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1.
Medicine (Baltimore) ; 99(6): e19049, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32028420

RESUMO

To assess the mental health of nurses and to find the post responsibility and psychological status of clinical nurses.A total of 447 nursing staff at different levels in a teaching hospital was assessed by nursing post responsibility scale and mental symptom checklist (SCL-90) then compared with each other. The study period was from April 1, 2018 to April 30, 2018.There was a positive correlation between the responsibility of post and interpersonal relationship (r = 0.11, P < .05), depression (r = 0.10, P < .05) and hostility (r = 0.10, P < .05). Post risk was negatively correlated with somatization (r = -0.10, P < .05), job involvement scope and communication ability were negatively correlated (r = -0.11, P < .05). Based on the multiple linear regression, knowledge and skills (ß = -0.20, P = .02) and risks of the post (ß=0.20, P < .01) both significantly related to SCL-90 total score.In conclusion, knowledge and skills and risks of the post associated with mental health of clinical nurses. The sustainable development of nursing post responsibility requires healthy physiological and mental health.


Assuntos
Transtornos Mentais/epidemiologia , Recursos Humanos de Enfermagem no Hospital/psicologia , China/epidemiologia , Hospitais de Ensino/estatística & dados numéricos , Humanos , Transtornos Mentais/etiologia , Recursos Humanos de Enfermagem no Hospital/estatística & dados numéricos , Doenças Profissionais/epidemiologia , Doenças Profissionais/etiologia , Doenças Profissionais/psicologia , Escalas de Graduação Psiquiátrica , Fatores de Risco
2.
Ann R Coll Surg Engl ; 102(1): 49-53, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31755741

RESUMO

INTRODUCTION: Testicular torsion treatment rests on the horns of a dilemma, with widespread national variation in whether the responsible surgical specialty is general surgery or urology, even in hospitals with both general surgery and urology emergency service assets. This study aimed to quantify higher surgical trainee operative experience and confidence in managing suspected testicular torsion in a single UK deanery (Wales). MATERIALS AND METHODS: Anonymised logbook data were obtained via the Intercollegiate Surgical Curriculum Programme version 10 using the head of school report function for all general surgery (n=53) and urology (n=15) higher surgical trainees, which were combined with the distribution of an electronic self-administered questionnaire. RESULTS: Median operative scrotal explorations recorded for all general surgery higher surgical trainees and senior general surgery higher surgical trainees (ST7+) was 7 (range 1-22) and 10 (range 1-22), compared with 21 (range 9-64, p=0.00104) and 24 (19-64, p<0.001) for urology higher surgical trainees. The questionnaire response rate was 64.6% (general surgery 31/50, urology 11/15). Confidence levels in assessing adult and paediatric patients were lower in general surgery when compared with urology higher surgical trainees: median adult confidence rate 7/10 compared with 9/10, and paediatric confidence rate 7/10 compared with 8/10 (p<0.001 and p=0.053, respectively). All higher surgical trainees preferred urology as the accountable hospital specialty when both assets were available. DISCUSSION AND CONCLUSION: General surgery higher surgical trainees receive less than 50% of the operative exposure of urology higher surgical trainees in emergency scrotal surgery, which has important implications for curriculum competence development and patient safety.


Assuntos
Cirurgia Geral/educação , Torção do Cordão Espermático/cirurgia , Urologia/educação , Adulto , Atitude do Pessoal de Saúde , Criança , Competência Clínica/normas , Educação de Pós-Graduação em Medicina/estatística & dados numéricos , Cirurgia Geral/estatística & dados numéricos , Hospitais de Ensino/estatística & dados numéricos , Humanos , Masculino , Pediatria/educação , Pediatria/estatística & dados numéricos , Inquéritos e Questionários , Urologistas/educação , Urologistas/normas , Urologia/estatística & dados numéricos , País de Gales
3.
Pol J Microbiol ; 68(3): 303-308, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31880875

