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2.
Z Geburtshilfe Neonatol ; 223(6): 337-349, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31801168

RESUMO

As far as prehospital but in part also clinical obstetrics is concerned, the acute nature of perinatal emergencies is overshadowed by limited diagnostic and therapeutic options. The need for acute and targeted intervention may result from both maternal and fetal indications. As common in emergency services for pregnant women, prehospital primary assessment and logistics management (e.g., transport time/type, choice of destination) define the prognosis. Non-specific emergencies coincident to pregnancy are to be distinguished from perinatal emergencies caused by expecting a child (hypertensive pregnancy disorders, perinatal bleeding, thrombosis, and embolism). In order to cope with rare and unpredictable emergencies, medical teams profit from standardized algorithms to support a high quality of prehospital care. Extensive information and training concepts are essential. The presented series on obstetric emergencies introduces the required knowledge and skills.


Assuntos
Emergências/epidemiologia , Serviços Médicos de Emergência/estatística & dados numéricos , Obstetrícia , Complicações na Gravidez/epidemiologia , Descolamento Prematuro da Placenta , Criança , Embolia Amniótica , Feminino , Humanos , Parto , Placenta Prévia , Pré-Eclâmpsia , Gravidez , Tromboembolia , Inércia Uterina
3.
Medicine (Baltimore) ; 98(47): e17739, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31764772

RESUMO

To examine trends and contributing factors of opioid, heroin, and cannabis-associated emergency department (ED) visits in Nevada.The 2009 to 2017 Nevada State ED database (n = 7,950,554 ED visits) were used. Use of opioid, heroin, and cannabis, respectively, was identified by the International Classification of Diseases, 9th & 10th Revisions. Three multivariable models, one for each of the 3 dependent variables, were conducted. Independent variables included year, insurance status, race/ethnicity, use of other substance, and mental health conditions.The number of individuals with opioid, heroin, cannabis-associated ED visits increased 3%, 10%, and 23% annually from 2009 to 2015, particularly among 21 to 29 age group, females, and African Americans. Use of other substance (odds ratio [OR] = 3.91; 95% confidence interval [CI] = 3.84, 3.99; reference - no use of other substance), mental health conditions (OR = 2.48; 95% CI = 2.43, 2.53; reference - without mental health conditions), Medicaid (OR = 1.41; 95% CI = 1.38, 1.44; reference - non-Medicaid), Medicare (OR = 1.44; 95% CI = 1.39, 1.49; reference - non-Medicare) and uninsured patients (OR = 1.52; 95% CI = 1.49, 1.56; reference - insured) were predictors of all three substance-associated ED visits.With a steady increase in trends of opioid, heroin, and cannabis-associated ED visits in recent years, the main contributing factors include patient sociodemographic factors, mental health conditions, and use of other substances.


Assuntos
Emergências/epidemiologia , Dependência de Heroína/epidemiologia , Abuso de Maconha/epidemiologia , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Adolescente , Adulto , Idoso , Criança , Estudos Transversais , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nevada/epidemiologia , Fatores de Risco , Adulto Jovem
5.
Afr Health Sci ; 19(2): 1910-1923, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31656474

RESUMO

Background: There is a high prevalence of paediatric emergency cases in less developed countries. However, prolonged hospital stay at emergency units may further overstretch the facilities. Objective: To assess the patterns of presentations, services offered and predictors of a prolonged stay at the Children Emergency Room of a tertiary hospital in Southern Nigeria. Methods: This prospective cross-sectional, study was conducted at the University of Calabar Teaching Hospital, Nigeria from 1st January-31st December 2014. Socio-demographic and clinical characteristics of consecutively recruited children (n=633) were recorded in a proforma. Binary logistic regression was conducted to determine predictors of prolonged stay (>72 hours). Result: The median age of participants was 2 (1 - 4.6) years. Three-fifths of children were admitted at off-hours and the commonest symptom was fever (73.9%). About 16.4% (95%CI:13.6% - 19.4%, n= 103/633) of the children had prolonged stay while those with sepsis had the longest mean stay (65.5±72.1 hours). Children admitted on account of Sickle cell disease (OR:11.2, 95%CI:1.3-95.1, P-value = 0.03), Malaria (OR:10.7, 95%CI:1.4-82.5, P-value = 0.02) or sepsis (OR:10.5, 95%CI:1.3 - 82.7, P-value = 0.03) had higher odds of prolonged hospital stay. There was no significant difference in hospital stay among children admitted by the consultant as compared to other health personnel (P-value = 0.08). Conclusion: Prevention and proper management of Sickle cell disease and malaria reduces paediatric hospital stay in our environment. Paediatric emergency medicine should be re-organized to cater for high volume of off-hour admissions.


