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1.
J. Health Biol. Sci. (Online) ; 10(1): 1-9, 01/jan./2022. ilus, tab, graf
Artigo em Inglês | LILACS | ID: biblio-1378522

RESUMO

Objective: the aim of this study was to relate sociodemographic, epidemiological and clinical conditions to the occurrence of severe cases of HZ in reference hospital of Fortaleza. Methods: this is a cross-sectional analytical study, based on medical records of patients admitted from 2009 to 2018. Pearson's x2 test or Fisher's exact test were used when appropriate. Results: we analyzed 196 medical records. The presence of complications occurred in 69.9%, the most affected region was the cranial (68.9%), and 1.5% died. The presence of vesicles (PR=1.37; 95%CI: 1.03-1.82; p=0.01) and the choice of antibiotic associated antiviral therapy (PR=0.58; 95%CI: 0.46-0.73; p=0.00) were significantly associated with the severity. Conclusions: the disease may be more severe at ages over 50. The presence of lesions in vesicles was associated with a higher prevalence of complications and the use of antibiotics and antivirals as a protective factor.


Objetivo: relacionar condições sociodemográficas, epidemiológicas e clínicas à ocorrência de casos graves de HZ em hospital de referência de Fortaleza. Métodos: trata-se de um estudo analítico transversal, baseado em prontuários de pacientes internados de 2009 a 2018. Foram utilizados o teste x2 de Pearson ou o teste exato de Fisher, quando apropriado. Resultados: foram analisados 196 prontuários. A presença de complicações ocorreu em 69,9%, a região mais acometida foi a craniana (68,9%), e 1,5% foi a óbito. A presença de vesículas (RP=1,37; IC95%: 1,03-1,82; p=0,01) e a escolha da terapia antiviral associada a antibióticos (RP=0,58; IC95%: 0,46-0,73; p=0,00) foram significativamente associadas com a gravidade. Conclusões: a doença pode ser mais grave a partir dos 50 anos. A presença de lesões em vesículas foi associada à maior prevalência de complicações e o uso de antibióticos e antivirais como fator de proteção.


Assuntos
Herpes Zoster , Registros Médicos , Doença , Epidemiologia , Herpesvirus Humano 3 , Hospitalização , Pacientes Internados , Métodos
2.
Nihon Ronen Igakkai Zasshi ; 59(3): 339-346, 2022.
Artigo em Japonês | MEDLINE | ID: mdl-36070908

RESUMO

AIM: To examine the predictive model that classifies the fluctuation in fall risk two weeks after an evaluation at the beginning of short-term intensive inpatient rehabilitation for elderly patients with Parkinson's disease (PD). METHODS: Of the patients with PD ≥65 years old who underwent intensive rehabilitation, 17 patients (mean age: 76.5±6.1 years old) who had a fall risk detected by the Timed "Up & Go" including a cognitive task (TUG-cognitive) were enrolled in this study. The patients were divided into two groups depending on the TUG-cognitive two weeks after starting intensive rehabilitation: reduced fall risk or residual fall risk. The differences in the evaluated items between the two groups were examined, and those items found to have significant differences were used as independent variables in the logistic regression analysis with the fluctuation in fall risk after two weeks as the dependent variable. RESULTS: A logistic regression analysis revealed that the fast-walking speed was a factor affecting the fluctuation in fall risk. In addition, the incidence of residual fall risk was calculated from the logistic function, and the risk was determined to be high when the fast-walking speed was ≤0.84 m/sec. CONCLUSIONS: The predictive model consisted of the TUG-cognitive and fast-walking speed at the beginning of intensive rehabilitation; it was suggested that the fluctuation in fall risk after two weeks could be classified based on these findings. Improvement of the fast-walking speed is important for reducing the fall risk in elderly patients with PD.