RESUMO

The data on susceptibility to antifungals of new species within Candida glabrata complex are limited. Our study was to enrich a global knowledge of yeast epidemiology and drug resistance. The study was focused on the identification of species within clinical isolates of the C. glabrata complex and on the determination of their resistance to antifungals. Four hundred forty-five clinical C. glabrata sensu lato strains were isolated from different clinical samples at routine mycological exams at the Infant Jesus Teaching Hospital in Warsaw. The identification of the most of tested isolates to species complex level was performed using the ID 32 C system. The identification of C. nivariensis and C. bracarensis species within the C. glabrata complex was performed by DNA sequencing. The MICs of amphotericin B, fluconazole, itraconazole, posaconazole, voriconazole, caspofungin, anidulafungin, and micafungin were determined by E-test. Twenty-four isolates did not have an ITS-1 region, characteristic of C. glabrata sensu stricto and their D1/D2 regions of the 26S rRNA were 99% homologous to C. nivariensis 26S rRNA. No strains of C. bracarensis were recovered. C. nivariensis strains were very susceptible to amphotericin B, anidulafungin, micafungin, and caspofungin. Ninety-two percent of C. nivariensis were resistant to itraconazole. The halves of the strains was resistant to posaconazole. Eighty-three percent of C. nivariensis were susceptible to voriconazole. None of the tested strains were susceptible to fluconazole. In the present study, none of the C. nivariensis strains were simultaneously resistant to azoles and echinocandins. C. nivariensis should be recognized as an emerging pathogen, resistant to azoles.The data on susceptibility to antifungals of new species within Candida glabrata complex are limited. Our study was to enrich a global knowledge of yeast epidemiology and drug resistance. The study was focused on the identification of species within clinical isolates of the C. glabrata complex and on the determination of their resistance to antifungals. Four hundred forty-five clinical C. glabrata sensu lato strains were isolated from different clinical samples at routine mycological exams at the Infant Jesus Teaching Hospital in Warsaw. The identification of the most of tested isolates to species complex level was performed using the ID 32 C system. The identification of C. nivariensis and C. bracarensis species within the C. glabrata complex was performed by DNA sequencing. The MICs of amphotericin B, fluconazole, itraconazole, posaconazole, voriconazole, caspofungin, anidulafungin, and micafungin were determined by E-test. Twenty-four isolates did not have an ITS-1 region, characteristic of C. glabrata sensu stricto and their D1/D2 regions of the 26S rRNA were 99% homologous to C. nivariensis 26S rRNA. No strains of C. bracarensis were recovered. C. nivariensis strains were very susceptible to amphotericin B, anidulafungin, micafungin, and caspofungin. Ninety-two percent of C. nivariensis were resistant to itraconazole. The halves of the strains was resistant to posaconazole. Eighty-three percent of C. nivariensis were susceptible to voriconazole. None of the tested strains were susceptible to fluconazole. In the present study, none of the C. nivariensis strains were simultaneously resistant to azoles and echinocandins. C. nivariensis should be recognized as an emerging pathogen, resistant to azoles.


Assuntos
Antifúngicos/farmacologia , Candida/efeitos dos fármacos , Candidíase/microbiologia , Anfotericina B/farmacologia , Candida/classificação , Candida/genética , Candida/isolamento & purificação , Candidíase/epidemiologia , Farmacorresistência Fúngica , Fluconazol/farmacologia , Hospitais de Ensino/estatística & dados numéricos , Humanos , Testes de Sensibilidade Microbiana , Polônia/epidemiologia , Prevalência , Triazóis/farmacologia
4.
Bull Cancer ; 106(12): 1094-1103, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31759512

RESUMO

Care, teaching, and research are all priorities of the French public teaching hospitals. In 2004, the remuneration method evolved from a global endowment to a fee-for-services system, based on the use of bibliometric tools. These were used in the present study to describe the research patterns of public teaching hospitals in regards to care and teaching activities. The present study was based on data from the 32 French public teaching hospitals, between 2004 and 2014. Records concerning the publications number, hospital stays, full-time equivalent (FTE) practitioners, and residents per FTE physician were accessed. Statistical analyses were performed using means, Pearson correlation coefficients, and regression lines. The mean number of publications per FTE physician was 0.73, the mean number of hospital stays per FTE physician was 235.8 and the mean number of residents per FTE physician was 0.63. There was a moderate positive correlation between the number of publications per FTE physician and the number of residents per FTE physician (R=0.53) and a negligible correlation between the number of residents per FTE physician and the number of hospital stays per FTE physician (R=0.12). There was a low negative correlation between publication numbers per FTE physician and the number of stays per FTE physician (R=-0.41). All public teaching hospitals presented different patterns in terms of care, teaching, and research activities. None of the 32 hospitals performed well in all three activities. Only nine performed well in at least two out of the three missions.


