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1.
Medicine (Baltimore) ; 98(45): e17940, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702683

RESUMO

Venous air embolism (VAE) can be observed in the right heart system on contrast-enhanced computed tomography (CT), following injection of contrast media with a power injector system. Although most VAEs are mostly asymptomatic, they may result in paradoxical air embolism (PAE).To evaluate whether the incidence of VAE on coronary CT angiography is associated with the process of preparation of the intravenous access route.We retrospectively evaluated 692 coronary CT examinations at 3 institutions. Trained CT nurses placed an intravenous cannula in the forearm. Tubes connected to the cannula were prepared in the following ways: A, using an interposed three-way cock and a 20-mL syringe filled with normal saline to collect air contamination in the tube; B, through direct connection to the power injector system without the interposed 3-way cock; and C, using an interposed three-way cock and a 100-mL normal saline drip infusion bottle system to keep the tube patent. The incidence and location of VAE and preparation of intravenous injection were assessed.The overall incidence of VAE was 55.3% (383/692), most frequently observed in the right atrium (81.5%, 312/383). Its incidence varied significantly across the 3 techniques (A: 21.6% (35/162), B: 63.2% (237/375) and C: 71.6% (111/155); P < .001). No patient demonstrated any symptom associated with VAE.Using a 3-way cock with syringe demonstrated the lowest incidence of VAE on coronary CT angiography. It is thus recommended to reduce potential complication risks related to intravenous contrast media injection.


Assuntos
Angiografia por Tomografia Computadorizada/efeitos adversos , Embolia Aérea/etiologia , Embolia Paradoxal/etiologia , Átrios do Coração/diagnóstico por imagem , Idoso , Meios de Contraste/administração & dosagem , Embolia Aérea/complicações , Embolia Aérea/epidemiologia , Embolia Paradoxal/epidemiologia , Humanos , Injeções Intravenosas/efeitos adversos , Injeções Intravenosas/instrumentação , Injeções Intravenosas/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
2.
J Res Health Sci ; 19(1): e00435, 2019 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31133625

RESUMO

BACKGROUND: Transmitting blood-borne diseases is alarming in places with high prevalence of people who inject drugs. This study aimed to determine the prevalence of drug injection and its related predictors among prisoners with a history of tattooing in Iran. STUDY DESIGN: Cross-sectional study. METHODS: By using a census sampling, 5493 prisoners with a history of tattooing of 11988 prisoners participated for hepatitis B and C bio-behavioral surveillance surveys (BSS) in prisons of Iran, during 2015-2016 from 55 prisons in 19 provinces were assessed. The data for the BSS were collected using face-to-face checklist-based interviews. Weighted prevalence and the association between variables and history of drug injection were determined using Chi-square test and adjusted odds ratio (AOR) was estimated through multivariate logistic regression test using survey package. RESULTS: The mean age of participants was 33.9 ±8.3 yr. Most of them were male (96.4%) and had a history of drug use (85.4%). The prevalence of drug injection among drug users was 20.2%, of which 33.9% had a history of shared injection. The prevalence of drug injection among prisoners with a history of tattooing is associated with male gender (P=0.047), age ≥35 yr (P<0.001), being single (P=0.002), being divorced/widow (P=0.039), and a history of imprisonment (P<0.001). CONCLUSION: The prevalence of drug injection increases in the presence of other high-risk behaviors. It is necessary to initiate harm reduction programs and preventive interventions in groups with multiple high-risk behaviors.


Assuntos
Prisões , Assunção de Riscos , Abuso de Substâncias por Via Intravenosa , Tatuagem , Adulto , Fatores Etários , Estudos Transversais , Feminino , Hepatite B/transmissão , Hepatite C/transmissão , Humanos , Injeções Intravenosas/estatística & dados numéricos , Irã (Geográfico)/epidemiologia , Modelos Logísticos , Masculino , Estado Civil , Uso Comum de Agulhas e Seringas/efeitos adversos , Uso Comum de Agulhas e Seringas/estatística & dados numéricos , Razão de Chances , Prevalência , Prisioneiros , Fatores de Risco , Fatores Sexuais , Abuso de Substâncias por Via Intravenosa/complicações , Abuso de Substâncias por Via Intravenosa/epidemiologia
3.
Bull Cancer ; 105(2): 155-161, 2018 Feb.
Artigo em Francês | MEDLINE | ID: mdl-29395041

RESUMO

INTRODUCTION: Our home care unit (HCU) developed the administration of IV chemotherapy at home for some pediatric oncologic patients. METHODS: We conducted a retrospective monocentric analysis, leading to identify patients with at least one sequence of chemotherapy at home in 2015. RESULTS: Two hundred and forty four sequences of home chemotherapy have been administered in 2015. We identified two situations for home IV chemotherapy. Pediatric oncologist of day hospital prescribes the sequence. The chemotherapy is delivered at hospital for the first day. HCU takes over for the next days at home. For a sequence replacing a conventional hospitalization, the attending physician examines the patient, and confirm the clinical validation. The pediatric oncologist of HCU checks lab exams, and prescribes the chemotherapy. For both situations, IV chemotherapy is prepared by our hospital pharmacy, delivers at home or at day hospital, and HCU team manages home material and organizes hospitalization. CONCLUSIONS: This kind of organization allows setting up home IV CT for more and more patients. It allows to limit daily hospitalization for some patients living far from the hospital, and whose therapies lead to several hospitalizations.