Assuntos
Emergências/epidemiologia , Hospitais de Ensino/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Anemia Falciforme/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Serviço Hospitalar de Emergência , Feminino , Febre/epidemiologia , Mortalidade Hospitalar , Humanos , Lactente , Malária/epidemiologia , Masculino , Nigéria/epidemiologia , Estudos Prospectivos , Sepse/epidemiologia , Fatores Socioeconômicos , Fatores de Tempo
6.
Am Surg ; 85(10): 1189-1193, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657322

RESUMO

Paraesophageal hernia (PEH) repair is typically performed electively. Complex PEHs (obstructed or gangrenous) require more urgent repair and can have significant complications. Although elective repair is primarily laparoscopic, limited data are available on the use of laparoscopy for complex cases. Patients undergoing complex PEH repair were identified from the NSQIP database, and predictors of morbidity and mortality were compared for 2473 laparoscopic and 861 open repairs. Compared with the laparoscopic approach, emergent surgeries (36.7% vs 10.8%, P < 0.001) and preoperative sepsis (22.9% vs 7.4%, P < 0.001) were more common in the open group. Operative times were shorter for open repairs (152.6 vs 172.2 minutes, P = 0.03). However, open repair was associated with increased morbidity (28.2% vs 11%, P < 0.001) and mortality (5.2% vs 1.4%, P < 0.001), likely because of higher rates of preoperative comorbidities in the open group. On multivariable regression analysis, preoperative sepsis was associated with increased mortality and morbidity, whereas laparoscopic repair was associated with decreased morbidity. If laparoscopic repair can be safely completed, it is associated with decreased morbidity, despite longer operative times.


Assuntos
Doenças do Esôfago/cirurgia , Hérnia Hiatal/cirurgia , Herniorrafia/mortalidade , Laparoscopia/mortalidade , Idoso , Emergências/epidemiologia , Feminino , Herniorrafia/efeitos adversos , Herniorrafia/métodos , Humanos , Laparoscopia/efeitos adversos , Masculino , Morbidade , Duração da Cirurgia , Análise de Regressão , Sepse/epidemiologia
8.
Farm. hosp ; 43(4): 128-133, jul.-ago. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-183899

RESUMO

Objetivo: Describir un programa de farmacovigilancia llevado a cabo por un servicio de farmacia y analizar las sospechas de reacciones adversas a medicamentos recogidas. Método: Estudio observacional, longitudinal, de nueve años de duración (2008-2016). El programa de farmacovigilancia está liderado por el servicio de farmacia, que realiza farmacovigilancia prospectiva, retrospectiva, intensiva y voluntaria en el paciente hospitalizado y ambulatorio (urgencias, hospital de día, consultas externas y centros sociosanitarios). Las reacciones adversas se incorporan en la historia clínica electrónica del paciente y se añade una alerta que indica su presencia. Resultados: Se recogieron 2.631 reacciones adversas a medicamentos en 2.436 pacientes (52% varones) con una media [rango] de edad de 63,3 [0-98] años. El 92,8% de las reacciones fueron notificadas por el farmacéutico y el 7,2% por médicos, enfermería y técnicos. El 63,7% se notificaron en hospitalización, el 19,2% en urgencias, el 10,6% en consultas externas, el 6,2% en hospital de día y el 0,3% en radiología. Se observó un incremento de notificación por farmacovigilancia prospectiva e intensiva. Los grupos terapéuticos mayoritariamente implicados fueron: antineoplásicos (21,3%), antibacterianos (12,3%), antitrombóticos (7,7%), analgésicos (6,7%), corticosteroides (5,2%), psicolépticos (5,2%), diuréticos (4,9%), antivirales (4,9%), antiinflamatorios y antirreumáticos (4,2%) e inmunosupresores (3,3%). Las reacciones adversas detectadas afectaron mayoritariamente a la piel y anejos (19,7%) y al tracto gastrointestinal (19,1%). Respecto a su gravedad, el 38,7% fueron leves, el 30,8% graves y el 30,5% moderadas. El 60,9% de los pacientes se recuperaron de las reacciones adversas y el 31,7% se encontraban en proceso de recuperación. Se interrumpió el tratamiento en el 65% de los casos y el 56% de los pacientes recibieron tratamiento específico. Conclusiones: La incorporación del programa de farmacovigilancia en la rutina diaria del farmacéutico de hospital aporta un valor añadido a la seguridad de la farmacoterapia del paciente