Assuntos
Bibliometria , Hospitais Públicos/estatística & dados numéricos , Hospitais de Ensino/estatística & dados numéricos , Corpo Clínico Hospitalar/estatística & dados numéricos , França , Humanos , Internato e Residência/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Pesquisa/estatística & dados numéricos , Ensino/estatística & dados numéricos
5.
Afr Health Sci ; 19(2): 1910-1923, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31656474

RESUMO

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


Assuntos
Emergências/epidemiologia , Hospitais de Ensino/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Anemia Falciforme/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Serviço Hospitalar de Emergência , Feminino , Febre/epidemiologia , Mortalidade Hospitalar , Humanos , Lactente , Malária/epidemiologia , Masculino , Nigéria/epidemiologia , Estudos Prospectivos , Sepse/epidemiologia , Fatores Socioeconômicos , Fatores de Tempo
6.
Rev Lat Am Enfermagem ; 27: e3190, 2019.
Artigo em Inglês, Português, Espanhol | MEDLINE | ID: mdl-31664408

RESUMO

OBJECTIVE: to clinically validate the nursing diagnosis "Impaired Physical Mobility", identifying its prevalence, defining characteristics, related factors, and associated conditions with the calculation of accuracy measures and generation of Decision Trees, as well as clinically and etiologically characterize the multiple traumas victims. METHOD: methodological, cross-sectional study of clinical validation type, using diagnostic accuracy measures and generating decision tree. RESULTS: the sample consisted of 126 patients, 73% male, with a mean age of 38.29 years. The frequency of the nursing diagnosis studied was 88.10%; the defining characteristic with the highest prevalence was "Difficulty turning" (58.73%), with a predictive power of 98.6%; the associated condition "Alteration in bone structure integrity" stood out with 72.22%. The accuracy measures also indicated their predictive power. CONCLUSION: the components aforementioned were considered predictors of this diagnosis. This study contributed to improve the identification of clinical indicators associated with advanced methods of diagnostic validation, directing care and reducing the variability present in clinical situations.


Assuntos
Atividade Motora/fisiologia , Traumatismo Múltiplo/enfermagem , Diagnóstico de Enfermagem/normas , Adulto , Osso e Ossos/fisiopatologia , Brasil/epidemiologia , Estudos Transversais , Feminino , Hospitais de Ensino/estatística & dados numéricos , Humanos , Masculino , Limitação da Mobilidade , Traumatismo Múltiplo/diagnóstico , Traumatismo Múltiplo/epidemiologia
7.
Rev Lat Am Enfermagem ; 27: e2939, 2019.
Artigo em Português, Inglês, Espanhol | MEDLINE | ID: mdl-31596404

RESUMO

OBJECTIVE: to estimate the prevalence and avoidability of surgical adverse events in a teaching hospital and to classify the events according to the type of incident and degree of damage. METHOD: cross-sectional retrospective study carried out in two phases. In phase I, nurses performed a retrospective review on a simple randomized sample of 192 records of adult patients using the Canadian Adverse Events Study form for case tracking. Phase II aimed at confirming the adverse event by an expert committee composed of physicians and nurses. Data were analyzed by univariate descriptive statistics. RESULTS: the prevalence of surgical adverse events was 21.8%. In 52.4% of the cases, detection occurred on outpatient return. Of the 60 cases analyzed, 90% (n = 54) were preventable and more than two thirds resulted in mild to moderate damage. Surgical technical failures contributed in approximately 40% of the cases. There was a prevalence of the infection category associated with health care (50%, n = 30). Adverse events were mostly related to surgical site infection (30%, n = 18), suture dehiscence (16.7%, n = 10) and hematoma/seroma (15%, n = 9). CONCLUSION: the prevalence and avoidability of surgical adverse events are challenges faced by hospital management.


Assuntos
Hospitais de Ensino/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Adulto , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Complicações Pós-Operatórias/prevenção & controle , Período Pós-Operatório , Estudos Retrospectivos , Procedimentos Cirúrgicos Operatórios/normas , Deiscência da Ferida Operatória/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia
8.
West Afr J Med ; 36(3): 217-221, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31622483

RESUMO

BACKGROUND: Placenta praevia is the most common cause of antepartum haemorrhage. It is a potentially life threatening condition associated with morbidity and mortality. There is no study on the pattern and management of placenta praevia in Sagamu. AIM AND OBJECTIVES: To determine the risk factors, pattern of presentation and management outcome of pregnancies complicated by placenta praevia. DESIGN: This was a five-year retrospective study Setting: Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria. MATERIALS AND METHODS: Relevant information was retrieved from the case notes of all patients who presented with placenta praevia from 1st January, 2013 to 31st December, 2017. The data were analyzed by using SPSS version 21. RESULTS: Out of the 5124 deliveries, there were 47 cases of placenta praevia giving a prevalence of 0.92%. Twenty-one subjects (50%) were within 31-40 years age group. The modal parity was 1. Twenty women (47.6%) had parity of 1-2. Thirty subjects (71.4%) were unbooked. Painless vaginal bleeding was the commonest mode of presentation in 30(73.8%) women while Type III was the commonest grade 15(35.7%). Nineteen subjects (45.2%) had no identifiable risk factors. Postpartum haemorrage was the most common complication (23.8%). There was no maternal death while the perinatal mortality was 13.5%. There was no significant association between booking status, type of placenta praevia, mode of delivery, blood loss at delivery, and the one minute APGAR score. CONCLUSION: The prevalence of placenta praevia in Olabisi Onabanjo University Teaching Hospital is comparable with other tertiary facilities in Nigeria. Upgrading comprehensive emergency obstetric services, improving neonatal services and a multidisciplinary approach to management of all cases will ensure good outcome for the mother and baby.