Assuntos
Antineoplásicos/administração & dosagem , Serviços Hospitalares de Assistência Domiciliar/organização & administração , Neoplasias/tratamento farmacológico , Antineoplásicos/uso terapêutico , Criança , Citarabina/administração & dosagem , Neoplasias Oculares/tratamento farmacológico , Feminino , Glioma/tratamento farmacológico , Acesso aos Serviços de Saúde , Neoplasias Hematológicas/tratamento farmacológico , Humanos , Injeções Intravenosas/estatística & dados numéricos , Masculino , Enfermagem Oncológica , Enfermagem Pediátrica , Pediatras , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Estudos Retrospectivos , Fatores de Tempo , Vimblastina/administração & dosagem
4.
J Patient Saf ; 14(1): 60-65, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-28902007

RESUMO

OBJECTIVES: Current literature estimates the error rate associated with the preparation and administration of all intravenous (IV) medications to be 9.4% to 97.7% worldwide. This study aims to compare the number of observed medication preparation and administration errors between the only commercially available ready-to-administer product (Simplist) and IV push traditional practice, including a cartridge-based syringe system (Carpuject) and vials and syringes. METHODS: A prospective, multisite, observational study was conducted in 3 health systems in various states within the United States between December 2015 and March 2016 to observe IV push medication preparation and administration. Researchers observed a ready-to-administer product and IV push traditional practice using a validated observational method and a modified data collection sheet. All observations were reconciled to the original medication order to determine if any errors occurred. RESULTS: Researchers collected 329 observations (ready to administer = 102; traditional practice = 227) and observed 260 errors (ready to administer = 25; traditional practice = 235). The overall observed error rate for ready-to-administer products was 2.5%, and the observed error rate for IV push traditional practice was 10.4%. CONCLUSIONS: The ready-to-administer group demonstrated a statistically significant lower observed error rate, suggesting that use of this product is associated with fewer observed preparation and administration errors in the clinical setting. Future studies should be completed to determine the potential for patient harm associated with these errors and improve clinical practice because it relates to the safe administration of IV push medications.


Assuntos
Infusões Intravenosas , Injeções Intravenosas , Erros de Medicação/estatística & dados numéricos , Humanos , Infusões Intravenosas/instrumentação , Infusões Intravenosas/métodos , Infusões Intravenosas/estatística & dados numéricos , Injeções Intravenosas/instrumentação , Injeções Intravenosas/métodos , Injeções Intravenosas/estatística & dados numéricos , Preparações Farmacêuticas , Estudos Prospectivos
5.
Bull Cancer ; 104(10): 869-874, 2017 Oct.
Artigo em Francês | MEDLINE | ID: mdl-29032944

RESUMO

New routes of administration available for some targeted therapies, especially subcutaneous injections, have an impact not only on the patients' daycare experience, but also on the unit's organization. This observational study conducted on 48 voluntary patients at the Institut universitaire du cancer Toulouse-Oncopole shows that the mean duration of the outpatient unit stay is diminished by one hour when a subcutaneous injection is used instead of an intravenous route. This duration decrease is mainly caused by an 82% average reduction in treatment duration. However, the waiting times before and after the treatment itself are not significantly impacted. Organizational methods related to the treatment prescription and preparation remain indeed the same. Anticipated prescription is not noticeably impacted either. This reduction of the duration of stay will truly be obtained if the whole unit's organization is adapted.


Assuntos
Antineoplásicos/administração & dosagem , Hospital Dia/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Terapia de Alvo Molecular/métodos , Institutos de Câncer/organização & administração , Institutos de Câncer/estatística & dados numéricos , Hospital Dia/organização & administração , Composição de Medicamentos/estatística & dados numéricos , Humanos , Injeções Intravenosas/estatística & dados numéricos , Injeções Subcutâneas/estatística & dados numéricos , Terapia de Alvo Molecular/estatística & dados numéricos , Pacientes Ambulatoriais , Fatores de Tempo
6.
Drug Alcohol Depend ; 179: 362-369, 2017 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-28844013

RESUMO

BACKGROUND: This study sought to determine the relative importance of a range of Bup/Nx doses compared to Bup alone in producing subjective and reinforcing effects. METHODS: Heroin-using volunteers (n=13) were transitioned onto daily oral hydromorphone (40mg). Laboratory sessions assessed the reinforcing and subjective effects of intravenous (IV) doses of Bup (1.51, 2.16, 6.15, and 8.64mg) and Bup/Nx (1.51/0.44, 2.16/0.61, 6.15/1.71, and 8.64/2.44mg). Placebo (Pbo), heroin (25mg) and Nx (0.3mg) were tested as neutral, positive, and negative controls, respectively. RESULTS: IV Bup alone was self-administered substantially less than IV heroin, though the two largest doses of Bup produced positive subjective effects, drug "Liking" (0-100mm), which were comparable to heroin (mean difference: Heroin vs Bup 6.15mg: -3.4mm, Heroin vs Bup 8.64mg: -11.3mm). All indicators of abuse potential seen with IV Bup alone were substantially decreased with the addition of Nx. All Bup/Nx combinations produced ratings of aversive effects, "Bad", which were comparable to, or greater than IV, Nx. On three of the four measures of aversive effects, the largest difference is seen with the 8.64 vs 8.64/2.44 condition. CONCLUSIONS: This study further demonstrates the ability of the Bup/Nx combination to deter IV use. Although none of the Bup/Nx combinations showed indications of abuse potential, formulations with larger absolute Nx, may be less abusable as they precipitate a greater degree of withdrawal.


