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1.
Isr Med Assoc J ; 22(1): 8-12, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31927798

RESUMO

BACKGROUND: Heart failure centers with specialized nurse-supervised management programs have been proposed to improve prognosis. The Heart Failure Center in Beit Shemesh, Israel, is located within a large primary care facility. The specialist team supervised the managememt of patients both within the frame of the center and while they were hospitalized. OBJECTIVES: To evaluate the health services utilization by heart failure patients treated at a heart failure center and their clinical outcome. METHODS: In this retrospective study, we compared the clinical outcome of patients treated at a heart failure center to patients who received the standard care in 2013-2014. The clinical outcome included primary care visits, emergency room visits, hospitalizations, and death. RESULTS: The study comprised 430 heart failure patients; 82 were treated at the heart failure center and 348 under standard care. At baseline, no significant differences were seen in clinical parameters between the groups. Healthcare utilization was higher among the study group. No significant changes in healthcare utilization were found. During follow-up, patients treated in a heart failure center were more likely to get recommended heart failure medications. Mortality was significantly lower in patients treated in the heart failure center compared with those receiving standard care 3.6% vs. 24%, respectively (P = 0.001), hazard ratio 0.19, 95% confidence interval 0.06-0.62, P = 0.005. CONCLUSIONS: Joint management of heart failure by primary clinics and a specialized community heart failure center reduced mortality. There was no decrease in healthcare utilizations among heart failure center patients, despite the reduction in mortality.


Assuntos
Centros Comunitários de Saúde/estatística & dados numéricos , Insuficiência Cardíaca/terapia , Idoso , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Insuficiência Cardíaca/mortalidade , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Estudos Retrospectivos
2.
MMWR Morb Mortal Wkly Rep ; 69(2): 44-49, 2020 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-31945038

RESUMO

CDC, the Food and Drug Administration (FDA), state and local health departments, and public health and clinical stakeholders continue to investigate a nationwide outbreak of e-cigarette, or vaping, product use-associated lung injury (EVALI) (1). EVALI patients in Illinois, Utah, and Wisconsin acquired tetrahydrocannabinol (THC)-containing products primarily from informal sources (2,3). This report updates demographic characteristics and self-reported sources of THC- and nicotine-containing e-cigarette, or vaping, products derived from EVALI patient data reported to CDC by state health departments. As of January 7, 2020, among 1,979 (76%) patients with available data on substance use, a total of 1,620 (82%) reported using any THC-containing products, including 665 (34%) who reported exclusive THC-containing product use. Use of any nicotine-containing products was reported by 1,128 (57%) patients, including 264 (13%) who reported exclusive nicotine-containing product use. Among 809 (50%) patients reporting data on the source of THC-containing products, 131 (16%) reported acquiring their products from only commercial sources (i.e., recreational dispensaries, medical dispensaries, or both; vape or smoke shops; stores; and pop-up shops), 627 (78%) from only informal sources (i.e., friends, family, in-person or online dealers, or other sources), and 51 (6%) from both types of sources. Among 613 (54%) EVALI patients reporting nicotine-containing product use with available data on product source, 421 (69%) reported acquiring their products from only commercial sources, 103 (17%) from only informal sources, and 89 (15%) from both types of sources. Adolescents aged 13-17 years were more likely to acquire both THC- and nicotine-containing products from informal sources than were persons in older age groups. The high prevalence of acquisition of THC-containing products from informal sources by EVALI patients reinforces CDC's recommendation to not use e-cigarette, or vaping, products that contain THC, especially those acquired from informal sources. Although acquisition of nicotine-containing products through informal sources was not common overall, it was common among persons aged <18 years. While the investigation continues, CDC recommends that the best way for persons to ensure that they are not at risk is to consider refraining from the use of all e-cigarette, or vaping, products.