Assuntos
Placenta Prévia/diagnóstico , Resultado da Gravidez/epidemiologia , Feminino , Hospitais de Ensino/estatística & dados numéricos , Humanos , Incidência , Nigéria/epidemiologia , Placenta Prévia/epidemiologia , Placenta Prévia/terapia , Gravidez , Estudos Retrospectivos , Fatores de Risco
9.
NeuroRehabilitation ; 45(2): 151-161, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31498143

RESUMO

The number of adults diagnosed with brain tumors is increasing, as are the survival rates. Neurological impairments from brain tumors can impact activity and participation. Adults with brain tumors benefit from post-acute rehabilitation. However, there is limited evidence from the acute care setting. The purpose of this study was to examine how acute care occupational therapy services were utilized and whether patients made functional gains after receiving occupational therapy services. A retrospective chart review of 153 electronic medical records was completed for patients who received occupational therapy services at a large teaching hospital. Data collected included number of occupational therapy visits, the types of interventions, and patient performance using the Boston University Activity Measure for Post-Acute Care "6 Clicks for Daily Activity" short form (AM-PAC). More than half the patients received one occupational therapy visit (54.2%) with a median length of stay of three days. Most interventions focused on activities of daily living (ADLs). Of those patients who received more than one visit, 67% showed improvements in their AM-PAC scores. Occupational therapy practitioners provided interventions that addressed ADLs, and patients demonstrated gains in functional performance. These findings suggest that patients benefit from occupational therapy services provided in the acute care setting.


Assuntos
Atividades Cotidianas , Neoplasias Encefálicas/reabilitação , Utilização de Instalações e Serviços , Terapia Ocupacional/estatística & dados numéricos , Adulto , Idoso , Feminino , Hospitais de Ensino/estatística & dados numéricos , Humanos , Masculino , Registros Médicos/estatística & dados numéricos , Pessoa de Meia-Idade
10.
Hosp Pract (1995) ; 47(4): 196-202, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31498733

RESUMO

Objective: Monitoring length of stay (LOS) can help medical decision makers identify areas of potential improvements and improve resource management, which results in better quality of care for patients. This study aims to monitor process performance at hospitals by implementing a statistical process control (SPC) approach on LOS.Methods: The study focuses on diabetic inpatients admitted to hospitals in two national healthcare systems. The data used in this study were collected from two hospitals: (1) a 500-bed teaching hospital in Southwest Virginia in the U.S., and (2) a 1100-bed teaching and research hospital located in Ankara, Turkey. I-MR charts were used to analyze the datasets and monitor the variations of LOS.Results: The results of I-MR charts showed that LOS was longer in Turkey than the U.S. LOS was skewed toward minimum values in the U.S. whereas it was spread out in Turkey. The average LOS was 3.27 days (STD = 2.30) in the U.S. while it was 7.28 days (STD = 4.56) in Turkey. The differences in two national healthcare systems may be reflected in the LOS variable.Conclusion: This study implements a control chart-based approach to monitor LOS and detect prolonged hospitalization for diabetic patients. As presented in I-MR charts, there are abnormal LOS observations in each data set. The decision makers and caregivers must analyze I-MR charts to identify either common or special causes of variation. Each abnormal LOS requires a detailed patient-centric analysis. Care providers and decision makers can investigate the root causes of abnormal LOS for each patient by further exploring the characteristics of diabetic patients who had abnormal LOS at hospitals, such as age, preexisting conditions, or the type of medical procedure conducted on each patient.


Assuntos
Hospitais de Ensino/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Interpretação Estatística de Dados , Diabetes Mellitus , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Turquia , Estados Unidos , Adulto Jovem
11.
Diabetes Metab Syndr ; 13(4): 2441-2444, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31405657

