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1.
J Surg Res ; 257: 50-55, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32818784

RESUMO

BACKGROUND: Emergency general surgery (EGS) has high rates of morbidity, mortality, and readmission. Therefore, it might be expected that an EGS service fields many consultations for postoperative patients. However, with the known overutilization of emergency department visits for nonurgent conditions, we hypothesized most postoperative consults received by an EGS service would be nonurgent and could be appropriately managed as an outpatient. METHODS: We reviewed all EGS consults at a single urban safety net hospital over a 12-month period, screening for patients who had undergone surgery in the previous 12 mo. This included consultations from the emergency room and inpatient setting. Demographics, admission status, procedures performed, and other details were abstracted from the chart and Vizient reports. Consultation questions were categorized and then reviewed by an expert panel to determine if conditions could have been managed as an outpatient. RESULTS: The EGS service received a total of 1112 consults, with 99 (9%) for a postoperative condition. Overall, 85% of postoperative consults were admitted after consultation, 19% underwent surgery and 21% underwent a procedure with gastroenterology or interventional radiology. Expert review classified slightly over one-third (36%) of consults as nonurgent. CONCLUSIONS: Most postoperative consults seen at our urban safety net hospital represent true morbidity that required admission, intervention, or surgery. Despite this high acuity, one-third of postoperative consults could have been managed as an outpatient. Efforts to improve discharge instructions and set patient expectations could limit unnecessary postoperative emergency department visits.


Assuntos
Tratamento de Emergência/estatística & dados numéricos , Cirurgia Geral/estatística & dados numéricos , Hospitais Urbanos , Cuidados Pós-Operatórios/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Provedores de Redes de Segurança/estatística & dados numéricos , Abdome/cirurgia , Adulto , Assistência Ambulatorial , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Encaminhamento e Consulta , Estudos Retrospectivos , Resultado do Tratamento
2.
Int J Infect Dis ; 102: 63-69, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33075539

RESUMO

BACKGROUND: New York City (NYC) has endured the greatest burden of COVID-19 infections in the US. Health inequities in South Bronx predisposed this community to a large number of infectious cases, hospitalizations, and mortality. Health care workers (HCWs) are at a high risk of exposure to the infection. This study aims to assess seroprevalence and the associated characteristics of consenting HCWs from an NYC public hospital. METHODS: This cross-sectional study includes serum samples for qualitative SARS-CoV-2 antibody testing with nasopharyngeal swabs for SARS-CoV-2; PCR and completion of an online survey capturing demographics, COVID-19 symptoms during the preceding months on duty, details of healthcare and community exposure, and travel history were collected from consenting participants in May 2020. Participants' risk of exposure to COVID-19 infection in the hospital and in the community was defined based on CDC guidelines. Travel history to high-risk areas was also considered an additional risk. The Odds Ratio with bivariable and multivariable logistic regression was used to assess characteristics associated with seroprevalence. RESULTS: A total of 500 HCW were tested, 137 (27%) tested positive for the SARS-CoV-2 antibody. Symptomatic participants had a 75% rate of seroconversion compared to those without symptoms. Subjects with anosmia and ageusia had increased odds of seroconversion in comparison to those without these symptoms. Community exposure was 34% among those who had positive antibodies. CONCLUSION: Seroprevalence among HCWs was high compared to the community at the epicenter of the pandemic. Further studies to evaluate sustained adaptive immunity in this high-risk group will guide our response to a future surge.


Assuntos
/epidemiologia , Pessoal de Saúde , Adulto , Estudos Transversais , Feminino , Hospitais Urbanos , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Pandemias , Estudos Soroepidemiológicos
3.
J Am Soc Nephrol ; 32(1): 151-160, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32883700

RESUMO

BACKGROUND: Early reports indicate that AKI is common among patients with coronavirus disease 2019 (COVID-19) and associated with worse outcomes. However, AKI among hospitalized patients with COVID-19 in the United States is not well described. METHODS: This retrospective, observational study involved a review of data from electronic health records of patients aged ≥18 years with laboratory-confirmed COVID-19 admitted to the Mount Sinai Health System from February 27 to May 30, 2020. We describe the frequency of AKI and dialysis requirement, AKI recovery, and adjusted odds ratios (aORs) with mortality. RESULTS: Of 3993 hospitalized patients with COVID-19, AKI occurred in 1835 (46%) patients; 347 (19%) of the patients with AKI required dialysis. The proportions with stages 1, 2, or 3 AKI were 39%, 19%, and 42%, respectively. A total of 976 (24%) patients were admitted to intensive care, and 745 (76%) experienced AKI. Of the 435 patients with AKI and urine studies, 84% had proteinuria, 81% had hematuria, and 60% had leukocyturia. Independent predictors of severe AKI were CKD, men, and higher serum potassium at admission. In-hospital mortality was 50% among patients with AKI versus 8% among those without AKI (aOR, 9.2; 95% confidence interval, 7.5 to 11.3). Of survivors with AKI who were discharged, 35% had not recovered to baseline kidney function by the time of discharge. An additional 28 of 77 (36%) patients who had not recovered kidney function at discharge did so on posthospital follow-up. CONCLUSIONS: AKI is common among patients hospitalized with COVID-19 and is associated with high mortality. Of all patients with AKI, only 30% survived with recovery of kidney function by the time of discharge.


