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1.
Pan Afr Med J ; 33: 186, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31565146

RESUMO

Introduction: Acute gastroenteritis (AGE) is a leading cause of mortality in children in developing countries. Management of AGE consumes medical resources, including antibiotics and intra-venous fluids, but factors affecting resource utilization in the management of AGE are under-studied. We hope to identify clinical predictors of resource utilization in AGE. Methods: We performed a retrospective chart review of patients 1-60 months of age admitted to a tertiary hospital in Northern Ghana between January 2013 and December 2014 with an admitting diagnosis of AGE. We collected data on patient demographics, presenting symptoms, and subsequent management. Our primary outcome was prolonged hospital length of stay, defined as >4 days. Secondary outcomes included other measures of resource utilization, such as use of antibiotics, antimalarials and intravenous fluids. Demographic and clinical characteristics were compared between groups with Pearson chi square test for categorical variables and ANOVA for continuous variables. Multivariable logistic regression modeling for each outcome included all variables found to be significant in the bivariate analysis. Results: We reviewed charts for 473 patients admitted for AGE during this timeframe. 264 (56%) were male, median age was 12 months. 448 (95%) received antibiotics, 396 (84%) received antimalarials and 365 (77.2%) received intravenous fluids. 167 (35.3%) had prolonged LOS >4 days. Following multiple logistic regression analysis, clinical features associated with prolonged LOS included fever duration (OR 2.87, 95% CI 2.28-3.61 per 1-day increase), mild (OR 2.39, 95% CI 1.12-5.08) or moderate (OR 3.13, 95% CI 1.57-6.21) dehydration (compared to none) and symptom duration (OR 1.13, 95% CI 1.01-1.27 per 1-day increase). Conclusion: Dehydration and duration of symptoms prior to presentation predict prolonged hospital LOS in young children with AGE in Northern Ghana.


Assuntos
Desidratação/terapia , Gastroenterite/terapia , Hospitalização/estatística & dados numéricos , Doença Aguda , Antibacterianos/administração & dosagem , Antimaláricos/administração & dosagem , Pré-Escolar , Desidratação/epidemiologia , Feminino , Febre/epidemiologia , Hidratação/estatística & dados numéricos , Gana , Recursos em Saúde/estatística & dados numéricos , Humanos , Lactente , Tempo de Internação/estatística & dados numéricos , Modelos Logísticos , Masculino , Estudos Retrospectivos , Centros de Atenção Terciária
2.
Medicine (Baltimore) ; 98(39): e17296, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574852

RESUMO

The angiotensin-receptor-neprilysin inhibitor (ARNI) reduced cardiovascular deaths and heart failure hospitalization in patients with heart failure of reduced ejection fraction (HFrEF). Its role in non-HFrEF patients was not clear. This study aims to answer this question.In this retrospective study, we enrolled 928 patients diagnosed with non-HFrEF, 492 of them received angiotensin converting enzyme inhibitor (ACEI) and the rest 436 received angiotensin-receptor-neprilysin inhibitor. Outcomes were compared by Kaplan-Meier survival analysis and various clinical parameters were investigated using Cox multivariable analysis, followed by interaction analysis. Minnesota living with heart failure Questionnaire (MLHFQ) was employed as one of the criteria to assess heart failure outcome.The cardiovascular (CV) death or HF hospitalization at 24 months occurred in 49 patients in ACEI group compared with 31 in ARNI group (Hazard Ratio (HR): 1.231, 95% confidence Interval (CI): 1.080-2.460, P = .031). And ARNI showed better prognosis of HF hospitalization (HR: 1.283, 95%CI: 1.065-1.360, P = .038). Cumulative Kaplan-Meier estimates of endpoints, ARNI could reduce the incidence of CV death or HF hospitalization (P = .042) and HF hospitalization (P = .035). The stratified analysis revealed that participants with age less than 70 years old had a lower incidence of CV death or HF hospitalization (HR: 1.194, 95%CI: 1.011-1992, P = .031) after treated with ARNI. Patients received diuretics could benefit from ARNI (HR: 1.383, 95%CI: 1.082-1.471, P = .019). Similar results were also observed in patients with heart rate lower than 90 bpm (HR: 1.556, 95%CI: 1.045-2.386, P = .003) and patients with atrial fibrillation history (HR: 1.873, 95%CI: 1.420-2.809, P = .011). ARNI could improve the quality of life both from the total, emotional and physical aspects.ARNI is an efficacy treatment strategy to improve the outcome and quality of life in patients with non-HFrEF.


