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1.
J Stroke Cerebrovasc Dis ; 29(1): 104464, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31699576

RESUMO

INTRODUCTION: Emergency departments play a key role in the diagnosis and treatment of transient ischemic attacks, but limited data are available about the early management of such patients in emergency wards. Therefore, we aimed to evaluate emergency physicians' management of transient ischemic attack and analyze variations factors. METHODS: A multicenter survey among emergency physicians of the Grand Est region network (Est-RESCUE) was conducted from January 28th to March 28th, 2019. Medical and administrative data were collected by the same network and the national directory of medical resources. RESULTS: Among 542 emergency physicians recipients, 78 answered (14%) and 71 were finally included, practicing in 25 public hospitals homogeneously distributed across the territory, including 3 university hospitals. A cerebral magnetic resonance imaging was obtained for 75%-100% of patients by 4.3% of responders, 36.4% of which were performed within more than 24 hours. A cardiac monitoring was prescribed in 75%-100% of cases by 32.4% of responders. A neurologic consultation was routinely requested by 84.6% of responders practicing in a university hospital and 36.8% of responders practicing in a community hospital (P = .02). Patients were hospitalized in a neurovascular unit in 75%-100% of cases by 17.4% of responders, which happened more likely in university hospitals (P < .001). CONCLUSIONS: Transient ischemic attack suffers from management disparities across territories, due to limited access to technical facilities and neurologic consultations. Therefore, international recommendations are too often not followed. Implementation of territorial neurovascular tracks may help to standardize the management of these patients.


Assuntos
Serviço Hospitalar de Emergência/tendências , Disparidades em Assistência à Saúde/tendências , Hospitais/tendências , Ataque Isquêmico Transitório/terapia , Padrões de Prática Médica/tendências , Tempo para o Tratamento/tendências , Adulto , Feminino , França , Pesquisas sobre Serviços de Saúde , Hospitalização/tendências , Humanos , Ataque Isquêmico Transitório/diagnóstico , Ataque Isquêmico Transitório/fisiopatologia , Masculino , Pessoa de Meia-Idade , Encaminhamento e Consulta/tendências , Fatores de Tempo , Resultado do Tratamento
3.
PLoS Med ; 16(11): e1002956, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31714940

RESUMO

BACKGROUND: Opioid misuse and deaths are increasing in the United States. In 2017, Ohio had the second highest overdose rates in the US, with the city of Cincinnati experiencing a 50% rise in opioid overdoses since 2015. Understanding the temporal and geographic variation in overdose emergencies may help guide public policy responses to the opioid epidemic. METHODS AND FINDINGS: We used a publicly available data set of suspected heroin-related emergency calls (n = 6,246) to map overdose incidents to 280 census block groups in Cincinnati between August 1, 2015, and January 30, 2019. We used a Bayesian space-time Poisson regression model to examine the relationship between demographic and environmental characteristics and the number of calls within block groups. Higher numbers of heroin-related incidents were found to be associated with features of the built environment, including the proportion of parks (relative risk [RR] = 2.233; 95% credible interval [CI]: [1.075-4.643]), commercial (RR = 13.200; 95% CI: [4.584-38.169]), manufacturing (RR = 4.775; 95% CI: [1.958-11.683]), and downtown development zones (RR = 11.362; 95% CI: [3.796-34.015]). The number of suspected heroin-related emergency calls was also positively associated with the proportion of male population, the population aged 35-49 years, and distance to pharmacies and was negatively associated with the proportion aged 18-24 years, the proportion of the population with a bachelor's degree or higher, median household income, the number of fast food restaurants, distance to hospitals, and distance to opioid treatment programs. Significant spatial and temporal heterogeneity in the risks of incidents remained after adjusting for covariates. Limitations of this study include lack of information about the nature of incidents after dispatch, which may differ from the initial classification of being related to heroin, and lack of information on local policy changes and interventions. CONCLUSIONS: We identified areas with high numbers of reported heroin-related incidents and features of the built environment and demographic characteristics that are associated with these events in the city of Cincinnati. Publicly available information about opiate overdoses, combined with data on spatiotemporal risk factors, may help municipalities plan, implement, and target harm-reduction measures. In the US, more work is necessary to improve data availability in other cities and states and the compatibility of data from different sources in order to adequately measure and monitor the risk of overdose and inform health policies.