Assuntos
Combinação Buprenorfina e Naloxona/farmacologia , Buprenorfina/farmacologia , Heroína/farmacologia , Injeções Intravenosas/estatística & dados numéricos , Naloxona/farmacologia , Buprenorfina/uso terapêutico , Combinação Buprenorfina e Naloxona/uso terapêutico , Heroína/uso terapêutico , Humanos , Naloxona/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico
7.
J Pain Symptom Manage ; 53(5): 842-850, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28062336

RESUMO

CONTEXT: Although patient-controlled analgesia (PCA) is an effective pain control modality, there is a lack of large studies on PCA safety in pediatric patients. OBJECTIVES: This study compared the delivery of morphine either via intravenous route (morphine IV) or via PCA device (morphine PCA) on risk of cardiopulmonary resuscitation (CPR) and mechanical ventilation (MV) using a large administrative database. METHODS: We assembled a retrospective cohort of pediatric inpatients between five and 21 years old in 42 children's hospitals between 2007 and 2011 from the Pediatric Health Information System database. After propensity score matching, we created matched cohorts of morphine PCA and morphine IV patients, in both surgical and nonsurgical samples, who were similar on demographic, clinical, and hospital-level factors. We examined if PCA administration was associated with greater likelihood of CPR or MV up to two days after drug administration. RESULTS: Surgical and nonsurgical patients administered morphine PCA generally had lower odds of having MV on the baseline day and up to two days after PCA exposure, although these estimates were not statistically significant. Similarly, PCA exposure was associated with about 20%-44% lower odds of same day CPR in both surgical and nonsurgical patients, with a slightly greater reduction in the odds of CPR in the surgical patients. CONCLUSION: In this large pediatric inpatient population, morphine administered via PCA device for surgical and nonsurgical pain was not associated with an increased risk of receiving CPR or MV, and was associated with slightly better safety outcomes than intravenous morphine.


Assuntos
Analgesia Controlada pelo Paciente/estatística & dados numéricos , Dor Crônica/tratamento farmacológico , Dor Crônica/epidemiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/mortalidade , Injeções Intravenosas/estatística & dados numéricos , Morfina/administração & dosagem , Insuficiência Respiratória/epidemiologia , Adolescente , Analgesia Controlada pelo Paciente/instrumentação , Analgésicos Opioides/administração & dosagem , Causalidade , Criança , Pré-Escolar , Dor Crônica/diagnóstico , Comorbidade , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico , Feminino , Humanos , Masculino , Medição da Dor/efeitos dos fármacos , Prevalência , Insuficiência Respiratória/diagnóstico , Estudos Retrospectivos , Autoadministração/instrumentação , Autoadministração/estatística & dados numéricos , Resultado do Tratamento , Estados Unidos/epidemiologia , Adulto Jovem
8.
J Emerg Med ; 52(1): 16-22, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27765438

RESUMO

BACKGROUND: After an index case of contrast-associated compartment syndrome, an urban hospital instituted a protocol limiting high-speed injection to intravenous (IV) lines started proximal to the forearm and testing those lines before contrast injection. OBJECTIVE: In this article, we estimate the safety and efficacy of high-speed injection using this protocol in patients with IV lines inserted under ultrasound guidance. METHODS: In an ambispective study, we enrolled prospective cohorts of ED patients requiring high-speed radiographic contrast media injection (≥3.5 mL/sec) into two groups: those with IV lines placed under ultrasound guidance and those with IV lines placed using traditional inspection and palpation. We also performed a retrospective review involving those groups. In addition, we reviewed hospital records for all patients with compartment syndrome between January 2010 and December 2011. We calculated 95% confidence intervals using normal approximation or exact calculation. RESULTS: Between November 2013 and August 2014, the ED referred 32 patients to the Department of Radiology for computed tomography angiography involving high-speed contrast injection through ultrasound-guided IV lines. Of these, 25 of 32 (78%) had successful injection (7 failed in the Department of Radiology) vs. 26 of 27 (96%) with catheters inserted using traditional methods (risk difference 0.18 [95% confidence interval -0.01 to 0.38]). Based on retrospective records, we estimated 79 additional cases. We found no cases of compartment syndrome during either period, for an incidence estimate of 0 per 100 cases (95% confidence interval 0-3). CONCLUSION: A hospital policy for high-speed contrast injection through ultrasound-guided IV lines has a safe record. However, 22% of patients with ultrasound-guided IV lines were refused for CT.


Assuntos
Meios de Contraste/administração & dosagem , Injeções Intravenosas/métodos , Política Organizacional , Segurança do Paciente/normas , Ultrassonografia/métodos , Cateteres/efeitos adversos , Cateteres/normas , Cateteres/estatística & dados numéricos , Síndromes Compartimentais/etiologia , Meios de Contraste/efeitos adversos , Meios de Contraste/uso terapêutico , Extravasamento de Materiais Terapêuticos e Diagnósticos/complicações , Extravasamento de Materiais Terapêuticos e Diagnósticos/etiologia , Humanos , Incidência , Injeções Intravenosas/estatística & dados numéricos , Segurança do Paciente/estatística & dados numéricos , Estudos Prospectivos , Estudos Retrospectivos , Ultrassonografia/instrumentação , Ultrassonografia/estatística & dados numéricos
9.
Rev. bras. hematol. hemoter ; 38(4): 325-330, Oct.-Dec. 2016. tab, graf
Artigo em Inglês | LILACS | ID: biblio-829952

