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2.
Medicine (Baltimore) ; 99(40): e22195, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019394

RESUMO

BACKGROUND: Conflicting data have been reported related to the impact of atrial fibrillation (AF) on outcomes after transcatheter mitral valve repair with MitraClip (MC) implantation. In this study, we assessed the prognosis of MC-treated patients according to the presence of pre-existing AF. METHODS: Randomized and observational studies reporting outcomes of pre-existing AF or sinus rhythm in patients undergoing MC treatment were identified with an electronic search. Outcomes of interest were short-and long-term mortality, stroke, bleeding, rehospitalization, myocardial infarction (MI), cardiogenic shock, acute procedure success, the hospital stay, and the number of Clips implanted. RESULTS: Eight studies (8466 individuals) were eligible. Compared to sinus rhythm, long-term mortality, the risk of bleeding, rehospitalization, and longer hospital stay were significantly higher in AF groups, whereas similar correlations were found in the analysis of other outcomes. CONCLUSION: AF may be related with worse outcomes in patients undergoing MC implantation, including long-term mortality, major bleeding, and rehospitalization. AF should be taken into account when referring a patient for MC treatment.


Assuntos
Fibrilação Atrial/mortalidade , Implante de Prótese de Valva Cardíaca/efeitos adversos , Insuficiência da Valva Mitral/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Implante de Prótese de Valva Cardíaca/mortalidade , Implante de Prótese de Valva Cardíaca/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Readmissão do Paciente/estatística & dados numéricos
3.
Stud Health Technol Inform ; 273: 189-194, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-33087611

RESUMO

The prevalence of Heart Failure is growing exponentially in the last decades, particularly amongst older adults. Heart Failure is a chronic cardiovascular disease that demands self-care management and substantial healthcare resources. For that reason, it is highly associated with hospital readmissions and mortality. Due to increased hospitalization costs, excessive waiting times and lack of specialized healthcare professionals to follow-up this growing population, telemedicine and telemonitoring technologies have become the best solutions to support health providers in the disease management tasks. Telemonitoring technologies offer better and more comfortable care because the elderly do not have to leave the comfort of their home to interact with the doctors, giving and receiving daily feedbacks trough these new applications, wearables, and health care platforms. This paper provides a comprehensive review covering the current progress of research in telemedicine and telemonitoring and their applications to Heart Failure Management services. It presents SmartBEAT, which demonstrated during a pilot phase, a user adherence of 97% for three months. Furthermore, SmartBEAT plus, an improved solution, is described, and the system usability a technology acceptance will be evaluated through a pilot with 40 Heart Failure Patients, involving nurses and cardiologists.


Assuntos
Insuficiência Cardíaca , Telemedicina , Idoso , Doença Crônica , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/terapia , Hospitalização , Humanos , Readmissão do Paciente
4.
Pharm. pract. (Granada, Internet) ; 18(3): 0-0, jul.-sept. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-194200

RESUMO

BACKGROUND: Total knee replacement (TKR) is a major orthopedic surgery that is considered high risk for the development of venous thromboembolism (VTE). OBJECTIVE: The aim of this study is to evaluate the clinical outcomes that resulted from the use of a new proposed VTE risk stratification protocol for selecting a suitable extended VTE prophylaxis for post TKR surgery patients administered in conjunction with patient education programs. METHOD: A randomized controlled trial was conducted in two medical centers in Saudi Arabia. A total of 242 patients were enrolled in the study, 121 patients in each group. The experimental group (A) was assessed by using the proposed VTE risk stratification protocol and also took part in patient education programs about TKR and its complications. The control group (B) was assessed by using the 2005 Caprini risk assessment tool and no education programs were given to this group. Both groups were followed for 35 days post operation. RESULTS: The mean age of the participants was 65.86 (SD 8.67) and the majority of them were female 137 (56.6%). The mean body mass index of the study sample was 32.46 (SD 5.51). There were no significant differences between the two groups except for surgery type; the proportion of bilateral TKR in group A was higher than in group B (69/121 (28.5%) vs. 40/121(16.5%), p˂0.05). There were no confirmed pulmonary embolism cases in the study sample and diagnosis of deep-vein thrombosis was confirmed in 12/242 (5.0%) of patients: 1/121 (0.8%) in group A and 11/121 (9.1%) in group B (p˂0.05). The readmission rate for all patients was 2.5% (6/242), all of whom were in group B (p˂0.05). CONCLUSION: The proposed VTE risk stratification protocol that was applied in conjunction with patient education programs reduced VTE complications and readmission events, post TKR surgery