Assuntos
Overdose de Drogas/epidemiologia , Dependência de Heroína/epidemiologia , Teorema de Bayes , Bases de Dados Factuais , Serviços Médicos de Emergência/tendências , Serviço Hospitalar de Emergência/tendências , Feminino , Heroína/efeitos adversos , Humanos , Masculino , Ohio/epidemiologia , Fatores de Risco , Análise Espaço-Temporal , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Estados Unidos
4.
Public Health Rep ; 134(6): 685-694, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31577517

RESUMO

OBJECTIVE: Emergency departments (EDs) are critical settings for hepatitis C care in the United States. We assessed trends and characteristics of hepatitis C-associated ED visits during 2006-2014. METHODS: We used data from the 2006-2014 Nationwide Emergency Department Sample to estimate numbers, rates, and costs of hepatitis C-associated ED visits, defined by either first-listed diagnosis of hepatitis C or all-listed diagnosis of hepatitis C. We assessed trends by demographic characteristics, liver disease severity, and patients' disposition by using joinpoint analysis, and we calculated the average annual percentage change (AAPC) from 2006 to 2014. RESULTS: During 2006-2014, the rate per 100 000 visits of first-listed and all-listed hepatitis C-associated ED visits increased significantly from 10.1 to 25.4 (AAPC = 13.0%; P < .001) and from 484.4 to 631.6 (AAPC = 3.4%; P < .001), respectively. Approximately 70% of these visits were made by persons born during 1945-1965 (baby boomers); 30% of visits were made by Medicare beneficiaries and 40% by Medicaid beneficiaries. Significant rate increases were among visits by baby boomers (first-listed: AAPC = 13.8%; all-listed: AAPC = 2.6%), persons born after 1965 (first-listed: AAPC = 14.3%; all-listed: AAPC = 9.2%), Medicare beneficiaries (first-listed: AAPC = 18.0%; all-listed: AAPC = 3.9%), and persons hospitalized after ED visits (first-listed: AAPC = 20.0%; all-listed: AAPC = 2.3%; all P < .001). Increasing proportions of compensated cirrhosis were among visits by baby boomers (first-listed: AAPC = 11.5%; all-listed: AAPC = 6.3%). Annual hepatitis C-associated total ED costs increased by 400.0% (first-listed) and 192.0% (all-listed) during 2006-2014. CONCLUSION: Public health efforts are needed to address the growing burden of hepatitis C care in the ED.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Hepatite C/complicações , Hepatite C/epidemiologia , Hospitalização , Idoso , Serviço Hospitalar de Emergência/tendências , Feminino , Pesquisas sobre Serviços de Saúde , Hepacivirus/isolamento & purificação , Hepatite C/diagnóstico , Humanos , Masculino , Medicaid/estatística & dados numéricos , Medicaid/tendências , Medicare/estatística & dados numéricos , Medicare/tendências , Pessoa de Meia-Idade , Estados Unidos
5.
Ig Sanita Pubbl ; 75(3): 211-229, 2019.
Artigo em Italiano | MEDLINE | ID: mdl-31645063

RESUMO

Emergency Department (ED) waiting times are a relevant concern both to health care professionals and consumers, because ED crowding may affect the quality of and access to health care. This has prompted a large amount of studies in the scientific literature, addressing the problem of waiting times as an "international crisis". The causes of long waiting times are complex and multifaceted and feasible solutions must consider this and other aspects such as limitation of resources and unpredicted surges in demand. In the present article, we address the issue of modeling ED flow of patients with a low score at the triage evaluation. This study aimed to develop a model to predict expected waiting times for patients with a "green" or "white" code at triage, by analyzing the patient flow in a regional referral hospital in an Italian district. The simulation model was developed through flow analysis; moreover, input analysis was performed by using registration data collected in the ED during daily activities. The simulation results were compared to data collected through direct observation at the hospital ED and to data extracted from the existing hospital information system, which represents an online transaction system tailored for routine care and patient services in the ED as well as in other hospital departments. The applied model was shown to be able to emulate patient flow in the ED and to find key critical points of the health care process, for patients who received a low category score at the triage. To face the problem of ED waiting times, adoption of patient flow analysis and improvement strategies are recommended, together with improvement of triage evaluation procedures. Simulation models can help to manage this complex issue.