Assuntos
Antagonistas de Receptores de Angiotensina , Insuficiência Cardíaca , Hospitalização/estatística & dados numéricos , Neprilisina/antagonistas & inibidores , Qualidade de Vida , Volume Sistólico , Idoso , Antagonistas de Receptores de Angiotensina/administração & dosagem , Antagonistas de Receptores de Angiotensina/efeitos adversos , China/epidemiologia , Feminino , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/psicologia , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento , Função Ventricular Esquerda
4.
J Glob Health ; 9(2): 020416, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31555441

RESUMO

Background: Kenyan paediatric treatment protocols recommend the use of zinc supplement for all children with diarrhoea. However, there is limited evidence of benefit for young children aged 1-5 months and those who are well-nourished. We examine effectiveness of zinc supplementation for children admitted with diarrhoea to Kenya's public hospitals with different nutritional and age categories. This is to determine whether the current policy where zinc is prescribed for all children with diarrhoea is appropriate. Methods: We explore the effect of zinc treatment on time to discharge for children aged 1-5 and 6-59 months and amongst those classified as either severely - moderately under-nourished or well-nourished. To overcome the challenges associated with non-random allocation of treatments and missing data in these observational data, we use propensity score methods and multiple imputation to minimize bias. Results: The analysis included 1645 (1-5 months) and 11 546 (6-59 months) children respectively. The estimated sub-distribution hazard ratios for being discharged in the zinc group vs the non-zinc group were 1.25 (95% confidence interval (CI) = 1.07, 1.46) and 1.17 (95% CI = 1.10, 1.24) in these respective age categories. Zinc treatment was associated with shorter time to discharge in both well and under-nourished children. Conclusion: Zinc treatment, in general, was associated with shorter time to discharge. In the absence of significant adverse effects, these data support the continued use of zinc for admissions with diarrhoea including those aged 1-5 months and in those who are well-nourished.


Assuntos
Diarreia/tratamento farmacológico , Hospitalização/estatística & dados numéricos , Hospitais Públicos , Zinco/uso terapêutico , Fatores Etários , Pré-Escolar , Feminino , Política de Saúde , Humanos , Lactente , Quênia , Masculino , Estado Nutricional , Alta do Paciente/estatística & dados numéricos , Fatores de Tempo , Resultado do Tratamento
5.
Rev Saude Publica ; 53: 65, 2019 Sep 02.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31483006

RESUMO

OBJECTIVE: To evaluate whether age group, complications or comorbidities are associated with the length of hospitalization of women undergoing cesarean section. METHODS: A cross-sectional study was carried out between June 2012 and July 2017, with 64,437 women undergoing cesarean section and who did not acquire conditions during their hospital stay. Hospital discharge data were collected from national health institutions, using the Diagnosis-Related Groups system (DRG Brasil®). The DRG referring to cesarean section with additional complications or comorbidities (DRG 765) and cesarean section without complications or associated comorbidities (DRG 766) were included in the initial diagnosis. The influence of age group and comorbidities or complications present at admission on the length of hospital stay was assessed based on the means of the analysis of variance. The size of the effect was verified by Cohen's D, which allows evaluating clinical relevance. The criticality levels were identified using the Duncan test. RESULTS: The longest length of hospital stay was observed in the age group from 15 to 17 years old and among those aged 45 years old or more. The hospital stay of women with complications or comorbidities at the time of admission was also longer. Moreover, it was noted that the increase in criticality level was associated with an increase in the mean length of hospital stay. CONCLUSIONS: The length of hospital stay of women is higher among those belonging to the age group ranging from 15 to 17 years old and for those aged 45 years old or more. The presence of associated comorbidities, such as eclampsia, pre-existing hypertensive disorder with superimposed proteinuria and gestational hypertension (induced by pregnancy) with significant proteinuria increase the length of hospital stay. This study enabled the construction of distinct criticality level profiles based on the combination of age groups and the main comorbidities, which were directly related to the length of hospital stay.


Assuntos
Cesárea/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Brasil , Comorbidade , Estudos Transversais , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Período Pós-Parto , Gravidez , Fatores de Risco , Adulto Jovem
6.
Pan Afr Med J ; 33: 152, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31558949

RESUMO

Introduction: Access to free diagnoses and treatments has been shown to be a major determinant in malaria control. The Cameroon government launched in 2011 and 2014 the exemption of the under-fives' simple and severe malaria treatment policy to increase access to health care and reduce inequality, so as to reduce the mortality related to malaria among the under-fives. This study assessed the effect of providing free malaria treatment in the Buea health district. Methods: This retrospective and cross sectional study was carried out in the Buea health district. Aggregated monthly data from (2008-2010) before and (2012-2014) after the implementation of free malaria treatment was compared, to assess the attributable outcomes of free treatment. A semi-structure questionnaire was also used to assess barriers faced in providing free malaria treatment services by health care workers. Data was collected using a semi-structure questionnaire and a data review summary sheet. The data was analysed using Epi-Info 7, Excel and SPSS (Statistical Package for the Social Sciences) version 20.0 for Windows. All statistical tests were performed at 95% confidence interval (significance level of 0.05). Results: Increase utilisation of health care; as general and malaria related consultations (by 5.7% (p=0.001) witnessed an increase after the implementation of free malaria treatment services. Severe malaria hospitalisation also increased, indicating that most caregivers used the health facility when complications had already set in, which could have led to no significant reduction in mortality due to malaria among under-five children (4.4%, p=0.533). Conclusion: Utilisation of health care increased; as consultation and morbidity rate increased after the implementation of free malaria treatment services. Communication strategy should therefore be strengthened so as to better disseminate information, so as to enhance the effectiveness of the program. There is the need to make a large-scale study to assess the impact of subsidized malaria treatment.


