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1.
Laryngoscope ; 131 Suppl 4: S1-S42, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33729584

RESUMO

OBJECTIVES/HYPOTHESIS: Facial nerve monitoring (FNM) has evolved into a widely used adjunct for many surgical procedures along the course of the facial nerve. Even though majority opinion holds that FNM reduces the incidence of iatrogenic nerve injury, there are few if any studies yielding high-level evidence and no practice guidelines on which clinicians can rely. Instead, a review of the literature and medicolegal cases reveals significant variations in methodology, training, and clinical indications. STUDY DESIGN: Literature review and expert opinion. METHODS: Given the lack of standard references to serve as a resource for FNM, we assembled a multidisciplinary group of experts representing more than a century of combined monitoring experience to synthesize the literature and provide a rational basis to improve the quality of patient care during FNM. RESULTS: Over the years, two models of monitoring have become well-established: 1) monitoring by the surgeon using a stand-alone device that provides auditory feedback of facial electromyography directly to the surgeon, and 2) a team, typically consisting of surgeon, technologist, and interpreting neurophysiologist. Regardless of the setting and the number of people involved, the reliability of monitoring depends on the integration of proper technical performance, accurate interpretation of responses, and their timely application to the surgical procedure. We describe critical steps in the technical set-up and provide a basis for context-appropriate interpretation and troubleshooting of recorded signals. CONCLUSIONS: We trust this initial attempt to describe best practices will serve as a basis for improving the quality of patient care while reducing inappropriate variations. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:S1-S42, 2021.


Assuntos
Eletromiografia/métodos , Nervo Facial/fisiologia , Nervo Facial/cirurgia , Monitorização Intraoperatória/instrumentação , Guias de Prática Clínica como Assunto/normas , Idoso , Lista de Checagem , Análise Custo-Benefício , Traumatismos do Nervo Facial/epidemiologia , Traumatismos do Nervo Facial/prevenção & controle , Feminino , Humanos , Doença Iatrogênica/epidemiologia , Doença Iatrogênica/prevenção & controle , Incidência , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória/métodos , Neurofisiologia/métodos , Neurofisiologia/estatística & dados numéricos , Preceptoria/normas , Qualidade da Assistência à Saúde , Reprodutibilidade dos Testes
3.
Medisan ; 24(5) ilus
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1135212

RESUMO

La iatrogenia es el daño ocasionado por el profesional de la salud a pacientes, familias u otras personas, de manera no intencional, que puede provocar desde un ligero malestar emocional hasta la propia muerte. Teniendo en cuenta lo anterior se realizó una revisión bibliográfica exhaustiva sobre el tema que recoge aspectos actualizados, a saber: concepto, diferencias entre esta y la mala praxis médica, modalidades de iatrogenia (principalmente la de orden psicológico) y recomendaciones para evitarla, con el objetivo de contribuir a un mejor desempeño de los profesionales de la salud y elevar la calidad de vida de la población.


Iatrogenesis is the damage caused by the health professional to patients, families or other people, in non intentional way, that can cause either a slight emotional distress or death. Keeping this in mind an exhaustive literature review on the topic was carried out that compiles up-to-date aspects: concept, differences between this and the bad medical practice, iatrogenesis modalities (mainly the psychological type) and recommendations to avoid it, aimed at contributing to a better performance of health professionals and elevating the population life quality.


Assuntos
Doença Iatrogênica/prevenção & controle , Doença Iatrogênica/epidemiologia , Qualidade de Vida , Imperícia
4.
Medicine (Baltimore) ; 99(36): e22013, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899052

RESUMO

BACKGROUND: Intensive care unit-acquired weakness (ICU-AW) is an acquired neuromuscular lesion and a common occurrence in patients who are critically ill. We will systematically summarize and incorporate the important risk factors and prevalence from previously published multivariate analyses for ICU-AW. METHODS: We will search the PubMed, Embase, Web of Science, and the Cochrane library to identify the relevant studies about the prevalence and risk factors for ICU-AW. Two reviewers will independently review the studies for eligibility according to the inclusion criteria. Two reviewers will independently assess the quality of studies by using the Newcastle-Ottawa scale for nonrandomized studies. Heterogeneity among studies will be estimated by the I statistic. RESULTS: This systematic review and meta-analysis will provide an evidence of prevalence and risk factors for the ICU-AW. CONCLUSION: We hope that our research will contribute to clinicians and public decision making about the ICU-AW.