Assuntos
Medicina , Doença de Parkinson , Idoso , Idoso de 80 Anos ou mais , Humanos , Incidência , Pacientes Internados
3.
Nihon Ronen Igakkai Zasshi ; 59(3): 347-359, 2022.
Artigo em Japonês | MEDLINE | ID: mdl-36070909

RESUMO

AIM: To clarify changes in location before hospital admission and discharge destination over the 10-year period of 2010 to 2020 and to identify prognostic factors associated with the survival in hospitals with chronic-phase inpatients. METHODS: The subjects were patients newly admitted to 12 hospitals in 2010 and 2020. The age, sex, location before hospital admission, outcomes at 90 days after admission, discharge destination, and results of 6 biochemical tests at admission were evaluated. A survival analysis was performed for the age, sex, and biochemical tests at admission. RESULTS: We analyzed 8007 newly hospitalized patients. Compared with 2010, there were more hospital admissions from acute-care hospitals and fewer admissions from long-term-care facilities in 2020. In addition, relative to 2010, regarding the outcomes at 90 days after admission, there were more discharges to home and residential facilities in 2020, fewer discharges to long-term-care facilities, and lower mortality rates. In the survival analysis, a multivariate analysis revealed that an elderly age, male sex, low albumin, high total cholesterol, high urea nitrogen, and low serum sodium were poor prognostic factors. These five variables were consistently poor prognostic factors in both 2010 and 2020, and Kaplan-Meier curves showed that the scores were dose-dependent prognostic factors for a poor survival. CONCLUSIONS: The present analysis of pre-admission location and discharge destination in hospitals with chronic-phase patients revealed an elderly age, male sex, high urea nitrogen, low serum sodium, and low albumin at the time of admission to be strong predictors of poor outcomes in these patients.


Assuntos
Pacientes Internados , Alta do Paciente , Idoso , Albuminas , Hospitais , Humanos , Masculino , Prognóstico , Sódio , Ureia
4.
Transl Psychiatry ; 12(1): 370, 2022 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-36071050

RESUMO

Mental disorders pose a worldwide growing public health burden. One of the major challenges for healthcare systems remains to respond to the need of patients with mental disorders for continuous and flexible treatment. The EVA64 study evaluates novel programs of flexible and integrative treatment (FIT) in hospitals. This manuscript presents results from the evaluation of FIT hospitals in comparison to hospitals from regular routine care. In addition to data from adult patients, we also present data from affiliated child and adolescent psychiatric wards employing FIT programs. Using comprehensive claims data, primary outcomes are the utilization of inpatient care and sick leave for a priori defined clusters of mental disorders. We stratify between patients already under treatment (ongoing treatment) and patients with incident treatment cases (initial treatment) at the point of inclusion in the study. In the initial treatment group, we found a significant reduction in the length of inpatient stay of 4.1 days in FIT hospitals compared to routine care. While patients with mood affective disorders (-1.8 days) and patients with neurotic, stress-related, and somatoform disorders (-3.6 days) showed an even stronger effect of the reduction of inpatient lengths of stay, the effect was significantly weaker in patients with mental and behavioral disorders due to use of alcohol (+3.3 days). Regarding the duration of sick leave, we found no significant treatment effect of FIT programs compared to routine care. In the ongoing treatment group of adult patients, we found a significantly lower utilization of inpatient treatment by 1.3 days as well as a shorter duration of sick leave by 4.3 days in FIT hospitals compared to routine care. In the cohort of children and adolescent patients, we also did not observe a significant treatment effect in either the initial treatment group or the ongoing treatment group. Registration: this study was registered in the database "Health Services Research Germany" (trial number: VVfD_EVA64_15_003713).


Assuntos
Transtornos Mentais , Transtornos Psicóticos , Adolescente , Adulto , Criança , Emprego , Humanos , Pacientes Internados , Transtornos Mentais/terapia , Licença Médica
6.
Biol Pharm Bull ; 45(9): 1306-1311, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36047199