Assuntos
Lesão Renal Aguda/etiologia , /complicações , Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/terapia , Lesão Renal Aguda/urina , Idoso , Idoso de 80 Anos ou mais , Feminino , Hematúria/etiologia , Mortalidade Hospitalar , Hospitais Privados/estatística & dados numéricos , Hospitais Urbanos/estatística & dados numéricos , Humanos , Incidência , Pacientes Internados , Leucócitos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Proteinúria/etiologia , Diálise Renal , Estudos Retrospectivos , Resultado do Tratamento , Urina/citologia
4.
Qual Manag Health Care ; 30(1): 61-68, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33306657

RESUMO

BACKGROUND AND OBJECTIVES: In response to the COVID-19 pandemic outbreak and to ensure the safety of epidemic prevention in the hospital, the hospital has established mitigation strategies in advance including risk assessment and effect analysis to control hospital visitors and accompanying persons. The study aims to assess the effectiveness of mitigation strategies implemented to effectively prevent the invasion and spread of the virus. METHOD: Conduct a status analysis in accordance with the Healthcare Failure Mode and Effect Analysis (HFMEA) 4-step model, construct a response workflow, confirm the failure mode and potential causes, perform hazard matrix analysis and decision tree analysis, and formulate risk control management measures. RESULTS: For the 4 main processes and 9 subprocesses of the accompanying carers and contract caregivers entering the hospital, 26 potential failure modes and 42 potential causes of failure were analyzed. Following implementing improvement measures including strategies targeting the accompanying person, mitigation workflow failure rates decreased from 42 to 13 items, the pass rate for the maximum body temperature cutoff increased from 53.1% to 90.8%, and the compliance rate of hand washing increased from 89.5% to 100%. CONCLUSION: The HFMEA model can effectively implement preventive risk assessment and workflow management of high-risk medical procedures. The model can adjudicate the health of hospital visitors during the epidemic/pandemic, provide epidemic/pandemic education training and preventive measure health education guidance for hospital visits, and improve their epidemic prevention cognition. When combined, these strategies can prevent nosocomial infection to achieve the best anti-epidemic effect.


Assuntos
/prevenção & controle , Infecção Hospitalar/prevenção & controle , Análise do Modo e do Efeito de Falhas na Assistência à Saúde , Visitas a Pacientes , /transmissão , Cuidadores , Infecção Hospitalar/transmissão , Desinfecção das Mãos , Análise do Modo e do Efeito de Falhas na Assistência à Saúde/métodos , Análise do Modo e do Efeito de Falhas na Assistência à Saúde/organização & administração , Hospitais Urbanos/organização & administração , Humanos , Modelos Organizacionais , Política Organizacional , Medição de Risco , Taiwan/epidemiologia
5.
Isr Med Assoc J ; 22(12): 765-769, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33381949

RESUMO

BACKGROUND: Lung percutaneous needle biopsy (PNB) is routinely used to diagnose lung cancer. The most prevalent complications of PNB are pneumothorax and bleeding. Differences in characteristics of medical procedures between rural and urban hospitals are well known. OBJECTIVES: To compare characteristics of patients and lesions between two hospitals and to evaluate whether lung PNB complications differ in rural vs. urban settings. METHODS: The authors examined case records of 561 patients who underwent lung biopsy at two different medical centers in Israel: Tel Aviv Sourasky Medical Center (urban) and Barzilai Medical Center (rural). To evaluate the complication rates, the authors analyzed findings from chest X-ray performed 2 hours after biopsy and computed tomography (CT) images at the site of biopsy. RESULTS: The study comprised 180 patients who underwent lung biopsy at Barzilai and 454 at Sourasky. The rate of pneumothorax did not differ between centers (12% at Barzilai and 19% at Sourasky, P = 0.08). Distance from pleura was positively correlated to pneumothorax occurrence in both centers; however, neither lesion size nor lesion locus was found to be a risk factor for pneumothorax. Mild bleeding at the biopsy site occurred equally at Barzilai and Sourasky (32% vs. 36%, P = 0.3, respectively). Furthermore, immediate CT post-biopsy at Barzilai showed 95% negative predictive value, showing that a CT scan performed immediately after lung biopsy cannot replace the routine follow-up chest X-ray in predicting iatrogenic pneumothorax. CONCLUSIONS: CT-guided percutaneous lung biopsies are comparable between rural and urban hospitals regarding procedure characteristics and complication rates.