Assuntos
Serviço Hospitalar de Emergência , Qualidade da Assistência à Saúde , Listas de Espera , Serviço Hospitalar de Emergência/estatística & dados numéricos , Serviço Hospitalar de Emergência/tendências , Humanos , Itália , Percepção , Fatores de Tempo , Triagem
6.
Int J Chron Obstruct Pulmon Dis ; 14: 1343-1353, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31388297

RESUMO

Background: Depression is common in people with chronic obstructive pulmonary disease (COPD) and has been associated with a variety of poor outcomes. A large proportion of health care costs in the UK are spent on emergency care. This study examined the prospective relationship between depression and use of emergency care in patients with COPD managed in primary care. Methods: This was a twelve-month, prospective longitudinal study of 355 patients with COPD in six primary care practices in the UK. Baseline measures included demographic characteristics, depression and anxiety, severity of COPD, presence or absence of other chronic diseases, and prior use of emergency care. Outcome measures were (a) number of emergency department (ED) visits; or (b) an emergency hospital admission in the follow-up year. Results: Older age, number of comorbid physical health conditions, severity of COPD, prior use of emergency care, and depression were all independently associated with both ED attendance and an emergency hospital admission in the follow-up year. Subthreshold depression (HADS depression score 4-7) was associated with a 2.8 times increased odds of emergency hospital admission, and HADS depression >8 was associated with 4.8 times increased odds. Conclusion: Depression is a predictor of emergency care in COPD, independent of severity of disease or physical comorbidity. Even mild (subthreshold) symptoms of depression more than double the risk of using emergency care, suggesting there is a strong case to develop and deploy integrated preventive strategies in primary care that can promote mental health in people with COPD.


Assuntos
Afeto , Depressão/terapia , Serviço Hospitalar de Emergência/tendências , Atenção Primária à Saúde/tendências , Doença Pulmonar Obstrutiva Crônica/terapia , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Depressão/diagnóstico , Depressão/epidemiologia , Depressão/psicologia , Estudos de Viabilidade , Feminino , Humanos , Estudos Longitudinais , Masculino , Saúde Mental , Pessoa de Meia-Idade , Admissão do Paciente/tendências , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/psicologia , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Reino Unido/epidemiologia
7.
J Stroke Cerebrovasc Dis ; 28(11): 104305, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31405791

RESUMO

BACKGROUND: Intravenous recombinant tissue plasminogen activator (rt-PA) has become a common treatment for acute ischemic stroke and has highly time-dependent benefits. We aimed to clarify temporal trends regarding the frequency and characteristics of patients receiving rt-PA and explore factors associated with door-to-needle time (DNT) in Japanese emergency hospitals. METHODS: Consecutive patients who received intravenous rt-PA for acute ischemic stroke from October 2005 to December 2015 were retrospectively registered from 4 hospitals. Temporal trends in the frequency and characteristics of patients receiving rt-PA and factors associated with DNT were investigated. RESULTS: A total of 750 patients, including 688 (420 men, median 75 years old) with out-of-hospital stroke, were registered. The frequency of patients receiving intravenous rt-PA for acute ischemic stroke continuously increased from 1.8% in 2005 to 9.5% in 2015. The proportion of patients who were elderly or had prestroke disability increased over time, while pretreatment stroke severity declined. The DNT gradually decreased (median 105 minutes in 2005, 61 minutes in 2015). According to multivariate regression analysis with correction for multiple comparisons, activation of a code stroke system (standardized partial regression coefficient (ß) -.50, P < .001, q < .001), onset-to-door time (ß -.15, P < .001, q < .001), pretreatment with antithrombotic agents (ß .12, P < .001, q = .001), and year of treatment (ß .11, P = .007, q = .011) were associated with DNT. CONCLUSIONS: Intravenous rt-PA was widely adopted in Japanese emergency hospitals. Characteristics of patients receiving intravenous rt-PA have changed over the past decade. Several factors, including the year of treatment, were associated with DNT, which has shortened over time.