RESUMO

We aimed to determine the efficacy of zinc acetate hydrate (ZAH) treatment for hypozincemia in elderly inpatients and to identify the factors affecting its therapeutic effect. We enrolled 79 patients with a mean age of 82 years. The mean serum zinc level before ZAH administration was 53.4 ± 11.5 µg/dL. More than half of the patients (67%) had zinc deficiency (<60 µg/dL), whereas 33% had subclinical zinc deficiency (60-80 µg/dL). The median increase in serum zinc level per ZAH tablet (25 mg) was 1.00 µg/dL. Based on the cutoff value, two groups were identified: slight increase (<1.00 µg/dL) and marked increase (≥1.00 µg/dL) groups; the difference between the two groups was significant (0.57 ± 0.22 µg/dL, n = 39 vs. 1.68 ± 0.70 µg /dL, n = 40; p < 0.0001, Wilcoxon rank sum test). Logistic regression analysis using total zinc dose, serum albumin level, impaired renal function, and diuretics as multivariate variables revealed a significant difference in total zinc dose (total number of tablets per 25 mg tablet: odds ratio 1.056, 95% confidence interval 1.019-1.095, p = 0.003). A significant increase in serum zinc levels was observed in the group with a total zinc dose of less than 1000 mg. The results suggest that an increasing trend in total zinc dose is associated with a low increase in serum zinc levels. Therefore, for the treatment of zinc deficiency in elderly inpatients, serum zinc levels need to be measured once, at a total dose of 1000 mg after initiation of ZAH.


Assuntos
Desnutrição , Acetato de Zinco , Idoso , Idoso de 80 Anos ou mais , Terapia de Reposição Hormonal , Humanos , Pacientes Internados , Zinco/uso terapêutico , Acetato de Zinco/uso terapêutico
7.
Biol Pharm Bull ; 45(9): 1340-1346, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36047203

RESUMO

This study aimed to clarify the details of outpatient oral antimicrobial use (AMU) at a Japanese community hospital and investigate the influence of the current inpatient-based antimicrobial stewardship (AS) on outpatients. A repeated cross-sectional study was conducted in Komaki City Hospital. Data on patients, physicians, and oral antibiotics were collected in October 2013, 2016, and 2019, and appropriateness of treatment and surgical antimicrobial prophylaxis (SAP) was evaluated. The percentage of patients receiving oral antibiotics increased significantly from 4.7% in 2013 (345/7338) to 5.9% in 2019 (365/6146), and the overall number of antimicrobial prescriptions per 1000 outpatients increased from 51.8 in 2013 to 68.0 in 2019. Prescriptions for third-generation cephalosporins per 1000 outpatients decreased (from 21.4 to 6.3), whereas the number of prescriptions for penicillin (from 3.8 to 15.3), fluoroquinolones (from 7.0 to 13.2), and co-trimoxazole (from 5.0 to 15.8) increased from 2013 to 2019. The appropriate AMU for overall infections significantly increased (from 68.4% in 2013 to 83.7% in 2019). The choice and duration of AMU significantly improved for SAP. However, even in 2019, only 29.3% of patients received antibiotics before surgery. The improved selection of antibiotics on outpatient prescription may be due to the influence of AS-which is focused on inpatients-while prescriptions for fluoroquinolones and prophylactics also increased. The challenges of antimicrobial administration after surgeries were also highlighted.


Assuntos
Anti-Infecciosos , Gestão de Antimicrobianos , Antibacterianos/uso terapêutico , Anti-Infecciosos/uso terapêutico , Estudos Transversais , Prescrições de Medicamentos , Fluoroquinolonas , Hospitais Comunitários , Humanos , Pacientes Internados , Japão , Pacientes Ambulatoriais
8.
PLoS One ; 17(9): e0273800, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36048863