Assuntos
Antimaláricos/administração & dosagem , Política de Saúde , Acesso aos Serviços de Saúde/economia , Malária/tratamento farmacológico , Antimaláricos/economia , Camarões , Cuidadores/estatística & dados numéricos , Pré-Escolar , Estudos Transversais , Financiamento Governamental/economia , Hospitalização/estatística & dados numéricos , Humanos , Malária/economia , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores Socioeconômicos , Inquéritos e Questionários
7.
Ann Agric Environ Med ; 26(3): 469-503, 2019 Sep 19.
Artigo em Inglês | MEDLINE | ID: mdl-31559810

RESUMO

OBJECTIVES: The aim of the study is to determine the scale of interregional migrating patients' hospitalizations in Poland in 2013-2017, as well as their demographic and medical factors, total costs and time changes. MATERIAL AND METHODS: Data from the NHF (National Health Fund) regarding hospitalizations in a given province of patients registered in another province in Poland in 2013-2017 were statistically analyzed. Times series analyses as well as coefficients of correlation, determination and variation were used. RESULTS: The number of patients hospitalized outside their regional registration and the cost of their hospitalization increased from year-to-year during 2013-2017. There was a large variation in provinces in terms of inflow of patients and costs of their hospitalization, while there was only a small variation in terms of outflow of patients and costs of their hospitalization in the analyzed years. Among the patients hospitalized outside the province where they were registered, there were more women then men, while the age group was dominated by 60-year-olds and their share in the subsequent years increased, while the share of other age groups remained unchanged or decreased. The most and increasingly more from year-to-year hospitalizations outside the regional registration were due to neoplasms and diseases of the circulatory system. CONCLUSIONS: The results of the study may significantly contribute to the proper planning of securing the health needs of the inhabitants of particular regions, and to improving the quality and economic efficiency of health services in individual NHF branches.


Assuntos
Hospitalização/economia , Pacientes/psicologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Comportamento de Escolha , Feminino , Custos Hospitalares , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Pacientes/estatística & dados numéricos , Polônia , Fatores de Tempo , Adulto Jovem
8.
Rev Assoc Med Bras (1992) ; 65(8): 1086-1092, 2019 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-31531606

RESUMO

OBJECTIVE: The objective of this study was to analyze the hospitalizations of the elderly for conditions sensitive to primary care (ICSAP) and associated contextual factors, referring to elderly people aged 60 and over, living in municipalities in the Northeast region. METHODS: Characterized as being an ecological study using data from the Hospital Information System (SIH) and the Basic Attention Information System (SIAB) referring to elderly people aged 60 and over. RESULTS: The total hospitalization rate was 527,524, with the highest number due to heart failure, followed by cerebrovascular diseases, and infectious gastroenteritis. Analyzing the ICSAP rates with the contextual factors, all were significant. Regarding the coverage of basic care, a similarity occurred between them, and for the rate of the number of consultations among the elderly, despite the greater number of these in the municipalities with higher hospitalization rates, there was no significant difference between them. CONCLUSION: We conclude that the contextual factors interfere in the conditions of this hospitalization, necessitating, besides the improvement of primary care, an improvement in the living conditions of the elderly population.


Assuntos
Serviços de Saúde para Idosos/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Idoso , Brasil , Sistemas de Informação Hospitalar , Humanos , Pessoa de Meia-Idade , Fatores Socioeconômicos
9.
Bone Joint J ; 101-B(9): 1129-1137, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31474142

