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1.
Einstein (Sao Paulo) ; 18: eAO4752, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31664323

RESUMO

OBJECTIVE: To evaluate the epidemiological profile of patients seen at a dementia outpatient clinic. METHODS: A retrospective study conducted by medical record review searching data on sex, race, age, schooling level, and diagnosis of patients seen from 2008 to 2015. RESULTS: A total of 760 patients were studied, with a predominance of female (61.3%; p<0.0001). The mean age was 71.2±14.43 years for women and 66.1±16.61 years for men. The most affected age group was 71 to 80 years, accounting for 29.4% of cases. In relation to race, 96.3% of patients were white. Dementia was diagnosed in 68.8% of patients, and Alzheimer's disease confirmed in 48.9%, vascular dementia in 11.3%, and mixed dementia in 7.8% of cases. The prevalence of dementia was 3% at 70 years and 25% at 85 years. Dementia appeared significantly earlier in males (mean age 68.5±15.63 years). As to sex distribution, it was more frequent in women (59.6%) than in men (40.4%; p<0.0001; OR=2.15). People with higher schooling level (more than 9 years) had a significantly younger age at onset of dementia as compared to those with lower schooling level (1 to 4 years; p=0.0007). CONCLUSION: Most patients seen in the period presented dementia, and Alzheimer was the most prevalent disease. Women were more affected, and men presented young onset of the disease. Individuals with higher schooling level were diagnosed earlier than those with lower level.


Assuntos
Disfunção Cognitiva/epidemiologia , Demência/epidemiologia , Pacientes Ambulatoriais/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/diagnóstico , Doença de Alzheimer/epidemiologia , Brasil/epidemiologia , Disfunção Cognitiva/diagnóstico , Demência/diagnóstico , Escolaridade , Feminino , Hospitais Privados/estatística & dados numéricos , Humanos , Masculino , Registros Médicos , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Distribuição por Sexo , Adulto Jovem
2.
Cancer Radiother ; 23(5): 395-400, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31331842

RESUMO

PURPOSE: Lung and some digestive tumours move during a respiratory cycle. Four-dimensional scanography (4D-CT) is commonly used in treatment planning to account for respiratory motion. Although many French radiotherapy centres are now equipped, there are no guidelines on this subject to date. We wanted to draw up a description of the use of the 4D-CT for the treatment planning in France. METHODS AND MATERIAL: We conducted a survey in all French radiotherapy centres between March and April 2017. RESULTS: One hundred and seventy-two were contacted. The participation rate was 88.37%. The use of the 4D-CT seems to be common and concerned planning for 15.28% of kidney and adrenal cancers, 19.72% of pancreatic cancers, 27.78% of oesophageal cancers and 73.24% of lung cancers in case of normofractionated treatments. The use of the 4D-CT was also widespread in the case of stereotactic body radiation therapy: with 61.11% in the case of pulmonary irradiation and 34.72% in the case of hepatic irradiation. Many centres declared they carried out several 4D-CT for treatment planning (29, 55% in case of stereotactic body radiation therapy for lung tumours and 20% for liver tumours). Private centres tend to repeat 4D-CT more. CONCLUSION: Although the use of the 4D-CT appears to be developing, it remains very heterogeneous. To date, the repetition of the 4D-CT has been very poorly studied and could be the subject of clinical studies, allowing to define in which indications and for which populations there is a real benefit.


Assuntos
Tomografia Computadorizada Quadridimensional , Planejamento da Radioterapia Assistida por Computador/métodos , Artefatos , Institutos de Câncer/estatística & dados numéricos , França , Pesquisas sobre Serviços de Saúde , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Hospitais Universitários/estatística & dados numéricos , Humanos , Imagem Tridimensional/estatística & dados numéricos , Movimento (Física) , Neoplasias/diagnóstico por imagem , Neoplasias/radioterapia , Utilização de Procedimentos e Técnicas , Serviço Hospitalar de Radiologia/estatística & dados numéricos , Radiocirurgia/métodos , Planejamento da Radioterapia Assistida por Computador/estatística & dados numéricos , Planejamento da Radioterapia Assistida por Computador/tendências , Respiração
3.
BMC Infect Dis ; 19(1): 654, 2019 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-31331280

RESUMO

BACKGROUND: Retaining patients on antiretroviral treatment in care is critical to sustaining the 90:90:90 vision. Nigeria has made some progress in placing HIV-positive patients on treatment. In an effort to increase access to treatment, ART decentralization has been implemented in the country. This is aimed at strengthening lower level health facilities to provide comprehensive antiretroviral treatment. We determined the level of retention and adherence to treatment as well as the associated factors among private and public secondary level hospitals in Anambra State. METHOD: We conducted a cross-sectional study among patients who had taken antiretroviral treatment for at least one complete year. A structured questionnaire and patient record review were used to extract information on patient adherence to treatment, and retention in care. Adherence to treatment was ascertained by patient self-report of missed pills in the 30 days prior to date of interview. Retention in care was ascertained using the 3-month visit constancy method reviewing the period spanning 12 months prior to the study. RESULT: We found a comparable level of retention in care (private 81.1%; public 80.3%; p = 0.722). However, treatment adherence was significantly higher amongst participants in the private hospitals compared to those in the public hospitals (private: 95.3%; public: 90.7%; p = 0.001). Determinants of good retention in the private hospitals included disclosure of one's HIV status (AOR: 1.94, 95% CI: 1.09-3.46), being on first-line regimen (AOR: 3.07, 95% CI: 1.27-7.41), whereas being on once-daily regimen (AOR: 0.58, 95% CI: 0.36-0.92), and being currently married (AOR: 0.54 95% CI: 0.32-0.91) determined poor retention. In the public hospitals, only disclosure (AOR: 3.12 95% CI: 1.81-5.56) determined good retention, whereas, spending less than N1000 on transport (AOR: 0.230 95% CI: 0.07-0.78) and residing in a rural area (AOR: 0.64 95% CI: 0.41-0.99) determined poor retention. None of the factors determined adherence. CONCLUSION: Retention in care was high and comparable among the different hospital types and HIV disclosure status was an important factor relating to retention in care. The other factors that determined retention were however different at public and private hospitals. The HIV program manager should consider these variations in designing programs to improve patient retention in care and adherence to treatment.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Retenção nos Cuidados/estatística & dados numéricos , Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Adulto , Estudos Transversais , Feminino , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Humanos , Masculino , Adesão à Medicação/estatística & dados numéricos , Nigéria , Cooperação do Paciente/estatística & dados numéricos , Inquéritos e Questionários
4.
Ethiop J Health Sci ; 29(2): 223-230, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31011270

