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1.
MMWR Morb Mortal Wkly Rep ; 69(44): 1622-1624, 2020 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-33151919

RESUMO

Preventive care or follow-up care have the potential to improve health outcomes, reduce disease in the population, and decrease health care costs in the long-term (1). Approximately one half of persons in the United States receive general recommended preventive services (2,3). Missed physician appointments can hinder the receipt of needed health care (4). With electronic health record (EHR) systems able to improve interaction and communication between patients and providers (5), electronic reminders are used to decrease missed care. These reminders can improve various types of preventive and follow-up care, such as immunizations (6) and cancer screening (7); however, computerized capability must exist to make use of these reminders. To examine this capability among U.S. office-based physicians, data from the National Electronic Health Records Survey (NEHRS) for 2017, the most recent data available, were analyzed. An estimated 64.7% of office-based physicians had computerized capability to identify patients who were due for preventive or follow-up care, with 72.9% of primary care physicians and 71.4% of physicians with an EHR system having this capability compared with surgeons (54.8%), nonprimary care physicians (58.5%), and physicians without an EHR system (23.4%). Having an EHR system is associated with the ability to send electronic reminders to increase receipt of preventive or follow-up care, which has been shown to improve patient health outcomes (8).


Assuntos
Assistência ao Convalescente , Registros Eletrônicos de Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde , Consultórios Médicos/estatística & dados numéricos , Médicos/estatística & dados numéricos , Serviços Preventivos de Saúde , Sistemas de Alerta/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos
2.
Br J Community Nurs ; 25(11): 526-530, 2020 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-33161746

RESUMO

The pandemic caused by Covid-19 has long term ramifications for many, especially those patients who have experienced an intensive care unit (ICU) admission including ventilation and sedation. This paper will explore aspects of care delivery in the ICU regarding the current pandemic and the impact of such on the mental health of some of these patients. Post discharge, patients will be returning to a very different community incorporating social distancing, and in some cases, social isolation and/or shielding. Many may experience a multitude of physical and mental health complications which can ultimately impact upon each other, therefore a bio-psycho-pharmaco-social approach to discharge, case management, risk assessment and positive behavioural support planning is recommended.


Assuntos
Assistência ao Convalescente/psicologia , Infecções por Coronavirus/enfermagem , Infecções por Coronavirus/psicologia , Cuidados Críticos/psicologia , Sedação Profunda/psicologia , Saúde Mental/estatística & dados numéricos , Pneumonia Viral/enfermagem , Pneumonia Viral/psicologia , Respiração Artificial/psicologia , Isolamento Social/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Admissão do Paciente/estatística & dados numéricos
5.
Medicine (Baltimore) ; 99(43): e22900, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120840

RESUMO

RATIONALE: Spinal cord infarction (SCI) accounts for only 1% to 2% of all ischemic strokes and 5% to 8% of acute myelopathies. Magnetic resonance imaging (MRI) holds a role in ruling out non-ischemic etiologies, but the diagnostic accuracy of this procedure may be low in confirming the diagnosis, even when extensive cord lesions are present. Indeed, T2 changes on MRI can develop over hours to days, thus accounting for the low sensitivity in the hyperacute setting (ie, within 6 hours from symptom onset). For these reasons, SCI remains a clinical diagnosis. Despite extensive diagnostic work-up, up to 20% to 40% of SCI cases are classified as cryptogenic. Here, we describe a case of cryptogenic longitudinally extensive transverse myelopathy due to SCI, with negative MRI and diffusion-weighted imaging at 9 hours after symptom onset. PATIENT CONCERNS: A 51-year-old woman presented to our Emergency Department with acute severe abdominal pain, nausea, vomiting, sudden-onset of bilateral leg weakness with diffuse sensory loss, and paresthesias on the trunk and legs. DIAGNOSES: On neurological examination, she showed severe paraparesis and a D6 sensory level. A 3T spinal cord MRI with gadolinium performed at 9 hours after symptom onset did not detect spinal cord alterations. Due to the persistence of a clinical picture suggestive of an acute myelopathy, a 3T MRI of the spine was repeated after 72 hours showing a hyperintense "pencil-like" signal mainly involving the grey matter from T1 to T6 on T2 sequence, mildly hypointense on T1 and with restricted diffusion. INTERVENTIONS: The patient was given salicylic acid (100 mg/d), prophylactic low-molecular-weight heparin, and began neuromotor rehabilitation. OUTCOMES: Two months later, a follow-up neurological examination revealed a severe spastic paraparesis, no evident sensory level, and poor sphincteric control with distended bladder. LESSONS: Regardless of its relatively low frequency in the general population, SCI should be suspected in every patient presenting with acute and progressive myelopathic symptoms, even in the absence of vascular risk factors. Thus, a clinical presentation consistent with a potential vascular syndrome involving the spinal cord overrides an initially negative MRI and should not delay timely and appropriate management.