RESUMO

AIMS: The aim of this study was to investigate mortality and risk of intraoperative medical complications depending on delay to hip fracture surgery by using data from the Norwegian Hip Fracture Register (NHFR) and the Norwegian Patient Registry (NPR). PATIENTS AND METHODS: A total of 83 727 hip fractures were reported to the NHFR between 2008 and 2017. Pathological fractures, unspecified type of fractures or treatment, patients less than 50 years of age, unknown delay to surgery, and delays to surgery of greater than four days were excluded. We studied total delay (fracture to surgery, n = 38 754) and hospital delay (admission to surgery, n = 73 557). Cox regression analyses were performed to calculate relative risks (RRs) adjusted for sex, age, American Society of Anesthesiologists (ASA) classification, type of surgery, and type of fracture. Odds ratio (OR) was calculated for intraoperative medical complications. We compared delays of 12 hours or less, 13 to 24 hours, 25 to 36 hours, 37 to 48 hours, and more than 48 hours. RESULTS: Mortality remained unchanged when total delay was less than 48 hours. Total delay exceeding 48 hours was associated with increased three-day mortality (RR 1.69, 95% confidence interval (CI) 1.23 to 2.34; p = 0.001) and one-year mortality (RR 1.06, 95% CI 1.04 to 1.22; p = 0.003). More intraoperative medical complications were reported when hospital delay exceeded 24 hours. CONCLUSION: Hospitals should operate on patients within 48 hours after fracture to reduce mortality and intraoperative complications. Cite this article: Bone Joint J 2019;101-B:1129-1137.


Assuntos
Artroplastia de Quadril/mortalidade , Fixação Interna de Fraturas/mortalidade , Fraturas do Quadril/mortalidade , Fraturas do Quadril/cirurgia , Complicações Intraoperatórias/mortalidade , Tempo para o Tratamento/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/estatística & dados numéricos , Feminino , Fixação Interna de Fraturas/estatística & dados numéricos , Hemiartroplastia/estatística & dados numéricos , Fraturas do Quadril/epidemiologia , Hospitalização/estatística & dados numéricos , Humanos , Complicações Intraoperatórias/epidemiologia , Complicações Intraoperatórias/etiologia , Masculino , Noruega/epidemiologia , Sistema de Registros/estatística & dados numéricos , Fatores de Risco
10.
Medicine (Baltimore) ; 98(37): e17090, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517831

RESUMO

The decision as to whether patients should be admitted to a medical intensive care unit (ICU), in the absence of information concerning survival rates or prognostic factors in survival, is often challenging. We analyzed survival trends in relation to hospital discharge and examined patient and hospital characteristics associated with survival following ICU care, using a sample of nationwide claims data in Korea from 2002 through 2013. The Korean government implements a compulsory social insurance program that covers the country's entire population, and the Korean National Health Insurance Service-National Sample Cohort (NHIS-NSC) data from 2002 based on this program were used for this study. The NHIS-NSC is a stratified random sample of 1,025,340 subjects selected from around 46 million Koreans. We evaluated annual survival trends using the Kaplan-Meier test. Analyses of the relationship between survival and patient and hospital characteristics were performed using Cox regression analyses. Employing a multivariate model, variables were selected using the forward selection method to consider the multicollinearity of variables. A total of 32,553 patients admitted to an ICU between 2002 and 2013 were identified among the eligible beneficiaries. The number of patients who had histories of ICU admission steadily increased throughout the study period, and patients older than 80 years constituted a progressively increasing proportion of ICU admissions, from 7.3% in 2002 to 16.9% in 2007 to 23.1% in 2013. The mean number of mechanical equipment items applied consistently increased, while no difference was observed in the trend for overall 1-year survival in patients following ICU treatment across the study period: the 1-year survival rate ranged from 66.7% (year 2003) to 64.2% (year 2010). Advanced age, cancer, renal failure, pneumonia, and influenza were all associated with heightened risk of mortality within 1 year. Our results should prove useful to older patients and their clinicians in their decisions regarding whether to seek ICU care, with the goals of improving the end-of life care and optimizing resource utilization.


Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Unidades de Terapia Intensiva/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Mortalidade Hospitalar/tendências , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva/economia , Unidades de Terapia Intensiva/organização & administração , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde/economia , Programas Nacionais de Saúde/estatística & dados numéricos , Modelos de Riscos Proporcionais , República da Coreia , Análise de Sobrevida
11.
Rev Saude Publica ; 53: 64, 2019 Aug 19.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31432929