RESUMO

Background: Marketing mix (7Ps) is a critical concept in healthcare management and health marketing. Hence, this study was conducted to investigating the role of 7Ps on patients' disposition to the kind of hospital from nurses' perspectives. Methods: A cross-sectional study design was used in 2015. The study was conducted in one state in Iran (Mazandaran). The statistical population included nurses (n=235) in public and private hospitals were selected randomly through the list. Data were collected by questionnaire and were analyzed using SPSS software (version 22). Results: The results showed that 38.6 percent of nurses were males and the others (61.4 percent) were females. Their mean age was 31.0±7.1 years, and the majority of them belonged to the 30-40 age group. The mean work experience of them was 11.42±6.5 years. The findings showed that there were significant differences between nurses' perspectives in public and private hospitals about the effect of 7Ps elements on patients' tendency to the public and private hospitals (p<0.05). Conclusions: According to the results, the officials of public hospitals should take more attention to the elements like product, place, promotion, people, physical assets and process management more than the past because these elements cause that the patients are disposed to the private hospitals while the government make more investment in public hospitals.


Assuntos
Atitude do Pessoal de Saúde , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Marketing de Serviços de Saúde , Recursos Humanos de Enfermagem no Hospital/psicologia , Adulto , Estudos Transversais , Feminino , Humanos , Irã (Geográfico) , Masculino , Recursos Humanos de Enfermagem no Hospital/estatística & dados numéricos , Inquéritos e Questionários
5.
Kobe J Med Sci ; 64(5): E160-E169, 2019 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-30988262

RESUMO

PURPOSE: This study aimed to quantify duration of in-hospital breastfeeding (BF)-related activities in mothers after childbirth in a mixed ward-type hospital with an obstetrics department in Japan (hereafter, mixed ward). METHODS: Twenty-two postpartum mothers (primiparous and multiparous) who had vaginal delivery in a mixed ward were instructed to wear radio beacons. A smartphone was placed in the BF room and detected the presence of a nearby beacon, 24 hours daily, measuring the number of hours a mother spent in the nursing room (defined as BF time [hereafter, BF-related duration]). BF-related duration included time spent for BF, diaper changes before and after BF, bottle feeding, and support from nurses. BF-related total hours during postpartum hospitalization were calculated. The effects of parity and each postpartum day number (postpartum days 1-4) on Daily BF-related duration were determined. RESULTS: Percentage of total postpartum hospitalization time spent for BF-related duration was 21.6% and 19.9% for primiparous and multiparous mothers, respectively, with no significant difference between groups. BF-related duration was significantly different between parity group and postpartum day, with peaks on postpartum day 4 (387.7 minutes) and day 2 (318.0 minutes) for primiparous and multiparous groups, respectively. (F = 2.813, p = 0.048). CONCLUSION: Mothers spent 20% of their postpartum hospitalization period for BF-related activities. Individual support is necessary, especially for primiparous mothers, who spent more time than multiparous mothers for BF-related activities on postpartum day 4. In a mixed ward, postpartum mothers need a comfortable hospital environment in which midwives can dedicate themselves to mother-child dyad care.


Assuntos
Aleitamento Materno/estatística & dados numéricos , Comportamento Materno , Cuidados de Enfermagem/métodos , Paridade , Adulto , Parto Obstétrico , Feminino , Hospitais Privados/estatística & dados numéricos , Humanos , Japão , Mães , Unidade Hospitalar de Ginecologia e Obstetrícia/estatística & dados numéricos , Período Pós-Parto , Gravidez , Estudos Prospectivos , Fatores de Tempo
6.
Med Educ Online ; 24(1): 1593785, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30957686

RESUMO

Burnout syndrome is a psychological condition that commonly affects health professionals, medical students, and others in professions with long shifts. It is defined by a high amount of emotional exhaustion, depersonalization, and low personal job satisfaction. We aimed to determine the prevalence of burnout syndrome in medical interns and establish the relationships between this condition and the time and type of hospital at which students worked during their medical internship. This was a survey study in which we used the Maslach Burnout Inventory, applied to fifth-year medical students on an internship at private and public hospitals in Mexico. The participants were 96 women (54.5%) and 80 men (45.5%), with ages ranging from 21 to 34 years old. We found burnout syndrome in 20% of these medical students 22% of the women and 18.6% of the men in the sample. Second-semester interns suffered burnout at a rate of 29%, in contrast to 15% of first-semester students. Emotional exhaustion and depersonalization scores were higher in second-semester interns who worked in public hospitals. However, the prevalence did not differ between public and private hospitals. Our study reports a higher prevalence of burnout syndrome during the second semester of internship. Students who practiced their internship in a public hospital showed higher scores in emotional exhaustion and depersonalization than those who practiced in a private hospital.


