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1.
Zhonghua Nei Ke Za Zhi ; 58(11): 829-831, 2019 Nov 01.
Artigo em Chinês | MEDLINE | ID: mdl-31665860

RESUMO

The study was to investigate whether the application of checklist during ward rounds could improve the prognosis of critical ill patients.The results suggested that the checklist used during ward rounds could not improve the inhospital mortality of critically ill patients, but it increased the proportion of deep vein thrombosis prophylaxis, and shortened prophylaxis treatment of gastric stress ulcer.


Assuntos
Lista de Checagem/métodos , Avaliação de Processos e Resultados (Cuidados de Saúde)/métodos , Visitas com Preceptor , China , Estado Terminal/mortalidade , Estado Terminal/terapia , Mortalidade Hospitalar , Humanos , Prognóstico , Visitas com Preceptor/métodos , Visitas com Preceptor/normas
2.
Am Surg ; 85(9): 961-964, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31638507

RESUMO

Enmeshment of emergency trauma providers (ETPs) into the United States health-care fabric resulted in the establishment of a formalized surgical critical care fellowship and certification for emergency medicine trainees. The aim of this study was to compare trauma outcomes for surgery-trained providers (STPs) and ETPs at our institution, hypothesizing patient outcome equivalency. We performed an institutional review board-exempt institutional registry review (January 1, 2004 to August 1, 2018), comparing 74 STPs and 6 ETPs. Comparator variables included all-cause mortality, all-cause morbidity, CT imaging studies per provider, time in ED (min), hospital/ICU lengths of stay, ICU admissions, and functional outcomes on discharge. Statistical comparisons included chi-square test for categorical data and analysis of covariance for continuous data (adjustments made for patient age, Injury Severity Score, and trauma mechanism; all P < 0.20). Statistical significance was set at P < 0.05, with an equivalence study design. A total of 33,577 trauma resuscitations were reviewed (32,299 STP-led and 1,278 ETP-led). Except for patient age (STP 50.2 ± 25.9 vs ETP 54.9 ± 25.3 years), Injury Severity Score (8.47 ± 8.14 vs 9.22 ± 8.40), and ICU admissions (16.1% vs 18.8%), we noted no significant intergroup differences. ETPs' performance was equivalent to that of STPs for all primary comparator variables (mortality, morbidity, CT utilization, time in the ED, lengths of stay, and functional outcomes). Incorporation of ETPs into our trauma center resulted in outcome parity between ETPs and STPs, while simultaneously expanding the expertise and experiential diversity within our multidisciplinary team. This study provides support for further incorporation of ETPs as equal partners across the growing network of United States regional trauma centers.


Assuntos
Competência Clínica , Medicina de Emergência/normas , Cirurgia Geral/normas , Ferimentos e Lesões/cirurgia , Cuidados Críticos , Medicina de Emergência/educação , Cirurgia Geral/educação , Mortalidade Hospitalar , Humanos , Tempo de Internação , Duração da Cirurgia , Avaliação de Resultados da Assistência ao Paciente , Pennsylvania , Complicações Pós-Operatórias , Tomografia Computadorizada por Raios X , Centros de Traumatologia , Estados Unidos
3.
Am Surg ; 85(9): 1033-1039, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31638520

RESUMO

Regionalization of complex surgical care has increased interhospital transfers to quaternary centers within large health-care systems. Risk-based patient selection is imperative to improve resource allocation without compromising care. This study aimed to develop predictive models for identifying low-risk patients for transfer to a fully integrated satellite hepatopancreatobiliary (HPB) service in the northeast region of the health-care system. HPB transfers to the quaternary center over 15 months from hospitals in proximity to the satellite HPB center. A predictive tool was developed based on simple pretransfer variables and outcomes for 30-day major complications (Clavien grade ≥ 3), readmission, and mortality. Thresholds for "low risk" were set at different SDs below mean for each model. Predictive models were developed from 51 eligible northeast region patient transfers for major complications (Brier score 0.1948, receiver operator characteristic (ROC) 0.7123, P = 0.0009), readmission (Brier score 0.0615, ROC 0.7368, P = 0.0020), and mortality (Brier score 0.0943, ROC 0.7989, P = 0.0023). Thresholds set from 2 SD below the mean for all models identified 2 as "low risk." Adjusting the threshold for the serious complication model to only 1 SD below the mean increased the "low-risk" cohort to five patients. These models demonstrate an easy-to-use tool to assist surgeons in identifying low-risk patients for diversion to a fully integrated satellite center. Improved interhospital transfers within a region could begin a transition from centers of excellence toward health-care systems of excellence.