RESUMO

BACKGROUND: Diabetes mellitus is a metabolic disease known as one of the most common illness in the world. It is believed that diabetic patients are at high risk of varied infections than non-diabetics. The aim of this study was to determine the frequency and pattern of infections in diabetic patients admitted to the internal wards of educational hospitals of Ahvaz Jundishapur University of Medical Sciences. METHODS: This descriptive cross-sectional study was performed on 700 diabetic patients from January 2014 to December 2015 in internal wards (general, endocrine, gastroenterology, lung, nephrology, cardiology, neurology and infectious diseases) of educational hospitals affiliated to Ahvaz JundishapurUniversity of Medical Sciences. Data includeddemographic information, type of diabetes treatment, duration of diabetes mellitus, final diagnosis, and blood sugar on admission that were analyzed statistically. RESULTS: Out of 700 patients, 374 (53.4%) women and 326 (46.6%) men were entered into this study. The number of non-infectious and infectious patients were 506 (72.3%) and 194 (27.7%). The mean of age,duration of diabetes, and glucose were 62.34 ±â€¯14.38 years, 11.11 ±â€¯7.18 years, and 271.98 ±â€¯90 (mg/dl) in patients with infectious diseases respectively. The most common infectious illnesses were diabetic foot infections (32.5%), pneumonia (18%), soft tissue abscess(13.9%), and urinary tract infections (11.3%). CONCLUSION: Infectious diseases are one of the most common factorsto hospitalize diabetic patients (27.7%), most of whom had diabetic foot infections, pneumonia, and soft tissue abscess.


Assuntos
Doenças Transmissíveis/epidemiologia , Complicações do Diabetes/epidemiologia , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Hospitais de Ensino/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Transmissíveis/etiologia , Estudos Transversais , Complicações do Diabetes/etiologia , Feminino , Seguimentos , Hospitalização , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
12.
Ethiop J Health Sci ; 29(3): 333-342, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31447501

RESUMO

Background: Globally, sepsis remains one of the major causes of morbidity and mortality in neonates, in spite of recent advances in health care units. The major burden of the problem occurs in the developing world while most evidence is derived from developed countries. The objective of this study was to evaluate the epidemiology of neonatal sepsis and associated factors among neonates admitted to Neonatal Intensive Care Unit (NICU). Methods: Hospital based prospective cross-sectional study was conducted from April 2016 to May 2017. Neonates with clinical sepsis were included into the study. Data were analyzed using SPSS version 20. Frequencies, proportion and summary statistics were used to describe the study population in relation to relevant variables. Multivariate logistic regressions were used to assess factors associated with neonatal sepsis. p-values of < 0.05 were considered statistically significant. Results: A total of 901neonates were admitted to NICU of which 303 neonates were admitted with diagnosis of clinical sepsis making the prevalence of neonatal sepsis to be 34%. Bacteremia were confirmed in 88/303(29.3%) of clinical sepsis, and gram-positive bacteria constituted 47/88(53.4%). Of all positive blood cultures, 52/88(59.1%) were reported from late onset sepsis. Coagulase negative staphylococcus (CoNS) accounted for 22/88(25%) followed by E. coli and S. aureus, each contributing 18/88(20.3%) and 16/88(18.2%) respectively. Prolonged PROM, low fifth Apgar score, prematurity and low birth weight were strongly associated with increased risk of neonatal sepsis. Neonates born to mothers who received antibiotics during labor and delivery were at significantly lower risk of acquiring neonatal sepsis. Conclusion: The prevalence of neonatal sepsis was high, and most causes of neonatal sepsis were gram positive bacteria and most bacteria isolates were from late onset sepsis. Obstetric factors were strongly associated with development of neonatal sepsis. Intrapartal antibiotic administration significantly reduces neonatal sepsis.


Assuntos
Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Sepse Neonatal/epidemiologia , Estudos Transversais , Etiópia/epidemiologia , Feminino , Hospitais de Ensino/estatística & dados numéricos , Humanos , Recém-Nascido , Masculino , Sepse Neonatal/etiologia , Estudos Prospectivos , Fatores de Risco
13.
Ethiop J Health Sci ; 29(4): 503-512, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31447524

RESUMO

Background: Abdominal injury is among the major causes of trauma admissions. The aim was to determine etiology, commonly injured organs, indication and outcome of patients with abdominal injuries requiring laparotomy. Methods: A retrospective study of all adult patients who underwent laparotomy for abdominal injury at St. Paul's Hospital Millennium Medical College was conducted from January 2014 to December 2016. The factors associated with outcome were identified with bivariate and multivariate logistic regressions. Results: Laparotomy for abdominal injury was performed for 145 patients. Of these, 129 (89%) case records were retrieved. The male to female ratio was 6.2:1. The mean age was 29 years, and most of them were unemployed. Penetrating trauma was the commonest injury, stab (46, 35.7%) and Road Traffic Accidents (RTA) (27, 20.9%) being the leading causes. Extra-abdominal injuries were seen in 33.3% (46) of the cases. Hollow organs were commonly injured than solid organs. Small intestine (35, 43.8%) and Spleen (17, 34.7%) were the leading injured organs in penetrating and blunt respectively. The main procedure performed was repair of hollow and solid organ laceration/perforation (70,54.3%). The negative laparotomy rate was 4.6% (6). Complications were seen in 23(17.8%) patients, the commonest being irreversible shock (7,30.4%). The mortality rate was 8.5 % (11), and it was significantly associated with blunt abdominal injury (AOR=7.25; 95% CI 1.09-48.37; p=0.041) and systolic blood pressure<90mmHg (AOR=8.66; 95% CI 1.1-68.41; p=0.041). Conclusion: Stab and RTA were the commonest indications of laparotomy. The mortality was significantly associated with blunt abdominal injury and hypotension (SBP<90mmHg).