Assuntos
Estado Terminal , Doença Iatrogênica/epidemiologia , Unidades de Terapia Intensiva , Debilidade Muscular/epidemiologia , Humanos , Metanálise como Assunto , Prevalência , Fatores de Risco , Revisões Sistemáticas como Assunto
5.
J Vasc Interv Radiol ; 31(10): 1636-1644.e1, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32943296

RESUMO

PURPOSE: To retrospectively investigate incidence, clinical outcome, and risk factors of iatrogenic pleural effusion in patients with hepatic tumors undergoing radiofrequency (RF) ablation using artificial ascites (AA). MATERIALS AND METHODS: Patients (N = 163) who underwent RF ablation using AA were classified into pleural effusion and non-pleural effusion groups according to the presence of pleural effusion on immediate follow-up CT and chest radiograph after RF ablation. The pleural effusion group included asymptomatic and symptomatic subgroups. The incidence and subsequent clinical outcomes of patients developing pleural effusion after RF ablation were evaluated. RESULTS: Overall, 96 patients (58.9%) developed pleural effusion, which resolved in 4.4 d ± 3.1. Hospital length of stay in the pleural effusion group was longer than the non-pleural effusion group (6.5 d ± 2.6 vs 5.7 d ± 2.8, P < .01). The pleural effusion group had longer AA infusion time (P = .01), larger infused AA volume (P < .01), and longer ablation time (P < .01) than the non-pleural effusion group. Eighteen patients (18.8%) developed symptomatic pleural effusion and had a larger infused AA volume than asymptomatic patients with pleural effusion (P < .01). Pleural effusion duration and hospital length stay were also longer in the symptomatic pleural effusion subgroup than in the asymptomatic subgroup (P < .01). Infused AA volume was the only independent prognostic factor of pleural effusion duration in multivariate analysis (P = .038). CONCLUSIONS: Pleural effusion frequently occurs after RF ablation using AA. Although generally considered negligible, pleural effusion could be a clinical problem and prolong hospitalization. Therefore, operators should be careful not to infuse too much AA when performing RF ablation.


Assuntos
Ascite , Doença Iatrogênica/epidemiologia , Neoplasias Hepáticas/cirurgia , Derrame Pleural/epidemiologia , Ablação por Radiofrequência/efeitos adversos , Idoso , Feminino , Humanos , Incidência , Infusões Parenterais , Tempo de Internação , Neoplasias Hepáticas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Derrame Pleural/diagnóstico por imagem , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
6.
Medicine (Baltimore) ; 99(31): e21474, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756170

RESUMO

RATIONALE: Tibial nerve injury is a sustainable but rare complication during total-ankle arthroplasty (TAA). We outlined 2 previously unreported cases of tibial nerve injury in TAA, including the prognoses and possible causes. PATIENT CONCERNS: First, a 63-year-old woman complained of a 5-month history of persistent tingling sensation and numbness on the medial and plantar aspects of her foot after TAA. Second, a 50-year-old woman complained of a 6-month history of tingling sensation and numbness on the plantar surface of her forefoot after TAA. DIAGNOSIS: Explorations were performed on suspicion of tarsal tunnel syndrome; however, both patients exhibited complete laceration of tibial nerve with neuroma formation. INTERVENTIONS: In both patients, we excised the neuroma and performed end-to-end nerve repair. OUTCOMES: The sensory disturbance of the sole considerably improved at long-term follow-up over 8 years after the neurorrhaphy procedures. LESSONS: Tibial nerve injury is rare following TAA, and is sometimes unrecognized or misdiagnosed. If tibial nerve injury is suspected, prompt surgical exploration should be performed; great precaution must also be taken to prevent injury of the tibial nerve during TAA.