Assuntos
Doenças Biliares/cirurgia , Hepatopatias/cirurgia , Modelos Logísticos , Pancreatopatias/cirurgia , Transferência de Pacientes , Medição de Risco/estatística & dados numéricos , Tomada de Decisão Clínica , Cuidados Críticos , Feminino , Mortalidade Hospitalar , Planejamento Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , North Carolina , Readmissão do Paciente , Complicações Pós-Operatórias , Medição de Risco/métodos
4.
Am Surg ; 85(9): 1044-1050, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31638522

RESUMO

Enhanced recovery after surgery (ERAS) may improve patients' postoperative course. Our center implemented the ERAS protocol for the colorectal service in 2016, and then expanded to multiple service lines over the course of 1.5 years. Our aim was to determine whether broad implementation of ERAS protocols across different service lines could improve patient care. All ERAS patients from 2018 were captured prospectively. For each service line using ERAS, one full year of data preceding ERAS was compared. ERAS service lines included colorectal, gynecology laparoscopic, gynecology open, hepatopancreaticobiliary, urology - nephrectomy and cystectomy, spinal fusion, cardiac surgery-coronary artery bypass grafting. ERAS and pre-ERAS services were compared based on length of stay (LOS), complications, readmission, and mortality rates. In addition, hospital costs were collected during this time frame. ERAS protocols significantly decreased LOS for colorectal, gynecology, and spine. Complications were significantly decreased in colorectal, gynecology, urology, and spine. Readmissions did not significantly increase in any service line except spine. There was no significant change in mortality. ERAS proved to save the hospital 1847 days and cost saving of almost $5 million in 2018. Implementing ERAS broadly improved patient outcomes (LOS, complications, readmission, and mortality) while providing cost savings to the hospital.


Assuntos
Protocolos Clínicos , Procedimentos Cirúrgicos Eletivos/economia , Procedimentos Cirúrgicos Eletivos/normas , Custos Hospitalares , Cuidados Pós-Operatórios/economia , Cuidados Pós-Operatórios/normas , Melhoria de Qualidade , Mortalidade Hospitalar , Humanos , Tempo de Internação/economia , Readmissão do Paciente/economia , Complicações Pós-Operatórias/economia , Complicações Pós-Operatórias/prevenção & controle
5.
Am Surg ; 85(9): 1061-1065, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31638525

RESUMO

As minimally invasive operations evolve, it is imperative to evaluate the advantages and risks involved. The aim of our study was to evaluate our institution's experience in incorporating a robotic platform for transhiatal esophagectomy (THE). Patients undergoing robotic THE were prospectively followed. Data are presented as median (mean ± SD). Forty-five patients were of 67 (67 ± 6.9) years and BMI 26 (27 ± 5.5) kg/m². Nine per cent of operations were converted to "open," but none in the last 25 operations. Operative duration of robotic THE was 334 (364 ± 108.8) minutes and estimated blood loss was 200 (217 ± 144.0) mL, which decreased with time (P = 0.017). Length of stay was 8 (12 ± 11.1) days. Twenty per cent had respiratory failure requiring intubation that resolved, 4 per cent developed pneumonia, 11 per cent developed a surgical site infection, 2 per cent developed renal insufficiency, and 2 per cent developed a UTI. Two per cent (one patient) died within 30 days postoperatively, because of cardiac arrest. Our experience with robotic THE promotes robotic application because we endeavor to achieve high-level proficiency. With experience, we improved estimated blood loss and converted fewer transhiatal esophagectomies to "open." Our length of hospital stay seems long but reflects the ill-health of patients, as does the variety of complications. Our data support the evolving future of THE, which will integrally include a robotic approach.