Assuntos
Surtos de Doenças , Hospitalização/estatística & dados numéricos , Lesão Pulmonar/epidemiologia , Vaping/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Dronabinol/efeitos adversos , Sistemas Eletrônicos de Liberação de Nicotina , Feminino , Humanos , Lesão Pulmonar/terapia , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Adulto Jovem
3.
Psychiatr Prax ; 47(1): 35-38, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31910459

RESUMO

OBJECTIVE: Borderline Personality Disorder (BPD) appears to be the most stigmatized diagnosis among personality disorders. This study aims to assess attitudes of psychiatric nurses towards patients with BPD compared to patients with depressive disorder. METHOD: 37 psychiatric nurses were randomized to an experimental between-subject design, in form of two questionnaires with different vignettes. The vignettes examined main outcomes such as negative attitudes, social distance and emotional reactions. RESULTS: Significant moderate to large differences in terms of social distance (p = 0.033, d = -0.736) and single emotional reactions towards patients with BPD (p = 0.017, d = 0.82), e. g. "I have compassion with her" were found. CONCLUSION: Patients with BPD have a substantial need for support. Quality and standards of inpatient care of patients with a BPS disorder can only guaranteed by giving adequate information about the causes of the disorder and professional treatment of the patients. Personnel must be trained to be able to cope with the specifics of the symptoms in BPD patients.


Assuntos
Transtorno da Personalidade Borderline , Enfermagem Psiquiátrica , Estigma Social , Transtorno da Personalidade Borderline/psicologia , Feminino , Alemanha , Hospitalização , Humanos , Masculino , Apoio Social , Inquéritos e Questionários
4.
Bone Joint J ; 102-B(1): 82-89, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31888355

RESUMO

AIMS: The aim of this study was to report our experience at 3.5 years with outpatient total hip arthroplasty (THA). METHODS: In this prospective cohort study, we included all patients who were planned to receive primary THA through the anterior approach between 1 April 2014 and 1 October 2017. Patient-related data and surgical information were recorded. Patient reported outcome measures (PROMs) related to the hip and an anchor question were taken preoperatively, at six weeks, three months, and one year after surgery. All complications, readmissions, and reoperations were registered. RESULTS: Of the 647 THA patients who had surgery in this period through the anterior approach, 257 patients (39.7%) met the inclusion criteria and were scheduled for THA in an outpatient setting. Of these, 40 patients (15.6%) were admitted to the hospital, mainly because of postoperative nausea and/or dizziness. All other 217 patients were able to go home on the day of surgery. All hip-related PROMs improved significantly up to 12 months after surgery, compared with the scores before surgery. There were three readmissions and two reoperations in the outpatient cohort. There were no complications related to the outpatient THA protocol. CONCLUSION: These study results confirm that outpatient THA can be performed safe and successfully in a selected group of patients, with satisfying results up to one year postoperatively, and without outpatient-related complications, readmissions, and reoperations. Cite this article: Bone Joint J 2020;102-B(1):82-89.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Artroplastia de Quadril/estatística & dados numéricos , Atividades Cotidianas , Idoso , Estudos de Casos e Controles , Feminino , Fraturas do Quadril/cirurgia , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Medidas de Resultados Relatados pelo Paciente , Satisfação do Paciente , Fraturas Periprotéticas/cirurgia , Estudos Prospectivos , Reoperação/estatística & dados numéricos , Índice de Gravidade de Doença , Inquéritos e Questionários
6.
J Clin Ethics ; 30(4): 356-359, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31851627

RESUMO

Intravenous drug abusers may incur bloodstream infections, in particular those involving the heart valves, that often require extended courses of antibiotics, commonly on the order of six weeks. Conventional wisdom has dictated that even when patients are sufficiently well to not need ongoing hospitalization, it is unsafe to complete their antibiotic course in any setting other than in a closely supervised facility, even if this is contrary to their wishes. The assumption has been that such patients would be at risk of using their indwelling intravenous catheter for illicit purposes. Recent advances in the care of patients who suffer from addiction disorders suggest that when patients receive state-of-the-art addiction treatment, many may be able to continue their intravenous antibiotic course unsupervised, at home. This represents a departure from the parentalistic model of care of impaired patients who are prone to self-harm, moving towards a model that respects autonomy and trusts patients who are in recovery to continue their care in a manner that is self-beneficial.