Assuntos
Esgotamento Profissional/epidemiologia , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Internato e Residência/estatística & dados numéricos , Estudantes de Medicina/psicologia , Adulto , Esgotamento Profissional/psicologia , Estudos Transversais , Emoções , Feminino , Humanos , Satisfação no Emprego , Masculino , México/epidemiologia , Prevalência , Estresse Psicológico/epidemiologia , Adulto Jovem
7.
Artigo em Inglês | MEDLINE | ID: mdl-30871065

RESUMO

The type of hospital (public or private) has been associated with the type of clinical practice carried out. The purpose of this study was to determine the association between the type of hospital (public or private) and delivery attendance with practices based on the recommendations by the World Health Organization (WHO). A cross-sectional study with puerperal women (n = 2906) was conducted in Spain during 2017. The crude Odds Ratios (OR), adjusted (aOR) and their 95% confidence intervals (CI) were calculated through binary logistic regression. For multiparous women in private centers, a higher rate of induced labor was observed (aOR: 1.49; 95% CI: 1.11⁻2.00), fewer natural methods were used to relieve pain (aOR: 0.51; 95% CI: 0.35⁻0.73), and increased odds of cesarean section (aOR: 2.50; 95% CI: 1.81⁻3.46) were found as compared to public hospitals. For primiparous women in private centers, a greater use of the epidural was observed (aOR: 1.57; 95% CI: 1.03⁻1.40), as well as an increased likelihood of instrumental birth (aOR: 1.53; 95% CI: 1.09⁻2.15) and of cesarean section (aOR: 1.77; 95% CI: 1.33⁻2.37) than in public hospitals. No differences were found in hospitalization times among women giving birth in public and private centers (p > 0.05). The World Health Organization birth attendance recommendations are more strictly followed in public hospitals than in private settings.


Assuntos
Medicina Baseada em Evidências , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Parto , Adulto , Analgésicos , Cesárea/estatística & dados numéricos , Estudos Transversais , Feminino , Hospitalização , Humanos , Modelos Logísticos , Complicações do Trabalho de Parto/epidemiologia , Razão de Chances , Gravidez , Espanha
8.
Medicine (Baltimore) ; 98(6): e14439, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30732205

RESUMO

BACKGROUND: After nearly 20 years of development, China has realized some achievements in helicopter emergency medical services (HEMS). The purpose of this article is to introduce and evaluate the development and characteristics of HEMS in China by collecting and analyzing relevant literature and, in so doing, help this vital service to further develop. METHOD: We conducted a Pubmed, Medline, Embase, ScienceDirect, Wanfang, CNKI, and VIP search of the literature on HEMS of China published between January 1950 and April 2017. The title, author name, number of authors, publishing date, country or region of origin, institution, type of article, study topic, funding source, and level of evidence of each article were recorded and analyzed. RESULTS: There were 41 papers included in the analysis. All articles were published in Chinese. The selected articles were published between 2002 and 2017. The 41 articles originated from China, but 7 different regions were represented: East China (n = 14), followed by North China (n = 12), Central China (n = 8), Southwest China (n = 3), South China (n = 2), and Northwest China (n = 2). The articles included 18 clinical studies, 12 reviews, and 11 clinical guidelines. Among these, 22 articles were from public hospitals; 18 were from military units and 1 came from a private hospital. One article from the public hospitals was funded by public foundations (4.5%); 11 articles from the army units received support from Army funding (61.1%). Compared with the public and private hospitals, articles from military units were more likely to receive financial support (χ = 15.7 P <.01). All the articles were assigned a level of evidence from 1 to 5. Level 5 (78.0%) was the most frequent level of evidence. There were 7 studies at level 4. Only 2 articles were assigned to level 3. There were no articles at levels 1 or 2. CONCLUSIONS: China's HEMS is a relatively new service. Its level of development is low, interregional development is uneven, and cooperation has been insufficient. We need to strengthen capital investment and develop a unified guideline to further enhance the development of HEMS in China.


Assuntos
Resgate Aéreo/estatística & dados numéricos , Bibliometria , China , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Humanos , Militares/estatística & dados numéricos
9.
JAMA Netw Open ; 2(1): e187096, 2019 01 04.
Artigo em Inglês | MEDLINE | ID: mdl-30657532

RESUMO

Importance: Concerns have been raised about the adequacy of health care access among patients cared for within the United States Department of Veterans Affairs (VA) health care system. Objectives: To determine wait times for new patients receiving care at VA medical centers and compare wait times in the VA medical centers with wait times in the private sector (PS). Design, Setting, and Participants: A retrospective, repeated cross-sectional study was conducted of new appointment wait times for primary care, dermatology, cardiology, or orthopedics at VA medical centers in 15 major metropolitan areas in 2014 and 2017. Comparison data from the PS came from a published survey that used a secret shopper survey approach. Secondary analyses evaluated the change in overall and unique patients seen in the entire VA system and patient satisfaction survey measures of care access between 2014 and 2017. Main Outcomes and Measures: The outcome of interest was patient wait time. Wait times in the VA were determined directly from patient scheduling. Wait times in the PS were as reported in Merritt Hawkins surveys using the secret shopper method. Results: Compared with the PS, overall mean VA wait times for new appointments in 2014 were similar (mean [SD] wait time, 18.7 [7.9] days PS vs 22.5 [7.3] days VA; P = .20). Department of Veterans Affairs wait times in 2014 were similar to those in the PS across specialties and regions. In 2017, overall wait times for new appointments in the VA were shorter than in the PS (mean [SD], 17.7 [5.9] vs 29.8 [16.6] days; P < .001). This was true in primary care (mean [SD], 20.0 [10.4] vs 40.7 [35.0] days; P = .005), dermatology (mean [SD], 15.6 [12.2] vs 32.6 [16.5] days; P < .001), and cardiology (mean [SD], 15.3 [12.6] vs 22.8 [10.1] days; P = .04). Wait times for orthopedics remained longer in the VA than the PS (mean [SD], 20.9 [13.3] vs 12.4 [5.5] days; P = .01), although wait time improved significantly between 2014 and 2017 in the VA for orthopedics while wait times in the PS did not change (change in mean wait times, increased 1.5 days vs decreased 5.4 days; P = .02). Secondary analysis demonstrated an increase in the number of unique patients seen and appointment encounters in the VA between 2014 and 2017 (4 996 564 to 5 118 446, and 16 476 461 to 17 331 538, respectively), and patient satisfaction measures of access also improved (satisfaction scores increased by 1.4%, 3.0%, and 4.0% for specialty care, routine primary care, and urgent primary care, P < .05). Conclusions and Relevance: Although wait times in the VA and PS appeared to be similar in 2014, there have been interval improvements in VA wait times since then, while wait times in the PS appear to be static. These findings suggest that access to care within the VA has improved over time.