No disponible


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Tromboembolia Venosa/tratamento farmacológico , Tromboembolia Venosa/prevenção & controle , Profilaxia Pós-Exposição/métodos , Artroplastia do Joelho/métodos , Educação de Pacientes como Assunto , Readmissão do Paciente
5.
Zhongguo Dang Dai Er Ke Za Zhi ; 22(9): 948-952, 2020 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-32933624

RESUMO

OBJECTIVE: To investigate the current status of readmission of neonates with hyperbilirubinemia and risk factors for readmission. METHODS: From January 2017 to December 2019, a total of 85 infants who were readmitted due to hyperbilirubinemia were enrolled as the study group. A total of 170 neonates with hyperbilirubinemia but without readmission during the same period of time were randomly selected as the control group. The medical data were compared between the two groups. Multivariate logistic regression was used to assess the risk factors for readmission due to hyperbilirubinemia. RESULTS: The readmission rate was 2.30%, and the interval between readmission and initial admission was 5 days. Compared with the control group, the study group had significantly higher levels of total bilirubin and indirect bilirubin at discharge (P<0.05) and a significantly longer duration of phototherapy during the first hospitalization (P<0.05). The univariate analysis showed that compared with the control group, the study group had significantly lower birth weight, gestational age, and age on initial admission (P<0.05) and a significantly higher proportion of infants with glucose-6-phosphate dehydrogenase (G-6-PD) deficiency or hemolytic disease (P<0.05). The multivariate analysis showed that low gestational age (OR=1.792, P<0.05), young age on initial admission (OR=1.415, P<0.05), and G-6-PD deficiency (OR=2.829, P<0.05) were independent risk factors for readmission of neonates with hyperbilirubinemia. CONCLUSIONS: The infants with hyperbilirubinemia who have lower gestational age, younger age on initial admission, and G-6-PD deficiency have a higher risk of readmission due to hyperbilirubinemia. It is thus important to strengthen the management during hospitalization and after discharge for these infants to prevent the occurrence of readmission.


Assuntos
Hiperbilirrubinemia Neonatal , Bilirrubina , Deficiência de Glucosefosfato Desidrogenase , Humanos , Recém-Nascido , Readmissão do Paciente , Fatores de Risco
6.
Bone Joint J ; 102-B(9): 1183-1193, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32862678

RESUMO

AIMS: The purpose of this study was to develop a personalized outcome prediction tool, to be used with knee arthroplasty patients, that predicts outcomes (lengths of stay (LOS), 90 day readmission, and one-year patient-reported outcome measures (PROMs) on an individual basis and allows for dynamic modifiable risk factors. METHODS: Data were prospectively collected on all patients who underwent total or unicompartmental knee arthroplasty at a between July 2015 and June 2018. Cohort 1 (n = 5,958) was utilized to develop models for LOS and 90 day readmission. Cohort 2 (n = 2,391, surgery date 2015 to 2017) was utilized to develop models for one-year improvements in Knee Injury and Osteoarthritis Outcome Score (KOOS) pain score, KOOS function score, and KOOS quality of life (QOL) score. Model accuracies within the imputed data set were assessed through cross-validation with root mean square errors (RMSEs) and mean absolute errors (MAEs) for the LOS and PROMs models, and the index of prediction accuracy (IPA), and area under the curve (AUC) for the readmission models. Model accuracies in new patient data sets were assessed with AUC. RESULTS: Within the imputed datasets, the LOS (RMSE 1.161) and PROMs models (RMSE 15.775, 11.056, 21.680 for KOOS pain, function, and QOL, respectively) demonstrated good accuracy. For all models, the accuracy of predicting outcomes in a new set of patients were consistent with the cross-validation accuracy overall. Upon validation with a new patient dataset, the LOS and readmission models demonstrated high accuracy (71.5% and 65.0%, respectively). Similarly, the one-year PROMs improvement models demonstrated high accuracy in predicting ten-point improvements in KOOS pain (72.1%), function (72.9%), and QOL (70.8%) scores. CONCLUSION: The data-driven models developed in this study offer scalable predictive tools that can accurately estimate the likelihood of improved pain, function, and quality of life one year after knee arthroplasty as well as LOS and 90 day readmission. Cite this article: Bone Joint J 2020;102-B(9):1183-1193.