Objective: To describe our pharmacovigilance program and to analyze the reported adverse drug reactions. Method: Observational longitudinal study conducted from 2008 to 2016. The Pharmacy Department leads the pharmacovigilance program and performs prospective, retrospective, intensive, and spontaneous reporting of inpatients and outpatients (emergencies, day hospital, external consultations, and nursing homes). Each adverse drug reaction is incorporated in the electronic health record of the patient along with an alert. Results: A total of 2,631 adverse drug reactions were reported in 2,436 patients. Of these patients, 52% were men with a mean age of 63.3 [0-98] years. A total of 92.8% drug events were reported by the pharmacists and 7.2% by doctors, nurses, and technicians. A total of 63.7% were reported in inpatients, 19.2% in emergencies, 10.6% in external consultations, 6.2% in the day hospital, and 0.3% in diagnostic radiology. There was an increase in adverse drug reactions detected by prospective and intensive pharmacovigilance. Principal therapeutic groups involved in adverse drug events were antineoplastic agents (21.3%), antibacterials (12.3%), antithrombotics (7.7%), analgesics (6.7%), corticosteroids (5.2%), psycholeptics (5.2%), diuretics (4.9%), anti virals (4.9%), antiinflammatories and antirheumatics (4.2%), and immunosupressants (3.3%). Adverse drug reactions mainly affected the skin and appendages (19.7%) and gastrointestinal tract (19.1%). Adverse drug reactions were mild (38.7%), severe (30.8%), and moderate (30.5%). In total, 60.9% of patients recovered from drug events and 31.7% were in recovery. The most frequent response was treatment interruption in 65% of cases and the patients received additional specific treatment in 56% of cases. Conclusions: The incorporation of the pharmacovigilance program within the daily routine of the hospital pharmacist provides added value to the safety and pharmacotherapy of the patient


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Serviço de Farmácia Hospitalar/métodos , Serviço de Farmácia Hospitalar/normas , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Antibacterianos , Fibrinolíticos , Antineoplásicos , Hospitalização/estatística & dados numéricos , Emergências/epidemiologia , Serviços Médicos de Emergência/estatística & dados numéricos , Corticosteroides , Diuréticos
9.
Medicine (Baltimore) ; 98(30): e16613, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31348310

RESUMO

Dental hygienists in Poland work in various settings, including public health care institutions, private dental practices, dental clinics, kindergartens, and schools. They can often face medical emergencies, whose rate is increasing owing to comorbidities and aging of dental patients' populations. The aim of the study was to assess the prevalence of medical emergencies in dental hygienists' practice in Poland and the hygienists' preparedness and attitudes toward emergencies.A 10-question authors' own questionnaire was filled in by 613 dental hygienist. It referred to their cardiopulmonary resuscitation training, availability of emergency medical equipment in the workplace, the prevalence of medical emergencies including the need for an emergency medical service (EMS) call, and the management of cardiac arrest.Overall, 613 dental hygienists working in Poland participated in the study; 38.99% had taken part in basic life support (BLS) training within the previous 12 months and 35.89% within 2 to 5 years; 15.17% had experienced at least 1 emergency situation requiring an EMS call within the previous 12 months. Vasovagal syncope was the most common medical emergency (15.97%), followed by moderate anaphylactic reaction (13.87%), seizures (8.81%), hyperventilation crisis (7.50%), and hypoglycemia (7.34%).The most common medical emergency in dental hygienists' practice in Poland is syncope followed by mild anaphylactic reaction. Most of the dental hygienist had participated in a BLS course within the previous 5 years; however, 20% of them have never participated since graduation. Dental hygienists should participate in BLS courses every 2 years to keep the cardiopulmonary resuscitation skills and stay up-to-date with current guidelines. An important part of the study participants declare the lack of availability in their workplaces of life-saving equipment, including self-expanding bag resuscitator, oropharyngeal, and supraglottic airway device and oxygen source. Medical emergency equipment as recommended in the international guidelines should be available in every practice.