RESUMO

BACKGROUND: Adverse event (AE) detection is a major patient safety priority. However, despite extensive research on AEs, reported incidence rates vary widely. OBJECTIVE: This study aimed: (1) to synthesize available evidence on AE incidence in acute care inpatient settings using Trigger Tool methodology; and (2) to explore whether study characteristics and study quality explain variations in reported AE incidence. DESIGN: Systematic review and meta-analysis. METHODS: To identify relevant studies, we queried PubMed, EMBASE, CINAHL, Cochrane Library and three journals in the patient safety field (last update search 25.05.2022). Eligible publications fulfilled the following criteria: adult inpatient samples; acute care hospital settings; Trigger Tool methodology; focus on specialty of internal medicine, surgery or oncology; published in English, French, German, Italian or Spanish. Systematic reviews and studies addressing adverse drug events or exclusively deceased patients were excluded. Risk of bias was assessed using an adapted version of the Quality Assessment Tool for Diagnostic Accuracy Studies 2. Our main outcome of interest was AEs per 100 admissions. We assessed nine study characteristics plus study quality as potential sources of variation using random regression models. We received no funding and did not register this review. RESULTS: Screening 6,685 publications yielded 54 eligible studies covering 194,470 admissions. The cumulative AE incidence was 30.0 per 100 admissions (95% CI 23.9-37.5; I2 = 99.7%) and between study heterogeneity was high with a prediction interval of 5.4-164.7. Overall studies' risk of bias and applicability-related concerns were rated as low. Eight out of nine methodological study characteristics did explain some variation of reported AE rates, such as patient age and type of hospital. Also, study quality did explain variation. CONCLUSION: Estimates of AE studies using trigger tool methodology vary while explaining variation is seriously hampered by the low standards of reporting such as the timeframe of AE detection. Specific reporting guidelines for studies using retrospective medical record review methodology are necessary to strengthen the current evidence base and to help explain between study variation.


Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Adulto , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Hospitalização , Humanos , Pacientes Internados , Segurança do Paciente , Estudos Retrospectivos
9.
J Psychiatr Pract ; 28(5): 383-390, 2022 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-36074107

RESUMO

Emerging adulthood is a critical developmental period characterized by emotional growth and unstructured living. To date, there is little research on emerging adults-defined as those 18 to 25 years old-with serious mental illnesses and even less on emerging adults in psychiatric hospitals. This study analyzed therapeutic alliance with the clinical team and change in anxiety symptoms in emerging adult psychiatric inpatients with the goal of establishing whether emotion regulation could serve as a mediator between these 2 constructs. Participants were 913 emerging adults (46.7% female; 18 to 25 y of age) who were voluntarily admitted to an intermediate length-of-stay (6 to 8 wk) inpatient psychiatric hospital. Each patient completed measures assessing anxiety symptoms, emotion regulation strategies, and working alliance as an assessment of therapeutic alliance. The results indicated that working alliance had significant indirect effects on change in anxiety symptoms through emotion dysregulation and lack of awareness, limited access to emotion regulation strategies, and lack of emotional clarity. This study emphasizes the need to understand emerging adults and the difficulties characteristic of this developmental period, and that clinicians should be aware that cognitive factors involved in emotion regulation may impact anxiety symptoms in emerging adult populations.


Assuntos
Regulação Emocional , Aliança Terapêutica , Adolescente , Adulto , Ansiedade/psicologia , Ansiedade/terapia , Transtornos de Ansiedade/psicologia , Transtornos de Ansiedade/terapia , Feminino , Humanos , Pacientes Internados/psicologia , Masculino , Adulto Jovem
10.
BMJ Open ; 12(9): e061212, 2022 09 17.
Artigo em Inglês | MEDLINE | ID: mdl-36115676