Assuntos
Artroplastia do Joelho , Medidas de Resultados Relatados pelo Paciente , Idoso , Artroplastia do Joelho/métodos , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente , Prognóstico , Estudos Prospectivos
7.
S Afr Med J ; 110(6): 537-539, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32880568

RESUMO

BACKGROUND: Unplanned readmission within 30 days is currently being used in high-income countries (HICs) for measuring the quality of surgical care. Surgical site infection (SSI), abdominal complaints and pain are the most common causes for such readmission. The correlation between readmission rates and mortality, increased patient volumes and complexity of surgery remains controversial. OBJECTIVES: To explore the risk factors for unplanned readmission in the surgical population in a low- and middle-income country setting. METHODS: This is a retrospective review of prospectively collected data of unplanned 30-day readmissions from January 2014 to December 2017 in the Department of General Surgery, Worcester Hospital, South Africa (SA). Basic patient demographics, reasons for readmission, operative urgency and severity, wound class, length of stay and final outcomes were used to compare the inpatient cohort and identify predictors for unplanned readmission. RESULTS: A total of 9 649 patients were admitted to the general surgery department at Worcester Hospital - 2.87% (n=270) were unplanned readmissions within 30 days. The mean age of this cohort was 42 (standard deviation (SD) 22) years, with 61% male patients. SSI (60.37%; n=163), gastrointestinal complications (24.44%; n=66) and blood transfusion (7.03%; n=19) were the most common causes for readmission. Median initial length of stay (LOS) was 4 days; after readmission it was 5 days. Readmissions were responsible for 1 914 additional patient days. Operative Portsmouth-POSSUM (P-POSSUM) (Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity) score (p<0.001), increase in operative wound classification (p=0.001) and emergency surgical procedures (p=0.001) were significant risk factors for readmission within 30 days. CONCLUSIONS: The Department of General Surgery, Worcester Hospital, had a readmission rate comparable with that in HICs. Readmission rate is an indicator of advanced surgical pathology requiring an operative intervention of greater magnitude, often presenting as an emergency. Our results can be used to improve postoperative surveillance and ultimately improve outcomes in high-risk surgical populations. This study provides a benchmark for other regional hospitals in SA and has implications for quality-improvement programmes.


Assuntos
Readmissão do Paciente/estatística & dados numéricos , Qualidade da Assistência à Saúde , Procedimentos Cirúrgicos Operatórios , Adulto , Feminino , Mortalidade Hospitalar , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Complicações Pós-Operatórias , Estudos Retrospectivos , África do Sul
8.
Am Surg ; 86(9): 1178-1184, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32935996

RESUMO

BACKGROUND: Nonoperative management of adhesive small bowel obstruction (ASBO) results in resolution for the majority of patients. Previous studies have demonstrated that outcomes for patients with ASBO are improved when patients are admitted to a surgical service, but the effect of general surgery resident coverage is unclear. This study measures quality outcomes for patients with ASBO after the establishment of a new general surgery residency program. METHODS: An institutional review board-approved retrospective chart review of admissions for ASBO was conducted following the implementation of a protocol for ASBO nested within a newly developed resident-run emergency general surgery (EGS) service. Patients successfully treated without operative intervention were analyzed. RESULTS: During the study period, 612 patients were admitted for ASBO. After initiation of the residency, 74% of ASBO were admitted to a surgical service compared with 35% prior to residency (P < .01). Length of stay was reduced by 0.77 days (P = .016), average direct total cost per patient was reduced by 24% (P = .002), and 30-day readmissions were reduced by 35.7% (P = .046). There was no significant difference in mortality (1.4% vs 1.0%). DISCUSSION: Admission to a resident-run surgical service was associated with statistically significant improvement in outcomes for patients with ASBO. These data corroborate prior studies demonstrating the positive impact of residency programs on patient outcomes and provide additional evidence that general surgery residency programs improve outcomes for patients with surgical disease.


Assuntos
Tratamento Conservador/métodos , Educação de Pós-Graduação em Medicina/métodos , Cirurgia Geral/educação , Internato e Residência/métodos , Obstrução Intestinal/terapia , Tempo de Internação/tendências , Readmissão do Paciente/tendências , Idoso , Feminino , Humanos , Intestino Delgado , Masculino , Estudos Retrospectivos
9.
Medicine (Baltimore) ; 99(38): e22245, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957371

RESUMO

BACKGROUND: CMS recently decided to produce private "healthcare disparities reports" that include dual eligibility (DE) as the sole stratifying variable used to assess pneumonia readmission disparities. RESEARCH DESIGN: We measure the relationship between DE status and readmissions, both with and without conceptually relevant social risk factors, including air pollution, severe housing problems, and food insecurity, using data from county- and hospital-level readmission rates, DE status, and social risk factors. RESULTS: At the county level, the relationship between DE status and readmissions is partially confounded by at least three social risk factors. DE populations vary widely across hospitals, creating unequal between-hospital comparisons. CONCLUSIONS: Because of differences in the DE population, between-hospital comparisons could be misleading using a methodology that stratifies by DE only. We suggest viable alternatives to sole-factor stratification to properly account for social risk factors and better isolate quality differences that might yield readmission rate inequities. IMPLICATIONS: CMS's healthcare disparities reports provided to hospitals are limited by relying exclusively on DE proportion as the measure of social risk, undercutting the power of quality measurement and its related incentives to close or minimize healthcare inequities.