Assuntos
Imagem de Difusão por Ressonância Magnética/métodos , Doenças da Medula Espinal/diagnóstico , Isquemia do Cordão Espinal/diagnóstico por imagem , Assistência ao Convalescente , Anti-Infecciosos/administração & dosagem , Anti-Infecciosos/uso terapêutico , Anticoagulantes/administração & dosagem , Anticoagulantes/uso terapêutico , Serviço Hospitalar de Emergência , Feminino , Heparina de Baixo Peso Molecular/administração & dosagem , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Pessoa de Meia-Idade , Debilidade Muscular/diagnóstico , Debilidade Muscular/etiologia , Exame Neurológico/métodos , Paraparesia/etiologia , Parestesia/diagnóstico , Parestesia/etiologia , Ácido Salicílico/administração & dosagem , Ácido Salicílico/uso terapêutico , Doenças da Medula Espinal/etiologia , Isquemia do Cordão Espinal/tratamento farmacológico , Isquemia do Cordão Espinal/patologia , Isquemia do Cordão Espinal/reabilitação
6.
Medicine (Baltimore) ; 99(43): e22756, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120779

RESUMO

OBJECTIVE: We conduct this research protocol for the assessment of the effect of phone-assisted care programs on functional outcomes in patients receiving shoulder instability surgery. METHODS: This is a randomized controlled, single center trial which will be implemented from October 2020 to December 2021. This trial is conducted according to the SPIRIT Checklist of randomized researches. It was authorized via the Ethics Committee of the First People's Hospital of Xiangyang city affiliated to Hubei Medical College (XY234-026). Ninety participants who undergo shoulder instability surgery are analyzed. Patients are randomly divided into control group (standard management group, with 45 patients) and study group (the phone program group, with 45 patients). In control group, the exercises at home are not monitored. Whereas in study group, patients are asked about their at-home activities, and the extra coaching sessions are provided to patients on self-care, exercise guidance, and the importance of exercise at home, and then answers to their questions. The primary outcome is the range of motion of the shoulder joint, and the pain arcs are determined through the range of motion. The extra assessments include the shoulder functional outcome, pain, and the quality of life. All the analysis needed in this study is implemented with SPSS (IBM, Chicago, USA) for Windows Version 19.0. RESULTS: The clinical outcome variables between groups are shown in Table. CONCLUSION: This investigation can offer a reliable basis for the effectiveness of phone assistance nursing program in patients after shoulder instability surgery. TRIAL REGISTRATION NUMBER: researchregistry6010.


Assuntos
Assistência ao Convalescente/métodos , Serviços de Assistência Domiciliar , Instabilidade Articular/cirurgia , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Autocuidado , Articulação do Ombro/cirurgia , Telefone , Humanos , Procedimentos Ortopédicos/enfermagem , Resultado do Tratamento
7.
Ophthalmologe ; 117(10): 1049-1060, 2020 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-33001262

RESUMO

The successful outcome of treatment for infant and childhood cataract depends on many factors. It is crucial that the treatment falls into a phase in which neither the eye nor the visual pathway and visual cortex are fully developed. This review summarizes the current state of knowledge and provides an overview of the epidemiology, causes and clinical forms, early detection and, above all, treatment options. Special attention is paid to time-critical stages of development, according to which the therapeutic concepts are based. Complications, such as amblyopia and glaucoma are discussed in detail. In addition to surgical aspects, much emphasis is placed on orthoptic-refractive aftercare, the quality and execution of which is the essential predictor of a good functional outcome.