Assuntos
Artroplastia de Substituição do Tornozelo/efeitos adversos , Neuroma/cirurgia , Parestesia/etiologia , Nervo Tibial/lesões , Assistência ao Convalescente , Feminino , Pé/fisiopatologia , Humanos , Hipestesia/etiologia , Doença Iatrogênica/epidemiologia , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Síndrome do Túnel do Tarso/diagnóstico , Nervo Tibial/patologia , Resultado do Tratamento
7.
J Vasc Surg ; 72(4): 1184-1195.e3, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32682063

RESUMO

OBJECTIVE: During the COVID-19 pandemic, central venous access line teams were implemented at many hospitals throughout the world to provide access for critically ill patients. The objective of this study was to describe the structure, practice patterns, and outcomes of these vascular access teams during the COVID-19 pandemic. METHODS: We conducted a cross-sectional, self-reported study of central venous access line teams in hospitals afflicted with the COVID-19 pandemic. To participate in the study, hospitals were required to meet one of the following criteria: development of a formal plan for a central venous access line team during the pandemic; implementation of a central venous access line team during the pandemic; placement of central venous access by a designated practice group during the pandemic as part of routine clinical practice; or management of an iatrogenic complication related to central venous access in a patient with COVID-19. RESULTS: Participants from 60 hospitals in 13 countries contributed data to the study. Central venous line teams were most commonly composed of vascular surgery and general surgery attending physicians and trainees. Twenty sites had 2657 lines placed by their central venous access line team or designated practice group. During that time, there were 11 (0.4%) iatrogenic complications associated with central venous access procedures performed by the line team or group at those 20 sites. Triple lumen catheters, Cordis (Santa Clara, Calif) catheters, and nontunneled hemodialysis catheters were the most common types of central venous lines placed by the teams. Eight (14%) sites reported experience in placing central venous lines in prone, ventilated patients with COVID-19. A dedicated line cart was used by 35 (59%) of the hospitals. Less than 50% (24 [41%]) of the participating sites reported managing thrombosed central lines in COVID-19 patients. Twenty-three of the sites managed 48 iatrogenic complications in patients with COVID-19 (including complications caused by providers outside of the line team or designated practice group). CONCLUSIONS: Implementation of a dedicated central venous access line team during a pandemic or other health care crisis is a way by which physicians trained in central venous access can contribute their expertise to a stressed health care system. A line team composed of physicians with vascular skill sets provides relief to resource-constrained intensive care unit, ward, and emergency medicine teams with a low rate of iatrogenic complications relative to historical reports. We recommend that a plan for central venous access line team implementation be in place for future health care crises.


Assuntos
Cateterismo Venoso Central , Infecções por Coronavirus/terapia , Prestação Integrada de Cuidados de Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/organização & administração , Doença Iatrogênica/prevenção & controle , Controle de Infecções/organização & administração , Pneumonia Viral/terapia , Betacoronavirus/patogenicidade , Cateterismo Venoso Central/efeitos adversos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Estudos Transversais , Pesquisas sobre Serviços de Saúde , Interações Hospedeiro-Patógeno , Humanos , Doença Iatrogênica/epidemiologia , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Medição de Risco , Fatores de Risco
9.
J Clin Neurosci ; 76: 36-40, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32331939

RESUMO

Hospital-acquired conditions (HACs) have been the focus of recent initiatives by the Centers for Medicare and Medicaid Services in an effort to improve patient safety and outcomes. Spine surgery can be complex and may carry significant comorbidity burden, including so called "never events." The objective was to determine the rates of common HACs that occur within 30-days post-operatively for elective spine surgeries and compare them to other common surgical procedures. Patients: >18 y/o undergoing elective spine surgery were identified in the American College of Surgeons' NSQIP database from 2005 to 2013. Patients were stratified by whether they experienced >1 HAC, then compared to those undergoing other procedures including bariatric surgery, THA and TKA. Of the 90,551 spine surgery patients, 3021 (3.3%) developed at least one HAC. SSI was the most common (1.4%), followed by UTI (1.3%), and VTE (0.8%). Rates of HACs in spine surgery were significantly higher than other elective procedures including bariatric surgery (2.8%) and THA (2.8%) (both p < 0.001). Spine surgery and TKA patients had similar rates of HACs(3.3% vs 3.4%, p = 0.287), though spine patients experienced higher rates of SSI (1.4%vs0.8%, p < 0.001) and UTI (1.3%vs1.1%, p < 0.001) but lower rates of VTE (0.8%vs1.6%, p < 0.001). Spine surgery patients had lower rates of HACs overall (3.3%vs5.9%) when compared to cardiothoracic surgery patients (p < 0.001). When compared to other surgery types, spine procedures were associated with higher HACs than bariatric surgery patients and knee and hip arthroplasties overall but lower HAC rates than patients undergoing cardiothoracic surgery.