Assuntos
Definição da Elegibilidade , Disparidades em Assistência à Saúde , Medicaid/organização & administração , Medicare/organização & administração , Determinantes Sociais da Saúde , Poluição do Ar/efeitos adversos , Abastecimento de Alimentos , Habitação , Humanos , Readmissão do Paciente , Pneumonia/terapia , Fatores de Risco , Estados Unidos
10.
J Frailty Aging ; 9(4): 226-231, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32996559

RESUMO

BACKGROUND: 90-day mortality and rehospitalizations are important hospital quality metrics. Biomarkers that predict these outcomes among malnourished hospitalized patients could identify those at risk and help direct care plans. OBJECTIVES: To identify biomarkers that predict 90-day (primary) and 30-day (secondary) mortality or nonelective rehospitalization. DESIGN AND PARTICIPANTS: An analysis of the ability of biomarkers to predict 90- and 30-day mortality and rehospitalization among malnourished hospitalized patients. SETTING: 52 blood biomarkers were measured in 193 participants in NOURISH, a randomized trial that determined the effects of a nutritional supplement on 90-day readmission and death in patients >65 years. Composite outcomes were defined as readmission or death over 90-days or 30-days. Univariate Cox Proportional Hazards models were used to select best predictors of outcomes. Markers with the strongest association were included in multivariate stepwise regression. Final model of hospital readmission or death was derived using stepwise selection. MEASUREMENTS: Nutritional, inflammatory, hormonal and muscle biomarkers. RESULTS: Mean age was 76 years, 51% were men. In univariate models, 10 biomarkers were significantly associated with 90-day outcomes and 4 biomarkers with 30-day outcomes. In multivariate stepwise selection, glutamate, hydroxyproline, tau-methylhistidine levels, and sex were associated with death and readmission within 90-days. In stepwise selection, age-adjusted model that included sex and these 3 amino-acids demonstrated moderate discriminating ability over 90-days (C-statistic 0.68 (95%CI 0.61, 0.75); age-adjusted model that included sex, hydroxyproline and Charlson Comorbidity Index was predictive of 30-day outcomes (C-statistic 0.76 (95%CI 0.68, 0.85). CONCLUSIONS: Baseline glutamate, hydroxyproline, and tau-methylhistidine levels, along with sex and age, predict risk of 90-day mortality and nonelective readmission in malnourished hospitalized older patients. This biomarker set should be further validated in prospective studies and could be useful in prognostication of malnourished hospitalized patients and guiding in-hospital care.


Assuntos
Biomarcadores , Desnutrição/mortalidade , Desnutrição/terapia , Readmissão do Paciente/estatística & dados numéricos , Idoso , Suplementos Nutricionais , Feminino , Humanos , Masculino
11.
PLoS Med ; 17(9): e1003284, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32925912