Assuntos
Esofagectomia/efeitos adversos , Esofagectomia/métodos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/métodos , Idoso , Perda Sanguínea Cirúrgica , Índice de Massa Corporal , Conversão para Cirurgia Aberta , Feminino , Seguimentos , Mortalidade Hospitalar , Humanos , Intubação Intratraqueal , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Pneumonia/diagnóstico , Complicações Pós-Operatórias , Estudos Prospectivos , Insuficiência Respiratória/terapia , Infecção da Ferida Cirúrgica , Infecções Urinárias
6.
Am Surg ; 85(10): 1089-1093, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657300

RESUMO

Older adults undergoing nonelective surgery are at risk for geriatric events (GEs: delirium, dehydration, falls/fractures, failure to thrive, and pressure ulcers), but the impact of GEs on postoperative outcomes is unclear. Using the 2013 to 2014 National Inpatient Sample, we analyzed nonelective hospital admissions for five common operations (laparoscopic cholecystectomy, colectomy, soft tissue debridement, small bowel resection, and laparoscopic appendectomy) in older adults (aged ≥65 years) and a younger referent group (aged 55-64 years). Nationally weighted descriptive statistics were generated for GEs. Logistic regression controlling for patient, procedure, and hospital characteristics estimated the association of 1) age with GEs and 2) GEs with outcomes. Of 471,325 overall admissions, 64.7 per cent were aged ≥65 years. The rate of any GE in older adults was 26.9 per cent; GEs varied by age and procedure (P < 0.001). After adjustment, the probability of any GE increased with age category (P < 0.001); having any GE was associated with higher probability of all outcomes (P < 0.001): mortality (4.5% vs 0.8%), postoperative complications (61.7% vs 24.9%), prolonged length of stay (24.3% vs 7.9%), and skilled nursing facility discharge (46.6% vs 10.3%). In addition, there was a dose-response relationship between GEs and negative outcomes. GEs are prevalent in the nonelective surgery setting and associated with worse clinical outcomes. Quality improvement efforts should focus on addressing GEs.


Assuntos
Apendicectomia/efeitos adversos , Colecistectomia Laparoscópica/efeitos adversos , Colectomia/efeitos adversos , Desbridamento/efeitos adversos , Intestino Delgado/cirurgia , Complicações Pós-Operatórias/epidemiologia , Acidentes por Quedas/estatística & dados numéricos , Fatores Etários , Idoso , Apendicectomia/estatística & dados numéricos , Colecistectomia Laparoscópica/estatística & dados numéricos , Colectomia/estatística & dados numéricos , Desbridamento/estatística & dados numéricos , Desidratação/epidemiologia , Desidratação/etiologia , Delírio/epidemiologia , Delírio/etiologia , Insuficiência de Crescimento/epidemiologia , Insuficiência de Crescimento/etiologia , Feminino , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/etiologia , Mortalidade Hospitalar , Hospitalização/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Lesão por Pressão/epidemiologia , Lesão por Pressão/etiologia , Instituições de Cuidados Especializados de Enfermagem/estatística & dados numéricos , Resultado do Tratamento
7.
Am Surg ; 85(10): 1129-1133, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657308

RESUMO

Best management for acute appendicitis (AA) in adults with liver cirrhosis is controversial and needs more investigation. We aimed to examine the impact of different treatment modalities on outcomes in this complex patient population. The Nationwide Inpatient Sample database from 2012 to 2014 was queried to identify AA patients with no cirrhosis, compensated cirrhosis (CC), and decompensated cirrhosis (DC). Each cohort was further stratified according to the treatment type: nonoperative management, open appendectomy, and laparoscopic appendectomy (LA). Chi-square, ANOVA, and binary regression analyses were used to determine differences between groups and risk factors for mortality and complications, with P < 0.05 considered statistically significant. A total of 108,289 AA patients were analyzed; of those, 304 with CC and 134 with DC were identified. Compared with CC and no cirrhosis, DC patients had significantly higher mortality, higher cost, and longer hospital length of stay. LA is accompanied by higher survival, lower cost, shorter duration of hospitalization, and lower incidence of complications across all groups. We conclude that LA is the best management strategy for AA in cirrhotic patients. Even in decompensated cirrhotics, which are associated with worse clinical outcomes, LA is still a favorable option over open appendectomy and nonoperative management.