Assuntos
Biópsia por Agulha/métodos , Hospitais Rurais , Pulmão/patologia , Radiografia Intervencionista , Biópsia por Agulha/efeitos adversos , Hemorragia/etiologia , Hospitais Urbanos , Humanos , Israel , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/patologia , Pneumotórax/etiologia , Radiografia Intervencionista/métodos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
8.
PLoS One ; 15(11): e0241615, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33147293

RESUMO

BACKGROUND: The recent introduction of direct acting antivirals for the treatment of hepatitis C virus (HCV) has dramatically improved treatment options for HCV infected patients. However, in the United States (US) treatment uptake has been low and time to initiation of therapy has been long. We sought to examine provider perspectives of facilitators and barriers to HCV treatment delivery. METHODS: From June to August 2019, we conducted in-depth, semi-structured interviews with medical staff providing HCV care as part of a university medical center in Los Angeles, CA. In order to understand the HCV treatment process, we interviewed key staff members providing care to the majority of HCV patients seeking care at the university medical center, including hepatologists and infectious disease specialists as well as key nursing and pharmacy staff. The interviews focused on workload and activities required for HCV treatment initiation for non-cirrhotic, treatment naïve patients. RESULTS: Providers noted that successful HCV treatment delivery was reliant on a care model involving close collaboration between a team of providers, in particular requiring a highly coordinated effort between dedicated nursing and pharmacy staff. The HCV care team overwhelmingly reported that the process of insurance authorization was the greatest obstacle delaying treatment initiation and noted that very few patient level factors served as a barrier to treatment uptake. CONCLUSIONS: In the US, prior authorization for HCV treatment is a requirement for most public and private insurance plans. In an era with access to therapies that allow for a cure-and until revocation of prior authorization for HCV treatment is a reality-implementing strategies that can expedite authorization to accelerate treatment access are critical. Not only will this benefit patients, but it has the potential to help expand treatment to settings that are otherwise too resource strained to successfully deliver HCV care.


Assuntos
Assistência à Saúde/estatística & dados numéricos , Uso de Medicamentos/tendências , Hepatite C/tratamento farmacológico , Autorização Prévia/estatística & dados numéricos , Antivirais/administração & dosagem , Antivirais/uso terapêutico , California , Pessoal de Saúde/psicologia , Pessoal de Saúde/estatística & dados numéricos , Hepatite C/epidemiologia , Hospitais Urbanos/estatística & dados numéricos , Humanos , Inquéritos e Questionários
9.
Am Surg ; 86(12): 1629-1635, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33231486

RESUMO

BACKGROUND: The role of an acute care surgery (ACS) service during the COVID-19 pandemic is not well established. METHODS: A retrospective review of the ACS service performance in an urban tertiary academic medical center. The study was performed between January and May 2020. The demographics, clinical characteristics, and outcomes of patients treated by the ACS service 2 months prior to the COVID surge (pre-COVID group) and during the first 2 months of the COVID-19 pandemic (surge group) were compared. RESULTS: Trauma and emergency general surgery volumes decreased during the surge by 38% and 57%, respectively; but there was a 64% increase in critically ill patients. The proportion of patients in the Department of Surgery treated by the ACS service increased from 40% pre-COVID to 67% during the surge. The ACS service performed 32% and 57% of all surgical cases in the Department of Surgery during the pre-COVID and surge periods, respectively. The ACS service managed 23% of all critically ill patients in the institution during the surge. Critically ill patients with and without confirmed COVID-19 infection treated by ACS and non-ACS intensive care units during the surge did not differ in demographics, indicators of clinical severity, or hospital mortality:13.4% vs. 13.5% (P = .99) for all critically ill patients; and 13.9% vs. 27.4% (P = .12) for COVID-19 critically ill patients. CONCLUSION: Acute care surgery is an "essential" service during the COVID-19 pandemic, capable of managing critically ill nonsurgical patients while maintaining the provision of trauma and emergent surgical services. LEVEL OF EVIDENCE: III. STUDY TYPE: Therapeutic.