RESUMO

BACKGROUND: Psychiatric comorbidity is known to impact upon use of nonpsychiatric health services. The aim of this systematic review and meta-analysis was to assess the specific impact of severe mental illness (SMI) on the use of inpatient, emergency, and primary care services for nonpsychiatric medical disorders. METHODS AND FINDINGS: PubMed, Web of Science, PsychINFO, EMBASE, and The Cochrane Library were searched for relevant studies up to October 2018. An updated search was carried out up to the end of February 2020. Studies were included if they assessed the impact of SMI on nonpsychiatric inpatient, emergency, and primary care service use in adults. Study designs eligible for review included observational cohort and case-control studies and randomised controlled trials. Random-effects meta-analyses of the effect of SMI on inpatient admissions, length of hospital stay, 30-day hospital readmission rates, and emergency department use were performed. This review protocol is registered in PROSPERO (CRD42019119516). Seventy-four studies were eligible for review. All were observational cohort or case-control studies carried out in high-income countries. Sample sizes ranged from 27 to 10,777,210. Study quality was assessed using the Newcastle-Ottawa Scale for observational studies. The majority of studies (n = 45) were deemed to be of good quality. Narrative analysis showed that SMI led to increases in use of inpatient, emergency, and primary care services. Meta-analyses revealed that patients with SMI were more likely to be admitted as nonpsychiatric inpatients (pooled odds ratio [OR] = 1.84, 95% confidence interval [CI] 1.21-2.80, p = 0.005, I2 = 100%), had hospital stays that were increased by 0.59 days (pooled standardised mean difference = 0.59 days, 95% CI 0.36-0.83, p < 0.001, I2 = 100%), were more likely to be readmitted to hospital within 30 days (pooled OR = 1.37, 95% CI 1.28-1.47, p < 0.001, I2 = 83%), and were more likely to attend the emergency department (pooled OR = 1.97, 95% CI 1.41-2.76, p < 0.001, I2 = 99%) compared to patients without SMI. Study limitations include considerable heterogeneity across studies, meaning that results of meta-analyses should be interpreted with caution, and the fact that it was not always possible to determine whether service use outcomes definitively excluded mental health treatment. CONCLUSIONS: In this study, we found that SMI impacts significantly upon the use of nonpsychiatric health services. Illustrating and quantifying this helps to build a case for and guide the delivery of system-wide integration of mental and physical health services.


Assuntos
Comorbidade/tendências , Transtornos Mentais/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Adulto , Idoso , Feminino , Hospitalização/estatística & dados numéricos , Hospitalização/tendências , Humanos , Tempo de Internação , Masculino , Saúde Mental/tendências , Pessoa de Meia-Idade , Readmissão do Paciente
12.
Plast Reconstr Surg ; 146(4): 859-862, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32970008

RESUMO

The purpose of this study was to delineate optimal age to perform unilateral or bilateral cleft lip repair in premature patients. The American College of Surgeons National Surgical Quality Improvement Program Pediatric data set was queried for unilateral and bilateral cleft lip repairs performed between 2012 and 2017. Complications, readmissions, and reoperations were analyzed in the context of prematurity with appropriate statistics. Degree of prematurity was significantly associated with adverse events (p = 0.001, rs = 0.44). Premature patients with unilateral cleft lip had a significantly decreased risk of adverse events when performing cleft lip repair after 150 days of age [OR, 18.1; p = 0.004; before cutoff, n = 10 of 140 (7.1 percent); after cutoff, n = 0 of 112 (0.0 percent)] in the absence of other risk factors. Premature patients with bilateral cleft lip had a significantly decreased risk of adverse events when performing cleft lip repair after 175 days of age (OR, 16.1; p = 0.010; before cutoff, n = 7 of 33 (21.2 percent); after cutoff, n = 0 of 28 (0.0 percent)] in the absence of other risk factors. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Risk, II.


Assuntos
Fenda Labial/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Fatores Etários , Estudos de Coortes , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Readmissão do Paciente/estatística & dados numéricos , Segurança do Paciente , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Medição de Risco
13.
Medicine (Baltimore) ; 99(37): e22157, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925775

RESUMO

Endovascular aneurysm repair (EVAR) and thoracic endovascular aortic repair (TEVAR) are effective and minimally invasive treatment options for high-risk surgical candidates. Nevertheless, knowledge about the management of aortic stent graft therapy in chronic kidney disease (CKD) is scarce. This study aimed to examine outcomes after EVAR and TEVAR in patients with CKD.Utilizing data from the Taiwan National Health Insurance Research Database, we retrospectively assessed patients who underwent EVAR and TEVAR therapy between January 1, 2006, and December 31, 2013. Patients were divided into CKD and non-CKD groups. Outcomes were in-hospital mortality, all-cause mortality, readmission, heart failure, and major adverse cardiac and cerebrovascular events.There were 1019 patients in either group after matching. The CKD group had a higher in-hospital mortality rate than the non-CKD group (15.2% vs 8.3%, respectively; odds ratio, 1.92; 95% confidence interval [CI], 1.46-2.54). Patients with CKD had higher risks of all-cause mortality including in-hospital death (46.1% vs 33.1%; hazard ratio [HR], 1.61; 95% CI, 1.35-1.92), readmission rate (62.6% vs 55.0%; subdistribution HR [SHR], 1.61; 95% CI, 1.32-1.69), redo stent (7.8% vs 6.2%; SHR, 1.50; 95% CI, 1.09-2.07), and major adverse cardiac and cerebrovascular events (13.3% vs 8.8%; SHR, 1.50; 95% CI, 1.15-1.95). The subgroup analysis did not demonstrate a variation in mortality between the TEVAR and EVAR cohorts (P for interaction = .725). The dialysis group had higher risks of all-cause mortality and readmission than the CKD without dialysis and non-CKD groups.Among EVAR/TEVAR recipients, CKD was independently associated with higher in-hospital mortality, postoperative complication, and all-cause mortality rates. Patients with end-stage renal disease on dialysis had worse outcomes than those in the CKD non-dialysis and non-CKD groups.