Assuntos
Higienistas Dentários/estatística & dados numéricos , Emergências/epidemiologia , Adulto , Atitude do Pessoal de Saúde , Serviços Médicos de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polônia , Prevalência
10.
Eur J Gen Pract ; 25(3): 136-142, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31272245

RESUMO

Background: Non-urgent care is an important factor responsible for rising healthcare costs and general practitioners (GPs) are known to be more cost-effective than emergency departments (EDs). Objectives: To understand the reasons why patients confronted with a medical problem perceived as urgent choose to consult either a GP or an ED. Methods: We conducted a qualitative study in Switzerland, using data collected between 2014 and 2015 through semi-structured interviews of adults with non-vital medical problems. Half were recruited after an ambulatory consultation in an ED, and half were patients who consulted their GP. The audio-recorded interviews were transcribed, coded, and analysed according to the constant comparative method. Results: The main reason given by patients who consulted their GP first was the quality of the relationship. The more meaningful the relationship, the more likely patients were to seek advice from their GP. One marker of a privileged relationship was GPs supplying their mobile phone number to the patient. The perceived nature of the complaint, for example, symptoms considered as life-threatening or severe pain, together with the expected waiting time in an ED were additional factors influencing the patients' choice. Conclusion: Our study showed that when patients are confronted with what they perceive as a medical emergency, the quality of the relationship with the GP, in particular the continuity of care provided, seem to be the major reasons why they consult their GP rather than an ED.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Medicina Geral/estatística & dados numéricos , Clínicos Gerais/estatística & dados numéricos , Relações Médico-Paciente , Adulto , Idoso , Idoso de 80 Anos ou mais , Tomada de Decisões , Emergências/epidemiologia , Emergências/psicologia , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Suíça , Fatores de Tempo , Adulto Jovem
11.
Dis Colon Rectum ; 62(8): 941-951, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31283592

RESUMO

BACKGROUND: Although elderly patients constitute most of the patients undergoing surgery for obstructed colon cancer, available data in the literature are very limited. OBJECTIVE: The purpose of this study was to assess the management and outcomes of elderly patients treated for obstructed colon cancer. DESIGN: This was a multicenter, retrospective cohort study. SETTINGS: Between 2000 and 2015, 2325 patients managed for an obstructed colon cancer in member centers of the French National Surgical Association were identified. Data were collected by each center on a voluntary basis after institutional approval. Bowel obstruction was defined clinically and confirmed by imaging. PATIENTS: Three age groups were defined, including patients <75 years, 75 to 84 years, and ≥85 years. MAIN OUTCOME MEASURES: Postoperative and oncologic results in elderly patients with an obstructed colon cancer were measured. Relative survival was calculated as the ratio of the overall survival with the survival that would have been expected based on the corresponding general population. INTERVENTIONS: A total of 302 patients (13%) underwent colonic stent insertion, and 1992 (87%) underwent surgery as emergency procedure. RESULTS: A total of 2294 patients were analyzed (<75 y, n = 1200 (52%); 75-84 y, n = 650 (28%); and ≥85 y, n = 444 (20%)). Elderly patients were more likely to be women (p < 0.0001), to have proximal colon cancer (p < 0.0001), and to have a higher incidence of comorbidities (p < 0.0001). The use of colonic stent or the type of surgery was identical regardless of age. In patients with resected colon cancer, elderly patients had less stage IV disease (p < 0.0001). The absence of tumor resection (p < 0.0001) and definitive stoma rate increased with age (p < 0.0001). Postoperative mortality and morbidity were significantly higher in elderly patients (p < 0.0001), but surgical morbidity was similar across age groups (p = 0.60). Postoperative morbidity was correlated to the 6-month mortality rate in elderly (p < 0.0001). Overall and disease-free survivals were significantly lower in more elderly patients (p < 0.0001) but relative survival was not (p = 0.09). LIMITATIONS: It is quite difficult to know how to interpret these data as a whole, given the inherent bias in the study population, lack of ability to stratify by performance status, and long study period duration. CONCLUSIONS: Elderly patients have high morbidity with lower survival in the highest age ranges of elderly subgroups. These data should be considered when deciding on an operative approach. See Video Abstract at http://links.lww.com/DCR/A964.