Assuntos
Ambliopia , Extração de Catarata , Catarata , Glaucoma , Assistência ao Convalescente , Ambliopia/diagnóstico , Ambliopia/terapia , Catarata/diagnóstico , Catarata/terapia , Pré-Escolar , Glaucoma/diagnóstico , Glaucoma/epidemiologia , Glaucoma/terapia , Humanos , Lactente
8.
BMC Infect Dis ; 20(1): 762, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33066737

RESUMO

BACKGROUND: Clostridioides difficile infection (CDI) is commonly associated with outcomes like recurrence and readmission. The effect of social determinants of health, such as 'neighborhood' socioeconomic disadvantage, on a CDI patient's health outcomes is unclear. Living in a disadvantaged neighborhood could interfere with a CDI patient's ability to follow post-discharge care recommendations and the success probability of these recommendations, thereby increasing risk of readmission. We hypothesized that neighborhood disadvantage was associated with 30-day readmission risk in Medicare patients with CDI. METHODS: In this retrospective cohort study, odds of 30-day readmission for CDI patients are evaluated controlling for patient sociodemographics, comorbidities, and hospital and stay-level variables. The cohort was created from a random 20% national sample of Medicare patients during the first 11 months of 2014. RESULTS: From the cohort of 19,490 patients (39% male; 80% white; 83% 65 years or older), 22% were readmitted within 30 days of an index stay. Unadjusted analyses showed that patients from the most disadvantaged neighborhoods were readmitted at a higher rate than those from less disadvantaged neighborhoods (26% vs. 21% rate: unadjusted OR = 1.32 [1.20, 1.45]). This relationship held in adjusted analyses, in which residence in the most disadvantaged neighborhoods was associated with 16% increased odds of readmission (adjusted OR = 1.16 [1.04, 1.28]). CONCLUSIONS: Residence in disadvantaged neighborhoods poses a significantly increased risk of readmission in CDI patients. Further research should focus on in-depth assessments of this population to better understand the mechanisms underlying these risks and if these findings apply to other infectious diseases.


Assuntos
Infecções por Clostridium/epidemiologia , Clostridium difficile , Readmissão do Paciente , Características de Residência , Classe Social , Adolescente , Adulto , Assistência ao Convalescente , Idoso , Infecções por Clostridium/microbiologia , Feminino , Humanos , Tempo de Internação , Masculino , Medicare , Pessoa de Meia-Idade , Alta do Paciente , Recidiva , Estudos Retrospectivos , Fatores de Risco , Estados Unidos , Adulto Jovem
9.
Medicine (Baltimore) ; 99(40): e22534, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019459

RESUMO

RATIONALE: Foreign bodies are frequently ingested, but only approximately 1% of them cause perforation. Perforations in the lesser curvature of the stomach are exceedingly rare. Here, we report a case of gastric perforation in the lesser curvature caused by a foreign body. The patient presented to the clinic complaining of abdominal skin swelling and reddening with upper abdominal discomfort as the initial symptoms. PATIENT CONCERNS: An 83-year-old female presented with a mass in the middle of the epigastrium for 10 days. Physical examination found an apparent local tenderness and inflammatory mass in the upper abdominal wall. Her body temperature was normal (37.5°C) and the white blood cell count was elevated (8.12 × 10/L [reference value 3.5-9.5 × 10/L]). DIAGNOSES: The ultrasound examination of the abdomen revealed a 4 cm strip-like hyperechoic object entangled in the muscles of the abdominal wall. The computed tomography scan revealed a thin strip of bone-like hyperdense shadow. Intraoperative findings showed a sharp fishbone protruding from the lesser curvature of the stomach into the abdominal cavity, part of which remained in the gastric cavity. The postoperative pathological report revealed chronic suppurative inflammation with abscess and sinus canal formation. INTERVENTIONS & OUTCOMES: The patient underwent a gastric foreign body removal with partial gastrectomy. Anti-inflammatory treatment post-surgery rapidly relieved the patient's symptoms of discomfort in the upper abdomen. At the 1-month follow-up, the patient showed no discomfort in the upper abdomen and the inflammatory mass was no longer present. LESSONS: A foreign body had penetrated through the lesser curvature of the stomach, an area with a flat gastric wall, which occurs infrequently. In such cases, computed tomography is the gold standard for diagnosis of foreign bodies in the digestive tract. Ultrasound can also be used as a supplemental diagnostic technique. It is recommended that people who wear dentures should exercise caution while eating, especially when the food contains bones.


