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1.
J Nurs Adm ; 50(2): 72-77, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31929345

RESUMO

OBJECTIVE: To examine whether end-of-life care quality is superior in Magnet hospitals, a recognition designating nursing excellence. BACKGROUND: Considerable research shows better patient outcomes in hospitals with excellent nurse work environments, but end-of-life care quality has not been studied in Magnet hospitals. METHODS: An analysis of cross-sectional data was completed using surveys of nurses and hospitals. Multivariate logistic regression models were used to determine the association between Magnet hospitals and measures of end-of-life care quality. RESULTS: Overall, nurses report poor quality of end-of-life care in US hospitals. In Magnet hospitals, nurses were significantly less likely to give their hospital an unfavorable rating on end-of-life care. CONCLUSIONS: Hospital Magnet status may signal better quality in end-of-life care. Administrators looking to improve the quality of end-of-life care may consider improving aspects of nursing that distinguish Magnet hospitals.


Assuntos
Hospitais/estatística & dados numéricos , Recursos Humanos de Enfermagem no Hospital/psicologia , Recursos Humanos de Enfermagem no Hospital/normas , Qualidade da Assistência à Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde/normas , Assistência Terminal/psicologia , Assistência Terminal/normas , Adulto , Atitude do Pessoal de Saúde , Estudos Transversais , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Satisfação no Emprego , Masculino , Pessoa de Meia-Idade , Cultura Organizacional , Assistência Terminal/estatística & dados numéricos , Estados Unidos
2.
Medicine (Baltimore) ; 99(2): e18714, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914082

RESUMO

To investigate the situation of antibiotic consumption and to assess the inappropriate use on pediatric inpatients of different types hospitals in Sichuan, China.A cross-sectional survey of antibiotic prescriptions among hospitalized children aged 1month -14years were conducted from April 2018 to June 2018 in southwestern China. Antibiotic prescriptions were extracted from electronic records during hospitalization of each inpatient in five different types hospitals.In this study, the antibiotic prescription rate of hospitalized children was 66.9% (1176/1758). Compared with tertiary children hospital (TC) (46.1%), general hospitals and non-tertiary children hospitals has higher rate of antibiotic prescription (almost 85%) (P < .001). 93.4% of inpatients received parenteral antibiotic. Overall, the most common antibiotics were Cefoperazone and enzyme inhibitor, Cefixime and Azithromycin. Lower respiratory tract infection (LRTI) was the leading reason for antibiotic consumption in pediatric wards (56.8%), followed by upper respiratory tract infection (URTI) (22.2%). For children with LRTI, Cephalosporins were heavy prescribed, especially broad-spectrum third-generation Cephalosporins (60.3%). The antibiotic prescription proportion of URTI in general hospitals and non-tertiary children hospitals (more than 18%) was higher than TC (8.1%) (P < .001).There was inappropriate use of antibiotic in hospitalized children including overuse of parenteral administration, overprescribing of antibiotic on URTI and misuse of third-generation Cephalosporins in pediatric inpatients with LRTI. Compared with tertiary freestanding children hospital, the irrational antibiotic prescription of general hospitals and non-tertiary children hospitals were more serious. Management strategy should be implementer on quality improvement of antibiotic use.


Assuntos
Antibacterianos/uso terapêutico , Uso de Medicamentos/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Prescrição Inadequada/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Adolescente , Antibacterianos/administração & dosagem , Criança , Criança Hospitalizada , Pré-Escolar , China , Estudos Transversais , Feminino , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Lactente , Masculino , Infecções Respiratórias/tratamento farmacológico
3.
Br J Anaesth ; 124(1): 73-83, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31860444

RESUMO

BACKGROUND: Socioeconomic circumstances can influence access to healthcare, the standard of care provided, and a variety of outcomes. This study aimed to determine the association between crude and risk-adjusted 30-day mortality and socioeconomic group after emergency laparotomy, measure differences in meeting relevant perioperative standards of care, and investigate whether variation in hospital structure or process could explain any difference in mortality between socioeconomic groups. METHODS: This was an observational study of 58 790 patients, with data prospectively collected for the National Emergency Laparotomy Audit in 178 National Health Service hospitals in England between December 1, 2013 and November 31, 2016, linked with national administrative databases. The socioeconomic group was determined according to the Index of Multiple Deprivation quintile of each patient's usual place of residence. RESULTS: Overall, the crude 30-day mortality was 10.3%, with differences between the most-deprived (11.2%) and least-deprived (9.8%) quintiles (P<0.001). The more-deprived patients were more likely to have multiple comorbidities, were more acutely unwell at the time of surgery, and required a more-urgent surgery. After risk adjustment, the patients in the most-deprived quintile were at significantly higher risk of death compared with all other quintiles (adjusted odds ratio [95% confidence interval]: Q1 [most deprived]: reference; Q2: 0.83 [0.76-0.92]; Q3: 0.84 [0.76-0.92]; Q4: 0.87 [0.79-0.96]; Q5 [least deprived]: 0.77 [0.70-0.86]). We found no evidence that differences in hospital-level structure or patient-level performance in standards of care explained this association. CONCLUSIONS: More-deprived patients have higher crude and risk-adjusted 30-day mortality after emergency laparotomy, but this is not explained by differences in the standards of care recorded within the National Emergency Laparotomy Audit.