Assuntos
Traumatismos Abdominais/cirurgia , Hospitais de Ensino/estatística & dados numéricos , Laparotomia/estatística & dados numéricos , Traumatismos Abdominais/epidemiologia , Traumatismos Abdominais/mortalidade , Traumatismos Abdominais/patologia , Adulto , Etiópia/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Ferimentos não Penetrantes/epidemiologia , Ferimentos não Penetrantes/patologia , Ferimentos não Penetrantes/cirurgia , Ferimentos Penetrantes/epidemiologia , Ferimentos Penetrantes/patologia , Ferimentos Penetrantes/cirurgia , Adulto Jovem
14.
Transplant Proc ; 51(7): 2176-2179, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31377064

RESUMO

BACKGROUND: We aimed to define the causes of brain death (BD), criteria, and tests used for diagnosis, rates of family consent, and rates of organ donation in intensive care units (ICUs) of an education and research hospital. METHODS: The data of patients with BD diagnosis in 7 years in our hospital was collected from an electronic database and archives retrospectively consisting of the demographic data, the causes of BD, criteria, and the tests used for diagnosis, family consent, and organ donation rates. RESULTS: A total of 210 patients with BD diagnosis were enrolled in the study. There was a decline in number of patients with BD diagnosis between 2012 (54.76%) and 2018 (17.64%) in the neurology and neurosurgery ICU, while it increased from 35.71% in 2012 to 70.6% in 2018 in the general ICU. The most common cause of hospitalization for BD was spontaneous intracranial hemorrhage (43.8%). A total of 47.6% of brain-dead patients who did not qualify for organ donation were resuscitated unnecessarily after cardiac death. In 2012, diagnosis was always supported by ancillary tests, while in 2018, a total of 35.29% of the patients were diagnosed solely by clinical examination; 23.8% of patients' families had given consent for organ donation, and 19.53% of 210 patients became donors. CONCLUSION: Physicians should be aware that patients with poor neurologic outcome can be candidates of BD donation, and careful examination and rapid diagnosis is crucial. All segments of society and the health care professionals should be informed and updated about organ donation and BD regularly to raise the numbers of organ donation.


Assuntos
Morte Encefálica/diagnóstico , Hospitais de Ensino/estatística & dados numéricos , Doadores de Tecidos/provisão & distribução , Obtenção de Tecidos e Órgãos/estatística & dados numéricos , Feminino , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
15.
BMC Infect Dis ; 19(1): 582, 2019 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-31277589

RESUMO

BACKGROUND: Varicella zoster virus (VZV) is a highly contagious herpesvirus with potential for nosocomial transmission. However, the importance of nosocomial chickenpox outbreak in China has often been ignored. With the increasing immunocompromised population in China, a thorough review of issues related to nosocomial transmission and the seroprevalence rate of VZV among healthcare workers is necessary. METHODS: Retrospective case finding for nosocomial transmission of chickenpox was conducted between January 1, 2013 and December 31, 2017. Cases were identified based on clinical features compatible with chickenpox. A cross-sectional study on the seroprevalence rate of VZV among healthcare workers (HCWs) was conducted between January 1, 2014 and December 31, 2017. The serum VZV antibodies of 1804 HCWs were measured by enzyme-linked immunosorbent assay (ELISA). The seroprevalence rate of VZV antibodies, the positive predictive value and negative predictive value of self-reported history of varicella were analyzed. The economic impact associated with nosocomial transmission of VZV was also assessed. RESULTS: A total of 8 cases of chickenpox were identified in three nosocomial transmissions, including 4 HCWs who were infected nosocomially. The overall seroprevalence rate of VZV was 88.4%, which significantly increased with age (P < 0.01). The seroprevalence rates of HCWs with different genders and occupations showed no statistically significant differences. The positive and negative predictive values of a self-reported history of varicella were 80.8 and 10.6% respectively. An estimation of 163.3 person-days of work were lost in each nosocomial transmission and 86.7 infection control unit person-hours were required for each outbreak investigation. The cost of VZV IgG ELISA screening was estimated to be 83 USD per nosocomial transmission. CONCLUSIONS: Nosocomial transmission of VZV occurred repeatedly in the hospital setting. An alarming 11.6% of HCWs were seronegative for VZV, which might increase the risk of nosocomial infection and outbreak for other susceptible co-workers and patients. This is especially important in the setting of a teaching hospital where many immunocompromised patients were managed. Furthermore, the positive predictive value of self-reported varicella on seroprevalence rate in our study was lower than those reported in other countries, therefore serological testing of VZV antibodies with subsequent vaccination for all non-immune HCWs should be considered.