Assuntos
Agendamento de Consultas , Hospitais Privados/estatística & dados numéricos , Hospitais de Veteranos/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Pesquisas sobre Serviços de Saúde , Acesso aos Serviços de Saúde/estatística & dados numéricos , Hospitais Privados/normas , Hospitais de Veteranos/normas , Humanos , Masculino , Medicina , Pessoa de Meia-Idade , Satisfação do Paciente , Fatores de Tempo , Estados Unidos , United States Department of Veterans Affairs , Adulto Jovem
10.
Bone Joint J ; 101-B(1): 92-95, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30601055

RESUMO

AIMS: Displaced femoral neck fractures (FNF) may be treated with partial (hemiarthroplasty, HA) or total hip arthroplasty (THA), with recent recommendations advising that THA be used in community-ambulant patients. This study aims to determine the association between the proportion of FNF treated with THA and year of surgery, day of the week, surgeon practice, and private versus public hospitals, adjusting for known confounders. PATIENTS AND METHODS: Data from 67 620 patients in the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) from 1999 to 2016 inclusive were used to generate unadjusted and adjusted analyses of the associations between patient, time, surgeon and institution factors, and the proportion of FNF treated with THA. RESULTS: Overall, THA was used in 23.7% of patients. THA was more frequently used over time, in younger patients, in healthier patients, in cases performed on weekdays (adjusted odds ratio (OR) 1.27; 95% confidence interval (CI) 1.14 to 1.41), in private hospitals (adjusted OR 4.34; 95% CI 3.94 to 4.79) and by surgeons whose hip arthroplasty practice has a relatively higher proportion of elective patients (adjusted OR 1.65; 95% CI 1.49 to 1.83). CONCLUSION: Practice variation exists in the proportion of FNF patients treated with THA due to variables other than patient factors. This may reflect variation in resources available and surgeon preference, and uncertainty regarding the relative indication.


Assuntos
Artroplastia de Quadril/estatística & dados numéricos , Fraturas do Colo Femoral/cirurgia , Hemiartroplastia/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Atitude do Pessoal de Saúde , Austrália/epidemiologia , Feminino , Fraturas do Colo Femoral/epidemiologia , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Cirurgiões Ortopédicos/psicologia , Cirurgiões Ortopédicos/estatística & dados numéricos , Satisfação Pessoal , Utilização de Procedimentos e Técnicas/estatística & dados numéricos , Fatores de Tempo
11.
Pan Afr Med J ; 30: 202, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30574221

RESUMO

Introduction: There is a decline in child mortality rate globally, courtesy of the erstwhile Millennium Development Goals. However, under-five mortality is still high in the African sub-regions. The need to review the morbidity and mortality pattern among children admitted into private health settings, where 60% of the medical conditions of the masses are being attended to in the sub-regions, cannot be overemphasized. This study aimed at documenting the morbidity pattern and outcomes of admissions among children admitted into the Living Word Mission Hospital (LWMH), Aba, Nigeria. Methods: This was a retrospective descriptive study over a 3 year period. The study population comprised of all children aged 1 month to 15 years that were admitted into the pediatric wards of the Living Word Mission Hospital, Aba, Nigeria. The age, gender, diagnoses and disease outcome of these patients, were all retrieved from the pediatric ward registers and hospital medical records. The data were analyzed using SPSS, version 20.0. Results: There were 2278 pediatric medical cases admitted over the study period. Males were 1364 and females were 914, giving a male: female ratio of 1.5:1. More than 90% of these patients were aged < less than 5 years. Severe malaria (31.1%), septicaemia (16.6%), bronchopneumonia (15.4%), uncomplicated malaria (11.9%), acute watery diarrhea (10.5%) and meningitis (3.7%) were the leading causes of admission. Mortality rate was 5.7%, with 87.5% of these deaths occurring in under-fives. Septicaemia (34.6%) and Severe malaria (23.2%) were the leading causes of death. Conclusion: There is a high rate of paediatric admissions at Living Word Hospital, Aba. The under-five population remains a vulnerable group to both childhood morbidity and mortality. Septicaemia, malaria, bronchopnuemonia and acute watery diarrhoea were the leading causes of morbidity and mortality. Childhood mortality at LWMH is lower than observed in most government hospitals in Nigeria.