Assuntos
Isquemia Encefálica/tratamento farmacológico , Serviço Hospitalar de Emergência/tendências , Fibrinolíticos/administração & dosagem , Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica/tendências , Tempo para o Tratamento/tendências , Ativador de Plasminogênio Tecidual/administração & dosagem , Administração Intravenosa , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/fisiopatologia , Feminino , Fibrinolíticos/efeitos adversos , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Terapia Trombolítica/efeitos adversos , Fatores de Tempo , Ativador de Plasminogênio Tecidual/efeitos adversos , Resultado do Tratamento
8.
Pediatrics ; 144(2)2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31285395

RESUMO

BACKGROUND AND OBJECTIVES: Adolescents represent the largest age group that presents to emergency departments (ED) for synthetic cannabinoid (SC) toxicity; however, the neurotoxic effects of acute SC exposures in this group are understudied. Our aim was to characterize the neuropsychiatric presentation of adolescents with SC-related exposure in the ED compared with those with traditional cannabis exposure. METHODS: A multicenter registry of clinical information prospectively collected by medical toxicologists (Toxicology Investigators Consortium Case Registry) was reviewed for adolescents presenting to the ED after SC or cannabis exposure from 2010 through 2018. Associations were measured between drug exposures and neuropsychiatric symptoms and/or signs. Exposures were classified into 4 groups: SC-only exposure, SC-polydrug exposures, cannabis-only exposure, and cannabis-polydrug exposures. RESULTS: Adolescents presenting to the ED with SC-only exposure (n = 107) had higher odds of coma and/or central nervous system depression (odds ratio [OR] 3.42; 95% confidence interval [CI] 1.51-7.75) and seizures (OR 3.89; 95% CI 1.39-10.94) than those with cannabis-only exposure (n = 86). SC-only drug exposure was associated with lower odds of agitation than cannabis-only exposure (OR 0.18; 95% CI 0.10-0.34). In contrast, the group with SC-polydrug exposures (n = 38) had higher odds of agitation (OR 3.11; 95% CI 1.56-7.44) and seizures (OR 4.8; 95% CI 1.80-12.74) than the cannabis-polydrug exposures group (n = 117). CONCLUSIONS: In this multisite cohort of US adolescents assessed in the ED, SC exposure was associated with higher odds of neuropsychiatric morbidity than cannabis exposure providing a distinct neurospychiatric profile of acute SC toxicity in adolescents.


Assuntos
Canabinoides/toxicidade , Serviço Hospitalar de Emergência/tendências , Abuso de Maconha/psicologia , Transtornos Mentais/induzido quimicamente , Transtornos Mentais/psicologia , Adolescente , Feminino , Humanos , Masculino , Abuso de Maconha/diagnóstico , Abuso de Maconha/terapia , Transtornos Mentais/terapia , Sistema de Registros , Adulto Jovem
9.
Pediatrics ; 144(1)2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31227564

RESUMO

BACKGROUND: Recent publications should have resulted in increased hydroxyurea usage in children with sickle cell disease (SCD). We hypothesized that hydroxyurea use in children with SCD increased over time and was associated with decreased acute care visits. METHODS: This was a secondary analysis of the Truven Health Analytics-IBM Watson Health MarketScan Medicaid database from 2009 to 2015. The multistate, population-based cohort included children 1 to 19 years old with an International Classification of Diseases, Ninth or 10th Revision diagnosis of SCD between 2009 and 2015. Changes in hydroxyurea were measured across study years. The primary outcome was the receipt of hydroxyurea, identified through filled prescription claims. Acute care visits (emergency department visits and hospitalizations) were extracted from billing data. RESULTS: A mean of 5138 children each year were included. Hydroxyurea use increased from 14.3% in 2009 to 28.2% in 2015 (P < .001). During the study period, the acute-care-visit rate decreased from 1.20 acute care visits per person-year in 2009 to 1.04 acute care visits per person-year in 2015 (P < .001); however, the drop in acute care visits was exclusively in the youngest and oldest age groups and was not seen when only children enrolled continuously from 2009 to 2015 were analyzed. CONCLUSIONS: There was a significant increase in hydroxyurea use in children with SCD between 2009 and 2015. However, in 2015, only ∼1 in 4 children with SCD received hydroxyurea at least once. Increases in hydroxyurea were not associated with consistently decreased acute care visits in this population-based study of children insured by Medicaid.