Assuntos
Procedimentos Cirúrgicos Eletivos/efeitos adversos , Doença Iatrogênica/epidemiologia , Coluna Vertebral/cirurgia , Idoso , Comorbidade , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados Unidos
10.
Medicine (Baltimore) ; 99(15): e19655, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32282715

RESUMO

Endovascular treatment of arterial injuries with stent-graft is a reliable alternative approach in patients not suitable for embolization or at high risk for surgery. The aim of our study was to evaluate the efficacy and the safety of the BeGraft stent-graft, a low-profile balloon expandable covered stent, for emergency endovascular treatment of iatrogenic arterial injuries.Between August 2015 and September 2018, 34 consecutive patients (mean age 71 ±â€Š12 years, 9 females) underwent implantation of BeGraft stent-grafts for iatrogenic arterial injuries (22 active bleedings, 11 pseudoaneurysms, and 1 enteric-iliac fistula). The primary endpoints were technical and clinical success and rates of major and minor complications. The secondary endpoint was the patency of the device during the follow-up. Imaging follow-up was performed by duplex ultrasound and/or computed tomography angiography (according to lesion site/target vessel), at 1-6-12-15 and 24 months.In all 34 patients (100%), the lesion or the defect was effectively excluded with a cumulative amount of 42 stent-grafts. The clinical success was documented in 30/34 patients (88.2%). Neither device- or procedure-related deaths, or major complications occurred. A minor complication was reported in 1 patient (2.9%), successfully treated during the same procedure. Thirty (88.2%) patients were available for a mean follow-up time of 390 ±â€Š168 days (minimum 184, maximum 770), with no observed loss of patency, yielding a 100% Kaplan-Meier cumulative survival patency function. The percentage of patent patients was 30/30 at 6 months, 22/22 at 12 months, and 5/5 at 15 months.Endovascular treatment of iatrogenic arterial injuries with the BeGraft stent-graft is minimally invasive and effective, with good patency rate at midterm follow-up.


Assuntos
Embolização Terapêutica/métodos , Tratamento de Emergência/normas , Doença Iatrogênica/epidemiologia , Lesões do Sistema Vascular/terapia , Idoso , Idoso de 80 Anos ou mais , Falso Aneurisma/epidemiologia , Falso Aneurisma/terapia , Oclusão com Balão/métodos , Procedimentos Endovasculares/métodos , Feminino , Hemorragia/epidemiologia , Hemorragia/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Stents/efeitos adversos , Resultado do Tratamento , Fístula Vascular/epidemiologia , Fístula Vascular/terapia , Grau de Desobstrução Vascular
11.
Fertil Steril ; 113(4): 704-716, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32228874

RESUMO

Around 20% of pregnant women undergo cesarean section (CS), and in most regions of the world CS rates continue to grow. There is still no clear definition of what is considered a normal physiologic aspect of a CS scar and what is abnormal. Cesarean scar defects (CSDs) should be suspected in women presenting with spotting, dysmenorrhea, pelvic pain, or infertility and a history of CS. CSDs can be visualized with the use of hysterosalpingography, transvaginal sonography, saline infusion sonohysterography, hysteroscopy, and magnetic resonance imaging. It is reasonable to consider hormone therapy for CSDs as a symptomatic treatment in women who no longer wish to conceive and have no contraindications. In case of failure of or contraindications to medical treatment, surgery should be contemplated according to the severity of symptoms, including infertility, the desire or otherwise to preserve the uterus, the size of the CSD, and residual myometrium thickness (RMT) measurement. Hysteroscopy is considered to be more of a resection than a repair, so women who desire pregnancy should be excluded from this technique if the RMT is <3 mm, in which case repair is essential and can be achieved by only laparoscopic or vaginal approach. Women with CSDs need to be given complete information, including available literature, before any treatment decision is made. Because prevention is better than cure, risk factors should be identified early to ensure appropriate management.