Assuntos
Mortalidade da Criança/tendências , Mortalidade Hospitalar/tendências , Hospitalização/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Adolescente , Causas de Morte , Criança , Pré-Escolar , Feminino , Hospitais Privados/estatística & dados numéricos , Humanos , Lactente , Malária/epidemiologia , Malária/mortalidade , Masculino , Nigéria/epidemiologia , Estudos Retrospectivos , Sepse/epidemiologia , Sepse/mortalidade
12.
Med. intensiva (Madr., Ed. impr.) ; 42(8): 463-472, nov. 2018. tab, graf
Artigo em Inglês | IBECS | ID: ibc-180518

RESUMO

Objective: To assess whether patient age is independently associated to Intensive Care Unit (ICU) admission after non-cardiac surgery. Design: An observational cohort study of the Spanish subset of the European Surgical Outcome Study (EuSOS) was carried out. Setting: Hospitals of the public National Health Care System and private hospitals in Spain. Intervention: None. Patients and methods: All patients over 16 years of age undergoing inpatient non-cardiac surgery in the participating hospitals during a 7-day period in the month of April 2011 were consecutively included. Main variables of interest: ICU admission rate, factors associated with ICU admission and hospital mortality were assessed using logistic regression analysis and fractional polynomial regression. Results: Out of 5412 patients, 677 (12.5%) were admitted to the ICU after surgery. The adjusted odds ratio (95% confidence interval [CI]) for ICU admission was 1.1 (0.8-1.4) for patients aged 65-74 years, 0.7 (0.5-1) for patients aged 75-85 years, and 0.4 (0.2-0.8) for patients over 85 years, respectively. Age, ASA score, grade of surgery (minor, intermediate, major), urgent surgery, surgical specialty, laparoscopic surgery and metastatic disease were independent factors for ICU admission. Global risk-adjusted mortality was 1.4 (95% CI 0.9-2.2). The ASA score, urgent surgery, surgical specialty and diabetes were predictors of hospital mortality. Conclusions: Elderly patients (over 80 years) appear less likely to be admitted to ICU after non-cardiac surgery in Spanish hospitals. There was no significant association between age and postoperative mortality in this cohort


Objetivo: Evaluar si la edad del paciente se asociaba independientemente con el ingreso en la unidad de cuidados intensivos (UCI) tras cirugía no cardiaca. Diseño: Estudio observacional de cohortes del subgrupo español del European Surgical Outcome Study (EuSOS). Ámbito: Hospitales públicos y privados en España. Intervención: Ninguna. Pacientes y métodos: Pacientes consecutivos mayores de 16 años sometidos a cirugía no cardiaca con ingreso durante un periodo de 7 días del mes de abril de 2011. Variables de interés principal: Tasa de ingreso en la UCI, factores asociados con ingreso en la UCI y mortalidad hospitalaria, analizadas mediante regresión logística y regresión fraccional polinómica. Resultados: De 5.412 pacientes, 677 (12,5%) fueron ingresados en la UCI tras la cirugía. La odds ratio ajustada (intervalo de confianza [IC] del 95%) de ingreso en la UCI fue de 1,1 (0,8-1,4) para 65-74 años, 0,7 (0,5-1) para 75-85 años y de 0,4 (0,2-0,8) para más de 85 años, respectivamente. La edad, el grado ASA, el grado de la cirugía (menor, intermedia, mayor), la cirugía urgente, la especialidad quirúrgica, la cirugía laparoscópica y la enfermedad metastásica fueron factores independientes de ingreso en la UCI. El riesgo global ajustado de mortalidad fue de 1,4 (IC 95%: 0,9-2,2). El grado ASA, cirugía urgente, especialidad quirúrgica y diabetes fueron predictores de mortalidad hospitalaria. Conclusiones: En los hospitales españoles, los pacientes ancianos (más de 80 años) son menos propensos a ser ingresados en la UCI tras cirugía no cardiaca. En esta cohorte, la edad y la mortalidad hospitalaria no se asociaron significativamente


Assuntos
Humanos , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Fatores Etários , Mortalidade Hospitalar , Unidades de Terapia Intensiva/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Arritmias Cardíacas/epidemiologia , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Hospitais Universitários/estatística & dados numéricos , Inquéritos e Questionários
13.
SEMERGEN, Soc. Esp. Med. Rural Gen. (Ed. Impr.) ; 44(7): 449-457, oct. 2018. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-181244

RESUMO

Objetivo: Las agudizaciones de la enfermedad pulmonar obstructiva crónica (AEPOC) generan un elevado consumo de recursos. El presente estudio evalúa recursos asistenciales y organizativos disponibles para el manejo de las AEPOC en servicios de atención primaria (AP), neumología, medicina interna y urgencias españoles, y los compara con las recomendaciones vigentes. Material y métodos: Estudio observacional mediante encuestas telefónicas a médicos de AP, neumólogos, internistas y de urgencias. Resultados: Se entrevistaron 284 médicos. Según su opinión, los centros de AP tienen elevada disponibilidad de pulsioximetría (98,9%) y electrocardiografía (100,0%), y baja disponibilidad de radiología de tórax (19,1%) o analítica urgente (17,0%) en el mismo centro. El 76,1% de las salas de hospitalización disponen de equipos de monitorización de ventilación mecánica no invasiva (VMNI), aunque solo el 69,7% del personal de enfermería está adecuadamente formado para manejarlos. El 18,3% de hospitales públicos disponen de unidades de cuidados respiratorios intermedios (UCRI) frente al 41,7% de los privados. El 47,9% de médicos de urgencias recibieron formación de manejo de las AEPOC en el último año. Solo el 31,9% de centros de AP tienen protocolos específicos de derivación a atención especializada. Algo más del 35% de centros de AP y hospitales refieren no disponer de historia informatizada integrada con otros niveles asistenciales. Conclusiones: En líneas generales, los recursos disponibles son adecuados. Sin embargo, se detectan áreas de mejora como el inadecuado nivel de integración de la historia informatizada entre niveles asistenciales, baja dotación de UCRI en hospitales públicos o deficiencias en formación específica del manejo de la VMNI