Assuntos
Aneurisma Aórtico/epidemiologia , Aneurisma Aórtico/cirurgia , Implante de Prótese Vascular/métodos , Insuficiência Renal Crônica/epidemiologia , Fatores Etários , Idoso , Aneurisma , Aorta Abdominal/cirurgia , Aorta Torácica/cirurgia , Implante de Prótese Vascular/efeitos adversos , Doenças Cardiovasculares/epidemiologia , Comorbidade , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/métodos , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente , Fatores Sexuais , Medicina Estatal , Taiwan
14.
Artigo em Inglês | MEDLINE | ID: mdl-32806775

RESUMO

In South Korea, 4.5% patients of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were readmitted to hospitals after discharge. However, there is insufficient research on risk factors for readmission and management of patients after discharge is poor. In this study, 7590 confirmed coronavirus disease (COVID-19) patients were defined as a target for analysis using nationwide medical claims data. The demographic characteristics, underlying diseases, and the use of medical resources were used to examine the association with readmission through the chi-square test and then logistic regression analysis was performed to analyze factors affecting readmission. Of the 7590 subjects analyzed, 328 patients were readmitted. The readmission rates of men, older age and patients with medical benefits showed a high risk of readmission. The Charlson Comorbidity Index score was also related to COVID-19 readmission. Concerning requiring medical attention, there was a higher risk of readmission for the patients with chest radiographs, computed tomography scans taken and lopinavir/ritonavir at the time of their first admission. Considering the risk factors presented in this study, classifying patients with a high risk of readmission and managing patients before and after discharge based on priority can make patient management and medical resource utilization more efficient. This study also indicates the importance of lifestyle management after discharge.


Assuntos
Infecções por Coronavirus/epidemiologia , Readmissão do Paciente/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Betacoronavirus , Distribuição de Qui-Quadrado , Criança , Pré-Escolar , Comorbidade , Coronavirus , Feminino , Gastos em Saúde/estatística & dados numéricos , Recursos em Saúde/estatística & dados numéricos , Humanos , Lactente , Revisão da Utilização de Seguros/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Pandemias , República da Coreia/epidemiologia , Fatores de Risco , Fatores Sexuais , Fatores Socioeconômicos , Adulto Jovem
15.
Front Immunol ; 11: 1936, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32849650

RESUMO

Background: The relationship between SARS-CoV-2-carrying time and specific antibody production has not yet been reported in re-admitted COVID-19 patients. We reported a case of mild COVID-19 with long virus-carrying time, weak production of virus-specific IgG and IgM antibodies, and recurrence of positive SARS-CoV-2 RNA in stool specimens after discharge. Case Presentation: A 27-year-old male was diagnosed as COVID-19 after returning to Meizhou from Wuhan. Despite extremely mild symptoms, the patient was hospitalized for 24 days because of persistent positive SARS-CoV-2 RNA detection. Three days after recovery discharge, he was hospitalized again for 7 days due to a recurrence of the positive SARS-CoV-2 RNA result, while in a good physical condition. Serological assay, using a fluorescent immunochromatography detection kit specific to SARS-CoV-2, showed that SARS-CoV-2-specific IgM antibodies were undetectable and IgG antibodies were very low on day 8 after onset; both of the antibodies seemingly reached top concentrations on day 15 (just a 6-fold increase of the IgG titer), and then decreased, remaining relatively stable from day 25 after onset until discharge. The production of the IgM and IgG targeting SARS-CoV-2 in this very mild case was much lower than that in a severe case of COVID-19 during the same hospitalizing period, and the latter was used as a control. Conclusion: Mild COVID-19 patients could carry SARS-CoV-2 for a long time, which may be related to the weak production of the virus-specific IgG and IgM. Recurrence of positive SARS-CoV-2 RNA could occur in mild COVID-19 possibly due to intermittent virus shedding, so strict quarantine and health surveillance should be taken for all discharged COVID-19 patients to prevent a potential virus spread.