Assuntos
Anemia Falciforme/tratamento farmacológico , Antidrepanocíticos/uso terapêutico , Uso de Medicamentos/tendências , Fidelidade a Diretrizes/estatística & dados numéricos , Hidroxiureia/uso terapêutico , Medicaid , Padrões de Prática Médica/tendências , Doença Aguda , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Serviço Hospitalar de Emergência/tendências , Utilização de Instalações e Serviços/tendências , Feminino , Hospitalização/tendências , Humanos , Lactente , Masculino , Guias de Prática Clínica como Assunto , Estados Unidos , Adulto Jovem
10.
Healthc Q ; 22(1): 11-13, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31244462

RESUMO

The opioid crisis in Canada is a complex issue with devastating consequences for individuals, families and communities. Pan-Canadian data that provide a better understanding of the crisis are a high priority to help guide efforts for reducing opioid-related harms. The objective of this study is to summarize recent trends of opioid-related harms and opioid prescribing across Canada. Opioid-related harms examined in this study include opioid poisonings, opioid use disorders, adverse reactions to opioids and infants born with neonatal withdrawal symptoms. Data are reported at the pan-Canadian, provincial and community levels.


Assuntos
Analgésicos Opioides/administração & dosagem , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Padrões de Prática Médica/tendências , Analgésicos Opioides/efeitos adversos , Canadá/epidemiologia , Serviço Hospitalar de Emergência/tendências , Hospitalização/tendências , Humanos , Recém-Nascido , Síndrome de Abstinência Neonatal/epidemiologia
11.
Alcohol Alcohol ; 54(4): 428-434, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31185085

RESUMO

AIMS: The objective of this study is to address equivocation in estimates of selective serotonin reuptake inhibitor initiation (SSRI) effect on all-cause and alcohol-related ER visits, and medical or psychiatric admissions within 2 years of initial Post-Traumatic Stress Disorder (PTSD) diagnosis in patients with PTSD and Alcohol Use Disorder (AUD). METHODS: This study is a quasi-experimental, new-user-design cohort study of 3235 patients seen at the VA North Texas Healthcare System between January 1, 2000 and December 31, 2016. High dimensional propensity score (HDPS) techniques were used to estimate likelihood of SSRI initiation within 30 days of first PTSD diagnosis. Propensity scores were used to calculate weights for likelihood of SSRI initiation which were used to control for baseline covariates in estimations of SSRI medication effect on odds of each outcome occurring. RESULTS: Compared to those who did not receive SSRIs, patients prescribed an SSRI within 30 days showed significantly lower odds of alcohol-related ER visits (OR=0.668, 95%CI = 0.476 to 0.938, P = 0.02) and alcohol-related medical admissions (OR=0.583, 95%CI = 0.399 to 0.851, P = 0.005). LIMITATIONS: Inconsistent assessment of PTSD severity necessitated the use of HDPS models to control for baseline confounding. Our study design mimicked intent-to-treat trial design and therefore could not control for SSRI initiations after the 30-day grace period following initial PTSD diagnosis. CONCLUSIONS: SSRI initiation in patients with AUD and PTSD is associated with significantly reduced odds of alcohol-related medical hospitalization and alcohol-related ER visits within 2 years of first PTSD diagnosis. Additional studies are needed to verify these results.