RESUMO

OBJECTIVES: To investigate the feasibility and acceptability of a mobile model of environmental enrichment (EE), a paradigm that promotes activity engagement after stroke, in patients with mixed medical conditions receiving inpatient rehabilitation. DESIGN: A mixed methods study design was used. An online qualitative survey assessed staff perspectives of acceptability of the mobile EE model including perceived barriers and enablers pre-implementation and post implementation. An A-B quasi-experimental case study of patient activity levels over a 2-week observational period provided feasibility data. This included recruitment and retention rates, completion of scheduled patient activity observations and validated baseline questionnaires, and number of adverse events. SETTING: A 30-bed mixed medical ward in a public hospital that services Brisbane's southern bayside suburbs. The rehabilitation programme operates with patients co-located throughout the medical/surgical wards. PARTICIPANTS: Nursing and allied health professionals working across the rehabilitation programme completed pre-implementation (n=19) and post implementation (n=16) qualitative questions. Patients admitted to the ward and who received the inpatient rehabilitation programme from June to November 2016 were also recruited. INTERVENTIONS: The mobile EE intervention included activities to primarily promote social and cognitive stimulation (eg, puzzles, board games) delivered by hospital volunteers and was designed to be moved throughout the wards. RESULTS: Four themes emerged from staff reports, suggesting that the role of patient, staff and intervention characteristics, and the ward environment were important barriers and enablers to implementation. Of the 12 eligible patients, six consented to the study, and five completed the intervention. All patients completed the baseline measures. No adverse events were reported. CONCLUSIONS: As interest grows in human EE models, it will be important to tailor EE interventions to the unique demands of hospital rehabilitation services. A mobile EE model delivered in a small, mixed rehabilitation ward appears feasible and acceptable to study in a larger controlled feasibility trial.


Assuntos
Medicina , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Estudos de Viabilidade , Humanos , Pacientes Internados , Reabilitação do Acidente Vascular Cerebral/métodos
11.
BMJ Open Qual ; 11(3)2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36100293

RESUMO

BACKGROUND: COVID-19 management guidelines are constantly evolving, making them difficult to implement practically. Ronapreve was a neutralising monoclonal antibody introduced into UK COVID-19 guidelines in 2021. It reduces mortality in seronegative patients infected with non-omicron variants. Antibody testing on admission is therefore vital in ensuring patients could be considered for Ronapreve as inpatients. LOCAL PROBLEM: We found that on our COVID-19 ward, 31.4% of patients were not having anti-S tests despite fulfilling the other criteria to be eligible for Ronapreve. This was identified as an important target to improve; by not requesting anti-S tests, we were forgoing the opportunity to use an intervention that could improve outcomes. METHODS: We analysed patient records for patients with COVID-19 admitted to our ward over 4 months to observe if awareness of the need to request anti-S increased through conducting plan-do-study-act (PDSA) cycles. INTERVENTIONS: Our first intervention was an multidisciplinary team (MDT) discussion at our departmental audit meeting highlighting our baseline findings and the importance of anti-S requesting. Our second intervention was to hang printed posters in both the doctors' room and the ward as a visual reminder to staff. Our final intervention was trust-wide communications of updated local COVID-19 guidance that included instructions for anti-S requesting on admission. RESULTS: Our baseline data showed that only 68.6% of patients with symptomatic COVID-19 were having anti-S antibody tests requested. This increased to 95.0% following our three interventions. There was also a reduction in the amount of anti-S requests being 'added on', from 57.1% to 15.8%. CONCLUSIONS: COVID-19 guidelines are constantly evolving and require interventions that can be quickly and easily implemented to improve adherence. Sustained reminders through different approaches allowed a continued increase in requesting. This agrees with research that suggests a mixture of educational sessions and visual reminders of guidelines increase their application in clinical practice.


Assuntos
COVID-19 , Melhoria de Qualidade , Humanos , Pacientes Internados
12.
Intern Med J ; 52(9): 1638-1642, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36100562

RESUMO

Obesity is a well-recognised risk factor for venous thromboembolism, and increased dosing of pharmacological prophylaxis is recommended in obese inpatients. We performed a clinical decision support intervention by adjusting order sentences of prophylactic enoxaparin within our electronic medical records, which significantly improved appropriate dosing for thromboprophylaxis in obese inpatients at our institution.


Assuntos
Tromboembolia Venosa , Anticoagulantes/uso terapêutico , Enoxaparina/uso terapêutico , Humanos , Pacientes Internados , Obesidade/complicações , Tromboembolia Venosa/tratamento farmacológico
13.
J Opioid Manag ; 18(4): 291-295, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36052927

RESUMO

The Rocky Mountain Chapter of the Society of Hospital Medicine developed 2020 Opioid Prescribing and Treatment Guidelines for the medical inpatient, including five pathways for treating medical inpatients with pain. Ten Colorado hospitals participated in a 6-month initiative to implement the prescribing pathways, with an aim of reducing opioid prescribing by 15 percent for five commonly encountered medical conditions. Results showed 9.4 percent decrease in opioid morphine equivalent units, 3.4 percent reduction in opioid administrations, and 5.1 percent increase in alternatives to opioid administrations per patient day. Specialty-specific opioid prescribing guidance can help hospitalists change opioid prescribing behavior and should be considered in other specialties.


