-9.7) g/dL at discharge from hospital. On admission, 100/108 (92.6%) of patients had an Oakland score of > 10 of which almost all patients (104/108 (96.2%)) continued to have persistent elevation of Oakland Score greater than 10 at discharge. Even though, the mean Oakland score improved from 21.7 (95% CI, 20.4-23.1) of the day of arrival to 20.3 (95% CI, 19.4-21.2) at discharge, only 4/108 (3.7%) of patients had an Oakland score of ≤ 10 at discharge. Despite this, only 9/108 (8.33%) required readmission for LGIB during a 1-year follow-up. We found that history of admission for previous LGIB was associated with readmission with adjusted odds ratio 4.42 (95% CI, 1.010-19.348, p = 0.048). CONCLUSIONS: In this study, nearly all patients who had Oakland score of > 10 at admission continued to have a score above 10 at discharge. If the Oakland Score was used as the sole criteria for discharge most patients would not have met discharge criteria. Interestingly, most of these patients did not require readmission despite an elevated Oakland score at time of discharge, indicating the Oakland score did not really predict safe discharge. A potential confounder was the Oakland score did not consider baseline anemia during calculation. A prospective study to evaluate a modified Oakland score that considers baseline anemia could add value in this patient population.


Assuntos
Hemorragia Gastrointestinal , Alta do Paciente , Humanos , Feminino , Masculino , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiologia , Estudos Retrospectivos , Pessoa de Meia-Idade , Idoso , Alta do Paciente/estatística & dados numéricos , Hemoglobinas/análise , Serviço Hospitalar de Emergência/estatística & dados numéricos , Doença Aguda , Adulto , Medição de Risco , Pressão Sanguínea , Hospitalização/estatística & dados numéricos
13.
PLoS One ; 19(7): e0305966, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38990821

RESUMO

INTRODUCTION: The COVID-19 pandemic led to a significant reorganization of health services, potentially affecting the quality of care for major public health concerns such as proximal femoral fractures. This study aimed to investigate potential changes in the timing of various steps in the patient journey after a hip fracture during the pandemic in Piedmont, a region in Northern Italy. METHODS: A retrospective study was conducted on the discharge records of patients aged 65 or older who were admitted for hip surgery following a femur fracture in 2019 and 2020. The study examined four-time steps: duration from hospital admission to surgery, length of hospital stay, interval between hospital discharge and admission to the rehabilitation facility, and duration of stay at the rehabilitation facility. To mitigate biases linked to sex and age factors, groups well-balanced across 2019 and 2020 were created using propensity score estimation. RESULTS: The dataset consisted of two cohorts of 583 patients each for the years 2019 and 2020. The average duration from admission to surgery was approximately 1.9 days in both years, with 75% of patients undergoing surgery within 2 days of hospital admission. The average hospital stay reduced from 13.49 days in 2019 to 11.34 days in 2020. The gap between hospital discharge and admission to rehabilitation was approximately 10-12 days, and the average duration of stay at the rehabilitation facility was about 31.6 days. DISCUSSION: The study indicates that healthcare systems can exhibit resilience and adaptability, even during a global pandemic, to ensure high-quality and safe standards of care. However, further long-term studies are needed to fully understand the pandemic's impact on primary health outcomes following hip replacement surgery and subsequent rehabilitation. The potential role of telemedicine in reducing the time between steps also warrants further investigation.


Assuntos
COVID-19 , Fraturas do Quadril , Tempo de Internação , Alta do Paciente , Humanos , COVID-19/epidemiologia , Itália/epidemiologia , Feminino , Masculino , Idoso , Fraturas do Quadril/cirurgia , Fraturas do Quadril/reabilitação , Estudos Retrospectivos , Idoso de 80 Anos ou mais , Pandemias , Centros de Reabilitação , SARS-CoV-2 , Hospitalização
14.
PLoS One ; 19(7): e0306981, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38990912