Assuntos
Cuidados Críticos/organização & administração , Serviço Hospitalar de Emergência/organização & administração , Centro Cirúrgico Hospitalar/organização & administração , Centros Médicos Acadêmicos/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitais Urbanos/organização & administração , Humanos , Pandemias , Estudos Retrospectivos , Centro Cirúrgico Hospitalar/estatística & dados numéricos , Centros de Atenção Terciária/organização & administração , Ferimentos e Lesões/cirurgia
10.
Saudi Med J ; 41(11): 1204-1210, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33130840

RESUMO

OBJECTIVES: To evaluate acute cardiac injury in COVID-19 patients and its association with adverse outcomes including mortality in the United Arab Emirates (UAE) population. METHODS: A retrospective study conducted between February and June 2020 in Dubai, UAE, for all laboratory-confirmed Coronavirus disease-19 patients. Demographic, clinical, laboratory, radiological, and clinical outcomes were compared between patients with and without acute cardiac injury. RESULTS: During the study period, 203 patients were included, of which, 44 (21.7%) had evidence of acute cardiac injury. Compared with patients without acute cardiac injury, patients with acute cardiac injury were: older, had more shortness of breath, diabetes, hypertension, and more bilateral airspace shadowing on admission chest radiography. These patients also had a higher neutrophil count, C-reactive protein, procalcitonin, ferritin, D-dimers and lactate dehydrogenase but lower lymphocyte count. Regarding outcomes, these patients had higher intensive care admissions; a higher rate of complications including acute kidney and liver injury, acidosis, septic shock, acute respiratory distress syndrome, needed more mechanical ventilation, and had a significantly higher risk of death. CONCLUSION: Acute cardiac injury is common among Coronavirus disease-19 patients. These patients present with higher comorbidities, have high inflammatory markers and have greater risk for in-hospital multi-organ damage, need for mechanical ventilation, and death. Prompt full assessment and intervention are recommended.


Assuntos
Causas de Morte , Infecções por Coronavirus/epidemiologia , Traumatismos Cardíacos/epidemiologia , Mortalidade Hospitalar/tendências , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Doença Aguda , Adulto , Idoso , Estudos de Coortes , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Feminino , Traumatismos Cardíacos/diagnóstico , Hospitalização/estatística & dados numéricos , Hospitais Urbanos , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Estudos Retrospectivos , Arábia Saudita/epidemiologia , Índice de Gravidade de Doença , Taxa de Sobrevida
11.
PLoS One ; 15(11): e0241544, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33141867

RESUMO

INTRODUCTION: COVID-19 has spread globally to now be considered a pandemic by the World Health Organisation. Initially patients appeared to have a respiratory limited disease but there are now increasing reports of multiple organ involvement including renal disease in association with COVID-19. We studied the development and outcomes of acute kidney injury (AKI) in patients with COVID-19, in a large multicultural city hospital trust in the UK, to better understand the role renal disease has in the disease process. METHODS: This was a retrospective review using electronic records and laboratory data of adult patients admitted to the four Manchester University Foundation Trust Hospitals between March 10 and April 30 2020 with a diagnosis of COVID-19. Records were reviewed for baseline characteristics, medications, comorbidities, social deprivation index, observations, biochemistry and outcomes including mortality, admission to critical care, mechanical ventilation and the need for renal replacement therapy. RESULTS: There were 1032 patients included in the study of whom 210 (20.3%) had AKI in association with the diagnosis of COVID-19. The overall mortality with AKI was considerably higher at 52.4% compared to 26.3% without AKI (p-value <0.001). More patients with AKI required escalation to critical care (34.8% vs 11.2%, p-value <0.001). Following admission to critical care those with AKI were more likely to die (54.8% vs 25.0%, p-value <0.001) and more likely to require mechanical ventilation (86.3% vs 66.3%, p-value 0.006). DISCUSSION: We have shown that the development of AKI is associated with dramatically worse outcomes for patients, in both mortality and the requirement for critical care. Patients with COVID-19 presenting with, or at risk of AKI should be closely monitored and appropriately managed to prevent any decline in renal function, given the significant risk of deterioration and death.