Assuntos
Antibacterianos/administração & dosagem , Infecções Bacterianas/tratamento farmacológico , Injeções Intravenosas/ética , Transtornos Relacionados ao Uso de Opioides/complicações , Hospitalização , Humanos
7.
Fortschr Neurol Psychiatr ; 87(12): 711-713, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31847033

RESUMO

Evaluations of cases of a neurological early rehabilitation clinic carried out by the medical services of health insurances (2018) are described and analyzed. More than a quarter of the 1098 cases were evaluated. Examinations focused on hours of ventilation, unnecessary hospitalization, intensity of nursing and features of the definition of early neurological rehabilitation. Strategies to minimize are errors described.


Assuntos
Seguro Saúde , Reabilitação Neurológica , Alemanha , Hospitalização , Humanos , Reabilitação Neurológica/economia
8.
JAMA ; 322(23): 2292-2302, 2019 12 17.
Artigo em Inglês | MEDLINE | ID: mdl-31846016

RESUMO

Importance: Short-term infusions of single vasodilators, usually given in a fixed dose, have not improved outcomes in patients with acute heart failure (AHF). Objective: To evaluate the effect of a strategy that emphasized early intensive and sustained vasodilation using individualized up-titrated doses of established vasodilators in patients with AHF. Design, Setting, and Participants: Randomized, open-label blinded-end-point trial enrolling 788 patients hospitalized for AHF with dyspnea, increased plasma concentrations of natriuretic peptides, systolic blood pressure of at least 100 mm Hg, and plan for treatment in a general ward in 10 tertiary and secondary hospitals in Switzerland, Bulgaria, Germany, Brazil, and Spain. Enrollment began in December 2007 and follow-up was completed in February 2019. Interventions: Patients were randomized 1:1 to a strategy of early intensive and sustained vasodilation throughout the hospitalization (n = 386) or usual care (n = 402). Early intensive and sustained vasodilation was a comprehensive pragmatic approach of maximal and sustained vasodilation combining individualized doses of sublingual and transdermal nitrates, low-dose oral hydralazine for 48 hours, and rapid up-titration of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or sacubitril-valsartan. Main Outcomes and Measures: The primary end point was a composite of all-cause mortality or rehospitalization for AHF at 180 days. Results: Among 788 patients randomized, 781 (99.1%; median age, 78 years; 36.9% women) completed the trial and were eligible for primary end point analysis. Follow-up at 180 days was completed for 779 patients (99.7%). The primary end point, a composite of all-cause mortality or rehospitalization for AHF at 180 days, occurred in 117 patients (30.6%) in the intervention group (including 55 deaths [14.4%]) and in 111 patients (27.8%) in the usual care group (including 61 deaths [15.3%]) (absolute difference for the primary end point, 2.8% [95% CI, -3.7% to 9.3%]; adjusted hazard ratio, 1.07 [95% CI, 0.83-1.39]; P = .59). The most common clinically significant adverse events with early intensive and sustained vasodilation vs usual care were hypokalemia (23% vs 25%), worsening renal function (21% vs 20%), headache (26% vs 10%), dizziness (15% vs 10%), and hypotension (8% vs 2%). Conclusions and Relevance: Among patients with AHF, a strategy of early intensive and sustained vasodilation, compared with usual care, did not significantly improve a composite outcome of all-cause mortality and AHF rehospitalization at 180 days. Trial Registration: ClinicalTrials.gov Identifier: NCT00512759.