RESUMO

OBJECTIVES: This study aimed to examine the mediating role of readiness for hospital discharge (RHD) and stoma self-efficacy (SSE) in the relationship between quality of discharge teaching (QDT) and health-related quality of life (HRQOL) in colorectal cancer patients with temporary enterostomy, and the gender difference of mediating effect. BACKGROUND: It is not clear how RHD, QDT, SSE and HRQOL interact in colorectal cancer patients with temporary enterostomy. METHODS: This was a prospective follow-up survey. 221 colorectal cancer patients with temporary enterostomy were conveniently recruited from a general hospital in Southeast China. The Quality of Discharge Teaching Scale, Readiness for Hospital Discharge Scale, Stoma Self-Efficacy Scale, and Stoma Quality of Life Scale were used to collect data. Pearson's correlation and structural equation models were used to analyze the data. SPSS 26.0 and Amos 28.0 software were used for analysis the collected data. RESULTS: Regarding the relationship of QDT and HRQOL, only QDT-T had a direct effect among colorectal cancer patients with stomas (b = 0.233, P<0.001, percentile 95% CI = [0.145, 0.314]). However, both QDT-T and QDT-R can predict HRQOL indirectly through three paths: (1) the mediating role of SSE (b = 0.050, P = 0.009, percentile 95% CI = [0.013, 0.098]; b = 0.077, P = 0.008, percentile 95% CI = [0.021, 0.164]), (2) the mediating role of RHD (b = 0.044, P = 0.004, percentile 95% CI = [0.014, 0.085]; b = 0.044, P = 0.005, percentile 95% CI = [0.010, 0.102]), and (3) the chain mediating role of SSE and RHD (b = 0.030, P = 0.003, percentile 95% CI = [0.011, 0.059]; b = 0.047, P = 0.003, percentile 95% CI = [0.015, 0.103]). The similar chain mediating effect in male stoma patients was also found (b = 0.041, P = 0.002, percentile 95% CI = [0.016, 0.080]; b = 0.046, P = 0.004, percentile 95% CI = [0.011, 0.114]). CONCLUSIONS: Stoma self-efficacy and readiness for hospital discharge played important intermediary roles in the relationship between quality of discharge teaching and health-related quality of life in colorectal cancer patients with stomas. Health care providers can design SSE-enhancing and RHD-enhancing discharge planning for colorectal cancer patients with temporary enterostomies.


Assuntos
Neoplasias Colorretais , Enterostomia , Alta do Paciente , Qualidade de Vida , Autoeficácia , Humanos , Neoplasias Colorretais/cirurgia , Neoplasias Colorretais/psicologia , Masculino , Feminino , Pessoa de Meia-Idade , Estudos Prospectivos , Idoso , Adulto , Estomas Cirúrgicos , Seguimentos , China , Inquéritos e Questionários
15.
J Am Heart Assoc ; 13(14): e032321, 2024 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-38958146

RESUMO

BACKGROUND: Patient outcome after stroke is frequently assessed with clinical scales such as the modified Rankin Scale score (mRS). Days alive and out of hospital at 90 days (DAOH-90), which measures survival, time spent in hospital or rehabilitation settings, readmission and institutionalization, is an objective outcome measure that can be obtained from large administrative data sets without the need for patient contact. We aimed to assess the comparability of DAOH with mRS and its relationship with other prognostic variables after acute stroke reperfusion therapy. METHODS AND RESULTS: Consecutive patients with ischemic stroke treated with intravenous thrombolysis or endovascular thrombectomy were analyzed. DAOH-90 was calculated from a national minimum data set, a mandatory nationwide administrative database. mRS score at day 90 (mRS-90) was assessed with in-person or telephone interviews. The study included 1278 patients with ischemic stroke (714 male, median age 70 [59-79], median National Institutes of Health Stroke Scale score 14 [9-20]). Median DAOH-90 was 71 [29-84] and median mRS-90 score was 3 [2-5]. DAOH-90 was correlated with admission National Institutes of Health Stroke Scale score (Spearman rho -0.44, P<0.001) and Alberta Stroke Program Early CT [Computed Tomography] Score (Spearman rho 0.24, P<0.001). There was a strong association between mRS-90 and DAOH-90 (Spearman rho correlation -0.79, P<0.001). Area under receiver operating curve for predicting mRS score >0 was 0.86 (95% CI, 0.84-0.88), mRS score >1 was 0.88 (95% CI, 0.86-0.90) and mRS score >2 was 0.90 (95% CI, 0.89-0.92). CONCLUSIONS: In patients with stroke treated with reperfusion therapies, DAOH-90 shows reasonable comparability to the more established outcome measure of mRS-90. DAOH-90 can be readily obtained from administrative databases and therefore has the potential to be used in large-scale clinical trials and comparative effectiveness studies.