Assuntos
Cesárea/efeitos adversos , Cicatriz/diagnóstico por imagem , Cicatriz/epidemiologia , Gerenciamento Clínico , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/epidemiologia , Cesárea/tendências , Cicatriz/cirurgia , Feminino , Humanos , Histeroscopia/métodos , Doença Iatrogênica/epidemiologia , Doença Iatrogênica/prevenção & controle , Laparoscopia/métodos , Complicações Pós-Operatórias/cirurgia , Gravidez , Prevalência , Resultado do Tratamento
12.
Am Surg ; 86(1): 21-27, 2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-32077412

RESUMO

Hospital-acquired conditions (HACs) are used to define hospital performance measures. Patient comorbidity may influence HAC development. The National Inpatient Sample database was used to investigate HACs for the patients who underwent liver transplantation. Multivariate analysis was used to identify HAC risk factors. We found a total of 13,816 patients who underwent liver transplantation during 2002-2014. Of these, 330 (2.4%) had a report of HACs. Most frequent HACs were vascular catheter-associated infection [220 (1.6%)], falls and trauma [66 (0.5%), catheter-associated UTI [24 (0.2%)], and pressure ulcer stage III/IV [22 (0.2%)]. Factors correlating with HACs included extreme loss function (AOR: 52.13, P < 0.01) and major loss function (AOR: 8.11, P = 0.04), hepatopulmonary syndrome (AOR: 3.39, P = 0.02), portal hypertension (AOR: 1.49, P = 0.02), and hospitalization length of stay before transplant (AOR: 1.01, P < 0.01). The rate of HACs for liver transplantation is three times higher than the reported overall rate of HACs for GI procedures. Multiple patient factors are associated with HACs, and HACs may not be a reliable measure to evaluate hospital performance. Vascular catheter-associated infection is the most common HAC after liver transplantation.


Assuntos
Doença Iatrogênica/epidemiologia , Transplante de Fígado , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Comorbidade , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Fatores de Risco , Estados Unidos/epidemiologia
13.
Medicine (Baltimore) ; 99(2): e18539, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914027

RESUMO

The purpose of this study was to determine the factors associated with parenteral nutrition-associated liver disease (PNALD) in infants who underwent surgery for necrotizing enterocolitis (NEC) and followed up the postoperative outcomes for long term parenteral nutrition (PN).This study included a retrospective review of 87 infants with NEC and managed surgically from July 2007 to May 2017 at the Children's Hospital, Chongqing Medical University. Clinical data and procedure information were collected and analyzed.Among the infants included, 16.1% of patients developed PNALD. Multivariable logistic regression analysis revealed progressive clinical deterioration (OR, 5.47; 95% CI, 1.10-26.96; P = .037) was independent risk factor for PNALD whereas congenital heart disease (OR, 0.068; 95% CI, 0.008-0.55; P = .012) presentation served as a protective factor.The current data suggested the distinct disease process for cardiac patients with NEC, which might help in the prevention and treatment of PNALD for patients with NEC.


Assuntos
Enterocolite Necrosante/complicações , Enterocolite Necrosante/cirurgia , Hepatopatias/etiologia , Nutrição Parenteral/efeitos adversos , Enterocolite Necrosante/dietoterapia , Enterocolite Necrosante/mortalidade , Feminino , Idade Gestacional , Cardiopatias Congênitas/epidemiologia , Cardiopatias Congênitas/mortalidade , Humanos , Doença Iatrogênica/epidemiologia , Doença Iatrogênica/prevenção & controle , Incidência , Lactente , Recém-Nascido , Hepatopatias/diagnóstico , Hepatopatias/epidemiologia , Masculino , Estudos Retrospectivos , Fatores de Risco
14.
PLoS One ; 15(1): e0227128, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31910240