Assuntos
Varicela/transmissão , Pessoal de Saúde/estatística & dados numéricos , Infecção pelo Vírus da Varicela-Zoster/transmissão , Adolescente , Adulto , Anticorpos Antivirais/sangue , Varicela/epidemiologia , China/epidemiologia , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/transmissão , Estudos Transversais , Surtos de Doenças , Suscetibilidade a Doenças , Ensaio de Imunoadsorção Enzimática , Feminino , Herpesvirus Humano 3/imunologia , Hospitais de Ensino/estatística & dados numéricos , Humanos , Controle de Infecções , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estudos Soroepidemiológicos , Estudantes de Medicina/estatística & dados numéricos , Infecção pelo Vírus da Varicela-Zoster/epidemiologia
16.
J Craniofac Surg ; 30(4): 1201-1205, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31166266

RESUMO

BACKGROUND: High volume centers (HVC) is commonly associated with increased resources and improved patient outcomes. This study assesses efficacy and outcomes of high volume centers in cleft palate repair. METHODS: Cleft palate procedures were identified in the Kids' Inpatient Database from 2003-2009. Demographics, perioperative factors, co-morbidities, and complications in HVC (90th percentile, >48 cases/year) and non-high volume centers (NHVC) were compared across various cohorts of cleft repair. RESULTS: Four thousand five hundred sixty-three (61.7%) total cleft palate surgeries were performed in HVC and 3388 (38.3%) were performed in NHVC. The NHVC treated a higher percentage of Medicaid patients (P = 0.005) and patients from low-income quartiles (P = 0.018). HVC had larger bedsizes (P <0.001), were more often government/private owned (P <0.001), and were more often teaching hospitals (P <0.001) located predominantly in urban settings (P <0.001). The HVC treated patients at younger ages (P = 0.008) and performed more concurrent procedures (P = 0.047). The most common diagnosis at HVC was complete cleft palate with incomplete cleft lip, while the most common diagnosis at NHVC was incomplete cleft palate without lip. Overall, length of stay and specific complication rates were lower in HVC (P = 0.048, P = 0.042). Primaries at HVCs showed lower pneumonia (P = 0.009) and specific complication rates (P = 0.023). Revisions at HVC were associated with older patients, fewer cardiac complications (P = 0.040), less wound disruption (P = 0.050), but more hemorrhage (P = 0.040).


Assuntos
Fissura Palatina/cirurgia , Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos , Fenda Labial/cirurgia , Fissura Palatina/economia , Bases de Dados Factuais , Feminino , Hospitais de Ensino/estatística & dados numéricos , Humanos , Renda , Seguro Saúde/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Medicaid/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Estados Unidos/epidemiologia , Serviços Urbanos de Saúde/estatística & dados numéricos
17.
Clin Imaging ; 57: 83-86, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31163294

RESUMO

OBJECTIVE: "Curbside consults" are informal opinions provided by one physician to another. In radiology, it often refers to opinions rendered on imaging performed at outside facilities and has evolved from being a targeted response to a discrete clinical question to a complete over-read in recent years. Given that the consults are usually sought for patients with complex conditions, the potential for error increases with informal reads, often due to the time constraint and lack of adequate information. Misinterpretations and inaccurate documentation by the referring clinician are also more likely. This study assesses the policies and views on curbside consults at academic centers in the United States. MATERIALS AND METHODS: An online survey (via SurveyMonkey.com) was circulated to the 319 active radiologist members of the Association of Program Directors. There were 80 responses, representing a 25% response rate. RESULTS: While most facilities provided second reads (92%), only a few (23%) provided written reports and read the case entirely. The majority (77%) tailored their read to answer specific clinical questions. Approximately two-thirds did not require the outside radiologist's report to be available before their interpretation. Seventy-nine percent were at least mildly concerned about liability. Up to 45% billed for the study; 39% were not aware of the billing practice. CONCLUSION: Curbside consults are widely provided at U.S. academic institutions with only a minority documenting their opinions. The majority are concerned about the legal implications and this paper puts forth recommendations to minimize the potential for errors in patient care and decrease liability.