Assuntos
Alcoolismo/tratamento farmacológico , Alcoolismo/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Inibidores de Captação de Serotonina/uso terapêutico , Transtornos de Estresse Pós-Traumáticos/tratamento farmacológico , Transtornos de Estresse Pós-Traumáticos/psicologia , Adulto , Alcoolismo/epidemiologia , Estudos de Coortes , Serviço Hospitalar de Emergência/tendências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Resultado do Tratamento
12.
Lupus ; 28(7): 906-913, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31159650

RESUMO

OBJECTIVES: Systemic lupus erythematosus (SLE) is a chronic, multisystemic, immune-mediated disorder associated with a substantial hospitalization risk. As a comparatively rare disease, there is a sparsity of research examining the burden of hospital admission in the contemporary era. We aim to describe national trends in hospitalization rates in England between 1998 and 2015 for SLE, using rheumatoid arthritis (RA) and general population rates as comparison cohorts for benchmarking. METHODS: Hospital admission rates, emergency and day-case admission rates, length of stay and bed days used were calculated using finished consultant episodes from Hospital Episode Statistics data. Cochran-Armitage tests and linear regression quantified the significance and magnitude of change over time. RESULTS: SLE admissions increased from 8.97 to 9.04 per 100,000 (p < 0.001) between 1998 and 2015. By comparison, RA admissions rose from 71.0 to 171.6 per 100,000 (p < 0.001) and all-cause admissions rose from 24,500 to 34,500 per 100,000 (p < 0.001). Emergency admissions decreased both for SLE (2.6 to 1.2 per 100,000) and RA (12.8 to 4.4 per 100,000) despite all-cause emergency admissions increasing from 9400 to 10,300 per 100,000. SLE and RA day cases increased, whilst median length of stay decreased. Despite increasing admissions, total bed days for SLE and RA fell by 60% and 90%, respectively. CONCLUSIONS: Whilst all-cause emergency admissions rose in the general population, those for SLE fell. Length of stay and bed days reduced and day cases increased, probably reflecting changing therapeutic strategies. This potentially large reduction in resource utilization warrants consideration when assessing the impact of new therapies.


Assuntos
Artrite Reumatoide/terapia , Recursos em Saúde/tendências , Hospitalização/tendências , Lúpus Eritematoso Sistêmico/terapia , Adulto , Artrite Reumatoide/epidemiologia , Serviço Hospitalar de Emergência/tendências , Inglaterra/epidemiologia , Recursos em Saúde/estatística & dados numéricos , Humanos , Tempo de Internação/tendências , Modelos Lineares , Estudos Longitudinais , Lúpus Eritematoso Sistêmico/epidemiologia , Pessoa de Meia-Idade , Admissão do Paciente/tendências
13.
Emerg Med Pract ; 21(7): 1-28, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31233303

RESUMO

As bariatric procedures have become more common, more of these patients present to the emergency department postoperatively. The most common complaints in these patients are abdominal pain, nausea, and vomiting, though each of the surgical procedures will present with specific complications, and management will vary according to the surgical procedure performed. Computed tomography is often the primary imaging modality, though it has it limits, and plain film imaging is appropriate in some cases. This review presents an overview of the various bariatric procedures, highlighting the potential complications of each, both surgical and nonsurgical, and provides evidence-based recommendations regarding patient management and disposition.


Assuntos
Cirurgia Bariátrica/efeitos adversos , Medicina de Emergência/métodos , Complicações Pós-Operatórias/terapia , Cirurgia Bariátrica/métodos , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/tendências , Humanos , Pacientes , Complicações Pós-Operatórias/fisiopatologia
14.
Int. j. cardiovasc. sci. (Impr.) ; 32(3): 227-237, May-June 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1002219

RESUMO

The knowledge on the management of patients with acute coronary syndrome (ACS) is essential to reduce the gap between evidence and practice. Objective: To describe a simulation training strategy for emergency healthcare professionals and provide preliminary data on knowledge acquisition, learners' confidence and prescription of medications after training. Methods: The training was part of the implementation of two myocardial infarction systems of care. It comprehended lectures and simulation-based learning using high and low-fidelity mannequins and actors. It was tested in two phases: the first one in Belo Horizonte and the second one in Montes Claros, both in the state of Minas Gerais. A test was applied before and after training to assess knowledge acquisition. Confidence to perform thrombolysis in ST-elevation myocardial infarction (STEMI) patients was assessed using a questionnaire, and the impact on medication prescription analyzed STEMI patients admitted to hospitals in Montes Claros. Results: In the first phase, 156 professionals answered both tests: 70% of them improved their results and the median number of right answers increased (6, interquartile range [IQR] 5-7; vs 7 ([IQR] 6-9; p < 0.05). In the second phase, 242 professionals answered both tests: 58% of the physicians and 83% of the nurses obtained better test scores. Participants referred a positive impact on their clinical practice, 95% reported feeling very secure when perform fibrinolysis after the training, and there was also an impact on medication prescription. Conclusions: There was an impact on the learners' knowledge acquisition and confidence using our two-phase training model, with evidence of impact on performance