Assuntos
Insuficiência Cardíaca/tratamento farmacológico , Vasodilatadores/administração & dosagem , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Comorbidade , Esquema de Medicação , Feminino , Insuficiência Cardíaca/mortalidade , Hospitalização , Humanos , Masculino , Readmissão do Paciente/estatística & dados numéricos , Vasodilatadores/efeitos adversos
9.
Soins ; 64(841): 22-25, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31864507

RESUMO

Modern day treatment of blood cancers is characterised by the introduction of targeted therapies. Alone or in combination with more traditional treatments, administered in a hospital or an outpatient setting, these new medicines possess specific mechanisms of action and particular side effects in addition to or instead of those of traditional treatments. To understand the changes to the care management of patients taking these new treatments, it is necessary to describe their mechanism of action and their side effects.


Assuntos
Neoplasias Hematológicas/terapia , Serviços de Assistência Domiciliar , Hospitalização , História do Século XXI , Humanos
10.
Nephrol Nurs J ; 46(6): 629-640, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31872993

RESUMO

Reducing the growing burden of acute kidney injury (AKI) is a real challenge. This article explores admissions and emergency visits of patients with AKI in California between 2005 and 2015. Data were drawn from California's Office of Statewide Health Planning and Development (OSHPD) hospital dataset. Trend analyses, including comorbidities and spatiotemporal analysis, were conducted. AKI hospital episodes almost doubled between 2005 and 2015 (25,495 vs. 48,845, respectively); the growing trend was largely attributable to an increasing number of patients with co-existing CKD and diabetes or hypertension (2,511 vs. 25,098 in 2005 and 2015, respectively). We also found an increasingly positive spatiotemporal correlation between diabetes prevalence and AKI hospitalization rate over time. Based on results of this study, we identified modifiable targets to reduce the growing number of AKI episodes and the potential escalating health care costs.


Assuntos
Lesão Renal Aguda , Complicações do Diabetes , Diabetes Mellitus , Hospitalização , Lesão Renal Aguda/complicações , Lesão Renal Aguda/epidemiologia , California/epidemiologia , Complicações do Diabetes/epidemiologia , Hospitalização/estatística & dados numéricos , Humanos , Estudos Retrospectivos , Fatores de Risco
11.
Artigo em Inglês | MEDLINE | ID: mdl-31875779

RESUMO

BACKGROUND: Heart Failure (HF) is accompanied by a high cost of care and gloomy prognosis despite recent advances in its management. Therefore, efforts to minimize HF rehospitalizations is a major focus of several studies. METHODS: We conducted a retrospective cohort study of 140 patients 18 years and above who had baseline clinical parameters, echocardiography, NT-ProBNP, troponin I and other laboratory parameters following a 3-year electronic medical record review. Patients with coronary artery disease, preserved ejection fraction, pulmonary embolism, cancer, and end-stage renal disease were excluded. RESULTS: Of the 140 patients admitted with HF with reduced Ejection Fraction (HFrEF) secondary to non-ischemic cardiomyopathy, 15 were re-hospitalized within 30 days of discharge while 42 were rehospitalized within 6 months after discharge for decompensated HF. Receiver operating characteristic (ROC) cutoff points were obtained for NT-ProBNP at 5178 pg/ml and serum troponin I at 0.045 ng/ml. After Cox regression analysis, patients with HFrEF who had higher hemoglobin levels had reduced odds of re-hospitalization (p = 0.007) within 30 days after discharge. NT-ProBNP and troponin I were independent predictors of re-hospitalization at 6 months after discharge (p = 0.047 and p = 0.02), respectively, after Cox regression analysis. CONCLUSION: Troponin I and NT-ProBNP at admission are the best predictors of re-hospitalization 6 months after discharge among patients with HFrEF. Hemoglobin is the only predictor of 30 -day rehospitalization among HFrEF patients in this study. High-risk patients may require aggressive therapy to improve outcomes.