Assuntos
Serviços Médicos de Emergência , Laparotomia/mortalidade , Complicações Pós-Operatórias/economia , Complicações Pós-Operatórias/mortalidade , Fatores Socioeconômicos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Inglaterra/epidemiologia , Feminino , Hospitais/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Assistência Perioperatória/economia , Assistência Perioperatória/normas , Pobreza , Risco Ajustado , Medicina Estatal , Adulto Jovem
4.
Pan Afr Med J ; 34: 68, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31819784

RESUMO

Introduction: More than 20 million infants were born with low birth weight in worldwide. Low birth weight contributes more than 80 percent of all the neonatal mortality. In Ethiopia, studies have shown that there is a high prevalence of low birth weight among newborns. Thus, this study was aimed to determine the magnitude and associated factors with low birth weight among newborns delivered at term in Kambata-Tembaro zone, Southern Ethiopia, 2018. Methods: Institution based cross-sectional study design was used. The sample size was proportionally allocated to each hospital. The total of 341 study participants was enrolled using systematic random sampling techniques. Data were collected by interview-administered questionnaire and entered using Epi-Info version-7 and exported to SPSS version 20 for analysis. Multivariate logistic regression analysis was carried out to identify associated factors with the low birth weight. Results: The prevalence of low birth weight was 18% and significantly associated with the mothers' non-employment [aOR=5.4;95%CI:1.7-17.4], residing in the rural [AOR=5.4; 95%CI:2.1-14.7], unintended pregnancy [aOR=2.0;95%CI:1.2-3.8], not attending antenatal care [aOR=2.3;95%CI: 1.3-2.7], mothers with greater than three births [aOR=1.5;95% CI:1.8-2.6], birth interval less than or equal to two years [aOR=1.9;95%CI:1.6-3.6] and intimate partner violence during pregnancy [aOR=2.1:95% CI: 1.1-3.9]. Conclusion: The study finding shown that the prevalence of low birth weight among newborn was high (18%) in the study. Preventing of low birth weight is an important intervention to reduce neonatal death. Therefore, maximizing women economic status, providing quality family planning services, enabling pregnant women to use antenatal care and preventing intimate partner violence during pregnancy via launching women empowering strategies in the community level is highly recommend.


Assuntos
Serviços de Planejamento Familiar/estatística & dados numéricos , Recém-Nascido de Baixo Peso , Violência por Parceiro Íntimo/estatística & dados numéricos , Cuidado Pré-Natal/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Etiópia/epidemiologia , Feminino , Hospitais/estatística & dados numéricos , Humanos , Recém-Nascido , Gravidez , Prevalência , Fatores de Risco , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
5.
Rev Chilena Infectol ; 36(5): 565-575, 2019 Oct.
Artigo em Espanhol | MEDLINE | ID: mdl-31859797

RESUMO

BACKGROUND: Antimicrobial resistance (AMR) is a global threat to public health. Antibiotic stewardship programs (AMSP) promote the proper use of antimicrobials, improve clinical and economic outcomes, and helps containing the AMR. AIM: To evaluate the diagnostic phase of the AMS programs and early implementation of AMS at three high complexity hospitals that belong to the social security system in Peru. METHODS: A quasi-experimental multicenter study was implemented. The construction of the AMSP, microbiological baselines, antimicrobial consumption and consensus on AMS activities were evaluated at the diagnosis and early implementation periods of the AMSP. RESULTS: Following implementation, hospitals doubled their score of resources and processes available for the AMS program from 6.75 to 13.75. The prevalence of extended spectrum beta-lactamase producing enterobacteria was 50-60% while Pseudomonas aeruginosa averaged 69% resistance to carbapenems. The defined daily dose (DDD) of ceftriaxone was 13.63, vancomycin 7.35 and meropenem 6.73 in average. Hospitals A and C decreased the use of antimicrobials (30-50%). DISCUSSION: The implementation of the AMSP in the three hospitals was achieved through diverse strategies designed by multidisciplinary teams, which in addition to its articulation, reduce the consumption of broad spectrum antimicrobials at an early stage.