Objective: Chronic obstructive pulmonary disease exacerbations (COPDE) lead to a high use of healthcare resources. This study assesses the healthcare and organisational resources of Spanish health care centres for the management of COPDE at different care levels (Primary Care (PC), Respiratory Diseases, Internal Medicine, and Emergency Departments), and compare with current recommendations. Material and methods: An observational study was carried out through telephone interviews to General Practitioners, Chest Diseases, Internal Medicine, and Emergency Department doctors. Results: A total of 284 doctors were interviewed. According to their responses, at PC centres there is a high availability of pulse oximetry (98.9%) and electrocardiograph (100%), and a low availability of Chest X-Ray (19.1%), or urgent laboratory tests (17.0%) in sites. In hospital wards, non-invasive mechanical ventilation (NIV) availability was 76.1%, with only a 69.7% of nursing staff properly trained in its use. Respiratory intermediate care units (RICUs) were available in 18.3% of public hospitals versus 41.7% of private hospitals. Specific training for COPDE management was received by 47.9% of Emergency Department doctors in the previous year. Only 31.9% of PC centres had specific protocols for referring patients to specialists. More than 35% of PC centres and hospitals do not have their electronic medical records integrated with other healthcare levels. Conclusions: In general terms, there are sufficient resources available in Spanish healthcare centres. However, several areas of improvement were identified, such as an insufficient level of electronic medical record integration between healthcare levels, limited implementation of RICUs in public hospitals, and deficiencies related to specific training in NIV management


Assuntos
Humanos , Masculino , Feminino , Adulto , Assistência à Saúde/organização & administração , Médicos/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/terapia , Encaminhamento e Consulta/estatística & dados numéricos , Assistência à Saúde/estatística & dados numéricos , Registros Eletrônicos de Saúde/estatística & dados numéricos , Recursos em Saúde/estatística & dados numéricos , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Espanha
14.
BMC Health Serv Res ; 18(1): 701, 2018 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-30200950

RESUMO

BACKGROUND: Hip fracture in elderly patients is a rising global public health concern because of population ageing, and increasing frailty. Long-term morbidity related to poor management of hip fracture is associated with decreased quality of life, survival, and increase in healthcare costs. Receiving postoperative rehabilitation is associated with better outcomes and a higher likelihood of returning to pre-existing level of functioning. However little is known about which postoperative rehabilitation pathways are more effective to optimize patient outcomes. Few studies have analyzed postoperative rehabilitation pathways in a universal healthcare system. The aim of this study is to analyze the impact of post-acute rehabilitation pathways on mortality and readmission in elderly patients undergoing surgery for hip fracture in a large metropolitan area in Italy. METHODS: In this retrospective cohort study, we analyzed 6-month mortality from admission and 6-month readmission after hospital discharge in patients who underwent surgical repair for hip fracture in the hospitals of the Bologna metropolitan area between 1.1.2013 and 30.6.2014. Data were drawn from the regional hospital discharge records database. Kaplan-Meier estimates and multiple Cox regression were used to analyze mortality as a function of rehabilitation pathways. Multiple logistic regression determined predictors of readmission. RESULTS: The study population includes 2208 patients, mostly women (n = 1677, 76%), with a median age of 83.8 years. Hospital rehabilitation was provided to 519 patients (23.5%), 907 (41.1%) received rehabilitation in private inpatient rehabilitation facilities (IRF) accredited by the National Health System, and 782 (35.4%) received no post-acute rehabilitation. Compared with patient receiving hospital rehabilitation, the other groups showed significantly higher mortality risks (no rehabilitation, Hazard Ratio (HR) = 2.19, 95%CI = 1.54-3.12, p < 0.001; IRF rehabilitation, HR = 1.66, 95%CI = 1.54-1.79, p < 0.001). The risk of readmission did not differ significantly among rehabilitation pathways. CONCLUSIONS: Intensive hospital rehabilitation was significantly associated with a lower risk of mortality compared to IRF rehabilitation and no rehabilitation. Our results may help in the development of evidence-based recommendations aimed to improve resource utilization and quality of care in hip fracture patients. Further research is warranted to investigate the impact of the rehabilitation pathway on other outcomes, such as patients' functional status and quality of life.


Assuntos
Fraturas do Quadril/reabilitação , Idoso , Idoso de 80 Anos ou mais , Feminino , Custos de Cuidados de Saúde , Recursos em Saúde/estatística & dados numéricos , Fraturas do Quadril/mortalidade , Fraturas do Quadril/cirurgia , Hospitais Privados/estatística & dados numéricos , Humanos , Pacientes Internados/estatística & dados numéricos , Itália , Masculino , Pessoa de Meia-Idade , Alta do Paciente/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Qualidade de Vida , Estudos Retrospectivos , Fatores de Risco
15.
Gac. sanit. (Barc., Ed. impr.) ; 32(4): 369-372, jul.-ago. 2018. tab, graf
Artigo em Inglês | IBECS | ID: ibc-174161

RESUMO

Objective: To measure time trends in major day surgery rates according to hospital ownership and other hospital characteristics among the providers of the public healthcare network of Catalonia, Spain. Method: Data from the Statistics of Health Establishments providing Inpatient Care. A generalized linear mixed model with Gaussian response and random intercept and random slopes. Results: The greatest growth in the rate of major day surgery was observed among private for-profit hospitals: 42.9 (SD: 22.5) in 2009 versus 2.7 (SD: 6.7) in 1996. These hospitals exhibited a significant increase in major day surgery compared to public hospitals (coefficient 2; p-value <0.01) Conclusions: The comparative evaluation of hospital performance is a decisive tool to ensure that public resources are used as rationally and efficiently as possible