Assuntos
Analgésicos Opioides , Padrões de Prática Médica , Analgésicos Opioides/efeitos adversos , Humanos , Pacientes Internados , Dor
14.
J Opioid Manag ; 18(4): 317-325, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36052930

RESUMO

OBJECTIVE: Post-operative ileus (POI) is a common and potentially serious complication after surgery. We assessed the incidence and identified predictors of POI in older surgical patients. DESIGN: A retrospective observational study. SETTING: University of California-San Francisco electronic medical record data. PARTICIPANTS: Opioid-naïve, noncancer patients, aged 65 and older, who underwent elective surgery in the period 2017-2019. EXPOSURE: Administration of opioid analgesics per day of hospitalization in opioid naïve patients. MAIN OUTCOMES MEASURE: Incidence of POI and likelihood of developing POI. RESULTS: In the study period, 3 percent of opioid naïve patients developed POI. Patients with POI used on average 197.1 oral morphine equivalents (OMEs) per day of hospitalization compared to 82.5 OME in patients without POI (p = 0.013). Yet, there were not statistically significant differences in post-operative pain scores between patients with and without POI. General surgery (p = 0.0031), length of surgery (p = 0.0031), and hospital length of stay (p < 0.0001) were significant predictors of the risk for developing POI. Adjusted inpatient administration of more than 90 OME per day of hospitalization was associated with a four times greater risk for developing POI (p = 0.016). Developing POI was associated with 6.5 (95 percent confidence interval: 5.2-7.8) additional days of hospitalization among patients who developed POI compared to patients who did not develop POI (p < 0.0001). CONCLUSIONS: Adjusted inpatient administration of more than 90 OME significantly increased the risk for developing POI in opioid-naïve older patients. Developing POI after surgery significantly increased the hospital length of stay. Optimizing inpatient administration of opioids may prevent opioid use-related POI and longer hospitalizations.


Assuntos
Analgésicos Opioides , Íleus , Idoso , Analgésicos Opioides/efeitos adversos , Hospitalização , Humanos , Íleus/complicações , Íleus/etiologia , Pacientes Internados , Tempo de Internação , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/epidemiologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos
15.
Palliat Support Care ; 20(5): 662-670, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36111731

RESUMO

OBJECTIVE: Accurate prognostication is important for patients and their families to prepare for the end of life. Objective Prognostic Score (OPS) is an easy-to-use tool that does not require the clinicians' prediction of survival (CPS), whereas Palliative Prognostic Score (PaP) needs CPS. Thus, inexperienced clinicians may hesitate to use PaP. We aimed to evaluate the accuracy of OPS compared with PaP in inpatients in palliative care units (PCUs) in three East Asian countries. METHOD: This study was a secondary analysis of a cross-cultural, multicenter cohort study. We enrolled inpatients with far-advanced cancer in PCUs in Japan, Korea, and Taiwan from 2017 to 2018. We calculated the area under the receiver operating characteristics (AUROC) curve to compare the accuracy of OPS and PaP. RESULTS: A total of 1,628 inpatients in 33 PCUs in Japan and Korea were analyzed. OPS and PaP were calculated in 71.7% of the Japanese patients and 80.0% of the Korean patients. In Taiwan, PaP was calculated for 81.6% of the patients. The AUROC for 3-week survival was 0.74 for OPS in Japan, 0.68 for OPS in Korea, 0.80 for PaP in Japan, and 0.73 for PaP in Korea. The AUROC for 30-day survival was 0.70 for OPS in Japan, 0.71 for OPS in Korea, 0.79 for PaP in Japan, and 0.74 for PaP in Korea. SIGNIFICANCE OF RESULTS: Both OPS and PaP showed good performance in Japan and Korea. Compared with PaP, OPS could be more useful for inexperienced physicians who hesitate to estimate CPS.