Assuntos
Cardiomiopatias/complicações , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/etiologia , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Troponina I/sangue , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Volume Sistólico
12.
Medicine (Baltimore) ; 98(52): e18475, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31876731

RESUMO

Rapid response system (RRS) efficacy and national early warning score (NEWS) performances have largely been reported in inpatient settings, with few such reports undertaken in outpatient settings.This study aimed to investigate NEWS validity in predicting poor clinical outcomes among outpatients who had activated the RRS using single-parameter criteria.A single-center retrospective cohort studyFrom April 1, 2014 to November 30, 2017 in an urban 350-bed referral hospital in JapanWe collected patient characteristics such as activation triggers, interventions, arrival times, dispositions, final diagnoses, and patient outcomes. Poor clinical outcomes were defined as unplanned intensive care unit transfers or deaths within 24 hours. Correlations between the NEWS and clinical outcomes at the time of deterioration and disposition were analyzed.Among 31 outpatients, the NEWS value decreased significantly after a medical emergency team intervention (median, 8 vs 4, P < .001). The difference in the NEWS at the time of deterioration and at disposition was significantly less in patients with poor clinical outcomes (median 3 vs 1.5, P = .03). The area under the curve (AUC) for the NEWS high-risk patient group at the time of deterioration for predicting hospital admission was 0.85 (95% confidence interval [CI], 0.67-1.0), while the AUC for the NEWS high-risk patient group at disposition for predicting poor clinical outcomes was 0.83 (95% CI, 0.62-1.0).The difference between the NEWS at the time of deterioration and at disposition might usefully predict admissions and poor clinical outcomes in RRS outpatient settings.


Assuntos
Assistência Ambulatorial/métodos , Equipe de Respostas Rápidas de Hospitais , Triagem/métodos , Idoso , Deterioração Clínica , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Resultado do Tratamento
13.
MMWR Morb Mortal Wkly Rep ; 68(46): 1076-1080, 2019 Nov 22.
Artigo em Inglês | MEDLINE | ID: mdl-31751326

RESUMO

CDC, the Food and Drug Administration (FDA), state and local health departments, and public health and clinical stakeholders are investigating a nationwide outbreak of e-cigarette, or vaping, product use-associated lung injury (EVALI) (1). As of November 13, 2019, 49 states, the District of Columbia, and two U.S. territories (Puerto Rico and U.S. Virgin Islands) have reported 2,172 EVALI cases to CDC, including 42 (1.9%) EVALI-associated deaths. To inform EVALI surveillance, including during the 2019-20 influenza season, case report information supplied by states for hospitalized and nonhospitalized patients with EVALI were analyzed using data collected as of November 5, 2019. Among 2,016 EVALI patients with available data on hospitalization status, 1,906 (95%) were hospitalized, and 110 (5%) were not hospitalized. Demographic characteristics of hospitalized and nonhospitalized patients were similar; most were male (68% of hospitalized versus 65% of nonhospitalized patients), and most were aged <35 years (78% of hospitalized versus 74% of nonhospitalized patients). These patients also reported similar use of tetrahydrocannabinol (THC)-containing products (83% of hospitalized versus 84% of nonhospitalized patients). Given the similarity between hospitalized and nonhospitalized EVALI patients, the potential for large numbers of respiratory infections during the emerging 2019-20 influenza season, and the potential difficulty in distinguishing EVALI from respiratory infections, CDC will no longer collect national data on nonhospitalized EVALI patients. Further collection of data on nonhospitalized patients will be at the discretion of individual state, local, and territorial health departments. Candidates for outpatient management of EVALI should have normal oxygen saturation (≥95% while breathing room air), no respiratory distress, no comorbidities that might compromise pulmonary reserve, reliable access to care, strong social support systems, and should be able to ensure follow-up within 24-48 hours of initial evaluation and to seek medical care promptly if respiratory symptoms worsen. Health care providers should emphasize the importance of annual influenza vaccination for all persons aged ≥6 months, including persons who use e-cigarette, or vaping, products (2,3).