RESUMO

ABSTRACT Anemia is a frequent complication in cancer patients, both at diagnosis and during treatment, with a multifactorial etiology in most cases. Iron deficiency is among the most common causes of anemia in this setting and can develop in nearly half of patients with solid tumors and hematologic malignancies. Surprisingly, this fact is usually neglected by the attending physician in a way that proper and prompt investigation of the iron status is either not performed or postponed. In cancer patients, functional iron deficiency is the predominant mechanism, in which iron availability is reduced due to disease or the therapy-related inflammatory process. Hence, serum ferritin is not reliable in detecting iron deficiency in this setting, whereas transferrin saturation seems more appropriate for this purpose. Besides, lack of bioavailable iron can be further worsened by the use of erythropoiesis stimulating agents that increase iron utilization in the bone marrow. Iron deficiency can cause anemia or worsen pre-existing anemia, leading to a decline in performance status and adherence to treatment, with possible implications in clinical outcome. Due to its frequency and importance, treatment of this condition is already recommended in many specialty guidelines and should be performed preferably with intravenous iron. The evidences regarding the efficacy of this treatment are solid, with response gain when combined with erythropoiesis stimulating agents and significant increments in hemoglobin as monotherapy. Among intravenous iron formulations, slow release preparations present more favorable pharmacological characteristics and efficacy in cancer patients.


Assuntos
Anemia Ferropriva/terapia , Injeções Intravenosas/estatística & dados numéricos , Deficiência de Ferro/terapia , Neoplasias/complicações
11.
Euro Surveill ; 21(19)2016 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-27195614

RESUMO

The recent, and rapid, emergence of injection of the short-acting stimulant mephedrone (4-methylmethcathione) has resulted in concerns about increased infection risks among people who inject drugs (PWID). Data from the bio-behavioural surveillance of PWID in the United Kingdom were analysed to examine the impact of mephedrone injection on infections among PWID. During the year preceding the survey, 8.0% of PWID (163/2,047) had injected mephedrone. In multivariable analyses, those injecting mephedrone were younger, less likely to have injected opiates, and more likely to have injected cocaine or amphetamines, used needle/syringe programmes or sexual health clinics, been recruited in Wales and Northern Ireland or shared needles/syringes. There were no differences in sexual risks. Those injecting mephedrone more often had hepatitis C antibodies (adjusted odds ratio (AOR) = 1.51; 95% confidence interval (CI): 1.08-2.12), human immunodeficiency virus (AOR = 5.43; 95% CI: 1.90-15.5) and overdosed (AOR = 1.70; 95% CI: 1.12-2.57). There were no differences in the frequency of injecting site infections or prevalence of hepatitis B. The elevated levels of risk and infections are a concern considering its recent emergence. Mephedrone injection may currently be focused among higher-risk or more vulnerable groups. Targeted responses are needed to prevent an increase in harm.


Assuntos
Patógenos Transmitidos pelo Sangue , Doenças Transmissíveis Emergentes/epidemiologia , Metanfetamina/análogos & derivados , Uso Comum de Agulhas e Seringas/estatística & dados numéricos , Abuso de Substâncias por Via Intravenosa/epidemiologia , Viremia/epidemiologia , Adulto , Distribuição por Idade , Causalidade , Estimulantes do Sistema Nervoso Central/administração & dosagem , Doenças Transmissíveis Emergentes/virologia , Comorbidade , Usuários de Drogas/estatística & dados numéricos , Feminino , Humanos , Incidência , Injeções Intravenosas/estatística & dados numéricos , Masculino , Metanfetamina/administração & dosagem , Fatores de Risco , Abuso de Substâncias por Via Intravenosa/virologia , Reino Unido/epidemiologia , Viremia/virologia , Populações Vulneráveis/estatística & dados numéricos
12.
J Ultrasound Med ; 35(3): 487-96, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26839372

RESUMO

OBJECTIVES: The purpose of this study was to collect and analyze the published data related to intravenous (IV) use of ultrasound (US) contrast agents in children. METHODS: We searched the literature to collect all of the published studies reporting the IV administration of a second-generation US contrast agent in children. RESULTS: We analyzed 9 case series and 5 case reports, as well as 5 individual cases, of pediatric contrast-enhanced US use reported in a study group that also included adults. We found that 502 children underwent contrast-enhanced US examinations (mean age, 9.7 years; range, 1 day-18 years). Most patients (89%) were injected with the sulfur hexafluoride contrast agent SonoVue (Bracco SpA, Milan, Italy). The mean dose used was 1.5 mL (range, 0.1-9.6 mL). Only 10 patients (2%) had adverse reactions related to the contrast agent administration: 1 life-threatening anaphylactic shock and 9 mild transitory adverse effects. We additionally found 38 papers in which the study groups included at least 1 child; thus, we obtained a total of 540 reported cases of off-label use of IV US contrast agents in children. The most frequent target organ was the liver, and most indications were related to space-occupying lesion characterization and abdominal evaluations after blunt trauma. Some studies also evaluated the diagnostic performance of contrast-enhanced US in different clinical scenarios and found very good accuracy. Concordance between contrast-enhanced US imaging and the respective reference-standard imaging methods ranged between 83% and 100% in different studies. CONCLUSIONS: Our results support the idea that the IV use of US contrast agents in children is safe, feasible, diagnostically robust, and effective.