Assuntos
Anti-Infecciosos/administração & dosagem , Gestão de Antimicrobianos/métodos , Avaliação de Programas e Projetos de Saúde/métodos , Resistência Microbiana a Medicamentos , Implementação de Plano de Saúde , Hospitais/estatística & dados numéricos , Humanos , Ensaios Clínicos Controlados não Aleatórios como Assunto , Peru , Previdência Social , Fatores de Tempo
6.
BMC Infect Dis ; 19(1): 988, 2019 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-31752719

RESUMO

BACKGROUND: Malaria and the human immunodeficiency virus (HIV) infection constitute public health problems in Cameroon including the South West Region (SWR). This study determined the prevalence of malaria parasites and haematological abnormalities in HIV positive patients in Limbe, Cameroon from April-July 2014. METHODS: The study was cross-sectional and involved 411 participants who were administered structured questionnaires to record socio-demographic and clinical data. Three hundred and nine (309) HIV positive patients and one hundred and two (102) HIV negative individuals were examined clinically and venous blood collected for malaria parasite detection, HIV infection diagnosis and full blood count analysis. RESULTS: Overall malaria parasite prevalence was 14.1% (58/411). This prevalence was significantly higher (P <  0.001) in the HIV negative participants (33.3%, 34/102) compared to the HIV positive patients (7.8%, 24/309). Amongst HIV positive participants, malaria parasite prevalence was significantly higher in female patients (P = 0.003), febrile patients (P <  0.001), anaemic patients (P = 0.015) and in patients who were not on antiretroviral treatment (ART) (P = 0.03) when compared with their respective counterparts. Among the HIV negative group, though not significant, malaria parasite prevalence was higher in females, febrile and anaemic patients when compared with their respective counterparts. Overall anaemia prevalence was 52.1% (214/309) and was significantly higher (P = 0.004) in HIV positive patients (56%, 173) than in HIV negative participants (40.2%, 41). Malaria/HIV co-infected patients had a significantly lower mean value of Hb (P = 0.002), RBC (P = 0.002) and Hct (P = 0.001) when compared with HIV-infected patients. CONCLUSION: HIV negative participants had a higher prevalence of malaria parasites than their HIV positive counterparts. Anaemia prevalence was higher in HIV positive patients than in HIV negative participants. Malaria/HIV co-infected patients presented with more red blood cell abnormalities than HIV-infected patients.


Assuntos
Coinfecção/epidemiologia , Infecções por HIV/epidemiologia , Malária/epidemiologia , Plasmodium/isolamento & purificação , Adolescente , Adulto , Idoso , Animais , Antirretrovirais/administração & dosagem , Camarões/epidemiologia , Criança , Pré-Escolar , Coinfecção/parasitologia , Coinfecção/virologia , Estudos Transversais , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , Hospitais/estatística & dados numéricos , Humanos , Lactente , Malária/parasitologia , Masculino , Pessoa de Meia-Idade , Plasmodium/classificação , Plasmodium/genética , Prevalência , Adulto Jovem
7.
J Surg Oncol ; 120(8): 1327-1334, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31680251

RESUMO

BACKGROUND: Despite the popularity of the U.S. News and World Report (USNWR) hospital rankings among the general public, the relationship between hospital rankings and actual patient outcomes for major cancers remains poorly investigated. METHODS: Medicare Inpatient Standard Analytic Files were queried from 2013-2015 to assess the relationship of postoperative outcomes and Medicare expenditures among patients undergoing surgery for colorectal, lung, esophageal, pancreatic, and liver cancer at hospitals ranked in the top-50 USNWR vs hospitals ranked below 50. RESULTS: Among 94 599 patients, 13 217 vs 81 382 patients underwent surgery at a top-50 hospital versus a non-top 50 ranked hospital. Other than among patients who underwent colorectal surgery, the odds of postoperative complications were lower at top ranked vs non-top ranked hospitals (colorectal: OR, 1.46, 95% CI, 1.28-1.65; lung: OR, 0.73, 95% CI, 0.61-0.87; esophagus: OR, 0.70, 95% CI, 0.52-0.94; pancreas: OR, 0.81, 95% CI, 0.70-0.94; liver: OR, 0.85, 95% CI, 0.69-1.04). Moreover, the odds of 90-day mortality were lower at top ranked hospitals vs non-top ranked hospitals (colorectal: OR, 0.59, 95% CI, 0.48-74; lung: OR, 0.66, 95% CI, 0.53-0.82; esophagus: OR, 0.56, 95% CI, 0.40-0.80; pancreas: OR, 0.51, 95% CI, 0.40-0.65; liver: OR, 0.61, 95% CI, 0.44-0.84). Outcomes were comparable among hospitals within the top-50 rank. CONCLUSION: Mortality rates were lower at hospitals in the top-50 USNWR versus non-top ranked, yet hospitals within the top-50 USNWR rankings had comparable outcomes.