RESUMO

OBJECTIVE: To analyze the impact of the Hospital-Acquired Conditions (HAC) in women in the puerperal and pregnancy cycle during length of stay. METHODS: This cross-sectional study was conducted with 113,456 women, between July 2012 and July 2017, in Brazil's national hospitals of the supplementary healthcare networks and philanthropists accredited to the Unified Health System (SUS). Data on hospital discharges were collected using the Diagnosis-Related Groups (DRG Brasil®) system. All DRGs of the major diagnostic category 14 (MDC14), including pregnancy, childbirth and puerperium, were included. The impact of HAC on length of stay was estimated by Student's t-test, and the effect size by Cohen's d, which allows to assess clinical relevance. RESULTS: The most prevalent diagnostic categories related to MDC14 were vaginal and cesarean deliveries without complicating diagnoses, both at institutions accredited to SUS and those for supplementary health care. The prevalence of HAC was 3.8% in supplementary health and 2.5% in SUS. Hospitals providing services to supplementary health care providers had a longer length of stay considering HAC for patients classified as DRG: cesarean section with complications or comorbidities at admission (p < 0.001; Cohen's d = 0.74), cesarean section without complications or comorbidities at admission (p < 0.001, Cohen's d = 0.31), postpartum and post abortion without listed procedure (p < 0.001, Cohen's d = 1.05), and other antepartum diagnoses with medical complications (p < 0.001; Cohen's d = 0.77). CONCLUSIONS: This study showed that the prevalence of HAC was low both in the institutions accredited to attend by SUS and in those of supplementary health; however, its presence contributes to increasing the length of stay in cases of cesarean sections without complications or comorbidities in supplementary health institutions.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Doença Iatrogênica , Tempo de Internação/estatística & dados numéricos , Brasil , Cesárea , Comorbidade , Estudos Transversais , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Alta do Paciente/estatística & dados numéricos , Período Pós-Parto , Gravidez
12.
BMC Public Health ; 19(1): 931, 2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31412819

RESUMO

BACKGROUND: Lyme disease is a tick-borne disease of increasing global importance. There is scant information on Lyme disease patient demographics in England and Wales, and how they interact with the National Health Service (NHS). Our aims were to explore the demographic characteristics of Lyme disease patients within the Hospital Episode Statistics (HES) and Patient Episode Database for Wales (PEDW), and to describe patient pathways. METHODS: Data from 1st January 1998 to 31st December 2015 was retrieved from the two administrative hospital datasets (HES and PEDW), based on patients coded with Lyme disease. Information was collected on demographic characteristics, home address and case management. Incidence rates were calculated, and demographics compared to the national population. RESULTS: Within HES and PEDW, 2361 patients were coded with Lyme disease. There was a significant increase (p < 0.01) in incidence from 0.08 cases/100,000 in 1998, to 0.53 cases/100,000 in 2015. There was a bimodal age distribution, patients were predominantly female, white and from areas of low deprivation. New cases peaked annually in August, with higher incidence rates in southern central and western England. Within hospital admission data (n = 2066), most cases were either referred from primary care (28.8%, n = 596) or admitted via accident and emergency (A&E) (29.5%, n = 610). This population entering secondary care through A&E suggest a poor understanding of the recommended care pathways for symptoms related to Lyme disease by the general population. CONCLUSIONS: These data can be used to inform future investigations into Lyme disease burden, and patient management within the NHS. They provide demographic information for clinicians to target public health messaging or interventions.


Assuntos
Hospitalização/estatística & dados numéricos , Doença de Lyme/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Bases de Dados Factuais , Inglaterra/epidemiologia , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Doença de Lyme/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , País de Gales/epidemiologia , Adulto Jovem
13.
MMWR Morb Mortal Wkly Rep ; 68(30): 664-666, 2019 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-31369523

RESUMO

Candida auris is an emerging drug-resistant yeast that causes outbreaks in health care facilities; cases have been reported from approximately 30 countries. U.S. cases of C. auris are likely the result of importation from abroad followed by extensive local transmission in health care settings (1). Early detection of Candida auris is key to preventing its spread. C. auris frequently co-occurs with carbapenemase-producing organisms (CPOs), like carbapenem-resistant Enterobacteriaceae (CRE), organisms for which testing and public health response capacity substantially increased beginning in 2017. In September 2018, the Maryland Department of Health (MDH) was notified of a hospitalized resident with CPO infection and colonization and recent hospitalization in Kenya. In light of this history, the patient was screened for C. auris and found to be colonized. Public health responses to CPOs can aid in the early identification of C. auris. As part of CPO investigations, health departments should assess whether the patient has risk factors for C. auris and ensure that patients at risk are tested promptly.


Assuntos
Proteínas de Bactérias/biossíntese , Candida/isolamento & purificação , Candidíase/diagnóstico , Hospitalização/estatística & dados numéricos , beta-Lactamases/biossíntese , Humanos , Quênia , Estados Unidos
14.
Am Surg ; 85(7): 772-777, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31405427