Assuntos
Surtos de Doenças , Hospitalização/estatística & dados numéricos , Lesão Pulmonar/epidemiologia , Vaping/efeitos adversos , Adolescente , Adulto , Idoso , Feminino , Humanos , Lesão Pulmonar/terapia , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Adulto Jovem
14.
Pneumologie ; 73(11): 670-676, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31715635

RESUMO

BACKGROUND: Home mechanical ventilation is dramatically evolving in Germany. Patients with non-invasive and invasive ventilation are increasingly treated at home. In-hospital treatment of these patients is also necessary either for control visits or the management of acute medical problems. However, the development of in-hospital patient care, morbidity and mortality of these patients is unknown. METHODS: All patients with long-term dependence on mechanical ventilation for more than three months requiring hospitalisation between 2006 and 2016 were analysed (data obtained from the Federal Statistical Office of Germany). RESULTS: There was an exponential increase in the number of in-patients with long-term dependence of mechanical ventilation. While 24 845 patients were treated in-hospital in 2006, 86 117 patients were treated in 2016. Correspondingly, mortality decreased from 13.2 % (2006) to 5.7 % (2016). In addition, in 2016 47 % of all patients were treated on the intensive care or high dependency care unit. Overall, patients had been severely ill, as there were plenty of medical and neurological co-morbidities. The most common diagnosis was COPD with 58 % of all cases, followed by several cardiology diagnosis. A high number of patients had an impairment of renal function (24 %), in part requiring dialysis. CONCLUSIONS: The rapid development of home mechanical ventilation substantially impacts on the development of the hospital landscape in Germany. The exponential increase of these care-intensive patients is challenging for the health care system and requires a discussion about its limits.


Assuntos
Cuidados Críticos , Serviços de Assistência Domiciliar , Assistência ao Paciente/tendências , Respiração Artificial , Cuidados Críticos/métodos , Cuidados Críticos/tendências , Alemanha , Serviços de Assistência Domiciliar/estatística & dados numéricos , Serviços de Assistência Domiciliar/tendências , Hospitalização , Humanos , Unidades de Terapia Intensiva , Respiração Artificial/métodos , Respiração Artificial/estatística & dados numéricos
15.
Rev Med Liege ; 74(11): 566-571, 2019 Nov.
Artigo em Francês | MEDLINE | ID: mdl-31729844

RESUMO

Following a solicitation of INAMI in 2016, a team of the CHU Liège pneumology department has proposed a telemonitoring pilot project in severe chronic obstructive pulmonary disease (COPD) patients. The main objective of the study was to reduce the number of hospitalizations for COPD exacerbation. The patients included in the study had been at least hospitalized once in 12 months before the beginning of the telemonitoring. A close collaboration with the general practitioner was required. Patients were educated in the manipulation of the application and connected objects. The numerous technical difficulties encountered limited the number of patients studied within the short time allowed by INAMI. However, some interesting observations could be made and a first experience in the field acquired. A project on a large scale seems necessary.


Assuntos
Doença Pulmonar Obstrutiva Crônica , Telemedicina , Hospitalização , Humanos , Projetos Piloto , Doença Pulmonar Obstrutiva Crônica/diagnóstico
16.
Artigo em Inglês | MEDLINE | ID: mdl-31738866

RESUMO

The Influenza Complications Alert Network (FluCAN) is a sentinel hospital-based surveillance program that operates at sites in all jurisdictions in Australia. This report summarises the epidemiology of hospitalisations with laboratory-confirmed influenza during the 2018 influenza season. In this observational surveillance system, cases were defined as patients admitted to any of the 17 sentinel hospitals with influenza confirmed by nucleic acid detection. Data were also collected on a frequency-matched control group of influenza-negative patients admitted with acute respiratory infection. During the period 3 April to 31 October 2018 (the 2018 influenza season), 769 patients were admitted with confirmed influenza to one of 17 FluCAN sentinel hospitals. Of these, 30% were elderly (≥65 years), 28% were children (<16 years), 6.4% were Aboriginal and Torres Strait Islander peoples, 2.2% were pregnant and 66% had chronic comorbidities. A small proportion of FluCAN admissions were due to influenza B (13%). Estimated vaccine coverage was 77% in the elderly (≥65 years), 45% in non-elderly adults with medical comorbidities and 26% in children (<16 years) with medical comorbidities. The estimated vaccine effectiveness (VE) in the target population was 52% (95% CI: 37%, 63%). There were a smaller number of hospital admissions detected with confirmed influenza in this national observational surveillance system in 2018 than in 2017, with the demographic profile reflecting the change in circulating subtype from A/H3N2 to A/H1N1.