Assuntos
Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/etiologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Lesão Renal Aguda/mortalidade , Lesão Renal Aguda/virologia , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/virologia , Feminino , Mortalidade Hospitalar , Hospitalização , Hospitais Urbanos , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/mortalidade , Pneumonia Viral/virologia , Respiração Artificial/métodos , Estudos Retrospectivos , Reino Unido/epidemiologia
12.
N Z Med J ; 133(1524): 64-81, 2020 10 30.
Artigo em Inglês | MEDLINE | ID: mdl-33119571

RESUMO

AIM: Primary percutaneous coronary intervention (PCI) is the optimal reperfusion strategy to manage ST-elevation myocardial infarction (STEMI). Where timely primary PCI cannot be achieved, an initial pharmacological reperfusion strategy is recommended with subsequent transfer to a PCI-capable hospital. The study aim was to assess STEMI outcomes according to the interventional capability of the New Zealand hospital to which patients initially present. METHODS: Nine thousand four hundred and eighty-eight New Zealand patients, aged 20-79 years, admitted with STEMI to a public hospital were identified. Patients were categorised into three groups-metropolitan hospitals with all-hours access to primary PCI (routine primary PCI cohort), metropolitan hospitals without routine access to PCI, and rural hospitals. The primary outcome was all-cause mortality. Secondary outcomes were major adverse cardiac events (MACE) and major bleeding. RESULTS: Invasive coronary angiography was more frequent in the routine primary PCI cohort compared to metropolitan hospitals without routine access to PCI and rural hospitals (90.6 vs 83.0 vs 85.0% respectively; p<0.001) and occurred more commonly on the day of admission (78.9 vs 28.7 vs 25.7% respectively; p<0.001). There were no differences in multivariable adjusted all-cause mortality, MACE or major bleeding between patients admitted to any of the hospital groupings. CONCLUSION: Outcomes after STEMI in New Zealand are similar regardless of the interventional capability of the hospital where they first present.


Assuntos
Angiografia Coronária , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Adulto , Idoso , Causas de Morte , Estudos de Coortes , Feminino , Hospitalização , Hospitais Rurais , Hospitais Urbanos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Tempo para o Tratamento , Resultado do Tratamento
13.
Am J Nephrol ; 51(10): 786-796, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33011717

RESUMO

BACKGROUND: Although diffuse alveolar damage and respiratory failure are the key features of coronavirus disease 2019 (COVID-19), the involvement of other organs such as the kidney has also been reported. The reports of the incidence of acute kidney injury (AKI) in COVID-19 patients vary widely. In this study, we report our unique experience with AKI in COVID-19 patients in a low socioeconomic and predominantly ethnic minority group and provide its incidence, risk factors, and prognosis to expand the current understanding of this complication. METHODS: In this single-center, retrospective cohort study, we analyzed the data of 469 COVID-19 patients admitted to the Brookdale University Hospital in Brooklyn, NY, from March 18 through April 23, 2020. Information regarding demographics, comorbidities, medications, clinical and laboratory data, and outcomes was collected from the electronic medical records. Both univariate and multivariate analyses were performed to determine the association of AKI with in-hospital mortality. RESULTS: The median age was 66 years (interquartile range [IQR] 25-75; range 19-101 years), and 268 (57.14%) patients were male. Estimated glomerular filtration rate (eGFR) as determined by the Modification of Diet in Renal Disease Study Equation was low (<60 mL/min/1.73 m2) in 207 (44.1%) patients. During hospitalization, 128 (27.3%) patients developed AKI, and the incidence was significantly higher in those patients presenting with a low eGFR (N = 81, 39.1%; p < 0.001). Male sex, hypertension, the use of angiotensin-converting enzyme inhibitors and non-steroidal anti-inflammatories, hemodynamic instability, mechanical ventilation, acute respiratory distress syndrome, and admission elevated ferritin, creatinine kinase, brain natriuretic peptide, and troponin 1 were identified as the risk factors for in-hospital AKI. Ninety-seven (28.45%) patients died in the non-AKI group versus 91 (71.1%) in the AKI group (p < 0.001). The Cox proportional hazard model after adjusting for age, gender, comorbidities, hemodynamic status, and PF ratio (arterial oxygen partial pressure [PaO2]/fractional inspired oxygen [FiO2]) determined that on admission, an elevated blood urea nitrogen (hazard ratio [HR]: 1.75; 95% confidence interval [CI] 1.23-2.48), a low eGFR (HR 1.43; CI 1.1-2.03), AKI stage 1 (HR 1.14; CI 0.64-2.03), AKI stage 2 (HR 1.86; CI 1.03-3.56), and AKI stage 3 (HR 2.1; CI 1.3-2.81) were independent risk factors for in-hospital mortality. Renal replacement therapy (RRT) did not improve survival in stage III AKI. CONCLUSION: AKI in our hospitalized COVID-19 patients was common and carried a high mortality, especially in patients with AKI stage 3. RRT did not improve survival. Policy changes and planning for this high incidence of AKI in COVID-19 patients and its associated high mortality are necessary at the local and national levels.