Assuntos
Neoplasias do Colo/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Emergências/epidemiologia , Obstrução Intestinal/cirurgia , Stents , Idoso , Idoso de 80 Anos ou mais , Doenças do Colo/epidemiologia , Doenças do Colo/cirurgia , Neoplasias do Colo/complicações , Neoplasias do Colo/epidemiologia , Feminino , Seguimentos , França/epidemiologia , Humanos , Incidência , Obstrução Intestinal/epidemiologia , Obstrução Intestinal/etiologia , Masculino , Estadiamento de Neoplasias , Estudos Retrospectivos , Sociedades Médicas , Resultado do Tratamento
12.
Dermatology ; 235(4): 276-286, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31163441

RESUMO

BACKGROUND: Psoriasis is associated with psychosocial distress. Little is known about the relationship between psoriasis and mental health (MH) emergencies. OBJECTIVE: To examine the associations of psoriasis and MH hospitalizations in the USA. METHODS: Data from the 2002-2012 National Inpatient Sample were analyzed, including an approximately 20% sample of all US hospitalizations (n = 87,053,155 children and adults). RESULTS: Hospitalization for MH disorders occurred more commonly in those with psoriasis compared to those without psoriasis (4.04 vs. 2.21%). In multivariable logistic regression models, psoriasis was associated with higher odds of admission for any MH disorder overall (adjusted odds ratio [95% confidence interval]: 2.32 [2.24-2.41]), as well as 9 of the 15 MH-specific disorders examined. Associated MH disorders included: anxiety, schizophrenia, personality disorder, depression, substance use disorders, history of MH disorder, alcohol-related disorders, adjustment disorders, and cognitive disorders. Children with versus those without psoriasis were also more likely to have a primary hospitalization for any MH disorder (2.82 [2.24-3.56]). Psoriasis inpatients were also more likely to have a primary hospitalization for any MH disorder compared to those with alopecia areata (1.99 [1.45-2.74]) or hidradenitis suppurativa (3.97 [3.49-4.52]). Psoriasis patients hospitalized with any MH disorder had higher mean [95% confidence interval] cost of inpatient care (USD 11,004 [10,846-11,241] vs. 9,547 [8,730-10,364]; p < 0.0001) compared to those without psoriasis, with USD 1,610,860 excess costs annually, with the majority of the costs coming from depression and mood disorders. CONCLUSIONS: Children and adults with psoriasis had increased hospitalization for multiple MH disorders, which were associated with a considerable financial burden.


Assuntos
Hospitalização/estatística & dados numéricos , Transtornos Mentais/epidemiologia , Psoríase/epidemiologia , Psoríase/psicologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Efeitos Psicossociais da Doença , Emergências/economia , Emergências/epidemiologia , Feminino , Hospitalização/economia , Humanos , Lactente , Recém-Nascido , Masculino , Transtornos Mentais/economia , Pessoa de Meia-Idade , Psoríase/economia , Estados Unidos/epidemiologia , Adulto Jovem
13.
Afr Health Sci ; 19(1): 1757-1767, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31149006

RESUMO

Background: Hypertension is increasing in sub-Saharan Africa (SSA) and it's the single most important modifiable stroke risk factor, yet it's control is not routinely emphasized.The prevalence, pattern and factors associated with hypertensive urgencies and emergencies in Uganda is not well established. A cross-sectional study, was conducted between November 2015 and February 2016, using a complete clinical examination and pre-tested standardized questionnaire subjects were enrolled. The prevalence of hypertensive crises and associations of demographic and clinical factors determined using logistic regression. Results: The prevalence of hypertensive crises was 5.1%, (203/4000) of all admissions at the medical section of the accident and emergency ward of Mulago National Referral Hospital. The hypertensive urgencies and emergencies accounted for 32.5% and 67.5% respectively among study subjects with hypertension. Among those with hypertensive crises, 41.1% were aged 45-65 years and half were female. Self-reported compliance was significantly different between those with hypertensive crisis compared to non-hypertensive crisis with OR; (95% CI) 52.4; (24.5 - 111.7), p-value =<0.001. Acute stroke was the commonest hypertensive emergency. Conclusion: Hypertensive emergencies are common and significantly associated with poor compliance to prescribed anti-hypertensive drugs. Acute stroke is the commonest presentation in our setting.