Assuntos
Hospitais/estatística & dados numéricos , Neoplasias/mortalidade , Neoplasias/cirurgia , Idoso , Idoso de 80 Anos ou mais , Falha da Terapia de Resgate/estatística & dados numéricos , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Readmissão do Paciente/estatística & dados numéricos , Publicações Periódicas como Assunto , Complicações Pós-Operatórias/epidemiologia , Estados Unidos/epidemiologia
8.
BMC Infect Dis ; 19(1): 922, 2019 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-31666012

RESUMO

BACKGROUND: In southern Papua, Indonesia, malaria is highly prevalent in young children and is a significant cause of morbidity and early mortality. The association between malaria and delayed mortality is unknown. METHODS: Routinely-collected hospital surveillance data from southern Papua, Indonesia, were used to assess the risk of recurrent malaria and mortality within 12 months of an initial presentation with malaria in all children younger than 5 years old attending the local hospital. Analysis was primarily by Kaplan Meier and Cox regression methods. RESULTS: In total 15,716 children presenting with malaria between April 2004 and December 2013 were included in the analysis; 6184 (39.3%) with Plasmodium falciparum, 7499 (47.7%) with P. vivax, 203 (1.3%) with P. malariae, 3 with P. ovale and 1827 (11.6%) with mixed infections. Within 1 year, 48.4% (7620/15,716) of children represented a total of 16,957 times with malaria (range 1 to 11 episodes), with the incidence of malaria being greater in patients initially presenting with P. vivax infection (1334 [95%CI 1307-1361] per 1000 patient years) compared to those with P. falciparum infection (920 [896-944]). In total 266 (1.7%) children died within 1 year of their initial presentation, 129 (48.5%) within 30 days and 137 (51.5%) between 31 and 365 days. There was no significant difference in the mortality risk in patients infected with P. vivax versus P. falciparum either before 30 days (Hazard Ratio (HR) 1.02 [0.69,1.49]) or between 31 and 365 days (HR = 1.30 [0.90,1.88]). Children who died had a greater incidence of malaria, 2280 [95%CI 1946-2671] per 1000 patient years preceding their death, compared to 1141 [95%CI 1124-1158] per 1000 patient years in those surviving. CONCLUSIONS: Children under-5 years old with P. vivax malaria, are at significant risk of multiple representations with malaria and of dying within 1 year of their initial presentation. Preventing recurrent malaria must be a public health priority in this vulnerable population.


Assuntos
Malária/mortalidade , Pré-Escolar , Coinfecção/epidemiologia , Coinfecção/mortalidade , Feminino , Hospitais/estatística & dados numéricos , Humanos , Incidência , Indonésia/epidemiologia , Lactente , Malária/epidemiologia , Malária Falciparum/epidemiologia , Malária Falciparum/mortalidade , Malária Vivax/epidemiologia , Malária Vivax/mortalidade , Masculino , Morbidade , Prevalência
9.
Medicine (Baltimore) ; 98(44): e17712, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689806

RESUMO

Accumulation of the literature has suggested an inverse association between healthcare provider volume and mortality for a wide variety of surgical procedures. This study aimed to perform meta-analysis of meta-analyses (umbrella review) of observational studies and to summarize existing evidence for associations of healthcare provider volume with mortality in major operations.We searched MEDLINE, SCOPUS, and Cochrane Library, and screening of references.Meta-analyses of observational studies examining the association of hospital and surgeon volume with mortality following major operations. The primary outcome is all-cause short-term morality after surgery. Meta-analyses of observational studies of hospital/surgeon volume and mortality were included. Overall level of evidence was classified as convincing (class I), highly suggestive (class II), suggestive (class III), weak (class IV), and non-significant (class V) based on the significance of the random-effects summary odds ratio (OR), number of cases, small-study effects, excess significance bias, prediction intervals, and heterogeneity.Twenty meta-analyses including 4,520,720 patients were included, with 19 types of surgical procedures for hospital volume and 11 types of surgical procedures for surgeon volume. Nominally significant reductions were found in odds ratio in 82% to 84% of surgical procedures in both hospital and surgeon volume-mortality associations. To summarize the overall level of evidence, however, only one surgical procedure (pancreaticoduodenectomy) fulfilled the criteria of class I and II for both hospital and surgeon volume and mortality relationships, with a decrease in OR for hospital (0.42, 95% confidence interval[CI] [0.35-0.51]) and for surgeon (0.38, 95% CI [0.30-0.49]), respectively. In contrast, most of the procedures appeared to be weak or "non-significant."Only a very few surgical procedures such as pancreaticoduodenectomy appeared to have convincing evidence on the inverse surgeon volume-mortality associations, and yet most surgical procedures resulted in having weak or "non-significant" evidence. Therefore, healthcare professionals and policy makers might be required to steer their centralization policy more carefully unless more robust, higher-quality evidence emerges, particularly for procedures considered as having a weak or non-significant evidence level including total knee replacement, thyroidectomy, bariatric surgery, radical cystectomy, and rectal and colorectal cancer resections.