Assuntos
Lesão Renal Aguda/mortalidade , Betacoronavirus/patogenicidade , Infecções por Coronavirus/complicações , Hospitais Urbanos/organização & administração , Pneumonia Viral/complicações , Políticas , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/terapia , Lesão Renal Aguda/virologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Grupos Étnicos/estatística & dados numéricos , Feminino , Mortalidade Hospitalar , Hospitais Urbanos/estatística & dados numéricos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Grupos Minoritários/estatística & dados numéricos , Cidade de Nova Iorque/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Prognóstico , Terapia de Substituição Renal/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Fatores Socioeconômicos , Análise de Sobrevida , Resultado do Tratamento , Adulto Jovem
16.
Obstet Gynecol ; 136(5): 1006-1015, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33030866

RESUMO

OBJECTIVE: To evaluate the result of an inpatient postpartum human papillomavirus (HPV) immunization pilot program in a diverse, low-income patient population from an urban, hospital-based obstetrics and gynecology clinic. METHODS: In this cohort study, we present results from the first 2 years of the inpatient postpartum HPV immunization program, in which vaccine-eligible postpartum women were identified and immunized during their hospital stays. The program was implemented after educational outreach with prenatal and postpartum clinicians and nurses. Associations between receipt of the HPV vaccine as an inpatient and the characteristics of patients, and the likelihood of and missed opportunities for receiving a subsequent dose of the HPV vaccine as an outpatient were determined using logistic regression, time-to-event analyses, chi-squared tests and t-tests. RESULTS: From April 11, 2017, to April 10, 2019, 394 (59.2%) of 666 postpartum women were eligible for the inpatient postpartum HPV immunization program. The majority (265/394, 67.3%) received the immunization pilot program HPV dose; 36 of those 265 (13.6%) completed the series with that dose. Among women due for additional doses after hospital discharge, those who received the inpatient dose were more likely to receive a subsequent outpatient dose (138/229) than were those who did not receive an inpatient dose (39/129; hazard ratio 2.51, 95% CI 1.76-3.58). On average, there were 30.7 fewer (95% CI 5.8-55.6, P<.02) missed opportunities for subsequent outpatient doses for every 100 eligible visits among women who received the inpatient dose, compared with women who did not. By the end of the study, the proportion of women who had completed the vaccine series was higher among women who received the inpatient dose (95/265, 35.8%) than in those who did not (12 out 129, 9.3%; odds ratio 5.45, 95% CI 2.86-10.38). CONCLUSION: The inpatient postpartum HPV immunization program was associated with increased rates of immunization and addressed a previously missed opportunity. Inpatient immunization programs can serve as a critical way to address gaps in vaccine uptake.


Assuntos
Programas de Imunização/estatística & dados numéricos , Pacientes Internados/estatística & dados numéricos , Infecções por Papillomavirus/prevenção & controle , Vacinas contra Papillomavirus/administração & dosagem , Cuidado Pós-Natal/estatística & dados numéricos , Adulto , Distribuição de Qui-Quadrado , Feminino , Hospitais Urbanos , Humanos , Programas de Imunização/métodos , Programas de Imunização/normas , Modelos Logísticos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Cuidado Pós-Natal/métodos , Cuidado Pós-Natal/normas , Pobreza/estatística & dados numéricos , Gravidez , Avaliação de Programas e Projetos de Saúde , Melhoria de Qualidade , Adulto Jovem
17.
N Z Med J ; 133(1520): 73-82, 2020 08 21.
Artigo em Inglês | MEDLINE | ID: mdl-32994595