Assuntos
Meios de Contraste/administração & dosagem , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Aumento da Imagem/métodos , Uso Off-Label/estatística & dados numéricos , Fosfolipídeos/administração & dosagem , Hexafluoreto de Enxofre/administração & dosagem , Ultrassonografia/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Injeções Intravenosas/estatística & dados numéricos , Masculino , Medição de Risco , Ultrassonografia/métodos , Revisão da Utilização de Recursos de Saúde
13.
JAMA ; 314(24): 2663-71, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26720027

RESUMO

IMPORTANCE: There has been limited surveillance for acute flaccid paralysis in North America since the regional eradication of poliovirus. In 2012, the California Department of Public Health received several reports of acute flaccid paralysis cases of unknown etiology. OBJECTIVE: To quantify disease incidence and identify potential etiologies of acute flaccid paralysis cases with evidence of spinal motor neuron injury. DESIGN, SETTING, AND PARTICIPANTS: Case series of acute flaccid paralysis in patients with radiological or neurophysiological findings suggestive of spinal motor neuron involvement reported to the California Department of Public Health with symptom onset between June 2012 and July 2015. Patients meeting diagnostic criteria for other acute flaccid paralysis etiologies were excluded. Cerebrospinal fluid, serum samples, nasopharyngeal swab specimens, and stool specimens were submitted to the state laboratory for infectious agent testing. MAIN OUTCOMES AND MEASURES: Case incidence and infectious agent association. RESULTS: Fifty-nine cases were identified. Median age was 9 years (interquartile range [IQR], 4-14 years; 50 of the cases were younger than 21 years). Symptoms that preceded or were concurrent included respiratory or gastrointestinal illness (n = 54), fever (n = 47), and limb myalgia (n = 41). Fifty-six patients had T2 hyperintensity of spinal gray matter on magnetic resonance imaging and 43 patients had cerebrospinal fluid pleocytosis. During the course of the initial hospitalization, 42 patients received intravenous steroids; 43, intravenous immunoglobulin; and 13, plasma exchange; or a combination of these treatments. Among 45 patients with follow-up data, 38 had persistent weakness at a median follow-up of 9 months (IQR, 3-12 months). Two patients, both immunocompromised adults, died within 60 days of symptom onset. Enteroviruses were the most frequently detected pathogen in either nasopharynx swab specimens, stool specimens, serum samples (15 of 45 patients tested). No pathogens were isolated from the cerebrospinal fluid. The incidence of reported cases was significantly higher during a national enterovirus D68 outbreak occurring from August 2014 through January 2015 (0.16 cases per 100,000 person-years) compared with other monitoring periods (0.028 cases per 100,000 person-years; P <.001). CONCLUSIONS AND RELEVANCE: In this series of patients identified in California from June 2012 through July 2015, clinical manifestations indicated a rare but distinct syndrome of acute flaccid paralysis with evidence of spinal motor neuron involvement. The etiology remains undetermined, most patients were children and young adults, and motor weakness was prolonged.


Assuntos
Neurônios Motores , Hipotonia Muscular/epidemiologia , Mielite/epidemiologia , Adolescente , Distribuição por Idade , California/epidemiologia , Criança , Pré-Escolar , Eletromiografia , Feminino , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Incidência , Injeções Intravenosas/estatística & dados numéricos , Imagem por Ressonância Magnética/métodos , Masculino , Hipotonia Muscular/líquido cefalorraquidiano , Hipotonia Muscular/terapia , Mielite/líquido cefalorraquidiano , Mielite/etiologia , Mielite/terapia , Troca Plasmática/estatística & dados numéricos , Recuperação de Função Fisiológica , Estudos Retrospectivos , Distribuição por Sexo , Esteroides/administração & dosagem , Adulto Jovem
14.
Curr Probl Diagn Radiol ; 43(5): 237-41, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24909428

RESUMO

OBJECTIVE: The purpose of our investigation was to determine the frequency of proximate acute and chronic confounding risk factors for acute kidney injury (AKI) in a cohort of adult hospitalized patients with stable renal function who developed AKI following an intravenous (IV) contrast-enhanced computed tomography (CT) examination. MATERIALS AND METHODS: Institutional review board approval was obtained for this retrospective, Health Insurance Portability and Accountability Act-compliant investigation. Overall, 100 adult inpatients (50 males [mean age = 61 years, range: 24-94 years] and 50 females [mean age = 60 years, range: 20-95 years]) with stable pre-CT renal function who developed post-CT AKI using the Acute Kidney Injury Network (AKIN) laboratory criteria following an IV contrast-enhanced CT examination comprised the study population. Electronic International Classification of Disease-9 analysis followed by a comprehensive manual electronic medical record review was systematically performed by 5 radiologists to identify known acute (n = 24, within 5 days before or 3 days after CT) and chronic (n = 21) risk factors for AKI other than contrast material administration that might confound a diagnosis of contrast-induced nephrotoxicity. Descriptive statistics were performed. RESULTS: Of 100 inpatients with post-CT AKI, 99 (99%) had 1 or more acute risk factor(s) for AKI other than contrast material administration (median = 3 risk factors, range: 0-8) and 86 (86%) had one or more chronic risk factor(s) for AKI (median = 2 risk factors, range: 0-7). The median number of risk factors (acute or chronic) per patient was 5 (range: 1-13). Only 1 inpatient (1%) developed post-CT AKI without a confounding acute risk factor (estimated glomerular filtration rate = 62-71 mL/min/1.73 m(2), 4 chronic risk factors, and CT 7 days after pancreaticoduodenectomy). The most common acute risk factors were nephrotoxic medications (83%) and parenteral blood product administration (30%). The most common chronic risk factors were hypertension (59%) and chronic kidney disease (56%). CONCLUSION: Nonconfounded post-CT AKI is rare in hospitalized adults with stable renal function who have been exposed to IV low- or iso-osmolality iodinated contrast material.