Assuntos
Vírus da Influenza A Subtipo H1N1/imunologia , Vírus da Influenza A Subtipo H3N2/imunologia , Vacinas contra Influenza/imunologia , Influenza Humana/epidemiologia , Cobertura Vacinal , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Relatórios Anuais como Assunto , Austrália/epidemiologia , Estudos de Casos e Controles , Feminino , Hospitalização , Hospitais , Humanos , Influenza Humana/prevenção & controle , Influenza Humana/virologia , Masculino , Pessoa de Meia-Idade , Gravidez , Vigilância de Evento Sentinela , Adulto Jovem
17.
Zhonghua Yi Xue Za Zhi ; 99(43): 3432-3436, 2019 Nov 19.
Artigo em Chinês | MEDLINE | ID: mdl-31752474

RESUMO

Objective: To explore the differences in epidemiology and clinical features of Guillain- Barré syndrome (GBS) between rural and urban areas of southern China. Methods: The clinical data of 759 hospitalized GBS patients from 31 hospitals of 13 provinces/cities in southern China, between January 1st, 2013 and September 30th, 2016, were collected and analyzed retrospectively. Results: The risk of GBS was higher for males than females in rural and urban areas and the median age was 49 and 48 years, respectively. Seasonal clustering in winter and spring was noted in both rural and urban areas, and the seasonal trend was more markedly in rural areas, but the differences showed no statistical significance. There were 70.37% of patients in rural areas and 73.69% in urban areas who had antecedent respiratory infection. The median time from onset to nadir was 7 days, and Hughes Disability Scale at admission, nadir and discharge were (2.95±1.10 vs 2.84±1.15), (3.25±1.11 vs 3.14±1.21), (2.02±1.24 vs 2.00±1.31) in rural and urban areas respectively. Albuminocytologic dissociation was present in 84.34% of patients in rural areas and 84.62% of cases in urban areas. There were 8.65% and 10.94% of cases in rural and urban areas who required mechanical ventilation during hospitalization, respectively. Demyelinating GBS accounted for 53.29% and 48.77%, respectively, in patients with findings of nerve conduction studies available in rural and urban areas. Conclusions: GBS in rural areas of southern China showed male predominance and a peak of spring and winter occurrence, with respiratory infection as the predominated preceding events and demyelinating GBS being main clinical subtype. Winter and spring showed a higher incidence of GBS in rural and urban areas. There were no significant differences of sex, age, preceding events, season trend, progression of disease, clinical subtypes and cerebrospinal fluid investigations in GBS patients between rural and urban areas.


Assuntos
Síndrome de Guillain-Barré , China , Feminino , Hospitalização , Humanos , Incidência , Masculino , Estudos Retrospectivos
18.
Pan Afr Med J ; 33: 189, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692788