Assuntos
Anticorpos Antivirais/imunologia , Betacoronavirus/imunologia , Infecções por Coronavirus/imunologia , Imunoglobulina G/imunologia , Imunoglobulina M/imunologia , Pneumonia Viral/imunologia , Adulto , Betacoronavirus/genética , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Humanos , Masculino , Pandemias , Alta do Paciente , Readmissão do Paciente , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Quarentena/métodos , RNA Viral/análise , Eliminação de Partículas Virais
16.
Med Care ; 58(9): 785-792, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32732787

RESUMO

BACKGROUND: Telephone call programs are a common intervention used to improve patients' transition to outpatient care after hospital discharge. OBJECTIVE: To examine the impact of a follow-up telephone call program as a readmission reduction initiative. RESEARCH DESIGN: Pragmatic randomized controlled real-world effectiveness trial. SUBJECTS: We enrolled and randomized all patients discharged home from a hospital general medicine service to a follow-up telephone call program or usual care discharge. Patients discharged against medical advice were excluded. The intervention was a hospital program, delivering a semistructured follow-up telephone call from a nurse within 3-7 days of discharge, designed to assess understanding and provide education, and assistance to support discharge plan implementation. MEASURES: Our primary endpoint was hospital inpatient readmission within 30 days identified by the electronic health record. Secondary endpoints included observation readmission, emergency department revisit, and mortality within 30 days, and patient experience ratings. RESULTS: All 3054 patients discharged home were enrolled and randomized to the telephone call program (n=1534) or usual care discharge (n=1520). Using a prespecified intention-to-treat analysis, we found no evidence supporting differences in 30-day inpatient readmissions [14.9% vs. 15.3%; difference -0.4 (95% confidence interval, 95% CI), -2.9 to 2.1; P=0.76], observation readmissions [3.8% vs. 3.6%; difference 0.2 (95% CI, -1.1 to 1.6); P=0.74], emergency department revisits [6.1% vs. 5.4%; difference 0.7 (95% CI, -1.0 to 2.3); P=0.43], or mortality [4.4% vs. 4.9%; difference -0.5 (95% CI, -2.0 to 1.0); P=0.51] between telephone call and usual care groups. CONCLUSIONS: We found no evidence of an impact on 30-day readmissions or mortality due to the postdischarge telephone call program.


Assuntos
Continuidade da Assistência ao Paciente/organização & administração , Readmissão do Paciente/estatística & dados numéricos , Telefone/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Recursos Humanos de Enfermagem no Hospital/organização & administração , Satisfação do Paciente , Avaliação de Programas e Projetos de Saúde , Inquéritos e Questionários , Fatores de Tempo
18.
PLoS One ; 15(8): e0238065, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32853223

RESUMO

BACKGROUND: Numerous predictive models in the literature stratify patients by risk of mortality and readmission. Few prediction models have been developed to optimize impact while sustaining sufficient performance. OBJECTIVE: We aimed to derive models for hospital mortality, 180-day mortality and 30-day readmission, implement these models within our electronic health record and prospectively validate these models for use across an entire health system. MATERIALS & METHODS: We developed, integrated into our electronic health record and prospectively validated three predictive models using logistic regression from data collected from patients 18 to 99 years old who had an inpatient or observation admission at NorthShore University HealthSystem, a four-hospital integrated system in the United States, from January 2012 to September 2018. We analyzed the area under the receiver operating characteristic curve (AUC) for model performance. RESULTS: Models were derived and validated at three time points: retrospective, prospective at discharge, and prospective at 4 hours after presentation. AUCs of hospital mortality were 0.91, 0.89 and 0.77, respectively. AUCs for 30-day readmission were 0.71, 0.71 and 0.69, respectively. 180-day mortality models were only retrospectively validated with an AUC of 0.85. DISCUSSION: We were able to retain good model performance while optimizing potential model impact by also valuing model derivation efficiency, usability, sensitivity, generalizability and ability to prescribe timely interventions to reduce underlying risk. Measuring model impact by tying prediction models to interventions that are then rapidly tested will establish a path for meaningful clinical improvement and implementation.