Assuntos
Neoplasias , Cuidados Paliativos , Estudos de Coortes , Humanos , Pacientes Internados , Japão , Neoplasias/complicações , Prognóstico , Estudos Prospectivos , República da Coreia
16.
Clin J Oncol Nurs ; 26(5): 553-558, 2022 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-36108210

RESUMO

Interprofessional rounds (IPRs) are associated with better patient outcomes and improved communication. Variables unique to each organization must be considered when determining team composition and meeting structure. This pr.


Assuntos
Pacientes Internados , Relações Interprofissionais , Comunicação , Humanos , Tempo de Internação , Equipe de Assistência ao Paciente
17.
PLoS One ; 17(9): e0266651, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36048763

RESUMO

INTRODUCTION: Stroke rehabilitation teams' skills and knowledge in treating persons with cognitive impairment (CI) contribute to their reduced access to inpatient rehabilitation. This study examined stroke inpatient rehabilitation referral acceptance rates for persons with CI before and after the implementation of a multi-faceted integrated knowledge translation (KT) intervention aimed at improving clinicians' skills in a cognitive-strategy based approach, Cognitive Orientation to daily Occupational Performance (CO-OP), CO-OP KT. METHODS: CO-OP KT was implemented at five inpatient rehabilitation centres, using an interrupted time series design and data from an electronic referral and database system called E-Stroke. CO-OP KT included a 2-day workshop, 4 months of implementation support, health system support, and a sustainability plan. A mixed effects model was used to model monthly acceptance rates for 12 months prior to the intervention and 6 months post. RESULTS: The dataset was comprised of 2604 pre-intervention referrals and 1354 post. In the mixed effects model, those with CI had a lower pre-intervention acceptance rate than those without. Post-intervention the model showed the acceptance rate for those with CI increased by 8.6% (p = 0.02), whereas those with no CI showed a non-significant increase of less than 1%. CONCLUSIONS: Proportionally more persons with CI gained access to inpatient stroke rehabilitation following an integrated KT intervention.


Assuntos
Disfunção Cognitiva , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Humanos , Pacientes Internados , Acidente Vascular Cerebral/psicologia , Ciência Translacional Biomédica
18.
PLoS One ; 17(9): e0272832, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36048812

RESUMO

PURPOSE: Preventing falls in patients is one of the most important concerns in acute hospitals. Balance disorder and hypnotic drugs lead to falls. The Standing Test for Imbalance and Disequilibrium (SIDE) is developed for the evaluation of static standing balance ability. There have been no reports of a comprehensive assessment of falls risk including hypnotic drugs and SIDE. The purpose of this study was to investigate the fall rate of each patient who took the hypnotic drug and the factor associated with falls. METHODS: Fall rates for each hypnotic drug were calculated as follows (number of patients who fell/number of patients prescribed hypnotic drug x 100). We investigated the hypnotic drugs as follows; benzodiazepine drugs, Z-drugs, melatonin receptor agonists, and orexin receptor antagonists. Hypnotic drug fall rate was analyzed using Pearson's chi-square test. Decision tree analysis is the method we used to discover the most influential factors associated with falls. RESULTS: This study included 2840 patients taking hypnotic drugs. Accidents involving falls were reported for 211 of inpatients taking hypnotic drugs. Z-drug recipients had the lowest fall rate among the hypnotic drugs. We analyzed to identify independent factors for falls, a decision tree algorithm was created using two divergence variables. The SIDE levels indicating balance disorder were the initial divergence variable. The rate of falls in patients at SIDE level ≦ 2a was 14.7%. On the other hand, the rate of falls in patients at SIDE level ≧ 2b was 2.9%. Gender was the variable for the second classification. In this analysis, drugs weren't identified as divergence variables for falls. CONCLUSION: The SIDE balance assessment was the initial divergence variable by decision tree analysis. In order to prevent falls, it seems important not only to select appropriate hypnotic drugs but also to assess patients for balance and implement preventive measures.