Assuntos
Parede Abdominal/patologia , Corpos Estranhos/cirurgia , Inflamação/etiologia , Pele/patologia , Estômago/cirurgia , Assistência ao Convalescente , Idoso de 80 Anos ou mais , Osso e Ossos , Ingestão de Alimentos , Feminino , Corpos Estranhos/diagnóstico por imagem , Humanos , Alimentos Marinhos , Perfuração Espontânea , Estômago/microbiologia , Estômago/patologia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Ultrassonografia/métodos
10.
Medicine (Baltimore) ; 99(40): e22535, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019460

RESUMO

RATIONALE: Adolescent wrist trauma can cause epiphyseal dysplasia and even distal radius deformity malunion. At present, there is no uniform treatment standard for the malunion of the distal radius of adolescents. Osteotomy and autologous bone grafting are currently one of the effective ways to treat the disease. We treated an adolescent patient with distal radius deformity malunion, and used this surgical method to treat the patient and achieved satisfactory results. PATIENT CONCERNS: A 16-year-old boy suffered from a serious distal radius deformity after trauma of the left wrist 8 years ago. DIAGNOSES: Physical examination, X-rays examination, high-resolution computed tomography scan, and 3-dimensional reconstruction images of the affected limb helped us diagnose the distal radius fracture malunion. INTERVENTIONS: The fracture malunion was treated by osteotomy and autologous iliac bone grafting. OUTCOMES: At the 2-year follow-up, wrist flexion returned to 68°, wrist dorsiflexion to 55°, radial deviation to 14°, ulnar deviation to 12°, forearm pronation to 75°, supination to 67°. Grip strength increased to 35.1 kg after 2 years of operation, recovered to 87% of the uninjured side. Quick DASH score at 2-year follow-up was 9. No complication, such as nonunion or infection, was observed. LESSONS: This rare case provides valuable insights for hand surgeons. High-resolution computed tomography scan and 3-dimensional reconstruction can help us effectively diagnose wrist diseases. Small lesions on the articular surface of the distal radius will change the position and function of the wrist joint, and cause traumatic arthritis of the wrist joint. Therefore, it is very important to reconstruct the normal structure of the distal radius articular surface. Osteotomy and autologous iliac bone grafting are effective treatments for serious distal radius fracture malunion in the adolescent patient. During the operation, care should be taken to protect the osteoepiphysis to avoid bone dysplasia.


Assuntos
Fraturas Mal-Unidas/cirurgia , Osteotomia/métodos , Fraturas do Rádio/complicações , Transplante Autólogo/métodos , Adolescente , Assistência ao Convalescente , Transplante Ósseo/métodos , Fraturas Mal-Unidas/diagnóstico por imagem , Humanos , Ílio/transplante , Processamento de Imagem Assistida por Computador/instrumentação , Masculino , Radiografia/métodos , Amplitude de Movimento Articular , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Articulação do Punho/fisiologia
11.
Medicine (Baltimore) ; 99(40): e22574, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019470

RESUMO

RATIONALE: Pulmonary sequestration (PS) presenting with elevated serum tumor markers is rare, and it might be misdiagnosed as malignancy. PATIENT CONCERNS: A 26-year-old asymptomatic male patient was admitted because the x-ray showed an intrathoracic lesion. Meanwhile, the serum neuron-specific enolase (NSE) was elevated. Three-dimensional computed tomography angiography revealed an isolated feeding vessel arising from the aorta. DIAGNOSES: Extralobular PS was confirmed by computed tomography angiography and postoperative pathological staining. INTERVENTIONS: Two-port thoracoscopic resection of the sequestrated lobe was performed. OUTCOMES: The serum NSE decreased to within the normal range and persisted during the follow up of 10 months. LESSONS: A thorough work-up should be considered for the PS patients presenting with abnormal serum NSE. Detailed knowledge regarding the relationship between NSE and PS necessitates further studies.