RESUMO

Trauma in pregnancy is a leading cause of poor fetal and obstetric outcomes. Trauma team activation (TTA) criteria include injury with ≥ 20 weeks gestational age (GA). A retrospective analysis was performed on pregnant patients evaluated at a Level 1 trauma center. Patients were characterized by TTA: full, partial, or non-TTA, and TTA criteria independent of pregnancy. Index trauma and delayed delivery hospitalization outcomes were examined. Bivariate analysis, t test, and logistic regression were used when appropriate. From 2010 to 2015, 216 full, 50 partial, and 50 non-TTAs presented. Independent of pregnancy, 79 per cent of patients did not meet the TTA criteria. Fourteen (4%) had a pregnancy-related complication during index hospitalization (eight fetal and two maternal deaths). Nine of ten deaths occurred in patients meeting TTA independent of pregnancy. Delivery complications were greater in the index (52%, 13/25) versus subsequent (5%, 17/155) hospitalizations and were predicted by the respiratory rate (P = 0.016) and injury severity score (P < 0.001). Poor delayed delivery outcomes were associated with earlier GA (P < 0.002) and longer index hospitalization (P < 0.024). Odds of complication are higher in patients meeting the physiologic and anatomic criteria criteria for TTA versus GA criteria alone, signifying overtriage. Trauma activation protocols should be adapted based on the physiologic and anatomic criteria criteria in pregnant patients.


Assuntos
Complicações na Gravidez/etiologia , Centros de Traumatologia/estatística & dados numéricos , Triagem/métodos , Ferimentos e Lesões , Adulto , Feminino , Idade Gestacional , Hospitalização/estatística & dados numéricos , Humanos , Escala de Gravidade do Ferimento , Modelos Logísticos , Gravidez , Estudos Retrospectivos , Ferimentos e Lesões/classificação , Adulto Jovem
15.
BMC Infect Dis ; 19(1): 681, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31370781

RESUMO

BACKGROUND: Human adenoviruses (HAdV) are important pathogens of pediatric respiratory tract infections in Taiwan. There were two major HAdV epidemics in southern Taiwan in 2011 and 2014, respectively. METHODS: The demographic, clinical characteristics, and risk factors for hospitalization of pediatric patients with HAdV infection in the two outbreaks were retrospectively compared. The epidemic was defined as > 7% HAdV detection rate for six consecutive weeks. HAdV infection was defined as positive HAdV isolates from respiratory tract specimens. HAdV genotype was determined by PCR-based hexon gene sequencing. RESULTS: A total of 1145 pediatric patients were identified (635 cases in 2011; 510 cases in 2014). HAdV genotype 3 and 7 contributed to both epidemics, although the proportion of HAdV3 decreased significantly (64.7% in 2011 to 25.5% in 2014, p < 0.001) and was replaced by other genotypes (type 1, 4, and 6) in the 2014 epidemic. Among the hospitalized patients, there were more patients hospitalized with bronchopneumonia/or pneumonia in the 2011 epidemic (10.6% vs 5.1%, p < 0.001), while more patients hospitalized with acute pharyngitis/pharyngoconjunctival fever (63.9% vs. 38.6%, p < 0.001) in the 2014 epidemic. In both epidemics, hospitalized patients had higher WBC and C-reactive protein (CRP) levels than non-hospitalized patients. Using multivariate regression analysis, underlying disease and elevated CRP levels were independent risk factors for hospitalization in both epidemics. CONCLUSION: There were significant differences in clinical, viral characteristics and risk factors of hospitalization between the 2011 and 2014 epidemics. Understanding changes in the epidemiological and clinical characteristics of HAdV epidemics is important from a public health perspective.


Assuntos
Infecções por Adenovirus Humanos/epidemiologia , Infecções por Adenovirus Humanos/etiologia , Infecções Respiratórias/epidemiologia , Adenovírus Humanos/genética , Adenovírus Humanos/patogenicidade , Criança , Pré-Escolar , Surtos de Doenças , Epidemias , Feminino , Genótipo , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Masculino , Pneumonia Viral/epidemiologia , Pneumonia Viral/etiologia , Reação em Cadeia da Polimerase , Infecções Respiratórias/virologia , Estudos Retrospectivos , Fatores de Risco , Taiwan/epidemiologia
16.
Am J Disaster Med ; 14(1): 65-70, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31441029

RESUMO

CONTEXT: The threat of terrorism is intensifying with a recent rise in the number of death and injuries. Nevertheless, few articles deal with the short and long-term medical costs of treating and assisting the civilian victims of terror. The objective of this article is to review the literature and describe the medical costs of supporting victims of terrorism. METHOD: The authors reviewed the literature on the medical costs following terror attacks in the PubMed/Medline and Google Web sites. Relevant scientific articles, textbooks, and global reports were included in the research. RESULTS: There was a scarcity of data related to the medical costs of terror. The authors review the few articles that describe the hospital and outpatient expenses. The terror attacks lead to increasing length of stay and the use of supplementary medical support. The authors detail the relevant global reports and working papers on terrorism that included the cost of injury and the over-all economic impact assessment. CONCLUSION: The medical costs result from hospital and outpatient treatment support. There is a clear need to track the long-term fate of the victims of terror. The authors recommend that future research should include all sectors of the healthcare system, including the whole rehabilitation process and have a precise tracking system for all victims.