RESUMO

INTRODUCTION: Parkinson's disease (PD) patients treated with pramipexole (PPX) and ropinirole (ROP) exhibit a higher risk of developing impulse control disorders (ICDs), including gambling disorder, compulsive shopping, and hypersexuality. The management of ICDs in PD is challenging, due to the limited availability of effective therapeutic alternatives or counteractive strategies. Here, we used a pharmacoepidemiological approach to verify whether the risk for PPX/ROP-associated ICDs in PD patients was reduced by drugs that have been posited to exert therapeutic effects on idiopathic ICDs-including atypical antipsychotics (AAs), selective serotonin reuptake inhibitors (SSRIs), and glutamatergic modulators (GMs). METHODS: To quantify the strength of the associations between PPX/ROP and other medications with respect to ICD risk, odds ratios (ORs) were calculated by multivariable logistic regression, adjusting for age, gender, marital status race, psychiatric comorbidities, and use of cabergoline and levodopa. RESULTS: A total of 935 patients were included in the analysis. Use of GMs, SSRIs, and AAs was not associated with a decreased ICD risk in PD patients treated with PPX/ROP; conversely, ICD risk was significantly increased in patients treated with either GMs (Adjusted Odds Ratio, ORa: 14.00 [3.58-54.44]) or SSRIs (ORa: 3.67 [1.07-12.59]). Results were inconclusive for AAs, as available data were insufficient to compute a reliable ORa. CONCLUSIONS: These results suggest that some of the key pharmacological strategies used to treat idiopathic ICD may not be effective for ICDs associated with PPX and ROP in PD patients. Future studies with larger cohorts are needed to confirm, validate, and extend these findings.


Assuntos
Antiparkinsonianos/efeitos adversos , Antipsicóticos/uso terapêutico , Transtornos Disruptivos, de Controle do Impulso e da Conduta/prevenção & controle , Doença de Parkinson/tratamento farmacológico , Inibidores de Captação de Serotonina/uso terapêutico , Idoso , Antiparkinsonianos/uso terapêutico , Transtornos Disruptivos, de Controle do Impulso e da Conduta/tratamento farmacológico , Transtornos Disruptivos, de Controle do Impulso e da Conduta/epidemiologia , Transtornos Disruptivos, de Controle do Impulso e da Conduta/etiologia , Feminino , Humanos , Doença Iatrogênica/epidemiologia , Doença Iatrogênica/prevenção & controle , Indóis/efeitos adversos , Indóis/uso terapêutico , Masculino , Pessoa de Meia-Idade , Pramipexol/efeitos adversos , Pramipexol/uso terapêutico
15.
Int J Gynaecol Obstet ; 148 Suppl 1: 33-36, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31943186

RESUMO

OBJECTIVE: To analyze trends in iatrogenic urogenital fistula among patients admitted for fistula repair at the Pakistan Institute of Medical Sciences, Islamabad. METHODS: In this longitudinal study, all patients who presented for fistula repair between 2006 and 2018 were included in the study. Patient data were collected on age, parity, and type and etiology of fistula, which was classified as ischemic or iatrogenic. RESULTS: Of 634 fistula patients, 371 (58.5%) had iatrogenic fistula, while 263 (41.5%) patients developed ischemic fistula due to obstructed labor. Mean age of patients was 31.6 years. Yearly trends showed an increase in iatrogenic fistula from 43.2% in 2006-2008 to 71.4% in 2017-2018. The major etiological contributor to iatrogenic fistula was hysterectomy (52.5%), followed by cesarean hysterectomy (26.4%), and cesarean delivery (19.9%). CONCLUSION: A rising trend in iatrogenic fistula was observed. This emphasizes the need for optimization of surgical approaches and surgical skills. Moreover, gynecologic surgeries should be restricted to authorized gynecologic surgeons.


Assuntos
Cesárea/efeitos adversos , Histerectomia/efeitos adversos , Doença Iatrogênica/epidemiologia , Fístula Vesicovaginal/epidemiologia , Adulto , Feminino , Ginecologia/educação , Ginecologia/normas , Humanos , Estudos Longitudinais , Paquistão/epidemiologia , Gravidez , Fístula Vesicovaginal/etiologia , Fístula Vesicovaginal/cirurgia
16.
Injury ; 51(2): 317-321, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31917010