Assuntos
Sequestro Broncopulmonar/diagnóstico por imagem , Angiografia por Tomografia Computadorizada/métodos , Fosfopiruvato Hidratase/sangue , Adulto , Assistência ao Convalescente , Aorta/anormalidades , Aorta/diagnóstico por imagem , Sequestro Broncopulmonar/patologia , Sequestro Broncopulmonar/cirurgia , Humanos , Masculino , Cirurgia Torácica Vídeoassistida/métodos , Resultado do Tratamento
12.
Medicine (Baltimore) ; 99(40): e22575, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019471

RESUMO

RATIONALE: Giant intra-abdominal liposarcomas weighing over 20 kg often increase the intra-abdominal pressure (IAP), which has severe effects on the cardiovascular and respiratory systems. Abdominal compartment syndrome is defined typically as the combination of a raised IAP of 20 mm Hg or higher and new onset of organ dysfunction or failure. The anesthetic management and perioperative management are very challenging. PATIENTS CONCERNS: We presented 2 patients with rare giant growing liposarcoma of the abdomen, weighing 21 kg and over 35 kg, respectively. Circulatory management was particularly difficult in the first case, while respiratory management and massive blood loss was very challenging in the second one. DIAGNOSIS: With a computed tomography scan and peritoneal-to-abdominal height ratio measurement, preoperatively the risk of developing intra-abdominal hypertension and abdominal compartment syndrome was recognized early in each patient. The inferior vena cava and right atrium of the first patient was compressed and malformed due to the uplifted diaphragm, while there was severe decreased lung volume and increased airway resistance, because of rare giant retroperitoneal liposarcomas in the second case. Histologic examination revealed dedifferentiated liposarcoma in both cases. INTERVENTIONS: Both of the patients underwent resection surgery with multiple monitoring; transesophageal echocardiography monitoring in the first case and pressure-controlled ventilation volume guaranteed mechanical ventilation mode in both cases. OUTCOMES: Intraoperatively and postoperatively no cardiopulmonary complications in both patients. The first patient was discharged without any complications on postoperative day 10, and the second patient underwent another surgery because of anastomotic leakage resulting from bowel resection. LESSONS: Multiple monitorings, in particular transesophageal echocardiography should be considered in patients with increased IAP due to a giant mass, while an appropriate lung protection ventilation strategy is crucial in these patients.


Assuntos
Hipertensão Intra-Abdominal/fisiopatologia , Lipossarcoma/complicações , Lipossarcoma/cirurgia , Neoplasias Retroperitoneais/complicações , Neoplasias Retroperitoneais/cirurgia , Adulto , Assistência ao Convalescente , Resistência das Vias Respiratórias/fisiologia , Fístula Anastomótica/cirurgia , Perda Sanguínea Cirúrgica , Sistema Cardiovascular/fisiopatologia , Ecocardiografia Transesofagiana/métodos , Feminino , Humanos , Cuidados Intraoperatórios/métodos , Cuidados Intraoperatórios/estatística & dados numéricos , Lipossarcoma/diagnóstico por imagem , Lipossarcoma/patologia , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/normas , Respiração Artificial/métodos , Neoplasias Retroperitoneais/diagnóstico por imagem , Neoplasias Retroperitoneais/patologia , Resultado do Tratamento
13.
Medicine (Baltimore) ; 99(40): e22578, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019472

RESUMO

RATIONALE: Exact restoration of the rotation center in total hip arthroplasty (THA) is technically challenging in patients with end-stage osteoarthritis due to developmental dysplasia of the hip (DDH), especially in the Crowe type II and III procedures. The technical difficulty is attributable to the complex acetabular changes. In this study, a novel 3-dimensional (3D) printed integral customized acetabular prosthesis for anatomical rotation restoration in THA for DDH Crowe type III was developed using patient-specific Computer-aided design and additive manufacturing (AM) methods. PATIENT CONCERNS: A 69-year-old female patient had developed left hip joint pain and restricted movement for 40 years; the symptoms had increased in the past 5 months. Pain, limited motion of the left hip joint, and lower limb length discrepancy were noted during physical examination. DIAGNOSIS: The patient was diagnosed with left hip end-stage osteoarthritis secondary to DDH (Crowe type III). INTERVENTION: A 3D printed acetabulum model was manufactured and a simulated operation was performed to improve the accuracy of reconstruction of the rotation center and bone defect. A 3D printed titanium alloy integral customized acetabular prosthesis was designed according to the result of simulated operation. The integral customized prothesis was implanted subsequently via the posterolateral approach. Radiography of the pelvis and Harris score assessment were performed during the perioperative period as well as at the 6- and 12-month follow-up. OUTCOMES: The 3D printed integral customized acetabular prosthesis matched precisely with the reamed acetabulum. The rotation center was restored and the bone defect was exactly reconstructed. There were no signs of prosthetic loosening at the 12-month follow-up. The Harris score gradually improved during the follow-up period. LESSONS: Satisfactory results of hip rotation restoration and bone defect reconstruction could be achieved by using 3D printed integral customized acetabular prosthesis, which provides a promising way to reconstruct the acetabulum in patients with DDH anatomically and rapidly for THA.