Assuntos
Mortalidade Hospitalar , Hospitais/estatística & dados numéricos , Cirurgiões/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/mortalidade , Feminino , Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos , Hospitais com Baixo Volume de Atendimentos/estatística & dados numéricos , Humanos , Masculino , Metanálise como Assunto , Estudos Observacionais como Assunto , Razão de Chances
10.
Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi ; 31(5): 479-485, 2019 Oct 12.
Artigo em Chinês | MEDLINE | ID: mdl-31713375

RESUMO

OBJECTIVE: To understand the prevalence and risk factors of Blastocystis hominis infection in inpatients in Jiangjin District, Chongqing City. METHODS: A cross-sectional study was conducted in a community hospital in Jiangjin District, Chongqing City, and the inpatients were surveyed by questionnaires. After obtaining the informed consent from the inpatients or legal guardians, the stool and blood samples were collected and examined by microscopy and PCR from April 17 to May 1, 2018. The univariate analysis and logistic regression analysis were used to analyze the risk factors of the B. hominis infection. RESULTS: A total of 198 hospitalized patients were investigated, and the infection rate of B. hominis was 10.61% (21/198), and the infection rate of the females (12.10%) was higher than that of the males (8.11%), but the difference was not statistically significant. The highest rate of infection was 19.23% in the age group of 10 to 20 years, followed by 17.74% in the age group of 60 years and above, and the lowest rate was 2.38% in the age group of 20 to 40 years. The difference in infection rates of B. hominis among the different age groups was statistically significant (P < 0.05). The infection rate of B. hominis in the people who used dry pail latrines was 33.30%, which was higher than that of the people who used water flush toilets (9.10%) (P < 0.05). The genotypes of B. hominis were ST1, ST3, ST6 and ST7, and ST6 and ST3 being the most predominant genotypes which accounted for 47.62% (10/21) and 38.10% (8/21) respectively, and among the infected males, the genotypes were only ST3 and ST6. The multiple logistic regression analysis showed that among the factors affecting B. hominis infection, only keeping pets was a risk factor [OR = 3.798, 95% CI (1.245, 11.581), P < 0.05]. CONCLUSIONS: A high prevalence of B. hominis infection is found in the inpatients in Jiangjin District, Chongqing City, the predominant genotypes are ST6 and ST3, and keeping pets may be one of the main risk factors.


Assuntos
Infecções por Blastocystis , Blastocystis hominis , Adolescente , Adulto , Infecções por Blastocystis/sangue , Infecções por Blastocystis/epidemiologia , Blastocystis hominis/genética , Criança , China/epidemiologia , Estudos Transversais , Fezes/parasitologia , Feminino , Hospitais/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Inquéritos e Questionários , Adulto Jovem
11.
BMC Health Serv Res ; 19(1): 698, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31615500

RESUMO

BACKGROUND: Few studies have estimated planned home deaths compared to actual place of death in a general population or the longitudinal course of home nursing services and associations with place of death. We aimed to investigate trajectories of nursing services, potentially planned home deaths regardless of place of death; and associations of place of death with potentially planned home deaths and nursing service trajectories, by analyzing data from the last 90 days of life. METHODS: A retrospective longitudinal study with data from the Norwegian Cause of Death Registry and National registry for statistics on municipal healthcare services included all community-dwelling people who died in Norway 2012-2013 (n = 53,396). We used a group-based trajectory model to identify joint trajectories of home nursing (hours per week) and probability of a skilled nursing facility (SNF) stay, each of the 13 weeks leading up to death. An algorithm estimated potentially planned home deaths. We used a multinomial logistic regression model to estimate associations of place of death with potentially planned home deaths, trajectories of home nursing and short-term SNF. RESULTS: We identified four home nursing service trajectories: no (46.5%), accelerating (7.6%), decreasing (22.1%), and high (23.5%) home nursing; and four trajectories of the probability of a SNF stay: low (69.0%), intermediate (6.7%), escalating (15.9%), and increasing (8.4%) SNF. An estimated 24.0% of all deaths were potentially planned home deaths, of which a third occurred at home. Only high home nursing was associated with increased likelihood of a home death (adjusted relative risk ratio (aRRR) 1.29; CI 1.21-1.38). Following any trajectory with elevated probability of a SNF stay reduced the likelihood of a home death. CONCLUSIONS: We estimated few potentially planned home deaths. Trajectories of home nursing hours and probability of SNF stays indicated possible effective palliative home nursing for some, but also missed opportunities of staying at home longer at the end-of-life. Continuity of care seems to be an important factor in palliative home care and home death.