Assuntos
AVC Isquêmico , Trombectomia , Terapia Trombolítica , Humanos , Masculino , Feminino , Idoso , Pessoa de Meia-Idade , AVC Isquêmico/terapia , AVC Isquêmico/diagnóstico , Fatores de Tempo , Resultado do Tratamento , Fibrinolíticos/uso terapêutico , Procedimentos Endovasculares , Alta do Paciente , Acidente Vascular Cerebral/terapia , Acidente Vascular Cerebral/diagnóstico , Tempo de Internação/estatística & dados numéricos , Avaliação da Deficiência
16.
BMC Geriatr ; 24(1): 591, 2024 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-38987669

RESUMO

BACKGROUND: Care transitions are high-risk processes, especially for people with complex or chronic illness. Discharge letters are an opportunity to provide written information to improve patients' self-management after discharge. The aim of this study is to determine the impact of discharge letter content on unplanned hospital readmissions and self-rated quality of care transitions among patients 60 years of age or older with chronic illness. METHODS: The study had a convergent mixed methods design. Patients with chronic obstructive pulmonary disease or congestive heart failure were recruited from two hospitals in Region Stockholm if they were living at home and Swedish-speaking. Patients with dementia or cognitive impairment, or a "do not resuscitate" statement in their medical record were excluded. Discharge letters from 136 patients recruited to a randomised controlled trial were coded using an assessment matrix and deductive content analysis. The assessment matrix was based on a literature review performed to identify key elements in discharge letters that facilitate a safe care transition to home. The coded key elements were transformed into a quantitative variable of "SAFE-D score". Bivariate correlations between SAFE-D score and quality of care transition as well as unplanned readmissions within 30 and 90 days were calculated. Lastly, a multivariable Cox proportional hazards model was used to investigate associations between SAFE-D score and time to readmission. RESULTS: All discharge letters contained at least five of eleven key elements. In less than two per cent of the discharge letters, all eleven key elements were present. Neither SAFE-D score, nor single key elements correlated with 30-day or 90-day readmission rate. SAFE-D score was not associated with time to readmission when adjusted for a range of patient characteristics and self-rated quality of care transitions. CONCLUSIONS: While written summaries play a role, they may not be sufficient on their own to ensure safe care transitions and effective self-care management post-discharge. TRIAL REGISTRATION: Clinical Trials. giv, NCT02823795, 01/09/2016.


Assuntos
Insuficiência Cardíaca , Alta do Paciente , Readmissão do Paciente , Humanos , Masculino , Feminino , Readmissão do Paciente/estatística & dados numéricos , Idoso , Doença Crônica/terapia , Insuficiência Cardíaca/terapia , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Suécia/epidemiologia , Doença Pulmonar Obstrutiva Crônica/terapia , Fatores de Tempo
18.
Sci Rep ; 14(1): 15285, 2024 07 03.
Artigo em Inglês | MEDLINE | ID: mdl-38961098