Objetivo: Medir la evolución temporal de la cirugía mayor ambulatoria entre los proveedores de la red sanitaria pública de Cataluña de acuerdo con la titularidad y otras características de los hospitales. Métodos: Con datos provenientes de la Estadística de Establecimientos Sanitarios con Régimen de Internamiento, se realizó un modelo lineal generalizado mixto con respuesta gaussiana y pendiente e intersección aleatorios. Resultados: Se observó que la mayor variación en la tasa de cirugía mayor ambulatoria era para los hospitales privados con fines de lucro: 42,9 (desviación estándar [DE]: 22,5) en 2009 frente a 2,7 (DE: 6,7) en 1996. Estos hospitales tuvieron un aumento significativo de la cirugía mayor ambulatoria en comparación con los hospitales públicos (coeficiente 2; p <0,01). Conclusiones: La evaluación comparativa del desempeño de los hospitales es una herramienta decisiva para garantizar que los recursos públicos se utilizan de la forma más racional y eficiente posible


Assuntos
Humanos , Procedimentos Cirúrgicos Ambulatórios/estatística & dados numéricos , Pesquisa sobre Serviços de Saúde/estatística & dados numéricos , Modelos Lineares , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos
16.
Rev Saude Publica ; 52: 69, 2018 Jul 23.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30043953

RESUMO

OBJECTIVE: To evaluate factors associated with hospital death in older inpatients for specific diseases of the circulatory system in the Brazilian Unified Health System considering the risk-adjusted hospital mortality as an indicator of effectiveness. METHODS: The data were extracted from the Brazilian Hospital Information System. A total of 385,784 hospitalizations of older were selected for hypertensive diseases, ischemic heart disease, congestive heart failure, and stroke in the Brazilian Southeast region between 2011 and 2012. Age, sex, emergency admission, principal diagnosis, and two comorbidity indexes were included in the logistic regression for the risk adjustment of hospital death. The analyses were developed at two levels: hospitalization and hospital. RESULTS: A greater chance of death was observed with increasing age, emergency hospitalizations, stroke, presence of comorbidities, especially pneumonia and weight loss, hospitalizations for clinical care, and use of intensive care units. The risk-adjusted hospital mortality rate was 11.1% in for-profit private hospitals, 12.3% in non-profit private hospitals, and 14.4% in public hospitals, but there was great variability among the hospitals. The hospital standardized mortality ratio (ratio between observed and predicted deaths) ranged from 103.3% in non-profit private hospitals to 118.2% in for-profit private hospitals. CONCLUSIONS: Although the information source has its shortcomings, the ability for discrimination of the risk adjustment model was reasonable. The variability in the risk-adjusted hospital mortality was great and comparatively higher in for-profit private hospitals. Despite the limits, the results favor the use of the risk-adjusted hospital mortality in the monitoring of the quality of hospital care provided to the older adult.


Assuntos
Doenças Cardiovasculares/mortalidade , Mortalidade Hospitalar , Distribuição por Idade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Causas de Morte , Estudos Transversais , Feminino , Hospitalização/estatística & dados numéricos , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Qualidade da Assistência à Saúde , Risco Ajustado , Fatores de Risco , Índice de Gravidade de Doença , Distribuição por Sexo
17.
Cad Saude Publica ; 34(6): e00156416, 2018 06 21.
Artigo em Português | MEDLINE | ID: mdl-29947661

RESUMO

This study aimed to identify birth clusters according to type of hospital (SUS vs. non-SUS) and the existence of differences in socioeconomic, maternal, neonatal, and healthcare access characteristics, measured by the distance between the mothers' homes and the hospitals where they gave birth. Births to mothers residing in the city of São Paulo, Brazil, in 2010 were georeferenced and allocated in 310 weighting areas from the population census, in addition to classifying them according to hospital of birth (SUS vs. non-SUS). Spatial clusters were identified through the spatial sweep technique for spatial dependence of SUS and non-SUS births, leading to the formation of ten SUS clusters and seven non-SUS clusters. Births in non-SUS hospitals formed clusters in the city's central area, with a lower proportion of low-income households. The SUS birth clusters were located on the outskirts of the city, where there are more households in subnormal clusters. Both SUS and non-SUS clusters were not internally homogeneous, showing differences in maternal age, schooling, and number of prenatal visits and very premature newborns. The theoretical mean distance traveled by mothers to the hospital was 51.8% lower in the SUS clusters (5.1km) than in the non-SUS clusters (9.8km). The formation of birth clusters showed differences in maternal, pregnancy, childbirth, and neonatal characteristics, in addition to displaying a radial-concentric spatial distribution, reflecting the city's prevailing socioeconomic differences. The shorter distance in SUS births indicates regionalization of childbirth care in the city of São Paulo.


Assuntos
Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Nascimento Vivo/epidemiologia , Adulto , Índice de Apgar , Brasil/epidemiologia , Cesárea/estatística & dados numéricos , Cidades , Análise por Conglomerados , Feminino , Sistemas de Informação Geográfica , Disparidades nos Níveis de Saúde , Humanos , Recém-Nascido , Idade Materna , Programas Nacionais de Saúde/estatística & dados numéricos , Gravidez , Fatores Socioeconômicos , Análise Espacial , Adulto Jovem
18.
BMC Health Serv Res ; 18(1): 276, 2018 04 11.
Artigo em Inglês | MEDLINE | ID: mdl-29642905