RESUMO

BACKGROUND: Patients who experience traumatic spine injuries remain in spinal precautions (SP) to minimize the risk of devastating cord injury while awaiting definitive management. This study examines the incidence of pneumonia (PNA), urinary tract infection (UTI), deep vein thrombosis (DVT), or pulmonary embolism (PE) in this population. STUDY DESIGN: From 2014 to 2016, 344 patients aged 18 and older with spinal column injuries were identified in a prospectively-collected registry at an urban, level 1 trauma center. After exclusion criteria, 330 patients were reviewed and the following were analyzed: demographics, duration of SP, time to intervention, and rates of PNA, UTI, and DVT or PE. Those patients kept in SP for ≤ 72 h ("prolonged") were compared to patients maintained in SP for > 72 h ("early"). RESULTS: Mean age was 54.6 years (SD, 21.7), median Injury Severity Score (ISS) 10 (IQR, 5-17). The median SP was 4.0 (IQR, 3.0-6.0) days. Fifty-eight (17.6%) patients underwent fixation and 170 (51.5%) received a brace. 102 (30.9%) patients initially awaiting a brace were cleared after MRI. 93 (28.2) patients suffered one of the tracked complications; 51 (15.5%) developed PNA, 35 (10.6%) UTI, 23 (7.0%) DVT, and 5 (1.5%) PE. Rate of overall complications between patients with SP ≤ 72 h versus patients with SP > 72 h was statistically significant (20.5% vs 34.6%, p = 0.005) as was the incidence of UTI (14.5 vs 6.0, p = 0.012). CONCLUSION: Prolonged SP (>72 h) is associated with increased rates of immobility-associated morbidities. Focus should be on prompt, definitive care and early mobilization. LEVEL OF EVIDENCE: III Retrospective review of prospectively-collected data.


Assuntos
Restrição Física/efeitos adversos , Traumatismos da Medula Espinal/prevenção & controle , Traumatismos da Coluna Vertebral/complicações , Ferimentos e Lesões/complicações , Adulto , Idoso , Braquetes/estatística & dados numéricos , Estudos de Casos e Controles , Feminino , Fixação de Fratura/métodos , Fixação de Fratura/estatística & dados numéricos , Humanos , Doença Iatrogênica/epidemiologia , Incidência , Escala de Gravidade do Ferimento , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Pneumonia/epidemiologia , Embolia Pulmonar/epidemiologia , Restrição Física/estatística & dados numéricos , Estudos Retrospectivos , Traumatismos da Coluna Vertebral/diagnóstico por imagem , Tempo para o Tratamento , Infecções Urinárias/epidemiologia , Trombose Venosa/epidemiologia , Ferimentos e Lesões/epidemiologia
17.
Eur J Pediatr ; 179(3): 473-482, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31814049

RESUMO

Healthcare can cause harm. The goal of this study is to evaluate the association between the occurrence of adverse events (AEs) and morbidity-mortality in critically ill children. A prospective cohort study was designed. All children admitted to the Pediatric Intensive Care Unit (PICU) between August 2016 and July 2017 were followed. An AE was considered any harm associated with a healthcare-related incident. AEs were identified in two steps: first, adverse clinical incidents (ACI) were recognized through direct observation and active surveillance by PICU physicians, and then the patient safety committee evaluated every ACI to define which would be considered an AE. The outcome was hospital morbidity-mortality. There were 467 ACI registered, 249 (53.31%) were considered AEs and the rate was 4.27/100 patient days. From the 842 children included, 142 (16.86%) suffered AEs, 39 (4.63%) experienced morbidity-mortality: 33 (3.92%) died, and 6 (0.71%) had morbidity. Multivariate analysis revealed that the occurrence of AEs was significantly associated with morbidity-mortality, OR 5.70 (CI95% 2.58-12.58, p = 0.001). This association was independent of age and severity of illness score.Conclusion: Experiencing AEs significantly increased the risk of morbidity-mortality in this cohort of PICU children.What is Known:• Many children suffer healthcare-associated harm during pediatric intensive care hospitalization.What is New:• This prospective cohort study shows that experiencing adverse events during pediatric intensive care hospitalization significantly increases the risk of morbidity and mortality independent of age and severity of illness at admission.


Assuntos
Doença Iatrogênica/epidemiologia , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Erros Médicos/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Criança , Pré-Escolar , Estado Terminal/terapia , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Morbidade , Segurança do Paciente/estatística & dados numéricos , Estudos Prospectivos
18.
Lancet Infect Dis ; 20(1): e2-e10, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31876504

RESUMO

Creutzfeldt-Jakob disease (CJD) is a fatal disease presenting with rapidly progressive dementia, and most patients die within a year of clinical onset. CJD poses a potential risk of iatrogenic transmission, as it can incubate asymptomatically in humans for decades before becoming clinically apparent. In this Review, we sought evidence to understand the current iatrogenic risk of CJD to public health by examining global evidence on all forms of CJD, including clinical incidence and prevalence of subclinical disease. We found that although CJD, particularly iatrogenic CJD, is rare, the incidence of sporadic CJD is increasing. Incubation periods as long as 40 years have been observed, and all genotypes have now been shown to be susceptible to CJD. Clinicians and surveillance programmes should maintain awareness of CJD to mitigate future incidences of its transmission. Awareness is particularly relevant for sporadic CJD, which occurs in older people in whom clinical presentation could resemble rapidly developing dementia.