RESUMO

Introduction: Burn injuries are a major cause of hospitalization and are associated with significant morbidity and mortality, particularly in children aged four years or below. In Cameroon, the mortality rate of pediatric severe burns was estimated at 41.2%. There is need to determine the predictors of such mortality in order to guide appropriate management. Methods: This study is aimed at assessing the predictors of mortality of pediatric patients who sustained a burn injury over a period of 11 years (between 1st of January 2006 and 31st of December 2016) in Douala General Hospital (DGH). The data for this study was entered in an electronic questionnaire and analyzed using Epi info version 7. All variables thought to be associated with mortality were entered in a multiple binary logistic regression model. The magnitude or risk was measured by odds ratio, and the 95% confidence interval was estimated. Results: A total of 125 cases of pediatric burns were recorded over the study period. A total of 69 (55.65%) were males, giving a male to female ratio of 1.25:1. The median age was 4 years. Most pediatric burns resulted from accidents. Most patient 78 (69%) came before 8 hours following injury. Scalding was the predominant mechanism of injury in 56 (45.5%) of patients. Most patients had partial thickness burn and most burns involved 1-9.9% body surface areas (BSA). The mean length of hospital stay in this study was 7 days, more than half of the patients had no complications during admission. Among those that developed complications, 19 (35%) developed sepsis. Conclusion: Mortality rate of pediatric burns obtained in this study was 29%, mostly due to cardiac arrest. Flame burns (p=0.03) and BSA >25% (p=0.001) were statistically significant predictors of mortality.


Assuntos
Acidentes/estatística & dados numéricos , Queimaduras/epidemiologia , Parada Cardíaca/epidemiologia , Hospitalização/estatística & dados numéricos , Adolescente , Queimaduras/complicações , Queimaduras/mortalidade , Camarões , Criança , Pré-Escolar , Estudos Transversais , Feminino , Parada Cardíaca/etiologia , Parada Cardíaca/mortalidade , Hospitais Gerais , Humanos , Lactente , Recém-Nascido , Tempo de Internação , Masculino , Estudos Retrospectivos , Inquéritos e Questionários
19.
Pan Afr Med J ; 33: 263, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31692806

RESUMO

The time between clinical symptoms onset and the diagnosis of bronchial cancer should be as short as possible so that it can be managed early and effectively. In Madagascar, this diagnostic delay is unknown. Therefore this study aims to evaluated the diagnostic delay of bronchopulmonary cancers at the the USFR Befelatanana Pneumology, Antananarivo, Madagascar. We conducted a retrospective descriptive study of patients with bronchopulmonary cancers diagnosed at the USFR Befelatanana Pneumology over the period 1st January 2011 to 31st December 2015 (5 years). All patients hospitalized during the study period and receiving anatomopathologically-confirmed diagnosis of bronchopulmonary cancer were included in the study. During the study period we collected data from 43 medical records of patients with bronchopulmonary cancer confirmed histologically, reflecting a rate of 0.64% of hospitalized patients. Pre-hospital delay, hospital delay and total delay were 171.74 days, 13.97 days and 185.71 days respectively. The time between symptom onset and consultation with a doctor was less than three months in 30 cases (69.76%), between 3 and 6 months in 8 cases (18.60%). Pre-hospital delay was very long according to the international recommendation for delayed diagnosis of bronchopulmonary cancers. An effort should be made to improve the diagnostic delay.


Assuntos
Neoplasias Brônquicas/diagnóstico , Hospitalização , Neoplasias Pulmonares/diagnóstico , Diagnóstico Tardio , Humanos , Madagáscar , Estudos Retrospectivos , Fatores de Tempo
20.
Rev Med Suisse ; 15(670): 2046-2051, 2019 Nov 06.
Artigo em Francês | MEDLINE | ID: mdl-31696680

RESUMO

Stroke is the most common acute neurological disease in the world. Approximately 16 000 strokes occur each year in Switzerland. In the older population, the stroke outcomes are related to high risk of malnutrition due to neurological deficits impacting oral feeding. Therefore, systematic screening of malnutrition is required upon admission to hospital. Then, assessment of the nutritional status by a specialist should be initiated before deciding on individualised nutritional strategy. Rehabilitation is complex and must be done in multidisciplinary team to provide optimal care to the patients.


Assuntos
Desnutrição/etiologia , Desnutrição/terapia , Avaliação Nutricional , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/complicações , Idoso , Hospitalização , Humanos , Desnutrição/diagnóstico , Estado Nutricional , Acidente Vascular Cerebral/epidemiologia , Suíça/epidemiologia
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