Assuntos
Lesão Renal Aguda/induzido quimicamente , Meios de Contraste/efeitos adversos , Injeções Intravenosas/estatística & dados numéricos , Iodo/efeitos adversos , Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Feminino , Taxa de Filtração Glomerular , Hospitalização , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Tomografia Computadorizada por Raios X/efeitos adversos
15.
Eur J Radiol ; 82(9): e387-99, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23711425

RESUMO

PURPOSE: To summarize the incidence of contrast-induced nephropathy (CIN) and associations between CIN incidence and risk factors in patients undergoing intravenous contrast-enhanced computed tomography (CECT) with low- or iso-osmolar iodinated contrast medium. METHODS: This review is performed in accordance with the preferred reporting items in systematic reviews and meta-analysis (PRISMA) guidelines. We searched the MEDLINE, EMBASE and Cochrane databases from 2002 till November 2012. Two reviewers included papers and extracted data. The pooled data were analysed by either fixed or random-effects approach depending on heterogeneity defined as the I(2) index. RESULTS: 42 articles with 18,790 patients (mean age 61.5 years (range: 38-83 years)) were included. The mean baseline eGFR was 59.8 mL/min and ranged from 4 to 256 mL/min. Of all patients 45.0% had an estimated glomerular filtration rate (eGFR)<60 mL/min, 55.2% had hypertension; 20.2% had diabetes mellitus (DM) and 6.5% had congestive heart failure (CHF). The overall pooled CIN incidence, defined as a SCr increase of ≥ 25% or ≥ 0.5mg/dL, was 4.96% (95%CI: 3.79-6.47). Data analysis showed associations between CIN and the presence of renal insufficiency, DM, malignancy, age>65 years and use of non-steroidal anti-inflammatory drugs (NSAID's) with odds ratios of 1.73 (95%CI: 1.06-2.82), 1.87 (95%CI: 1.55-2.26), 1.79 (95%CI: 1.03-3.11), 1.95 (95%CI: 1.02-3.70) and 2.32 (95%CI: 1.04-5.19), respectively while hypertension, anaemia and CFH were not associated (p=0.13, p=0.38, p=0.40). CONCLUSION: The mean incidence of CIN after intravenous iodinated CECT was low and associated with renal insufficiency, diabetes, presence of malignancy, old age and NSAID's use.


Assuntos
Meios de Contraste , Diabetes Mellitus/epidemiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Iodo , Nefropatias/epidemiologia , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Humanos , Incidência , Injeções Intravenosas/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Neoplasias , Fatores de Risco
16.
Radiology ; 268(3): 719-28, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23579046

RESUMO

PURPOSE: To determine the effect of intravenous (IV) low-osmolality iodinated contrast material (LOCM) on the development of post-computed tomography (CT) acute kidney injury (AKI), stratified by pre-CT estimated glomerular filtration rate (eGFR), in patients with stable renal function. MATERIALS AND METHODS: Institutional review board approval was obtained and patient consent waived for this HIPAA-compliant, retrospective study. CT examinations performed over a 10-year period on unique adult inpatients with sufficient serum creatinine (SCr) data and stable renal function (difference between baseline and pre-CT SCr within 0.3 mg/dL and 50% of baseline) were identified. A 1:1 propensity score matched cohort analysis with multivariate analysis of effects was performed with post-CT AKI as the primary outcome measure (8826 nonenhanced and 8826 IV contrast agent-enhanced CT studies in 17 652 patients). Propensity matching was performed with respect to likelihood of receiving IV contrast material (19 tested covariates). Post-CT AKI with Acute Kidney Injury Network SCr criteria was the primary endpoint. A stepwise multivariate conditional logistic regression model was performed to identify the effect of IV LOCM on post-CT AKI. RESULTS: After 1:1 propensity matching, IV LOCM had a significant effect on the development of post-CT AKI (P = .04). This risk increased with decreases in pre-CT eGFR (≥ 60 mL/min/1.73 m(2): odds ratio, 1.00; 95% confidence interval: 0.86, 1.16; 45-59 mL/min/1.73 m(2): odds ratio, 1.06; 95% confidence interval: 0.82, 1.38; 30-44 mL/min/1.73 m(2): odds ratio, 1.40; 95% confidence interval: 1.00, 1.97; <30 mL/min/1.73 m(2): odds ratio, 2.96; 95% confidence interval: 1.22, 7.17). CONCLUSION: IV LOCM is a nephrotoxic risk factor in patients with a stable eGFR less than 30 mL/min/1.73 m(2), with a trend toward significance at 30-44 mL/min/1.73 m(2). IV LOCM does not appear to be a nephrotoxic risk factor in patients with a pre-CT eGFR of 45 mL/min/1.73 m(2) or greater.