Assuntos
Cuidados de Enfermagem/estatística & dados numéricos , Assistência Terminal/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Feminino , Serviços de Assistência Domiciliar/estatística & dados numéricos , Assistência Domiciliar/métodos , Assistência Domiciliar/estatística & dados numéricos , Cuidados Paliativos na Terminalidade da Vida/métodos , Cuidados Paliativos na Terminalidade da Vida/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Humanos , Vida Independente , Lactente , Recém-Nascido , Modelos Logísticos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Noruega , Cuidados de Enfermagem/métodos , Cuidados Paliativos/métodos , Cuidados Paliativos/estatística & dados numéricos , Sistema de Registros , Projetos de Pesquisa , Estudos Retrospectivos , Instituições de Cuidados Especializados de Enfermagem/estatística & dados numéricos , Assistência Terminal/métodos , Adulto Jovem
12.
BMC Health Serv Res ; 19(1): 701, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31615508

RESUMO

BACKGROUND: Readmissions following exacerbations of chronic obstructive pulmonary disease (COPD) are prevalent and costly. Multimorbidity is common in COPD and understanding how comorbidity influences readmission risk will enable health systems to manage these complex patients. OBJECTIVES: We compared two commonly used comorbidity indices published by Charlson and Elixhauser regarding their ability to estimate readmission odds in COPD and determine which one provided a superior model. METHODS: We analyzed discharge records for COPD from the Nationwide Readmissions Database spanning 2010 to 2016. Inclusion and readmission criteria from the Hospital Readmissions Reduction Program were utilized. Elixhauser and Charlson Comorbidity Index scores were calculated from published methodology. A mixed-effects logistic regression model with random intercepts for hospital clusters was fit for each comorbidity index, including year, patient-level, and hospital-level covariates to estimate odds of thirty-day readmissions. Sensitivity analyses included testing age inclusion thresholds and model stability across time. RESULTS: In analysis of 1.6 million COPD discharges, readmission odds increased by 9% for each half standard deviation increase of Charlson Index scores and 13% per half standard deviation increase of Elixhauser Index scores. Model fit was slightly better for the Elixhauser Index using information criteria. Model parameters were stable in our sensitivity analyses. CONCLUSIONS: Both comorbidity indices provide meaningful information in prediction readmission odds in COPD with slightly better model fit in the Elixhauser model. Incorporation of comorbidity information into risk prediction models and hospital discharge planning may be informative to mitigate readmissions.


Assuntos
Readmissão do Paciente/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/terapia , Índice de Gravidade de Doença , Idoso , Comorbidade , Feminino , Hospitais/estatística & dados numéricos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Prevalência , Estudos Retrospectivos
13.
New Microbiol ; 42(4): 197-204, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31609454

RESUMO

Klebsiella pneumoniae due to the presence of multiple antibiotic resistance mechanisms is one of the most threatening human pathogens nowadays. The aim of the study was to characterize antimicrobial susceptibility, presence of resistance mechanisms and the prevalence of selected genes encoding ESBLs in 170 K. pneumoniae isolates recovered from children and adults hospitalized in two Polish medical centers from 2008 to 2015. The phenotypic identification of strains was confirmed by amplification of mdh gene. ESBLs, metallo-beta- lactamases, Klebsiella pneumoniae carbapenemases and OXA-48 were detected using phenotypic tests. The blaCTX-M-1, blaTEM and blaSHV ESBL genes were amplified by PCR. Pediatric K. pneumoniae isolates displayed significantly higher resistance to piperacillin/tazobactam, cefoxitin, imipenem, amikacin and ciprofloxacin than strains obtained from adults (P<0.05). The presence of ESBLs, OXA-48, KPC and MBL was confirmed in 80.6%, 21.8%, 8.2% and 2.4%, respectively, of the tested strains. The CTX-M-1 enzymes were predominant (91.2%), followed by TEM (63.5%) and SHV (11.8%). The blaTEM was significantly more common in adults than in children (P<0.05). Dual or triple bla genes were observed in 55.9% and 8.2% of K. pneumoniae isolates. Further local epidemiological studies are required to monitor the dissemination of multidrug-resistant K. pneumoniae strains.