Assuntos
Padrões de Prática Médica , Radiologia/métodos , Encaminhamento e Consulta , Documentação , Hospitais de Ensino/estatística & dados numéricos , Humanos , Responsabilidade Legal , Encaminhamento e Consulta/ética , Encaminhamento e Consulta/legislação & jurisprudência , Encaminhamento e Consulta/normas , Estados Unidos
18.
J Cardiothorac Surg ; 14(1): 98, 2019 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-31151461

RESUMO

OBJECTIVES: Despite a long history of concerns regarding patient safety during clinical care, some patients undergoing thoracic surgery continue to experience adverse events (AEs). AEs are a major significant source of perioperative morbidity and mortality following thoracic surgery. This study analysed the causes, treatment and prognosis of perioperative AEs to provide a reference for further surgical safety. METHODS: The authors collected a total of 62,571 thoracic surgery anaesthesia records via the Anaesthesia Information Management System (AIMS) from 14 August 2006 to 14 August 2017 and obtained 150 cases of perioperative serious AEs from the "adverse events registration" subsystem. The related hospitalization data of the 150 patients were analysed, including anaesthesia, recovery room time, ICU records and follow-up outcomes. The causes of these AEs were classified as follows: events related to the patients' pathogenic conditions(P); surgery-related factors(S); anaesthesia-related factors(A); and interactions between pathogenic, surgical and anaesthesia factors (P&S&A). We then analysed the main clinical manifestations, causes and treatment of these events. RESULTS: The overall rate of perioperative AEs in thoracic surgery (n = 62,571) was 0.2%. Of these, 10.7% were. caused by P and 23.3% by A; neither cause led to patient death. S and P&S&A accounted for 55.3 and 10.7% of AEs, respectively; together, they accounted for 66%. Twelve patients with postoperative AEs caused by S or P&S&A died within 3 days (8% of 150 cases). A total of 33%(50/150) of patients experienced sudden cardiac arrest (SCA) and recovered successfully. Surgical massive haemorrhage (22%, 33/150) was reported as a predominant mortality-related outcome in this group, and 8 of the 12 deaths were caused by massive haemorrhage. CONCLUSIONS: The rate of perioperative AEs after thoracic surgery was 0.2%. AEs must be identified and treated immediately. An important factor in anaesthesia-related events was respiratory management. Two major clinical manifestations of surgery-related events were cardiac arrest and massive haemorrhage. Cardiac arrest was the major factor contributing to AEs, but its adverse consequences could be avoided with timely discovery and proper treatment. Massive haemorrhage is a significant cause of mortality that can be prevented with a surgeon's early diagnosis and appropriate interventions.


Assuntos
Anestesia/efeitos adversos , Países em Desenvolvimento/estatística & dados numéricos , Hospitais de Ensino/estatística & dados numéricos , Complicações Intraoperatórias/etiologia , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Perda Sanguínea Cirúrgica/mortalidade , China/epidemiologia , Parada Cardíaca/etiologia , Humanos , Complicações Intraoperatórias/epidemiologia , Período Perioperatório , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/terapia , Prognóstico , Estudos Retrospectivos , Centros de Atenção Terciária/estatística & dados numéricos
20.
Pediatr Surg Int ; 35(7): 803-806, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31037325

RESUMO

PURPOSE: We aim to evaluate the sociodemographic and medical features of child-aged refugee patients and identify their health-related problems. METHODS: Refugee children admitted to pediatric surgery department of a teaching hospital during the years 2012-2017 were included. Patients' files were reviewed retrospectively for sociodemographic and medical features. RESULTS: A total of 254 patients with the mean age of 4.6 ± 4.15 years (0-16 years) were treated. Male-to-female ratio was 1.7. Most common diagnosis were inguino-scrotal pathologies (n = 50, 19.7%) followed by foreign body ingestion (n = 37, 14.6%) and corrosive esophagitis (n = 22, 8.7%). The cause of admission was a potentially preventable trauma in 24.4% of cases. Comorbid medical conditions were present in 49 patients (19.3%). Anemia was detected in 23.2% of cases. Weight according to age and gender were < 3 percentile in 29.1% of patients. Difficulties in communication, lack of former medical history and advanced presentation of disease were the challenges faced by caregivers. CONCLUSION: The primary diagnoses for admission of refugee children were different from the routine practice and a significant part were from preventable causes. Comorbidities were common potentially having a negative influence on treatment processes. This can be a result of unfavorable living conditions and lack of medical care during migration.


Assuntos
Conflitos Armados , Doenças do Sistema Digestório/etnologia , Nível de Saúde , Hospitais de Ensino/estatística & dados numéricos , Refugiados , Procedimentos Cirúrgicos Operatórios , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Doenças do Sistema Digestório/cirurgia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Morbidade/tendências , Estudos Retrospectivos , Síria/etnologia , Turquia/epidemiologia
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