Assuntos
Artroplastia de Quadril/instrumentação , Luxação Congênita de Quadril/patologia , Prótese de Quadril/efeitos adversos , Osteoartrite do Quadril/cirurgia , Impressão Tridimensional/instrumentação , Assistência ao Convalescente , Idoso , Feminino , Luxação Congênita de Quadril/classificação , Luxação Congênita de Quadril/complicações , Prótese de Quadril/tendências , Humanos , Desigualdade de Membros Inferiores/diagnóstico , Desigualdade de Membros Inferiores/etiologia , Osteoartrite do Quadril/etiologia , Período Perioperatório/normas , Radiografia/métodos , Rotação , Resultado do Tratamento
14.
Medicine (Baltimore) ; 99(40): e22583, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019474

RESUMO

INTRODUCTION: Henoch-Schönlein purpura (HSP) is an extremely rare condition in patients with pulmonary tuberculosis, with only a few reported cases. Compared to patients with typical clinical symptoms, it is difficult to make a definitive diagnosis when HSP presents as an initial manifestation in pulmonary tuberculosis patients. Herein, a case of pulmonary tuberculosis that showed HSP at first was reported, and the related literatures were reviewed. PATIENT CONCERNS: A 24-year-old man presented with palpable purpura on the extremities, accompanied by abdominal pain, bloody stools, and knee pain. DIAGNOSES: The patient was diagnosed with pulmonary tuberculosis based on the results of interferon gamma release assays, purified protein derivative test, and computed tomography. INTERVENTIONS: The patient was treated with vitamin C and chlorpheniramine for 2 weeks, and the above-mentioned symptoms were relieved. However, 3 weeks later, the purpura recurred with high-grade fever and chest pain during the inspiratory phase. The patient was then treated with anti-tuberculosis drugs, and the purpura as well as the high fever disappeared. OUTCOMES: The patient recovered well and remained free of symptoms during the follow-up examination. CONCLUSION: Pulmonary tuberculosis presenting with HSP as an initial manifestation is not common. Therefore, it is difficult to clinically diagnose and treat this disease. When an adult patient shows HSP, it is important to consider the possibility of tuberculosis to avoid misdiagnosis and delayed treatment.


Assuntos
Antituberculosos/uso terapêutico , Púrpura de Schoenlein-Henoch/etiologia , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/tratamento farmacológico , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Assistência ao Convalescente , Ácido Ascórbico/uso terapêutico , Clorfeniramina/uso terapêutico , Diagnóstico Diferencial , Febre/diagnóstico , Febre/etiologia , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiologia , Antagonistas dos Receptores Histamínicos H1/uso terapêutico , Humanos , Testes de Liberação de Interferon-gama/métodos , Masculino , Púrpura de Schoenlein-Henoch/tratamento farmacológico , Resultado do Tratamento , Tuberculina , Tuberculose Pulmonar/sangue , Tuberculose Pulmonar/diagnóstico por imagem , Vitaminas/uso terapêutico , Adulto Jovem
15.
Inflamm Bowel Dis ; 26(11): e134-e136, 2020 10 23.
Artigo em Inglês | MEDLINE | ID: mdl-33029612
16.
PLoS One ; 15(10): e0239570, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33052920