Assuntos
Apendicectomia/métodos , Apendicite/cirurgia , Laparoscopia , Cirrose Hepática/complicações , Doença Aguda , Adulto , Análise de Variância , Apendicectomia/efeitos adversos , Apendicectomia/economia , Apendicectomia/mortalidade , Apendicite/complicações , Apendicite/mortalidade , Distribuição de Qui-Quadrado , Conversão para Cirurgia Aberta/estatística & dados numéricos , Custos e Análise de Custo , Feminino , Preços Hospitalares , Mortalidade Hospitalar , Humanos , Incidência , Laparoscopia/economia , Laparoscopia/mortalidade , Tempo de Internação/economia , Cirrose Hepática/classificação , Cirrose Hepática/mortalidade , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Análise de Regressão , Fatores de Risco , Resultado do Tratamento
8.
Am Surg ; 85(10): 1134-1138, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657309

RESUMO

Traumatic esophageal injury is a highly lethal but rare injury with minimal data in the trauma population. We sought to provide a descriptive analysis of esophageal trauma (ET) to identify the incidence, associated injuries, interventions, and outcomes. We hypothesized that blunt trauma is associated with higher risk of death than penetrating trauma. The Trauma Quality Improvement Program (2010-2016) was queried for patients with ET. Patients with blunt and penetrating trauma were compared using chi-square and Mann-Whitney U tests. A multivariable logistic regression model was used to determine risk of mortality. Of 1,403,466 adult patients, 651 (<0.01%) presented with ET. The most common associated thoracic injuries were rib fractures (38.7%) and pneumothorax (26.7%). More patients with a penetrating mechanism underwent open repair of the esophagus than those with blunt mechanism (46.2% vs 11.7%, P < 0.001). After controlling for covariates, there was no difference in risk of mortality between blunt and penetrating trauma (P = 0.65). The mortality rate for patients with esophageal injury surviving greater than 24 hours was 7.5 per cent. In this large national database analysis, ET was rare and most commonly associated with rib fractures and pneumothorax. Contrary to our hypothesis, the risk of mortality was equivalent between blunt and penetrating ET.


Assuntos
Esôfago/lesões , Ferimentos não Penetrantes/mortalidade , Ferimentos Penetrantes/mortalidade , Adulto , Distribuição de Qui-Quadrado , Esôfago/cirurgia , Feminino , Mortalidade Hospitalar , Humanos , Incidência , Tempo de Internação , Modelos Logísticos , Masculino , Morbidade , Pneumonia/epidemiologia , Pneumonia/etiologia , Pneumotórax/complicações , Pneumotórax/epidemiologia , Melhoria de Qualidade , Estudos Retrospectivos , Fraturas das Costelas/complicações , Fraturas das Costelas/epidemiologia , Fatores de Risco , Estatísticas não Paramétricas , Stents/estatística & dados numéricos , Taxa de Sobrevida , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/epidemiologia , Ferimentos não Penetrantes/cirurgia , Ferimentos Penetrantes/complicações , Ferimentos Penetrantes/epidemiologia , Ferimentos Penetrantes/cirurgia
9.
Am Surg ; 85(10): 1175-1178, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657319

RESUMO

Early surgical intervention decreases mortality in necrotizing soft tissue infections (NSTIs). Yet, a subset of patients will not have NSTIs (non-NSTIs) at the time of exploration. We hypothesized that NSTI and non-NSTI patients had similar causative organisms and that intraoperative wound cultures could help guide management. Culture results and outcomes were compared for all patients undergoing surgery for suspected NSTIs over a seven-year-period. Of 295 patients, 240 (81.4%) had NSTIs. Of the 55 non-NSTI patients (18.6%), 50 had cellulitis and 5 had abscesses. NSTI and non-NSTI patients had similar rates of bacteremia (20.4% vs 17.6%, P = 0.66), septic shock (15.9% vs 12.7%, P = 0.68), and mortality (10.4% vs 7.2%, P = 0.62). Wound cultures were collected more often in NSTI patients (229/240, 95.4%) than in non-NSTI patients (42/55, 76.4%, P < 0.01). Non-NSTI patients had positive deep wound cultures more than half of the time (23/42, 54.8%). The microbiologic profile was similar between groups, with Methicillin Resistant Staphylococcus aureus and Group A Streptococcus occurring with the same frequency. We advocate for deep wound cultures in all patients being evaluated operatively for NSTIs even if the exploration is considered negative because these patients have similar clinical characteristics and virulent microbiology, and culture results can help guide antimicrobial therapy.