Assuntos
Síndrome de Creutzfeldt-Jakob/epidemiologia , Síndrome de Creutzfeldt-Jakob/patologia , Doença Iatrogênica/epidemiologia , Período de Incubação de Doenças Infecciosas , Adulto , Idoso , Idoso de 80 Anos ou mais , Síndrome de Creutzfeldt-Jakob/transmissão , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prevalência , Medição de Risco , Adulto Jovem
19.
Health Info Libr J ; 37(1): 26-34, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31628725

RESUMO

OBJECTIVES: To explore how social network analysis (SNA) can be used to analyse intra-hospital patient networks of individuals with a hospital acquired infection (HAI) for further analysis in a geographical information systems (GIS) environment. METHODS: A case and control study design was used to select 2008 patients. We retrieved locational data for the patients, which was then translated into a network with the SNA software and then GIS software. Overall metrics were calculated for the SNA based on three datasets and further analysed with a GIS. RESULTS: The SNA analysis compared cases to control indicating significant differences in the overall structure of the networks. A GIS visual representation of these metrics was developed, showing spatial variation across the example hospital floor. DISCUSSION: This study confirmed the importance that intra-hospital patient networks play in the transmission of HAIs, highlighting opportunities for interventions utilising these data. Due to spatial variation differences, further research is necessary to confirm this is not a localised phenomenon, but instead a common situation occurring within many hospitals. CONCLUSION: Utilising SNA and GIS analysis in conjunction with one another provided a data-rich environment in which the risk inherent in intra-hospital transfer networks was quantified, visualised and interpreted for potential interventions.


Assuntos
/patogenicidade , Infecções por Clostridium/prevenção & controle , Doença Iatrogênica/prevenção & controle , Transferência de Pacientes/normas , Estudos de Casos e Controles , Infecções por Clostridium/epidemiologia , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Mapeamento Geográfico , Humanos , Doença Iatrogênica/epidemiologia , Transferência de Pacientes/estatística & dados numéricos , Rede Social
20.
Libyan J Med ; 15(1): 1688916, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31694490

RESUMO

The American Association of Endodontists (AAE) released a case difficulty assessment form to help general dentists and students treat cases within their expertise or refer advanced cases to reduce the risk of iatrogenic errors. The purpose of this study was to determine the incidence of iatrogenic complications after the use of the case difficulty assessment form. Arandom sample of 1000 cases that received root canal treatment in undergraduate clinics during the academicyear (2016-2017) was selected. Case difficulty assessment was made for each case before treatment onset. Once the case was approved for treatment in the undergraduate clinics, the endodontic treatments were performed following the standard procedure the endodontic department of the Dentistry School of King Abdulaziz University mandates. Digital radiographs were obtained during routine root canal treatment and were evaluated by four observers to detect any iatrogenic errors, after which the data were analyzed statistically. Iatrogenic errors were correlated significantly with case difficulty (p= 0.003), and were detected in 22.1% of all teeth treated in the undergraduate clinics. Underfilling accounted for the highestpercent of errors detected (8.4%), followed by ledge formation (4.2%). Molar teeth had the highest frequency of errors, and mesio-buccal roots of maxillary molars showed the highest percentage of errors. The AAE developed asignificantly useful tool to determine the difficulty of each case treated in undergraduate clinics, and following their recommendations will minimize the risk of iatrogenic errors.


Assuntos
Competência Clínica/normas , Endodontia/educação , Doença Iatrogênica/prevenção & controle , Tratamento do Canal Radicular/efeitos adversos , Estudantes de Odontologia/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Educação em Odontologia/métodos , Endodontia/tendências , Humanos , Doença Iatrogênica/epidemiologia , Incidência , Erros Médicos/estatística & dados numéricos , Pessoa de Meia-Idade , Estudos Retrospectivos , Tratamento do Canal Radicular/estatística & dados numéricos , Arábia Saudita/epidemiologia , Universidades
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