RESUMO

Unplanned hospital readmission is a safety and quality healthcare measure, conferring significant costs to the healthcare system. Elderly individuals, particularly, are at high risk of readmissions, often due to issues related to medication management. Pharmacists play a pivotal role in addressing medication-related concerns, which can potentially reduce readmissions. This retrospective single-centre cohort study, conducted from November 2022 to February 2023 in an emergency department, aimed to determine if integrating emergency medicine pharmacists into Emergency Department care models reduces unplanned hospital readmissions within 28 days and to identify the interventions they employ. The inclusion criteria included patients aged ≥ 65, taking ≥ 3 medications, and presenting with falls, cognition changes, or reduced mobility and were planned for discharge to home from the emergency department. Collaborating with the Emergency Department Aged Care Service Emergency Team, a pharmacist provided comprehensive medication management consultations, discharge liaison services, and other pharmacy related interventions to eligible participants whenever the pharmacist was available. Patients who met the eligibility criteria but did not receive pharmacist interventions due to the pharmacist's unavailability served as the control group. This method was chosen to ensure that the control group consisted of comparable patients who only differed in terms of receiving the pharmacist intervention. The study included 210 participants, with 120 receiving pharmacist interventions and 90 acting as controls. The results revealed a significant reduction in unplanned hospital readmissions among participants who received pharmacist interventions (10.0%, n = 12) compared to controls (22.2%, n = 20), with a notable difference of 12.2% (95% confidence interval 2.4-23.4%, p = 0.01). A total of 107 interventions were documented, emphasising medication selection recommendations (28.0%) and identification of adverse drug reactions/drug-drug interactions (21.5%) as primary areas of focus. These findings suggest that integrating skilled pharmacists into Emergency Department Aged Care Service Emergency Team (ASET) lowered the rate of unplanned hospital readmission within 28 days resulting in improved hospital performance metric outcomes. This highlights the potential role of pharmacists in addressing medication-related issues and enhancing the quality and safety of healthcare delivery, particularly for elderly patients transitioning from the ED to home care settings.


Assuntos
Serviço Hospitalar de Emergência , Alta do Paciente , Readmissão do Paciente , Farmacêuticos , Humanos , Readmissão do Paciente/estatística & dados numéricos , Idoso , Estudos Retrospectivos , Feminino , Masculino , Idoso de 80 Anos ou mais , Serviço de Farmácia Hospitalar/organização & administração , Conduta do Tratamento Medicamentoso/organização & administração
19.
Trials ; 25(1): 454, 2024 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-38965624

RESUMO

Challenges to recruitment of family caregivers exist and are amplified when consent must occur in the context of chaotic healthcare circumstances, such as the transition from hospital to home. The onset of the COVID-19 pandemic during our randomized controlled trial provided an opportunity for a natural experiment exploring and examining different consent processes for caregiver recruitment. The purpose of this publication is to describe different recruitment processes (in-person versus virtual) and compare diversity in recruitment rates in the context of a care recipient's hospitalization. We found rates of family caregiver recruitment for in-person versus virtual were 28% and 23%, respectively (p = 0.01). Differences existed across groups with family caregivers recruited virtually being more likely to be younger, white, have greater than high school education, and not be a spouse or significant other to the care recipient, such as a child. Future work is still needed to identify the modality and timing of family caregiver recruitment to maximize rates and enhance the representativeness of the population for equitable impact.


Assuntos
COVID-19 , Cuidadores , Seleção de Pacientes , Humanos , COVID-19/epidemiologia , Feminino , Masculino , Pessoa de Meia-Idade , Idoso , SARS-CoV-2 , Ensaios Clínicos Controlados Aleatórios como Assunto , Alta do Paciente
20.
S D Med ; 77(6): 270-273, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-39013100

RESUMO

Critical care advancements have allowed clinicians to discover the many functional disabilities that survivors suffer. Recent research has focused on improving the long-term outcomes of critical illness survivors and optimizing their functional recovery. Post-intensive care syndrome (PICS) describes the disability that remains in those surviving critical illness following discharge from the intensive care unit (ICU). This comprises impairment in cognition, neuropsychiatric health, and physical function of the ICU survivor. Consequent to this, the health of family members of the survivor may also be affected adversely, termed PICS-family. PICS is defined as a new or worsening impairment in physical (ICU-acquired neuromuscular weakness), cognitive (thinking and judgment), or mental health status arising after critical illness and persisting beyond discharge from the acute care setting.


Assuntos
Cuidados Críticos , Estado Terminal , Humanos , Estado Terminal/terapia , Estado Terminal/psicologia , Cuidados Críticos/métodos , Unidades de Terapia Intensiva/organização & administração , Sobreviventes/psicologia , Alta do Paciente , Atenção Primária à Saúde
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