Assuntos
Doença Aguda/epidemiologia , Estado Terminal/epidemiologia , Emergências/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hipertensão/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Adulto , Idoso , Anti-Hipertensivos/uso terapêutico , Estudos Transversais , Feminino , Humanos , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Acidente Vascular Cerebral/complicações , Uganda/epidemiologia
14.
Afr Health Sci ; 19(1): 1768-1777, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31149007

RESUMO

Background: Surgical emergencies account for a major part of the surgeon's workload. Evaluation of pattern of surgical emergencies will assist in developing concrete proposals for improved care. The aim was to assess the pattern of surgical emergencies in our center. Methods: We undertook one-year prospective study of all the emergency surgical admissions at Federal Medical Centre Makurdi from January to December 2011. Results: There were 575 surgical emergencies which constituted 56.8% of surgical admission, and 27.2% of allemergency hospital admissions. The commonest trauma cases were soft tissue injuries (30.3%), while the commonest non-trauma case was acute abdomen (41.6%). The mean age of the patients was 33.7 ± 17.2 years. Multiple injuries and traumatic brain injuries requiring intensive care monitoring, and malignancies were associated with higher mortality rates (p = 0.001). The 1-year mortality rate was 7.8% and the preventable death rate (PDR) for the trauma-related emergencies was 71.4%. Conclusion: There is a wide spectrum of surgical emergencies in our setting with trauma accounting for a substantial proportion of cases. Improved trauma care, neurosurgical services and intensive care facilities may improve the outcome of surgical emergencies in our environment.


Assuntos
Emergências/epidemiologia , Tempo de Internação/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Ferimentos e Lesões/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Serviço Hospitalar de Emergência , Feminino , Mortalidade Hospitalar , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Prevalência , Estudos Prospectivos , Fatores de Risco , Centros de Atenção Terciária , Resultado do Tratamento , Ferimentos e Lesões/epidemiologia , Adulto Jovem
15.
J Pediatr Endocrinol Metab ; 32(5): 513-518, 2019 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-31042645

RESUMO

Background Many barriers exist to the appropriate recognition and management of life-threatening adrenal crisis in the emergency department (ED). Clinical decision support (CDS) is a health information technology (IT) component that provides useful information to providers as healthcare is being delivered. We hypothesized that CDS incorporated into the electronic health record (EHR) could improve the recognition and management of adrenal crisis within the pediatric ED. Methods We retrospectively analyzed the impact of electronic CDS on the management of patients with known adrenal insufficiency (AI) presenting to two pediatric ED locations over a 19-month period with symptoms suggestive of adrenal crisis. Outcome variables assessed included the frequency of hydrocortisone (HC) administration, appropriateness of HC dosing, and timing to HC order placement and administration. Results A total of 145 encounters were reviewed. When the electronic CDS was in place at the time of the ED visit, patients were nearly 3 times as likely to receive HC (p = 0.002). Among those patients who received HC, the presence of the CDS increased the likelihood of an appropriate 50-mg/m2 dose of HC being given from 20 to 53% (p = 0.02). However, the CDS did not significantly reduce the time from ED arrival to HC order placement (p = 0.36) or administration (p = 0.59). Conclusions The use of innovative health IT strategies, such as the electronic CDS, can improve the recognition and management of adrenal crisis among patients with AI presenting to the pediatric ED.


Assuntos
Insuficiência Adrenal/diagnóstico , Insuficiência Adrenal/prevenção & controle , Competência Clínica/normas , Erros de Diagnóstico/prevenção & controle , Registros Eletrônicos de Saúde/estatística & dados numéricos , Emergências/epidemiologia , Serviço Hospitalar de Emergência/organização & administração , Adolescente , Adulto , Criança , Pré-Escolar , Sistemas de Apoio a Decisões Clínicas , Gerenciamento Clínico , Feminino , Seguimentos , História do Século XXI , Humanos , Lactente , Recém-Nascido , Masculino , Prognóstico , Estudos Retrospectivos , Estados Unidos/epidemiologia , Adulto Jovem
16.
Turk Neurosurg ; 29(3): 317-322, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30984992