RESUMO

AIM: Takotsubo syndrome (TS) mimics acute coronary syndrome but has a distinct pathophysiology. This study aimed to compare and contrast the clinical presentation, management and outcomes of patients with TS in five large New Zealand hospitals. METHODS: We identified 632 consecutive patients presenting to the five major tertiary hospitals in New Zealand (Middlemore Hospital, Auckland City Hospital, North Shore Hospital, Christchurch Hospital and Dunedin Hospital) between January 2006 and June 2018 and obtained clinical, laboratory, electrocardiography, echocardiography, coronary angiography and long-term follow-up data. RESULTS: Six hundred and thirty-two consecutive patients with TS (606 women, mean age 65.0+11.1 years) were included. An associated stressor was identified in two-thirds of patients, and emotional triggers were more frequent than physical triggers (62.9% and 37.1%, respectively). Overall, 12.7% of patient had depression and 11.7% anxiety but this was more common in patients from Christchurch Hospital (20.4% and 23.4%, respectively). The in-hospital mortality among the five hospitals ranges between 0 to 2.0%. The mean follow-up was 4.9+3.4 years (median 4.4 years). Fifty-four people died post-discharge, all but one from a non-cardiac cause. Forty patients had recurrent TS. Mortality post-discharge (p=0.63) and TS recurrence (p=0.38) did not differ significantly among the five hospitals. CONCLUSION: In this large New Zealand TS cohort, the clinical characteristics and presentation were similar among the five hospitals. A subset of patients had a complicated in-hospital course, but late deaths were almost all from non-cardiac causes and recurrence was infrequent. Mortality post-discharge and recurrence was similar between the hospitals.


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Mortalidade Hospitalar/tendências , Hospitais Urbanos/estatística & dados numéricos , Cardiomiopatia de Takotsubo/diagnóstico , Cardiomiopatia de Takotsubo/mortalidade , Síndrome Coronariana Aguda/fisiopatologia , Idoso , Angiografia Coronária/métodos , Diagnóstico Diferencial , Ecocardiografia/métodos , Eletrocardiografia/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Nova Zelândia/etnologia , Alta do Paciente/tendências , Estudos Prospectivos , Recidiva , Estresse Psicológico/epidemiologia , Cardiomiopatia de Takotsubo/epidemiologia , Cardiomiopatia de Takotsubo/fisiopatologia , Centros de Atenção Terciária/estatística & dados numéricos
18.
Pediatr Blood Cancer ; 67(11): e28579, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32893954

RESUMO

New York City has emerged as one of the epicenters of the SARS-COV-2 pandemic, with the Bronx being disproportionately affected. This novel coronavirus has caused significant respiratory manifestations raising the concern for development of acute chest syndrome (ACS) in patients with sickle cell disease (SCD). We report a series of pediatric SCD SARS-COV-2-positive patients admitted with ACS. SARS-COV-2-positive SCD patients, who did not develop ACS, were the comparison group. Hydroxyurea use (P-value = .02) and lower absolute monocyte counts (P-value = .04) were noted in patients who did not develop ACS. These preliminary findings need to be further evaluated in larger cohorts.


Assuntos
Síndrome Torácica Aguda/complicações , Anemia Falciforme/complicações , /complicações , Síndrome Torácica Aguda/diagnóstico , Síndrome Torácica Aguda/tratamento farmacológico , Adolescente , Anemia Falciforme/tratamento farmacológico , Antibacterianos/uso terapêutico , Antidrepanocíticos/uso terapêutico , /tratamento farmacológico , Criança , Doxiciclina/uso terapêutico , Feminino , Hospitais Urbanos , Humanos , Hidroxiureia/uso terapêutico , Masculino , Cidade de Nova Iorque , Reação em Cadeia da Polimerase , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto Jovem
19.
J Transl Med ; 18(1): 354, 2020 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-32933530