Assuntos
Anti-Infecciosos , Infecções por Klebsiella , Klebsiella pneumoniae , beta-Lactamases , Adulto , Anti-Infecciosos/farmacologia , Criança , Hospitais/estatística & dados numéricos , Humanos , Infecções por Klebsiella/epidemiologia , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/efeitos dos fármacos , Testes de Sensibilidade Microbiana , Polônia/epidemiologia , Prevalência , beta-Lactamases/metabolismo
14.
Plast Reconstr Surg ; 144(4): 897-905, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31568300

RESUMO

BACKGROUND: Health care reforms aimed at bundling payments attempt to contain costs. Uncovering variation in spending provides one strategy for decreasing expenditure. This study aims to investigate interhospital cost variation for thumb replantation. METHODS: A retrospective cross-sectional analysis of patients undergoing thumb replantation using data from the Healthcare Cost and Utilization Project National Inpatient Sample database from 2001 to 2011 was performed. Univariate and multivariable logistic regression models were used to investigate associations between patient-level and hospital-level characteristics and cost. RESULTS: A total of 778 patients were included in the study, with a mean cost for thumb replantation of $20,965. Thumb replantations performed at high-volume hospitals were significantly more expensive than those performed at low-volume hospitals (median cost, $20,395 versus $13,463; p < 0.001), with longer lengths of stay (5 days versus 4 days), despite having similar surgical complication rates (p = 0.07). Thumb replantations performed in the West were significantly more expensive than those performed in the South (median cost, $22,579 in the West versus $14,823 in the South; p < 0.001), with longer lengths of stay (5 days versus 4 days; p = 0.005) and similar surgical complications (p = 0.239). In multivariable logistic regression, hospital volume (p < 0.001), hospital region (p < 0.001), and increased length of stay (p < 0.001) were predictive of higher cost. CONCLUSIONS: High-volume hospitals and hospitals in the West are more expensive, with longer lengths of stay, despite having similar complications. Expedited discharge may be one avenue for decreasing expenditure without compromising care.


Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Reimplante/economia , Polegar/cirurgia , Adulto , Estudos Transversais , Feminino , Hospitais/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados Unidos
15.
Artigo em Inglês | MEDLINE | ID: mdl-31540354

RESUMO

Irrational antibiotic usage not only causes an increase in antibiotic-borne diseases, but also inflicts pain on patients, as a result of inappropriate treatment. In order to resolve the hazards caused by irrational antibiotic usage, a kind of e-health service, the Rational Antibiotic Use System (RAUS), has been incorporated into the hospital information system. The RAUS provides doctors and patients with the functions of antibiotic usage monitoring, antibiotic information consultation and antibiotic prescription support. Though existing literature has already proved the usefulness of the RAUS on monitoring doctors' behavior, the effects on hospital performance from an organizational perspective has rarely been measured by empirical data. Therefore, our study has explored the effects of the RAUS on the performance of a large Chinese hospital, which has implemented the RAUS since March 2014. Through empirical research, we quantified the effects of the implementation of the RAUS on a hospital's performance from both the direct effects on the "drug income" and the spillover effect on the "treatment income". The results indicate a significant positive spillover effect on the treatment incomes of a hospital in its inpatient activities (seen as significant in the long term) and in its outpatient activities (seen as significant in both the short and long terms). In addition, this research provides certain theoretical and practical implications for the dilemma of e-health services application in irrational antibiotic usage.


Assuntos
Antibacterianos/uso terapêutico , Hospitais/estatística & dados numéricos , Telemedicina/estatística & dados numéricos , China , Revisão de Uso de Medicamentos/estatística & dados numéricos , Humanos , Pacientes Internados/estatística & dados numéricos , Pacientes Ambulatoriais/estatística & dados numéricos
16.
Health Serv Res ; 54(5): 971-980, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31506956

RESUMO

OBJECTIVE: To estimate the relationship between breach remediation efforts and hospital care quality. DATA SOURCES: Department of Health and Human Services' (HHS) public database on hospital data breaches and Medicare Compare's public data on hospital quality measures for 2012-2016. MATERIALS AND METHODS: Data breach data were merged with the Medicare Compare data for years 2012-2016, yielding a panel of 3025 hospitals with 14 297 unique hospital-year observations. STUDY DESIGN: The relationship between breach remediation and hospital quality was estimated using a difference-in-differences regression. Hospital quality was measured by 30-day acute myocardial infarction mortality rate and time from door to electrocardiogram. PRINCIPAL FINDINGS: Hospital time-to-electrocardiogram increased as much as 2.7 minutes and 30-day acute myocardial infarction mortality increased as much as 0.36 percentage points during the 3-year window following a breach. CONCLUSION: Breach remediation efforts were associated with deterioration in timeliness of care and patient outcomes. Thus, breached hospitals and HHS oversight should carefully evaluate remedial security initiatives to achieve better data security without negatively affecting patient outcomes.