RESUMO

Data on residual clinical damage after Coronavirus disease-2019 (COVID-19) are lacking. The aims of this study were to investigate whether COVID-19 leaves behind residual dysfunction, and identify patients who might benefit from post-discharge monitoring. All patients aged ≥18 years admitted to the Emergency Department (ED) for COVID-19, and evaluated at post-discharge follow-up between 7 April and 7 May, 2020, were enrolled. Primary outcome was need of follow-up, defined as the presence at follow-up of at least one among: respiratory rate (RR) >20 breaths/min, uncontrolled blood pressure (BP) requiring therapeutic change, moderate to very severe dyspnoea, malnutrition, or new-onset cognitive impairment, according to validated scores. Post-traumatic stress disorder (PTSD) served as secondary outcome. 185 patients were included. Median [interquartile range] time from hospital discharge to follow-up was 23 [20-29] days. 109 (58.9%) patients needed follow-up. At follow-up evaluation, 58 (31.3%) patients were dyspnoeic, 41 (22.2%) tachypnoeic, 10 (5.4%) malnourished, 106 (57.3%) at risk for malnutrition. Forty (21.6%) patients had uncontrolled BP requiring therapeutic change, and 47 (25.4%) new-onset cognitive impairment. PTSD was observed in 41 (22.2%) patients. At regression tree analysis, the ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2) and body mass index (BMI) at ED presentation, and age emerged as independent predictors of the need of follow-up. Patients with PaO2/FiO2 <324 and BMI ≥33 Kg/m2 had the highest odds to require follow-up. Among hospitalised patients, age ≥63 years, or age <63 plus non-invasive ventilation or diabetes identified those with the highest probability to need follow-up. PTSD was independently predicted by female gender and hospitalisation, the latter being protective (odds ratio, OR, 4.03, 95% confidence interval, CI, 1.76 to 9.47, p 0.0011; OR 0.37, 95% CI 0.14 to 0.92, p 0.033, respectively). COVID-19 leaves behind physical and psychological dysfunctions. Follow-up programmes should be implemented for selected patients.


Assuntos
Disfunção Cognitiva/epidemiologia , Infecções por Coronavirus/epidemiologia , Dispneia/epidemiologia , Desnutrição/epidemiologia , Pneumonia Viral/epidemiologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Assistência ao Convalescente/estatística & dados numéricos , Idoso , Infecções por Coronavirus/complicações , Infecções por Coronavirus/reabilitação , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/reabilitação
17.
Rev Fac Cien Med Univ Nac Cordoba ; 77(3): 143-148, 2020 08 21.
Artigo em Inglês | MEDLINE | ID: mdl-32991103

RESUMO

INTRODUCTION: Hospitalization represents a major factor that may precipitate the loss of functional status and the cascade into dependence. The main objective of our study was to determine the effect of functional status measured before hospital admission on survival at one year after hospitalization in elderly patients. METHODS: Prospective cohort study of adult patients (over 65 years of age) admitted to either the general ward or intensive Care units (ICU) of a tertiary teaching hospital in Buenos Aires, Argentina. Main exposure was the pre-admission functional status determined by means of the modified "VIDA" questionnaire, which evaluates the instrumental activities of daily living. We used a multivariate Cox proportional hazards model to estimate the effect of prior functional status on time to all-cause death while controlling for measured confounding. Secondarily, we analyzed the effect of post-discharge functional decline on long-term outcomes. RESULTS: 297 patients were included in the present study. 12.8% died during hospitalization and 86 patients (33.2%) died within one year after hospital discharge. Functional status prior to hospital admission, measured by the VIDA questionnaire (e.g., one point increase), was associated with a lower hazard of all-cause mortality during follow-up (Hazard Ratio [HR]: 0.96; 95% Confidence Interval [CI]: 0.94-0.98). Finally, functional decline measured at 15 days after hospital discharge, was associated with higher risk of all-cause death during follow-up (HR: 2.19, 95% CI: 1.09-4.37) Conclusion: Pre-morbid functional status impacts long term outcomes after unplanned hospitalizations in elderly adults. Future studies should confirm these findings and evaluate the potential impact on clinical decision-making.


Assuntos
Atividades Cotidianas , Assistência ao Convalescente , Idoso , Argentina/epidemiologia , Hospitalização , Humanos , Alta do Paciente , Estudos Prospectivos
18.
JAMA Netw Open ; 3(9): e2015470, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32876682