Assuntos
Registros Eletrônicos de Saúde , Mortalidade Hospitalar , Modelos Estatísticos , Readmissão do Paciente/estatística & dados numéricos , Idoso , Feminino , Humanos , Masculino , Medição de Risco
19.
Cerebrovasc Dis Extra ; 10(2): 94-104, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32854098

RESUMO

BACKGROUND AND PURPOSE: Rates of depression after ischemic stroke (IS) and myocardial infarction (MI) are significantly higher than in the general population and associated with morbidity and mortality. There is a lack of nationally representative data comparing depression and suicide attempt (SA) after these distinct ischemic vascular events. METHODS: The 2013 Nationwide Readmissions Database contains >14 million US admissions for all payers and the uninsured. Using International Classification of Disease, 9th Revision, Clinical Modification Codes, we identified index admission with IS (n = 434,495) or MI (n = 539,550) and readmission for depression or SA. We calculated weighted frequencies of readmission. We performed adjusted Cox regression to calculate hazard ratio (HR) for readmission for depression and SA up to 1 year following IS versus MI. Analyses were stratified by discharge home versus elsewhere. RESULTS: Weighted depression readmission rates were higher at 30, 60, and 90 days in patients with IS versus MI (0.04%, 0.09%, 0.12% vs. 0.03%, 0.05%, 0.07%, respectively). There was no significant difference in SA readmissions between groups. The adjusted HR for readmission due to depression was 1.49 for IS versus MI (95% CI 1.25-1.79, p < 0.0001). History of depression (HR 3.70 [3.07-4.46]), alcoholism (2.04 [1.34-3.09]), and smoking (1.38 [1.15-1.64]) were associated with increased risk of depression readmission. Age >70 years (0.46 [0.37-0.56]) and discharge home (0.69 [0.57-0.83]) were associated with reduced hazards of readmission due to depression. CONCLUSIONS: IS was associated with greater hazard of readmission due to depression compared to MI. Patients with a history of depression, smoking, and alcoholism were more likely to be readmitted with depression, while advanced age and discharge home were protective. It is unclear to what extent differences in type of ischemic tissue damage and disability contribute, and further investigation is warranted.


Assuntos
Afeto , Isquemia Encefálica/psicologia , Depressão/psicologia , Infarto do Miocárdio/psicologia , Readmissão do Paciente , Acidente Vascular Cerebral/psicologia , Tentativa de Suicídio , Fatores Etários , Idoso , Alcoolismo/epidemiologia , Alcoolismo/psicologia , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/epidemiologia , Bases de Dados Factuais , Depressão/diagnóstico , Depressão/epidemiologia , Depressão/terapia , Feminino , Humanos , Masculino , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/epidemiologia , Alta do Paciente , Medição de Risco , Fatores de Risco , Fumar/efeitos adversos , Fumar/epidemiologia , Fumar/psicologia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Fatores de Tempo , Estados Unidos/epidemiologia
20.
Ann R Coll Surg Engl ; 102(8): 611-615, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32735121

RESUMO

INTRODUCTION: Laparoscopic anti-reflux surgery is the standard surgical treatment for gastro-oesophageal reflux disease in patients for who long-term pharmacotherapy is intolerable or ineffective. Advances in anaesthesia and minimally invasive surgery have led to day case treatment being adopted by some centres. The objective of this study is to describe our day case pathway and peri- and postoperative outcomes. MATERIALS AND METHODS: This is a single centre, retrospective case series review of a prospectively collected database from October 2014 to August 2019 performed in a tertiary centre for upper gastrointestinal surgery. Data collected included demographics, comorbidities, indications, complications, length of stay and readmission. RESULTS: A total of 362 patients underwent laparoscopic anti-reflux surgery with or without hiatus hernia repair of up to 10cm, with day case rates of 59%. Unplanned admission following day surgery was 5.1% (13/225) and 30-day readmission was 2.2% (8/362); 90.6% of patients remained in hospital for less than 24 hours. There was one intraoperative complication and one patient required revisional surgery within 30 days. The rate of all postoperative complications was 1.38% (5/362) with one postoperative mortality. DISCUSSION: The inclusion of larger hernias is unusual, as most studies limit size to 5cm or less. Our results show the safety and feasibility of the procedure even when applied to hiatus hernias up to 10cm. Success was multifactorial and based on standardisation of procedures and support from dedicated specialist nursing staff. CONCLUSION: Laparoscopic anti-reflux surgery can be performed safely as a day case procedure even in larger hiatus hernias, with a dedicated care pathway and specialist nurse practitioners to support it.


Assuntos
Hérnia Hiatal/epidemiologia , Hérnia Hiatal/cirurgia , Herniorrafia , Adulto , Idoso , Idoso de 80 Anos ou mais , Redução de Custos/estatística & dados numéricos , Refluxo Gastroesofágico/etiologia , Hérnia Hiatal/complicações , Herniorrafia/efeitos adversos , Herniorrafia/economia , Herniorrafia/métodos , Herniorrafia/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento , Reino Unido , Adulto Jovem
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