RESUMO

BACKGROUND: Severe COVID-19 infection results in a systemic inflammatory response (SIRS). This SIRS response shares similarities to the changes observed during the peri-operative period that are recognised to be associated with the development of multiple organ failure. METHODS: Electronic patient records for patients who were admitted to an urban teaching hospital during the initial 7-week period of the COVID-19 pandemic in Glasgow, U.K. (17th March 2020-1st May 2020) were examined for routine clinical, laboratory and clinical outcome data. Age, sex, BMI and documented evidence of COVID-19 infection at time of discharge or death certification were considered minimal criteria for inclusion. RESULTS: Of the 224 patients who fulfilled the criteria for inclusion, 52 (23%) had died at 30-days following admission. COVID-19 related respiratory failure (75%) and multiorgan failure (12%) were the commonest causes of death recorded. Age ≥ 70 years (p < 0.001), past medical history of cognitive impairment (p ≤ 0.001), previous delirium (p < 0.001), clinical frailty score > 3 (p < 0.001), hypertension (p < 0.05), heart failure (p < 0.01), national early warning score (NEWS) > 4 (p < 0.01), positive CXR (p < 0.01), and subsequent positive COVID-19 swab (p ≤ 0.001) were associated with 30-day mortality. CRP > 80 mg/L (p < 0.05), albumin < 35 g/L (p < 0.05), peri-operative Glasgow Prognostic Score (poGPS) (p < 0.05), lymphocytes < 1.5 109/l (p < 0.05), neutrophil lymphocyte ratio (p ≤ 0.001), haematocrit (< 0.40 L/L (male)/ < 0.37 L/L (female)) (p ≤ 0.01), urea > 7.5 mmol/L (p < 0.001), creatinine > 130 mmol/L (p < 0.05) and elevated urea: albumin ratio (< 0.001) were also associated with 30-day mortality. On multivariate analysis, age ≥ 70 years (O.R. 3.9, 95% C.I. 1.4-8.2, p < 0.001), past medical history of heart failure (O.R. 3.3, 95% C.I. 1.2-19.3, p < 0.05), NEWS > 4 (O.R. 2.4, 95% C.I. 1.1-4.4, p < 0.05), positive initial CXR (O.R. 0.4, 95% C.I. 0.2-0.9, p < 0.05) and poGPS (O.R. 2.3, 95% C.I. 1.1-4.4, p < 0.05) remained independently associated with 30-day mortality. Among those patients who tested PCR COVID-19 positive (n = 122), age ≥ 70 years (O.R. 4.7, 95% C.I. 2.0-11.3, p < 0.001), past medical history of heart failure (O.R. 4.4, 95% C.I. 1.2-20.5, p < 0.05) and poGPS (O.R. 2.4, 95% C.I. 1.1-5.1, p < 0.05) remained independently associated with 30-days mortality. CONCLUSION: Age ≥ 70 years and severe systemic inflammation as measured by the peri-operative Glasgow Prognostic Score are independently associated with 30-day mortality among patients admitted to hospital with COVID-19 infection.


Assuntos
Betacoronavirus , Infecções por Coronavirus/fisiopatologia , Pandemias , Pneumonia Viral/fisiopatologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Proteína C-Reativa/metabolismo , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/mortalidade , Feminino , Mortalidade Hospitalar , Hospitalização , Hospitais de Ensino , Hospitais Urbanos , Humanos , Inflamação/fisiopatologia , Linfócitos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Neutrófilos , Pneumonia Viral/epidemiologia , Pneumonia Viral/mortalidade , Prognóstico , Escócia/epidemiologia , Pesquisa Médica Translacional
20.
J Stroke Cerebrovasc Dis ; 29(10): 105106, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912515

RESUMO

INTRODUCTION: Previous studies have reported a "weekend effect" on stroke mortality, whereby stroke patients admitted during weekends have a higher risk of in-hospital death than those admitted during weekdays. AIMS: We aimed to investigate whether patients with different types of stroke admitted during weekends have a higher risk of in-hospital mortality in rural and urban hospitals in the US. METHODS: We used data from the 2016 National Inpatient Sample and used logistic regression to assess in-hospital mortality for weekday and weekend admissions among stroke patients aged 18 and older by stroke type (ischemic or hemorrhagic) and rural or urban status. RESULTS: Crude stroke mortality was higher in weekend admissions (p <0.001). After adjusting for confounding variables, in-hospital mortality among hemorrhagic stroke patients was significantly greater (22.0%) for weekend admissions compared to weekday admissions (20.2%, p = 0.009). Among rural hospitals, the in-hospital mortality among hemorrhagic stroke patients was also greater among weekend admissions (36.9%) compared to weekday admissions (25.7%, p = 0.040). Among urban hospitals, the mortality of hemorrhagic stroke patients was 21.1% for weekend and 19.6% for weekday admissions (p = 0.026). No weekend effect was found among ischemic stroke patients admitted to rural or urban hospitals. CONCLUSIONS: Our results help to understand mortality differences in hemorrhagic stroke for weekend vs. weekday admissions in urban and rural hospitals. Factors such as density of care providers, stroke centers, and patient level risky behaviors associated with the weekend effect on hemorrhagic stroke mortality need further investigation to improve stroke care services and reduce weekend effect on hemorrhagic stroke mortality.


Assuntos
Plantão Médico , Isquemia Encefálica/mortalidade , Mortalidade Hospitalar , Hospitais Rurais , Hospitais Urbanos , Hemorragias Intracranianas/mortalidade , Acidente Vascular Cerebral/mortalidade , Adolescente , Adulto , Idoso , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/terapia , Estudos Transversais , Bases de Dados Factuais , Feminino , Humanos , Pacientes Internados , Hemorragias Intracranianas/diagnóstico , Hemorragias Intracranianas/terapia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia , Fatores de Tempo , Estados Unidos/epidemiologia , Adulto Jovem
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