Assuntos
Infecções dos Tecidos Moles/microbiologia , Infecções dos Tecidos Moles/cirurgia , Abscesso/epidemiologia , Abscesso/microbiologia , Adulto , Bacteriemia/epidemiologia , Técnicas Bacteriológicas , Celulite (Flegmão)/epidemiologia , Celulite (Flegmão)/microbiologia , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Pessoa de Meia-Idade , Necrose/microbiologia , Estudos Retrospectivos , Choque Séptico/epidemiologia , Infecções dos Tecidos Moles/epidemiologia , Infecções dos Tecidos Moles/patologia , Streptococcus pyogenes/isolamento & purificação
10.
Medicine (Baltimore) ; 98(41): e17404, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593092

RESUMO

Type 2 myocardial infarction (MI) is defined as myocardial necrosis due to imbalance between myocardial oxygen supply and demand. The objective of this study was to assess the features, treatments, and outcomes of patients with type 2 MI in comparison with patients with type 1 MI hospitalized in general medical wards. A retrospective review was performed on patients admitted to general medicine wards diagnosed with MI in Sheba Medical Center between January 1, 2016 and December 31, 2016. Comparative analysis between patients with type 1 and type 2 MI was performed. The study included 349 patients with type 1 MI and 206 patients with type 2 MI. The main provoking factors for type 2 MI were sepsis (38.1%), anemia (29.1%), and hypoxia (23.8%). Patients with type 2 MI were older (79.1 ±â€Š11.9 vs 75.2 ±â€Š11.7, P < .001) and had a lower rate of prior MI (23.3% vs 38.1%, P < .001) and percutaneous coronary intervention (PCI) (34% vs 48.7%, P = .023) compared with patients with type 1 MI. Patients with type 2 MI were significantly less prescribed antiplatelet therapy (79.1% vs 96%, P < .001) and statins (60.7% vs 80.2%, P < .001), and were less referred to coronary angiography (10.7% vs 54.4%, P < .001). Type 2 MI was associated with a significantly higher 1-year mortality rate compared with type 1 MI (38.8% vs 26.6%, P = .004), but after accounting for age and sex differences, this association lacked statistical significance. In conclusion, type 2 MI patients were older and had similar comorbidities compared with those with type 1 MI. These patients were less prescribed medical therapy and coronary intervention, and had a higher 1-year mortality rate. Establishing a clear therapeutic approach for type 2 MI is required.


Assuntos
Angiografia Coronária/estatística & dados numéricos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Infarto do Miocárdio/mortalidade , Quartos de Pacientes/estatística & dados numéricos , Intervenção Coronária Percutânea/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/patologia , Infarto do Miocárdio/terapia , Prognóstico , Estudos Retrospectivos
11.
Medicine (Baltimore) ; 98(38): e17278, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31568009

RESUMO

INTRODUCTION: Pneumonia is one of the leading causes of death worldwide, represents a potentially life-threatening condition. In recent studies, adjuvant corticosteroids therapy has been shown to improve outcome in severe community-acquired pneumonia (CAP); however, the treatment response to corticosteroids vary. It is important to select patients likely to benefit from the treatment. Currently, the optimal patient selection of corticosteroids treatment is not yet clearly defined. METHODS: Sphingosine-1-phosphate and pneumonia (SOPN) trial is a double-blinded, randomized, placebo-controlled trial that will investigate if sphingosine-1-phosphate (S1P) can be an indicator for initiating adjuvant corticosteroids therapy in patients with severe CAP. Participants will be recruited from the emergency department and randomized to receive 20 mg of methylprednisolone twice daily or placebo for 5 days. The primary outcome will be "in-hospital mortality." Secondary outcomes will include intensive care unit (ICU) admission, length of ICU stay, length of hospital stay, and clinical outcomes at Day 7 and Day 14. CONCLUSION: SOPN trial is the first randomized placebo-controlled trial to investigate whether S1P can be a predictive biomarker for adjuvant corticosteroids therapy in patients with severe CAP. The trial will add additional data for the appropriate use of adjuvant corticosteroids therapy in patients with severe CAP. Results from this clinical trial will provide foundational information supporting that if the S1P is appropriate for guiding the patient selection for corticosteroids adjuvant therapy.