Assuntos
Assistência Ambulatorial/economia , Vítimas de Crime/economia , Vítimas de Crime/estatística & dados numéricos , Custos de Cuidados de Saúde/estatística & dados numéricos , Hospitalização/economia , Serviços de Saúde Mental/economia , Terrorismo/economia , Assistência Ambulatorial/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Hospitais , Humanos , Israel , Serviços de Saúde Mental/estatística & dados numéricos , Terrorismo/estatística & dados numéricos
17.
Crit Care Resusc ; 21(3): 180-187, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31462205

RESUMO

BACKGROUND: Australian in-hospital cardiac arrest (IHCA) literature is limited, and mostly published before rapid response teams (RRTs). Contemporary data may inform strategies to improve IHCA outcomes. STUDY DESIGN: Prospective observational study of ward adult IHCAs in seven Australian hospitals. PARTICIPANTS AND OUTCOMES: IHCA was defined as unresponsiveness, no respiratory effort, and commencement of external cardiac compressions. Data included IHCA frequency, patient demographics, resuscitation management, intensive care unit (ICU) management, and hospital discharge status. RESULTS: There were 15 953 RRT calls, 185 896 multiday admissions and 159 IHCAs in 152 patients (median age, 71.5 years; interquartile range [IQR], 61.6-81.3 years). The median IHCA frequency was 0.62 IHCAs per 1000 multiday admissions (IQR, 0.50-1.19). Most patients (93.4%) were admitted from home, and 68.4% (104/152) were medical admissions. Eighty-two IHCAs (51.6%) occurred within 4 days of admission, and 66.0% (105/159) of initial rhythms were non-shockable. The median resuscitation duration was 6.5 minutes (IQR, 2.0-18.0 minutes) and adrenaline was the most common intervention (95/159; 59.8%). Death on the ward occurred in 30.2% of IHCAs (48/159), and 49.7% (79/159) were admitted to the ICU, where vasoactive medications (75.9%), ventilation (82.3%), and renal replacement therapy (29.1%) use was extensive. Overall, 92 patients (60.5%) died and 40 (26.3%) were discharged home. CONCLUSION: Among seven Australian hospitals, IHCAs were infrequent, mostly occurred in older medical patients early in the hospital admission. Most were non-shockable, ICU therapy was extensive and nearly two-thirds of patients died in hospital. Further strategies are needed to prevent and improve ICHA outcomes.


Assuntos
Reanimação Cardiopulmonar/estatística & dados numéricos , Parada Cardíaca/epidemiologia , Hospitalização/estatística & dados numéricos , Unidades de Terapia Intensiva , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Feminino , Parada Cardíaca/mortalidade , Parada Cardíaca/terapia , Mortalidade Hospitalar , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados (Cuidados de Saúde) , Estudos Prospectivos
18.
Crit Care Resusc ; 21(3): 200-211, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31462207

RESUMO

OBJECTIVE: To provide a contemporary description of the demographics, characteristics and outcomes of critically ill Indigenous patients in Australia. DESIGN, SETTING AND PARTICIPANTS: Retrospective database review using the Australian and New Zealand Intensive Care Society Adult Patient Database for intensive care unit (ICU) admissions in 2017-18. Characteristics of critically ill Indigenous patients were compared with non-Indigenous patients. MAIN OUTCOME MEASURES: Primary outcome was hospital mortality. Secondary outcomes examined demographics and resource use. RESULTS: Per capita, Indigenous Australians were overrepresented in the intensive care. They were younger (51 v 66 years), more likely to be admitted from outer regional, rural and remote settings (59% v 15%), more likely to require emergency admission (81% v 59%), and had higher rates of mechanical ventilation (35% v 32%; P < 0.01 for all). Indigenous patients were over-represented in the diagnostic categories of sepsis (15% v 9%), trauma (7% v 5%), and respiratory illness (17% v 15%), and had higher rates of ICU re-admission (7% v 5%; P < 0.01 for all). There was no difference in either unadjusted (7.9% for each; P = 0.96) or adjusted (odds ratio, 1.1; 95% CI, 1.0-1.2) in-hospital mortality. CONCLUSION: Indigenous patients, especially young Indigenous patients, were disproportionately represented in Australian ICUs, particularly for sepsis. The high level of acute illness and high proportion of emergency admissions could be interpreted as representing delayed presentation, which, with a higher re-admission rate, suggest access barriers to health care may exist. Nevertheless, there was no mortality gap between Indigenous and non-Indigenous Australians during a hospital admission for critical illness.