Assuntos
Hipnóticos e Sedativos , Pacientes Internados , Hospitais , Humanos , Hipnóticos e Sedativos/efeitos adversos , Estudos Retrospectivos , Fatores de Risco
19.
J Korean Acad Nurs ; 52(4): 391-406, 2022 Aug.
Artigo em Coreano | MEDLINE | ID: mdl-36117301

RESUMO

PURPOSE: The purpose of this study was to provide foundational knowledge on nursing tasks performed on patients with COVID-19 in a nationally-designated inpatient treatment unit. METHODS: This study employs both quantitative and qualitative approaches. The quantitative method investigated the content and frequency of nursing tasks for 460 patients (age ≥ 18 y, 57.4% men) from January 20, 2020, to September 30, 2021, by analyzing hospital information system records. Qualitative data were collected via focus group interviews. The study involved interviews with three focus groups comprising 18 nurses overall to assess their experiences and perspectives on nursing care during the pandemic from February 3, 2022, to February 15, 2022. The data were examined with thematic analysis. RESULTS: Overall, 49 different areas of nursing tasks (n = 130,687) were identified based on the Korean Patient Classification System for nurses during the study period. Among the performed tasks, monitoring of oxygen saturation and measuring of vital signs were considered high-priority. From the focus group interview, three main themes and eleven sub-themes were generated. The three main themes are "Experiencing eventfulness in isolated settings," "All-around player," and "Reflections for solutions." CONCLUSION: During the COVID-19 pandemic, it is imperative to ensure adequate staffing levels, compensation, and educational support for nurses. The study further propose improving guidelines for emerging infectious diseases and patient classification systems to improve the overall quality of patient care.


Assuntos
COVID-19 , COVID-19/epidemiologia , Feminino , Grupos Focais , Hospitalização , Humanos , Pacientes Internados , Masculino , Pandemias
20.
BMC Cardiovasc Disord ; 22(1): 397, 2022 09 06.
Artigo em Inglês | MEDLINE | ID: mdl-36068504

RESUMO

BACKGROUND: A key outcome in coronary heart disease (CHD) is Health Related Quality of Life (HRQoL), and family functioning is important in the management of CHD. But few studies have examined both together, and little is known about them among inpatients with CHD in less developed areas of China. Therefore, this study aimed to assess the HRQoL and family functioning status of inpatients with CHD in Lanzhou from Northwest China, and identify the factors that affect their HRQoL. METHODS: A cross­sectional study was conducted in 224 CHD inpatients at one major hospital. Sociodemographic data and disease information of CHD inpatients were collected by face-to-face using a structured questionnaire and data were also obtained from patient medical records. HRQoL was measured using the Sickness Impact Profile (SIP). Family functioning was measured using the family APGAR index. Multiple binary logistic regression analysis (MBLRA) was used to explore potential risk factors associated with HRQoL, and Pearson's correlations were used to assess the relationship between family functioning and HRQoL. RESULTS: The overall, physical and psychosocial SIP scores were 25.03 ± 8.52, 18.61 ± 9.90 and 28.08 ± 9.64, respectively. The total family APGAR score was 6.11 ± 2.45. MBLRA found older age, poorer cardiac function and more severe disease were associated with poorer HRQoL, while better family functioning, higher monthly income, and urban living were associated with better HRQoL. Family functioning was weakly to moderately correlated with total and psychosocial HRQoL. CONCLUSIONS: Older and less affluent inpatients with lower educational level, less family support and more severe CHD have poorest quality of life, and health care providers should consider interventions to support them.


Assuntos
Doença das Coronárias , Qualidade de Vida , China/epidemiologia , Doença das Coronárias/diagnóstico , Doença das Coronárias/epidemiologia , Doença das Coronárias/psicologia , Estudos Transversais , Humanos , Pacientes Internados , Qualidade de Vida/psicologia , Inquéritos e Questionários
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