Assuntos
Glucocorticoides/uso terapêutico , Lisofosfolipídeos/sangue , Metilprednisolona/uso terapêutico , Pneumonia/tratamento farmacológico , Esfingosina/análogos & derivados , Adjuvantes Farmacêuticos , Adulto , Biomarcadores/sangue , Protocolos Clínicos , Infecções Comunitárias Adquiridas/sangue , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/mortalidade , Método Duplo-Cego , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Pneumonia/sangue , Pneumonia/mortalidade , Esfingosina/sangue
12.
Rev Saude Publica ; 53: 83, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31576943

RESUMO

OBJECTIVE: Assess the magnitude and trend of hospitalization rates due to traumatic injuries in intensive care units (ICU) in Brazil from 1998 to 2015. METHODS: This is an ecological time-series study that analyzed data from the Hospital Information System. A trend analysis of hospitalization rates was performed according to diagnosis, sex and age using generalized linear regression models and Prais-Winsten estimation. RESULTS: Rates were higher among male patients, but increased hospitalization due to trauma among female patients influenced the ratio between both sexes. Falls and transport accidents were the most frequent causes of trauma. The average annual growth was 3.6% in ICU trauma hospitalization rates in Brazil, the highest growth was reported in the North region (8%; 95%CI 6.4-9.6), among women (5.4%; 95%CI 4.5-6.3), and among people aged 60 years and older (5.5%; 95%CI, 4.7-6.3). The most frequent causes of trauma are falls (4.5%; 95%CI 3.5-5.5) and care complications (5.4%; 95%CI 4.5-6.3). On the other hand, the annual hospital mortality rate due to trauma in ICU is 1.7% lower, on average (95%CI 2.1-1.3). CONCLUSION: An increase in ICU hospitalization rate due to trauma in Brazil may be the result of some factors, such as an increasing number of accidents and cases of violence, the implementation of pre-hospital care, and improved access to care, with more beds in ICU. In addition, population aging is another factor, as a greater increase in hospitalization was observed among people aged 60 years and older.


Assuntos
Hospitalização/estatística & dados numéricos , Hospitalização/tendências , Unidades de Terapia Intensiva/estatística & dados numéricos , Unidades de Terapia Intensiva/tendências , Ferimentos e Lesões/epidemiologia , Acidentes por Quedas/estatística & dados numéricos , Acidentes de Trânsito/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Brasil/epidemiologia , Feminino , Mortalidade Hospitalar/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Distribuição por Sexo , Fatores de Tempo , Adulto Jovem
13.
Medicine (Baltimore) ; 98(42): e17592, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626132

RESUMO

Data on outcomes of patients receiving mechanical ventilation (MV) in China are scarce.To investigate factors associated with the prognosis of patients given MV in the intensive care unit (ICU).A 12-year (January 1, 2006-December 31, 2017) retrospective cohort study.ICU of Beijing Geriatric Hospital, China.A total of 905 patients aged ≥16 years given MV during the study period.None.Among 905 patients included (610 men; median age, 78 years; Acute Physiology and Chronic Health Evaluation [APACHE]-II score, 27.3 ±â€Š8.9), 585 survived (388 men; median age, 77 years; average APACHE-II score, 25.6 ±â€Š8.4), and 320 died in the ICU (222 men; median age, 78 years; APACHE-II score, 30.6 ±â€Š8.9). All-cause ICU mortality was 35.4%. In patients aged <65 years, factors associated with ICU mortality were APACHE-II score (odds ratio [OR], 1.108; 95% confidence interval [95% CI], 1.021-1.202; P = .014), nosocomial infection (OR, 6.618; 95% CI, 1.065-41.113; P = .043), acute kidney injury (OR, 17.302; 95% CI, 2.728-109.735; P = .002), invasive hemodynamic monitoring (OR, 10.051; 95% CI, 1.362-74.191; P = .024), MV for cardiopulmonary resuscitation (OR, 0.122; 95% CI, 0.016-0.924; P = .042), duration of MV (OR, 0.993; 95% CI, 0.988-0.998; P = .008), successful weaning from MV (OR, 0.012; 95% CI, 0.002-0.066; P < .001), and renal replacement therapy (OR, 0.039; 95% CI, 0.005-0.324; P = .003). In patients aged ≥65 years, factors associated with mortality were APACHE-II score (OR, 1.062; 95% CI, 1.030-1.096; P < .001), nosocomial infection (OR, 2.427; 95% CI, 1.359-4.334; P = .003), septic shock (OR, 2.017; 95% CI, 1.153-3.529; P = .014), blood transfusion (OR, 1.939; 95% CI, 1.174-3.202; P = .010), duration of MV (OR, 0.999; 95% CI, 0.999-1.000; P = .043), and successful weaning from MV (OR, 0.027; 95% CI, 0.015-0.047; P < .001).APACHE-II score, successful weaning, and nosocomial infection in the ICU are independently associated with the prognosis of patients given MV in the ICU.