Assuntos
Segurança Computacional/estatística & dados numéricos , Segurança Computacional/normas , Confidencialidade/normas , Registros Eletrônicos de Saúde/normas , Hospitais/normas , Medicare/normas , Qualidade da Assistência à Saúde/normas , Registros Eletrônicos de Saúde/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Humanos , Medicare/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Estados Unidos
17.
Chemosphere ; 235: 969-975, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31561313

RESUMO

Polychlorinated biphenyls (PCB) have been classified by the International Agency for Research on Cancer (IARC) in Group 1 as carcinogenic to human, based on sufficient evidence in humans of an increased risk of cutaneous malignant melanoma and limited evidence for non-Hodgkin lymphoma (NHL). However present findings on the association of PCB exposure and NHL are still controversial. This study examined the relationship between PCB serum levels and risk of NHL in a Northern Italy area (Brescia province), where a chemical factory produced PCBs from 1938 to 1984, causing human contamination. A case-control study of 215 NHL patients and 215 control subjects was conducted. Cases and controls were assayed for serum levels of 33 PCB congeners. No associations were found between risk of NHL and serum levels of total PCBs (OR = 0.51; 95% CI: 0.25-1.04 for highest vs lowest quartile) or specific PCB congeners. The study confirmed a strong association of NHL with HCV infection (OR = 3.60; 95% CI: 1.30-10.02). This case-control study does not support the hypothesis of an association between current serum levels of PCBs and NHL development in the general population.


Assuntos
Poluentes Ocupacionais do Ar/sangue , Hospitais/estatística & dados numéricos , Linfoma não Hodgkin/sangue , Linfoma não Hodgkin/etiologia , Exposição Ocupacional/efeitos adversos , Bifenilos Policlorados/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Humanos , Incidência , Itália/epidemiologia , Linfoma não Hodgkin/epidemiologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Adulto Jovem
18.
Parasitol Res ; 118(11): 3191-3194, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31511977

RESUMO

Aeromonas hydrophila, considered as an emerging pathogen, is increasingly involved in opportunistic human infections. This bacterium, mainly present in aquatic environments, can therefore develop relationships with the free-living amoeba Vermamoeba vermiformis in hospital water networks. We showed in this study that the joint presence of V. vermiformis and A. hydrophila led to an increased bacterial growth in the first 48 h of contact and moreover to the protection of the bacteria in adverse conditions even after 28 days. These results highlight the fact that strategies should be implemented to control the development of FLA in hospital water systems.


Assuntos
Aeromonas hydrophila/crescimento & desenvolvimento , Amoeba/microbiologia , Antibiose/fisiologia , Lobosea/microbiologia , Hospitais/estatística & dados numéricos , Humanos , Água/análise , Microbiologia da Água
19.
BMC Health Serv Res ; 19(1): 681, 2019 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-31547824

RESUMO

BACKGROUND: Telemedicine services are promoting more access to healthcare. Portugal was an early adopter of telemedicine to overcome both its geological barriers and the shortage of healthcare professionals. The Pediatric Cardiology Service (PCS) at Coimbra University Hospital Centre (CHUC) has been using telemedicine to increase access and coverage since 1998. Their Pediatric Telecardiology Service has been daily connecting CHUC with 13 other Portuguese national hospitals, and regularly connecting with Portuguese-speaking African countries, through a teleconsultation platform. METHODS: This study aims at exploring the Pediatric Telecardiology Service's evolution, through a comprehensive assessment of the PCS's development, evolution and impact in public health, to better understand the critical factors for implementation and sustainability of telemedicine, in the context of healthcare services digitalization. A case study was performed, with cost-benefit, critical factors and organizational culture assessment. Finally, the Kingdon's framework helped to understand the implementation and scale-up process and the role of policy-making. RESULTS: With the total of 32,685 out-patient teleconsultations, growing steadily from 1998 to 2016, the Pediatric Telecardiology Service has reached national and international recognition, being a pioneer and an active promotor of telemedicine. This telemedicine service has saved significant resources, about 1.1 million euros for the health system (e.g. in administrative and logistic costs) and approximately 419 euros per patient (considering an average of 1777 patients per year). PCS presents a dominant "Clan" culture. The Momentum's critical factors for telemedicine service implementation enabled us to understand how barriers were overcome (e.g. political forces). Willingness, perseverance and teamwork, allied with partnership with key stakeholders, were the foundation for professionals' engagement and service networking development. Its positive results, new regulations and the increasing support from the hospital board, set up a window of opportunity to establish a sustainable telemedicine service. CONCLUSION: The Pediatric Telecardiology Service enables real-time communication and the sharing of clinical information, overcoming many barriers (from geographical ones to shortage of healthcare professionals), improving access to specialized care both in Portugal and Africa. Motivation and teamwork, and perseverance, were key for the Pediatric Telecardiology Service to tackle the window of opportunity which created conditions for sustainability.


Assuntos
Cardiologia/métodos , Pediatria/métodos , Consulta Remota/organização & administração , Telemedicina/organização & administração , África , Criança , Comunicação , Assistência à Saúde/organização & administração , Assistência à Saúde/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Humanos , Portugal , Consulta Remota/estatística & dados numéricos , Consulta Remota/tendências , Telemedicina/estatística & dados numéricos , Telemedicina/tendências
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