Assuntos
Humanos , Masculino , Feminino , Indicadores de Qualidade em Assistência à Saúde , Serviço Hospitalar de Emergência/tendências , Síndrome Coronariana Aguda/mortalidade , Prescrições de Medicamentos , Heparina/uso terapêutico , Reperfusão Miocárdica/métodos , Análise Estatística , Telemedicina/métodos , Assistência Centrada no Paciente/métodos , Educação Médica Continuada/métodos , Eletrocardiografia/métodos , Serviços Médicos de Emergência , Infarto do Miocárdio
15.
Pediatrics ; 143(6)2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31118219

RESUMO

OBJECTIVES: After the Affordable Care Act (ACA) took full effect in 2014, 900 000 children obtained health insurance. Researchers have found variable effects of insurance on adult emergency department (ED) use, but the effect in pediatric patients is unknown. We examined ED visit rates before and after 2014 among children. METHODS: We used estimates of ED visit counts from the Nationwide Emergency Department Sample and population estimates from the American Community Survey in a cross-sectional, retrospective study of ED visit rates among children. We compared the trend in ED visit rates before (2009-2013) and after (2014-2016) the ACA took full effect, controlling for age, sex, and census region. RESULTS: The mean ED use rate was 35.2 visits per 100 children from 2009 to 2013 and 36.6 from 2014 to 2016. ED visit rates increased by 1.1% per year pre-2014 and 9.8% from 2014 to 2016 (incidence rate ratio 1.09, 95% confidence interval 1.03-1.15, P = .005). Results did not vary significantly when insurance was included as a control variable. CONCLUSIONS: There was no immediate change in pediatric ED visit rates the year after the ACA took full effect in 2014, but the rate of change from 2014 to 2016 was significantly higher than previous rate trends. In our model, increased pediatric insurance coverage neither drove nor counteracted the observed trends.


Assuntos
Serviço Hospitalar de Emergência/tendências , Cobertura do Seguro/tendências , Aceitação pelo Paciente de Cuidados de Saúde , Patient Protection and Affordable Care Act/tendências , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Serviço Hospitalar de Emergência/economia , Feminino , Humanos , Lactente , Recém-Nascido , Cobertura do Seguro/economia , Masculino , Patient Protection and Affordable Care Act/economia , Estudos Retrospectivos
16.
BMC Geriatr ; 19(1): 121, 2019 04 29.
Artigo em Inglês | MEDLINE | ID: mdl-31035946