Assuntos
Estado Terminal/terapia , Infecção Hospitalar/epidemiologia , Unidades de Terapia Intensiva/estatística & dados numéricos , Respiração Artificial/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Estado Terminal/mortalidade , Infecção Hospitalar/etiologia , Feminino , Seguimentos , Mortalidade Hospitalar/tendências , Humanos , Incidência , Masculino , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida/tendências
14.
Bone Joint J ; 101-B(10): 1209-1217, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31564156

RESUMO

AIMS: There is an increasing demand for hip arthroplasty in China. We aimed to describe trends in in-hospital mortality after this procedure in China and to examine the potential risk factors. PATIENTS AND METHODS: We included 210 450 patients undergoing primary hip arthroplasty registered in the Hospital Quality Monitoring System in China between 2013 and 2016. In-hospital mortality after hip arthroplasty and its relation to potential risk factors were assessed using multivariable Poisson regression. RESULTS: During the study period, 626 inpatient deaths occurred within 30 days after hip arthroplasty. Mortality decreased from 2.9% in 2013 to 2.6% in 2016 (p for trend = 0.02). Compared with their counterparts, old age, male sex, and divorced or widowed patients had a higher rate of mortality (all p < 0.05). Risk ratio (RR) for mortality after arthroplasty for fracture was two-fold higher (RR 2.0, 95% confidence interval (CI) 1.5 to 2.6) than that for chronic disease. RRs for mortality were 3.3 (95% CI 2.7 to 3.9) and 8.2 (95% CI 6.5 to 10.4) for patients with Charlson Comorbidity Index (CCI) of 1 to 2 and CCI ≥ 3, respectively, compared with patients with CCI of 0. The rate of mortality varied according to geographical region, the lowest being in the East region (1.8%), followed by Beijing (2.1%), the North (2.9%), South-West (3.6%), South-Central (3.8%), North-East (4.1%), and North-West (5.2%) regions. CONCLUSION: While in-hospital mortality after hip arthroplasty in China appears low and declined during the study period, discrepancies in mortality after this procedure exist according to sociodemographic factors. Healthcare resources should be allocated more to underdeveloped regions to further reduce mortality. Cite this article: Bone Joint J 2019;101-B:1209-1217.


Assuntos
Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/mortalidade , Causas de Morte , Mortalidade Hospitalar/tendências , Sistema de Registros , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/métodos , China , Estudos de Coortes , Bases de Dados Factuais , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Distribuição de Poisson , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/fisiopatologia , Falha de Prótese , Estudos Retrospectivos , Fatores Sexuais , Fatores de Tempo , Resultado do Tratamento
15.
Rev Assoc Med Bras (1992) ; 65(9): 1168-1173, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31618332

RESUMO

OBJECTIVE: Treatment limitation, as well as do-not-resuscitate (DNR) directives, are difficult but important to improve patients' quality of life and minimize dysthanasia. We aimed to study the approach to withholding, withdrawal, and DNR decisions, patients' characteristics, and process documentation in a general Intensive Care Unit (ICU) in Portugal. METHODS: A retrospective analysis of data regarding the limitation of treatment decisions collected from previously-designed forms and complemented by medical record consultation. RESULTS: A total of 1602 patients were admitted to the ICU between 2011 and 2016. DNR decisions were documented in 127 cases (7.9%). Patients with treatment limitations were older and had higher Simplified Acute Physiology Score II. The most frequent diagnosis preceding these decisions was sepsis (52.0%, n = 66); the most common main reason for limiting treatment was a poor prognosis of acute illness. Of the patients to whom a DNR was implemented, 117 (92.1%) died in the ICU (40.1% of the total number of ICU deaths), and hospital mortality was 100%. Participants in these decisions, as well as types of treatment withdrawn and their respective timings, were not registered in medical records. CONCLUSION: Treatment limitation and DNR decisions were relatively common, in line with other Southern European studies, but behind Northern European and North American centers. Patients with these limitations were older and more severely ill than patients without such decisions. Documentation of these processes should be clear and detailed, either in specific forms or computerized clinical records; there is room for improvement in this area.