RESUMO

Importance: Home health care is one of the fastest growing postacute services in the US and is increasingly important in the era of coronavirus disease 2019 and payment reform, yet it is unknown whether patients who need home health care are receiving it. Objective: To examine how often patients referred to home health care at hospital discharge receive it and whether there is evidence of disparities. Design, Setting, and Participants: This cross-sectional study used Medicare data regarding the postacute home health care setting from October 1, 2015, through September 30, 2016. The participants were Medicare fee-for-service and Medicare Advantage beneficiaries who were discharged alive from a hospital with a referral to home health care (2 379 506 discharges). Statistical analysis was performed from July 2019 to June 2020. Exposures: Hospital referral to home health care. Main Outcomes and Measures: Primary outcomes included whether discharges received their first home health care visit within 14 days of hospital discharge and the number of days between hospital discharge and the first home health visit. Differences in the likelihood of receiving home health care across patient, zip code, and hospital characteristics were also examined. Results: Among 2 379 506 discharges from the hospital with a home health care referral, 1 358 697 patients (57.1%) were female, 468 762 (19.7%) were non-White, and 466 383 (19.6%) were dually enrolled in Medicare and Medicaid; patients had a mean (SD) age of 73.9 (11.9) years and 4.1 (2.1) Elixhauser comorbidities. Only 1 284 300 patients (54.0%) discharged from the hospital with a home health referral received home health care services within 14 days of discharge. Of the remaining 1 095 206 patients (46.0%) discharged, 37.7% (896 660 discharges) never received any home health care, while 8.3% (198 546 discharges) were institutionalized or died within 14 days without a preceding home health care visit. Patients who were Black or Hispanic received home health at lower rates than did patients who were White (48.0% [95% CI, 47.8%-48.1%] of Black and 46.1% [95% CI, 45.7%-46.5%] of Hispanic discharges received home health within 14 days compared with 55.3% [95% CI, 55.2%-55.4%] of White discharges). In addition, disadvantaged patients waited longer for their first home health care visit. For example, patients living in high-unemployment zip codes waited a mean of 2.0 days (95% CI, 2.0-2.0 days), whereas those living in low-unemployment zip codes waited 1.8 days (95% CI, 1.8-1.8 days). Conclusions and Relevance: Disparities in the use of home health care remain an issue in the US. As home health care is increasingly presented as a safer alternative to institutional postacute care during coronavirus disease 2019, and payment reforms continue to pressure hospitals to discharge patients home, ensuring the availability of safe and equitable care will be crucial to maintaining high-quality care.


Assuntos
Assistência ao Convalescente/estatística & dados numéricos , Acesso aos Serviços de Saúde , Disparidades em Assistência à Saúde/etnologia , Serviços de Assistência Domiciliar/estatística & dados numéricos , Encaminhamento e Consulta , Afro-Americanos/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Planos de Pagamento por Serviço Prestado , Feminino , Disparidades em Assistência à Saúde/estatística & dados numéricos , Hispano-Americanos/estatística & dados numéricos , Humanos , Masculino , Medicaid/estatística & dados numéricos , Medicare , Medicare Part C , Alta do Paciente , Pobreza/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Desemprego/estatística & dados numéricos , Estados Unidos
19.
Nervenarzt ; 91(10): 920-925, 2020 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-32914296

RESUMO

BACKGROUND: Besides the treatment of cardiovascular risk factors, the prevention and treatment of secondary complications is the main focus of outpatient poststroke care. The spectrum of noteworthy complications after a stroke changes during the course of the treatment and constitutes a specific challenge of outpatient poststroke care. OBJECTIVE AND METHODS: This article provides references to the importance, management, diagnosis and treatment of the wide spectrum of nonvascular complications after stroke in the context of outpatient stroke aftercare. RESULTS: Poststroke depression (PSD), anxiety disorders and post-stroke fatigue are common complications after stroke, which require a timely diagnosis and treatment. Furthermore, the incidence of newly diagnosed dementia is 20% within the first 6 months after a stroke. Here too, therapeutic and preventive strategies especially in the early stage can delay the subsequent burden of the disease and the dependency on care. About half of every newly diagnosed epilepsy in patients older than 60 years is the result of a stroke. Falls and subsequent injuries are another important complication and a common reason for rehospitalization after a stroke. Although nearly 50% of patients suffer from chronic pain after a stroke this is often not sufficiently recognized. CONCLUSION: The wide spectrum of secondary complications after a stroke constitutes a complex, sustained and multidisciplinary challenge, which requires a cross-sectoral interaction of various and numerous actors in outpatient poststroke care.


Assuntos
Assistência ao Convalescente , Acidente Vascular Cerebral , Assistência Ambulatorial , Depressão , Humanos , Incidência , Pacientes Ambulatoriais , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia
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