RESUMO

Every year, natural or people-generated disasters disrupt the functioning of society, causing human, and material loses, which lead to an increase in the demand for medical attention. In the morning of September 19, 2017, a 7.1-magnitude earthquake struck Mexico City and four other cities, leaving around 19 million people affected and 331 dead. Although the medical response was timely, most of the efforts fell short because demand exceeded responsiveness. This incident evidenced the challenges that we have as caregivers with mass medical emergency, and the need for direct and well-structured interventions of professional-medical associations in the immediate response, on both in-site and in-hospital settings. The aim of this paper is to analyze how we respond to these medical emergencies and what new strategies have been proposed in order to identify the weaknesses and areas of improvement, as well as to restructure our methods of emergency intervention. We searched all the information in both official institutional and social media with a public sanitary scope. We submitted this information to a descriptive qualitative analysis and compared with official information and management. We found an important role for social media as a means of communication and civil organization. Collegiate medical societies, such as neurosurgeons, showed a limited reach, little on-site intervention, and poor use of social media and other strategies to improve the response. Finally, we propose how we may approach these mass medical emergencies in a better way, taking advantage of new technologies and strategies.


Assuntos
Desastres , Terremotos , Emergências/epidemiologia , Procedimentos Neurocirúrgicos/tendências , Socorristas , Humanos , México/epidemiologia , Neurocirurgia , Procedimentos Neurocirúrgicos/métodos
17.
Scand J Trauma Resusc Emerg Med ; 27(1): 43, 2019 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-30975178

RESUMO

INTRODUCTION: Soluble urokinase plasminogen activator receptor (suPAR) is a prognostic and nonspecific biomarker associated with short-term mortality in emergency department (ED) patients. Therefore, the blood level of suPAR might be usable for identification of patients at high- and low risk, shortly after arrival at the ED. Here, we investigate the value of adding suPAR to triage and how this may impact on risk stratification regarding mortality. METHODS: The analyses were performed on the TRIAGE III cohort. Patients were triaged in four groups: Red, Orange, Yellow, and Green. Outcome was all-cause mortality within seven days. Discriminative abilities of triage and suPAR on mortality were assessed using the area under the curve (AUC) for receiver operating characteristics (ROC) curves. A suPAR cut-off value was generated using the Youden's index. Patients were subsequently reclassified one triage level up if the suPAR level was above this cut-off and one level down if the suPAR level was below that value. RESULTS: The study included 4420 patients with an available triage category and suPAR measurement. suPAR was significantly better in predicting mortality than triage; AUC (95% confidence interval): 0.85 (0.80-0.89) vs. 0.71 (0.64-0.78), P < 0.001. Combining suPAR and triage yielded an AUC of 0.87 (0.82-0-93). The Youden's cut-off of suPAR was 5.9 ng/mL and reclassified triage using this value resulted in a more accurate risk stratification regarding hospital admission and mortality. CONCLUSION: Addition of suPAR to triage potentially improves prediction of short-term mortality. Measurement of suPAR in relation to the triage process may allow a more accurate identification of ED patients at risk. TRIAL REGISTRATION: Clinicaltrials.gov , NCT02643459. Registered 31 December 2015. https://clinicaltrials.gov/ct2/show/NCT02643459?cond=NCT02643459&rank=1 .


Assuntos
Algoritmos , Emergências/epidemiologia , Serviço Hospitalar de Emergência/normas , Receptores de Ativador de Plasminogênio Tipo Uroquinase/sangue , Medição de Risco/tendências , Triagem/métodos , Biomarcadores/sangue , Dinamarca/epidemiologia , Feminino , Mortalidade Hospitalar/tendências , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prognóstico , Curva ROC
18.
Scand J Trauma Resusc Emerg Med ; 27(1): 42, 2019 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-30975182

RESUMO

BACKGROUND: Pre-hospital Emergency Anaesthesia (PHEA) is regarded as one of the highest risk interventions that pre-hospital providers perform. AAGBI guidance from 2017 suggests the use of Key Performance Indicators (KPIs) to audit PHEA quality. The aim of this study was to develop KPIs for use in our service and evaluate their impact. METHODS: Using the AAGBI 2017 document as a guide we developed a list of ten auditable domains. Data for each case was extracted from the Electronic Patient Record (EPR) and a score assigned to each of the domains; one if the domain is achieved and zero if the domain is not achieved or if data is missing, giving a total score out of ten. This analysis is then presented as a colour-coded matrix alongside the score. Data were analysed monthly at our case review and governance meeting. The process was refined during the year and after 12 months a formal review of the KPI process occurred. RESULTS: Eighty-two cases were analysed. Domains with the highest percentage of achievement were: Indication 96%; Tube position confirmed 94% and Full AAGBI monitoring and Grade of view < 3 both 89%. The amount of missing data declined throughout the year. The results of the clinician survey showed that almost all respondents found the TVAA PHEA review process useful. CONCLUSION: The KPI process has demonstrated areas of good quality practice and led to improvements in equipment, processes and documentation and therefore patient care. We offer suggestions to other organisations considering implementing KPIs for PHEA.