Assuntos
Unidades de Terapia Intensiva/organização & administração , Registros Médicos , Ordens quanto à Conduta (Ética Médica) , Suspensão de Tratamento/normas , Idoso , Idoso de 80 Anos ou mais , Tomada de Decisões , Feminino , Mortalidade Hospitalar , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Portugal , Qualidade de Vida , Estudos Retrospectivos , Sepse/mortalidade
16.
J Frailty Aging ; 8(4): 176-179, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31637402

RESUMO

The preponderance of studies on frailty assessment in critically ill adults have used the Clinical Frailty Scale (CFS) to quantify frailty and previous research suggests that surrogates were more likely to be optimistic than physicians in their CFS scores. Whether discordance between surrogates and physicians was relevant to prognosis has been underexplored. Therefore, in a prospective observational cohort of 298 critically ill older adults, we aimed 1) to describe factors related to discordance and 2) to estimate the relationship between such discordance and hospital mortality and other short-term outcomes. Discordance between surrogates and physician was present in 89/298 (29.9%) and independently associated with a higher risk of hospital mortality. Discordance was not associated with markers of intensity of treatment such as intubation, blood transfusion, incident dialysis for acute renal failure and prolonged hospital length of stay. Understanding factors relevant to discordance between physicians and surrogates may lend further insights into short-term prognosis for older adults with critical illness.


Assuntos
Estado Terminal/mortalidade , Fragilidade/diagnóstico , Mortalidade Hospitalar/tendências , Idoso , Humanos , Variações Dependentes do Observador , Prognóstico , Estudos Prospectivos
17.
J Frailty Aging ; 8(4): 222-223, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31637410

RESUMO

Hyponatremia is the most common electrolyte disorder. It may have serious consequences in asyntomatic patients with a mild disease. Therefore, an evaluation of unsual causes is of paramount importance. Polypharmacy is highly prevalent in older people and many drugs can cause hyponatremia as a collateral effect. In our retrospective analysis of geriatric medical records dated 2015 we found that 39 out of the 273 hospitalized patients had hyponatremia. Polipharmacy was highly prevalent, especially in hyponatremic patients. Non-steroidal anti-inflammatory drugs, which are seldom considered as a cause of hyponatremia were instead found to be associated to an increased risk of the disorder (adjustedOR 3.61, 95% CI 1 - 12.99, p = 0.05). In-hospital mortality was higher in patients with moderate or severe hyponatremia at hospital admission. Our study underlines the importance of considering rare but potentially reversible causes of hyponatremia, which can lead to serious consequences.


Assuntos
Anti-Inflamatórios não Esteroides/efeitos adversos , Hiponatremia/induzido quimicamente , Idoso , Mortalidade Hospitalar/tendências , Hospitalização , Humanos , Registros Médicos , Estudos Retrospectivos
18.
Medicine (Baltimore) ; 98(43): e17644, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31651883

RESUMO

BACKGROUND: The aim of this study is to explore the efficacy and safety of ulinastatin for the treatment of patients with severe acute pancreatitis (SAP). METHODS: We will search randomized controlled trials which assess the efficacy and safety of ulinastatin for patients with SAP from the electronic databases of Cochrane Library, MEDILINE, EMBASE, CINAHL, PsycINFO, Scopus, CBM, Wangfang, VIP, and CNKI. All electronic databases will be searched from inception to the present with no limitations of language and publication status. Two researchers will carry out study selection, data extraction, and study quality assessment independently. Another researcher will help to resolve any disagreements between 2 researchers. RESULTS: The outcomes include overall mortality, time of hospital stay, complications of systematic or local infection, multiple organ deficiency syndrome, health related quality of life (as measured as the 36-Item Short Form Health Survey), and adverse events related to nutrition. CONCLUSION: This study will provide evidence to evaluate the efficacy and safety of ulinastatin in the treatment of patients with SAP. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42019149566.


Assuntos
Glicoproteínas/uso terapêutico , Pancreatite/tratamento farmacológico , Inibidores da Tripsina/uso terapêutico , Doença Aguda , Mortalidade Hospitalar , Humanos , Tempo de Internação/estatística & dados numéricos , Pancreatite/mortalidade , Qualidade de Vida , Projetos de Pesquisa , Revisão Sistemática como Assunto , Resultado do Tratamento
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