Assuntos
Lesão Renal Aguda/epidemiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Taxa de Filtração Glomerular , Iodo , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Lesão Renal Aguda/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste/administração & dosagem , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico , Feminino , Humanos , Incidência , Injeções Intravenosas/estatística & dados numéricos , Iodo/administração & dosagem , Masculino , Michigan/epidemiologia , Pessoa de Meia-Idade , Concentração Osmolar , Medição de Risco , Adulto Jovem
17.
J Clin Immunol ; 33(1): 49-54, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22961047

RESUMO

PURPOSE: Utilization reports on immunoglobulin (Ig) use for immunodeficiency in the United States (U.S.) have focused on prescribing practices in hospitals. There have been no large-scale reports on Ig use for immune deficiency in the home. We investigated the use of Ig in 3,187 subjects diagnosed with primary immunodeficiency. METHODS: Cross-sectional data on 4,580 subjects in the U.S. receiving Ig in 2011 was obtained from a major home care provider. Demographics, route, dose, and frequency of Ig use by subjects with ICD-9 coded primary immunodeficiencies were analyzed. RESULTS: Of 4,580 subjects, 3,187 had ICD-9 codes suggesting primary immunodeficiencies; 1,939 (60.8 %) were females and 1,248 (39.2 %) were males, with age ranging from 0 to 95 years. The predominant diagnoses were: common variable immunodeficiency (279.06; n=1,764; 55.3 %), hypogammaglobulinemia (279.00; n=635; 19.9 %), unspecified immunity deficiency (279.3; n=286; 9 %), other selective Ig deficiencies (279.03; n=171; 5.4 %), and agammaglobulinemia (279.04; n=127; 4 %). 54 % of subjects received Ig by the subcutaneous (SC) route, and 46 % by intravenous (IV) route, with more SC use by older subjects. The mean dose prescribed was 483 mg/kg/month, but less Ig was ordered for subjects on SCIg (409 mg/kg/month), as compared to subjects on IVIg (568 mg/kg/month). A highly significant inverse correlation between increasing age and dosage of Ig ordered was found (P= <.0001). CONCLUSION: Analysis of home care use of Ig in primary immune deficiency revealed that the SC route was prescribed more than the IV route, especially for older patients. By either method of administration, less immunoglobulin was prescribed for older subjects.


Assuntos
Imunodeficiência de Variável Comum/tratamento farmacológico , Imunodeficiência de Variável Comum/imunologia , Serviços de Assistência Domiciliar/estatística & dados numéricos , Serviços de Assistência Domiciliar/tendências , Imunoglobulinas Intravenosas/uso terapêutico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Imunodeficiência de Variável Comum/epidemiologia , Estudos Transversais , Feminino , Humanos , Imunoglobulinas Intravenosas/administração & dosagem , Lactente , Recém-Nascido , Injeções Intravenosas/estatística & dados numéricos , Injeções Intravenosas/tendências , Injeções Subcutâneas/estatística & dados numéricos , Injeções Subcutâneas/tendências , Masculino , Pessoa de Meia-Idade , New York/epidemiologia , Adulto Jovem
18.
Enferm. glob ; 11(26): 237-245, abr. 2012.
Artigo em Espanhol | IBECS | ID: ibc-100542

RESUMO

Objetivo: Analizar el nivel de conocimientos adquiridos durante el desarrollo de un curso-taller de terapia intravenosa y su relación con la aplicación práctica del procedimiento. Material y métodos: Estudio cuasiexperimental, descriptivo y de corte transversal. Muestra total de 30 enfermeras operativas de los servicios donde se realiza esta técnica. Se utilizó como instrumentó de evaluación un cuestionario y una guía de observación estructurada que se aplicó en 3 ocasiones. El procesamiento estadístico se realizo a través del programa Excel y SPSS, utilizándose un análisis descriptivo. Resultados: el 63.3% del profesional de enfermería obtuvo un nivel medio de conocimiento, en lo que respecta al mantenimiento y prevención de complicaciones predominó el nivel alto con un 83.8%. Conclusión: El presente estudio permite identificar que la preparación constante del personal de enfermería mediante la aplicación de cursos-talleres incrementa de manera positiva el manejo de conocimiento y la práctica pero sobre todo garantiza al usuario una atención con el menor riesgo y una mayor calidad (AU)


Aim: To analyse the level of knowledge acquired during the development of a workshop on intravenous therapy and its relation to the practical application of the procedure. Material and methods: quasi-experimental, descriptive, transversal study applied to 30 operational nurses who worked in the services where this technique is carried ou. For evaluation a questionnaire and a structured guide of observation was used, which was applied on 3 occasions. The statistical analysis was performed in Excel and SPSS, using descriptive analysis. Results: 63.3% of nursing professional obtained a mean level of knowledge, with regard to maintenance and prevention of complications, thee was a high level, 83.8%. Conclusion: This study identifies that the constant preparation of nurses through the implementation of workshops increases positively management knowledge and practice but especially guarantees the user a lower risk and higher quality attentio (AU)


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Conhecimentos, Atitudes e Prática em Saúde , Infusões Intravenosas/enfermagem , Injeções Intravenosas/enfermagem , Injeções Intravenosas/estatística & dados numéricos , Injeções Intravenosas/tendências , Educação em Enfermagem/métodos , Educação em Enfermagem/estatística & dados numéricos , Injeções Intravenosas/instrumentação , Injeções Intravenosas/métodos , Estudos Transversais/métodos , Inquéritos e Questionários , Coleta de Dados/métodos , Coleta de Dados/estatística & dados numéricos , Análise de Dados/métodos , Análise de Dados/estatística & dados numéricos , Educação em Enfermagem/organização & administração , Educação em Enfermagem/tendências
19.
Thromb Res ; 129(2): 139-45, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-21816454