Assuntos
Cuidados Críticos/estatística & dados numéricos , Serviços de Saúde do Indígena/estatística & dados numéricos , Mortalidade Hospitalar/etnologia , Hospitalização/estatística & dados numéricos , Unidades de Terapia Intensiva/estatística & dados numéricos , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Adulto , Distribuição por Idade , Austrália , Estado Terminal , Diagnóstico Tardio , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Estudos Retrospectivos , Adulto Jovem
19.
BMJ ; 366: l4466, 2019 08 07.
Artigo em Inglês | MEDLINE | ID: mdl-31391161

RESUMO

OBJECTIVE: To quantify the association between major surgery and the age related cognitive trajectory. DESIGN: Prospective longitudinal cohort study. SETTING: United Kingdom. PARTICIPANTS: 7532 adults with as many as five cognitive assessments between 1997 and 2016 in the Whitehall II study, with linkage to hospital episode statistics. Exposures of interest included any major hospital admission, defined as requiring more than one overnight stay during follow-up. MAIN OUTCOMES MEASURES: The primary outcome was the global cognitive score established from a battery of cognitive tests encompassing reasoning, memory, and phonemic and semantic fluency. Bayesian linear mixed effects models were used to calculate the change in the age related cognitive trajectory after hospital admission. The odds of substantial cognitive decline induced by surgery defined as more than 1.96 standard deviations from a predicted trajectory (based on the first three cognitive waves of data) was also calculated. RESULTS: After accounting for the age related cognitive trajectory, major surgery was associated with a small additional cognitive decline, equivalent on average to less than five months of aging (95% credible interval 0.01 to 0.73 years). In comparison, admissions for medical conditions and stroke were associated with 1.4 (1.0 to 1.8) and 13 (9.6 to 16) years of aging, respectively. Substantial cognitive decline occurred in 2.5% of participants with no admissions, 5.5% of surgical admissions, and 12.7% of medical admissions. Compared with participants with no major hospital admissions, those with surgical or medical events were more likely to have substantial decline from their predicted trajectory (surgical admissions odds ratio 2.3, 95% credible interval 1.4 to 3.9; medical admissions 6.2, 3.4 to 11.0). CONCLUSIONS: Major surgery is associated with a small, long term change in the average cognitive trajectory that is less profound than for major medical admissions. The odds of substantial cognitive decline after surgery was about doubled, though lower than for medical admissions. During informed consent, this information should be weighed against the potential health benefits of surgery.


Assuntos
Transtornos Cognitivos/epidemiologia , Disfunção Cognitiva/epidemiologia , Hospitalização/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Adulto , Idoso , Transtornos Cognitivos/etiologia , Disfunção Cognitiva/etiologia , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos
20.
Niger J Clin Pract ; 22(8): 1099-1108, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31417053

RESUMO

Background: Upper gastrointestinal system (GIS) bleeding is one of the most common causes of mortality and morbidity. The predictive values of pre-endoscopic Rockall score (PERS), full Rockall score (FRS), Glasgow-Blatchford score (GBS), pre-endoscopic Baylor score (PEBS), and full Baylor score (FBS) to predict bleeding at follow-up, endoscopic therapy, blood transfusion requirement, and death are investigated in our study. Methods: This study was retrospectively conducted in patients admitted to emergency department with upper GIS bleeding. Demographic and clinical characteristics of the patients were recorded. The relationships of the aforementioned scores with in-hospital termination, bleeding at follow-up, endoscopic therapy, blood transfusion requirement, and death were explored. Results: The study included a total of 420 subjects, of which 269 (64%) were men. All scoring systems were able to predict transfusion need and GBS was superior to other scores (P < 0.0001). In terms of endoscopic treatment, it was determined that only PERS, FRS, and FBS were statistically significant in predicting ability and PERS >3, FRS >5 and FBS >10 patients needed endoscopic treatment. All scoring systems were able to predict rebleeding. In comparison of two groups for rebleeding, it was found that PEBS was better able to predict bleeding during follow-up than both FRS and FBS, and PERS was better able to predict bleeding during follow-up than both FRS and FBS. All scoring systems were able to predict mortality. FRS and PERS scores had a greater discriminatory power for predicting death than the rest of the scores (P < 0.001). Conclusion: All scoring systems were effective for predicting need for blood transfusion, rebleeding, and death. GBS had more predictive power for transfusion need, PERS and PEBS for rebleeding, and FRS for mortality. PERS, FRS, and FBS were found to be effective in predicting endoscopic treatment.


Assuntos
Hemorragia Gastrointestinal/diagnóstico , Hospitalização/estatística & dados numéricos , Medição de Risco/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Transfusão de Sangue/estatística & dados numéricos , Serviço Hospitalar de Emergência , Endoscopia do Sistema Digestório , Feminino , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/mortalidade , Hemorragia Gastrointestinal/terapia , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Curva ROC , Estudos Retrospectivos , Índice de Gravidade de Doença , Turquia/epidemiologia
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