Assuntos
Anestesia/normas , Anestesiologia/organização & administração , Emergências/epidemiologia , Hospitais , Indicadores de Qualidade em Assistência à Saúde/normas , Serviços Médicos de Emergência/normas , Humanos , Incidência , Reino Unido/epidemiologia
19.
Khirurgiia (Mosk) ; (3): 88-97, 2019.
Artigo em Russo | MEDLINE | ID: mdl-30938363

RESUMO

In the following article, we present the key trends in emergency surgical care in the Russian Federation between 2000 and 2017. The study used data from federal statistical observations and a survey of state medical institutions in 80 regions encompassing 99.3% of the country's population. We discovered a change in the correlation between acute abdominal diseases, particularly a significant reduction in the occurrence of acute appendicitis and perforated peptic ulcer. Reduction in the number of emergency surgeries by 27.8% annually was also observed. Mortality rate decreased in cases of strangulated hernia, acute cholecystitis and acute pancreatitis, while it is stable for bowel obstruction and acute appendicitis and increasing in perforated peptic ulcer cases. The total annual number of lethal outcomes due to acute abdominal diseases was decreased by 1900 cases. Significant changes were observed in mortality rate and minimally invasive surgeries proportions between federal districts and individual regions of the country. The range of administrative measures was proposed.


Assuntos
Doenças do Sistema Digestório/epidemiologia , Doenças do Sistema Digestório/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/estatística & dados numéricos , Doença Aguda/epidemiologia , Doença Aguda/mortalidade , Doença Aguda/terapia , Doenças do Sistema Digestório/mortalidade , Emergências/epidemiologia , Hérnia/epidemiologia , Hérnia/mortalidade , Herniorrafia/mortalidade , Herniorrafia/estatística & dados numéricos , Herniorrafia/tendências , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/mortalidade , Procedimentos Cirúrgicos Minimamente Invasivos/tendências , Federação Russa/epidemiologia
20.
J Trauma Acute Care Surg ; 87(1): 43-48, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30939578

RESUMO

BACKGROUND: Emergency general surgery (EGS) patients require greater resources and have increased rates of morbidity and mortality. Previous work has shown mortality differences in colectomy patients between direct admissions and transfers patients based on source, including emergency department, inpatient, and nursing home transfers. We hypothesize that patient transfer status negatively effects morbidity, mortality, and resource utilization in a mixed population of EGS patients. METHODS: Data were obtained for patients undergoing EGS using public files from the American College of Surgeons National Surgery Quality Improvement Program for the years 2014 through 2016. We analyzed risk factors and 30-day outcomes by transfer status on frequently performed procedures using χ analysis and multivariable logistic regression. Significance was set at p < 0.001 for the bivariate analyses and p < 0.05 for the multivariable analyses. RESULTS: A total of 167,636 procedures were identified. Transferred patients had increased clinical risk, operative complexity, and poorer outcomes. Fewer transfers were initiated for less technically sophisticated cases such as laparoscopic appendectomy and cholecystectomy, whereas more complex acute open cases were more often transferred. Transfer patients required longer operations and more transfusions and experienced more complications likely to require an intensive care unit stay. Transfer patients returned to the operating room more often, had higher rates of readmission, and greater 30-day mortality. These effects remained after adjusting for procedure group, secondary procedures, age, sex, and American Society of Anesthesiologists class. CONCLUSION: Our study demonstrates significant increases in mortality, morbidity, and resource utilization in EGS transfer patients who were not attributable to case mix, demographics, and comorbid status alone. These data point to potential financial and quality assessment challenges for tertiary referral centers. LEVEL OF EVIDENCE: Prognostic, level III; therapeutic, level IV.


Assuntos
Emergências , Transferência de Pacientes/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Transfusão de Sangue/estatística & dados numéricos , Emergências/epidemiologia , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Fatores de Risco , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos
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