RESUMO

BACKGROUND: Drug resistance is a growing challenge to tuberculosis (TB) control worldwide, but particularly salient to countries such as Myanmar, where the health system is fragmented across the public and private sector. A recent systematic review has identified a critical lack of evidence for local policymaking, particularly in relation to drivers of drug-resistance that could be the target of preventative efforts. To address this gap from a health systems perspective, our study investigates the healthcare-seeking behavior and preferences of recently diagnosed patients with drug-resistant tuberculosis (DR-TB), focusing on the use of private versus public healthcare providers. METHODS: The study was conducted in ten townships across Yangon with high DR-TB burden. Patients newly-diagnosed with DR-TB by GeneXpert were enrolled, and data on healthcare-seeking behavior and socio-economic characteristics were collected from patient records and interviews. A descriptive analysis of healthcare-seeking behavior was followed by the investigation of relationships between socio-economic factors and type of provider visited upon first feeling unwell, through univariate logistic regressions. RESULTS: Of 202 participants, only 8% reported first seeking care at public facilities, while 88% reported seeking care at private facilities upon first feeling unwell. Participants aged 25-34 (Odds Ratio = 0.33 [0.12-0.95]) and males (Odds Ratio = 0.39 [0.20-0.75]) were less likely to visit a private clinic or hospital than those aged 18-24 and females, respectively. In contrast, participants with higher income were more likely to utilize private providers. Prior to DR-TB diagnosis, 86% of participants took medications from private providers. After DR-TB diagnosis, only 7% of participants continued to take medications from private providers. CONCLUSION: In urban Myanmar, most patients shifted to being managed exclusively in the public sector after being formally diagnosed with DR-TB. However, since the vast majority of DR-TB patients first visited private providers in the period leading to diagnosis, related issues such as unregulated quality of care, potential delays to diagnosis, and lack of care continuity may greatly influence the emergence of drug-resistance. A greater understanding of the health system and these healthcare-seeking behaviors may simultaneously strengthen TB control programmes and reduce government and out-of-pocket expenditures on the management of DR-TB.


Assuntos
Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Setor Privado/estatística & dados numéricos , Tuberculose Resistente a Múltiplos Medicamentos/terapia , Tuberculose Pulmonar/terapia , Adolescente , Adulto , Idoso , Terapias Complementares/estatística & dados numéricos , Estudos Transversais , Assistência à Saúde , Feminino , Pessoal de Saúde , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Mianmar , Setor Público/estatística & dados numéricos , Estudos Retrospectivos , Adulto Jovem
19.
Transplant Proc ; 50(2): 449-453, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29579825

RESUMO

BACKGROUND: Kidney transplantation (KT) is the replacement therapy of choice in patients with end-stage renal disease (ESRD). Here we show a cohort of kidney transplant recipients from the period of May 1994 to May 2016 in 2 2nd-level private hospitals from the city of Toluca in the state of Mexico. METHODS: We checked the clinical files of all the patients that received KT in the period of study. RESULTS: We report 25 KT: 23 performed in Sanatorio Toluca and 2 in Sanatorio Florencia; 16 (64%) male and 9 (26%) female; mean age 36.03 ± 15.9 years (range, 10-66); 19 (76%) hemodialysis and 9 (24%) continuous ambulatory peritoneal dialysis before KT; ESRD etiology unknown in 16 (64%), diabetes in 5 (20%), IgA nephropathy in 2 (8%), and other in 2 (8%); living donors in 13 (52%) and deceased donors in 12 (48%); blood group 0+ in 18 (72%), A+ in 5 (20%), and B+ in 2 (8%); 21 (84%) with 0 and 4 (16%) with 1 HLA mismatch; and delayed graft function in 8 (32%), of which 7 were from deceased donors and 1 from a living donor. All 25 (100%) had a functional kidney at 1 year of follow-up. Immunosuppression regime consisted of multitarget maintenance therapy in all 25 (100%): cyclosporine in 18 (72%) and tacrolimus in 7 (28%). We used only methylprednisolone (MTP) as induction therapy. There were only 2 cases (8%) of acute rejection during the 1st 6 months of follow-up, and both responded to treatment with MTP. CONCLUSIONS: KT is the treatment of choice for patients with ESRD. The obtained results using only an MTP induction regime are satisfactory, with graft and patient survivals of 100% in the 1st year of follow-up.


Assuntos
Falência Renal Crônica/cirurgia , Transplante de Rim , Adolescente , Adulto , Idoso , Criança , Ciclosporina/uso terapêutico , Feminino , Hospitais Privados/estatística & dados numéricos , Humanos , Imunossupressão/métodos , Transplante de Rim/efeitos adversos , Transplante de Rim/métodos , Transplante de Rim/mortalidade , Masculino , México , Pessoa de Meia-Idade , Estudos Retrospectivos , Tacrolimo/uso terapêutico , Resultado do Tratamento , Adulto Jovem
20.
Indian Heart J ; 70(1): 32-36, 2018 Jan - Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29455784

RESUMO

OBJECTIVE: Complications after percutaneous coronary interventions (PCI) are associated with significant morbidity and mortality, although institutional discrepancies can occur when public and private hospitals coexist within the healthcare system. The aim of this study was to compare the in-hospital complication rates and mortality in addition to long-term survival following elective PCI in two reference public and private cardiology hospitals in Rio de Janeiro, Brazil. METHODS: From January 1st 2013 to December 31st 2014, a total of 440 procedures were identified in both hospitals (public: 328 vs. private: 112) and retrospectively analyzed by chart review. RESULTS: There were no significant differences between the two hospitals regarding the total number of procedures with at least one complication (public: 23.8 vs. private: 17.9%, p=0.2) or in-hospital mortality rates (public: 0.6% vs. private: 0%, p=0.5). Post-procedural renal insufficiency was more frequent in the private hospital, whereas coronary-related complications were more prevalent in the public hospital. After a mean follow up of 30.3 months (SD±9.2), the survival rate was also similar. CONCLUSIONS: Clinical complications after elective PCI are common both in public and private hospitals. Meticulous pre-procedural clinical assessment and patient selection as well as adherence to guideline-based practices could minimize the risk of PCI-related adverse events.


Assuntos
Doença da Artéria Coronariana/cirurgia , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Intervenção Coronária Percutânea/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Idoso , Brasil/epidemiologia , Feminino , Mortalidade Hospitalar/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida/tendências
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