RESUMO

INTRODUCTION: Acceptability of a prescribed treatment regimen is crucial to its clinical success, and the route of drug administration can play an important role in determining acceptability. This international survey explored physician and patient perceptions of injectable and oral treatments, and how these perceptions affect acceptability of treatments. Findings are discussed in the context of patient acceptance of treatments for venous thromboembolism (VTE) management. METHODS: Physicians who are regular prescribers of VTE prophylaxis and a randomly selected patient population were recruited to take part in a questionnaire. Patients had to answer 23 questions and physicians gave their predictions of patients' responses. RESULTS: In total, 568 physicians and 825 patients from 5 countries took part in the survey. More patients considered injectable treatments effective than considered oral treatments effective (87% versus 76%, respectively). This trend was well predicted by the physicians (98% and 61%, respectively). Additionally, 46% of patients would accept an injectable treatment program lasting >2months (rising to 67% for life-threatening diseases), a figure underestimated by physicians (11% and 46%, respectively). Overall, 73% of patients stated they would never miss an injection, where as 54% of physicians expected patients to miss one injection in a month of therapy. CONCLUSIONS: Physicians who are regular prescribers of VTE prophylaxis underestimate patients' ability to accept injectable treatments as an alternative to oral therapy. This survey suggests that injectable treatments may be an acceptable, and often preferred, option over oral administration of therapeutic and preventive medicines.


Assuntos
Atitude do Pessoal de Saúde , Fibrinolíticos/administração & dosagem , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Tromboembolia Venosa/tratamento farmacológico , Tromboembolia Venosa/epidemiologia , Administração Oral , Adulto , Idoso , Idoso de 80 Anos ou mais , Coleta de Dados , Feminino , Humanos , Injeções Intravenosas/estatística & dados numéricos , Internacionalidade , Masculino , Pessoa de Meia-Idade , Prevalência , Resultado do Tratamento
20.
Rev. esp. sanid. penit ; 14(1): 3-11, 2012. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-97761

RESUMO

Objetivos: Evaluar la eficacia de un programa de intercambio de jeringuillas (PIJ) en una prisión para reducir la prevalencia de infecciones asociadas al uso de drogas intravenosas, y conocer la aceptación del programa por internos y funcionarios del centro penitenciario. Material y métodos: Estudio observacional con cortes transversales al inicio, 6 y 12 meses y 10 años de desarrollo del programa. Se realizaron entrevistas a los usuarios del programa y encuestas a muestras accidentales de funcionarios en los distintos cortes, y a una muestra aleatoria de internos a los 10 años. Se registraron diariamente los indicadores de actividad del programa, y se valoró la prevalencia de infección por VIH, hepatitis B y C al inicio y a los 10 años. Para el análisis estadístico utilizamos la prueba ji-cuadrado con la corrección de Yates en caso necesario. Resultados: Durante estos diez años se suministraron 15.962 jeringuillas a 429 usuarios (media de 20,2 usuarios/mes), recuperándose 11.327 (70,9%). La prevalencia de infección por VIH pasó del 21% en 1999 al 8,5% en 2009, la de VHC del 40% al 26,1% (p<0,01). La mayoría de internos y funcionarios consideran que el programa no incrementa el consumo de drogas intravenosas y que mejora las condiciones higiénicas de vida en la prisión. Conclusiones: Tras diez años de PIJ, se observa un significativo descenso en la prevalencia de infección por VIH y por VHC en la población reclusa del centro, y el programa es aceptado como beneficioso por la mayoría de los internos y funcionarios encuestados(AU)


Objectives: To evaluate the effectiveness of NEPs in prison to reduce the prevalence of infections associated with intravenous drug use and to know more about acceptance of the program by inmates and staff. Material and methods: cross-sectional observational study at baseline, 6 and 12 months and 10 years of program development. Interviews were conducted with program users, as well as random sample surveys of officials at the various cuts, and a random sample of inmates from the centre after10 years. Activity indicators of the program were recorded continuously, and the prevalence of HIV, HBV and HCV at baseline and after 10 years was evaluated. For the statistical analysis, the chi-square test was used with the Yates correction when necessary. Results: In ten years we have supplied a total of 15,962 syringes to 429 users, (average 20.2 users/month), and 11,327 (70.9%) were returned. The prevalence of HIV infection decreased from 21% in 1999 to 8.5% in 2009, HCV prevalence from 40% to 26.1% (p <0.01), finding no significant differences in the prevalence of HBsAg +. Most of the inmates and civil servants believe that the program did not increase intravenous drug use and improves hygienic living conditions in prison. Conclusions: After ten years of development of the NEP, there was a significant decrease in the prevalence of HIV and HCV in the prison population at the centre, and the program is accepted as beneficial by most of the inmates and staff participating in the survey(AU)


Assuntos
Humanos , Masculino , Adulto , Prisões/organização & administração , Prisões/normas , Prisioneiros/legislação & jurisprudência , Prisioneiros/estatística & dados numéricos , Injeções Intravenosas/métodos , Injeções Intravenosas/tendências , Abuso de Substâncias por Via Intravenosa/epidemiologia , Abuso de Substâncias por Via Intravenosa/prevenção & controle , /métodos , Injeções Intravenosas/mortalidade , Injeções Intravenosas/estatística & dados numéricos , Abuso de Substâncias por Via Intravenosa/fisiopatologia , Abuso de Substâncias por Via Intravenosa/psicologia , /organização & administração , /estatística & dados numéricos , /normas , Centros de Tratamento de Abuso de Substâncias/organização & administração
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