RESUMO

BACKGROUND: The Drug Burden Index (DBI) quantifies exposure to medications with anticholinergic and/or sedative effects. A consensus list of DBI medications available in Ireland was recently developed for use as a DBI tool. The aim of this study was to validate this DBI tool by examining the association of DBI score with important health outcomes in Irish community-dwelling older people. METHODS: This was a cohort study using data from The Irish Longitudinal Study on Ageing (TILDA) with linked pharmacy claims data. Individuals aged ≥65 years participating in TILDA and enrolled in the General Medical Services scheme were eligible for inclusion. DBI score was determined by applying the DBI tool to participants' medication dispensing data in the year prior to outcome assessment. DBI score was recoded into a categorical variable [none (0), low (> 0 and < 1), and high (≥1)]. Outcome measures included any Activities of Daily Living (ADL) impairment, any Instrumental Activities of Daily Living (IADL) impairment, any self-reported fall in the previous 12 months, any frailty criterion met (Fried Phenotype measure), quality of life (QoL) score (CASP-19 [Control Autonomy Self-realisation Pleasure] measure), and healthcare utilisation (any hospital admission and any emergency department (ED) visit) in the previous 12 months. Statistical analyses included multivariate logistic and linear regression models controlling for potential confounders. RESULTS: 61.3% (n = 1946) of participants received at least one DBI prescription in the year before their outcome assessment. High DBI exposure (DBI score ≥ 1) vs none was significantly associated with impaired function (ADL impairment adjusted OR 1.89, 95% CI 1.25, 2.88; IADL impairment adjusted OR 2.97, 95% CI 1.91, 4.61), self-reported falls (adjusted OR 1.50, 95%CI 1.03, 2.18), frailty (adjusted OR 1.74, 95% CI 1.14, 2.67), and reduced QoL (ß = - 1.84, 95%CI -3.14, - 0.54). There was no significant association between DBI exposure and healthcare utilisation. CONCLUSIONS: The findings validate the use of the DBI tool for predicting risk of functional impairment, falls, frailty and reduced QoL in older people in Ireland, and may be extended to other European countries. Integration of this tool into routine practice may be an appropriate step forward to improve outcomes in older people.


Assuntos
Envelhecimento/efeitos dos fármacos , Antagonistas Colinérgicos/efeitos adversos , Efeitos Psicossociais da Doença , Hipnóticos e Sedativos/efeitos adversos , Vida Independente/tendências , Acidentes por Quedas/prevenção & controle , Atividades Cotidianas/psicologia , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/psicologia , Estudos de Coortes , Serviço Hospitalar de Emergência/tendências , Feminino , Hospitalização/tendências , Humanos , Vida Independente/psicologia , Irlanda/epidemiologia , Estudos Longitudinais , Masculino , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Qualidade de Vida/psicologia , Resultado do Tratamento
17.
Drugs Aging ; 36(8): 759-768, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31073846

RESUMO

BACKGROUND: Clopidogrel has been widely used to prevent atherothrombotic events. Since 2011, pharmacists have offered their patients the opportunity to switch to generic clopidogrel, an economic alternative. Whether bioequivalence of generic cardiovascular drugs translates into clinical equivalence at a population level remains unclear and needs to be further documented. OBJECTIVE: We aimed to evaluate the impact of generic clopidogrel commercialization on adverse events (AEs): hospitalizations or emergency room (ER) consultations. METHODS: This is an interrupted time series analysis using the Quebec Integrated Chronic Disease Surveillance System. We included all patients ≥ 66 years old who were users of the brand-name clopidogrel or a generic version (n = 6) 24 months before and up to 12 months after generics commercialization. Rates of AEs were computed, and periods before and after generics commercialization were analyzed by segmented regression models along with exploratory analyses (generic vs. brand name). Sensitivity analyses were also performed using stratification of the time series by (1) sex, (2) the number of prevalent cardiovascular comorbidities, and (3) socioeconomic status. RESULTS: Time series were constituted of 89,525 clopidogrel users (mean age 78 years, 45% women, 71% ischemic heart disease, 34% stroke). For all users, there was a mean rate of 157 AEs per 1000 user-months, stable trend before (-0.1% [95% confidence interval -0.3 to 0.1] and after (0.0% [- 0.5 to 0.6]) generics commercialization. In exploratory analyses, once generic clopidogrel versions were commercialized, rates of AEs were 19.2% (95% CI 11.7-26.7) higher for generic versus brand-name users. This difference persisted up to 1 year. Sensitivity analyses yielded similar results. CONCLUSIONS: The population treated with clopidogrel had similar rates of hospitalizations or ER consultations before and after generics commercialization. However, differences in rates of hospitalizations or ER consultations between generic and brand-name clopidogrel users may represent a drug safety signal which remains to be validated. Using a different study design, permitting adjustment for potential confounders, could be useful in this regard.


Assuntos
Clopidogrel/uso terapêutico , Medicamentos Genéricos/uso terapêutico , Serviço Hospitalar de Emergência/tendências , Hospitalização/tendências , Encaminhamento e Consulta/tendências , Adulto , Idoso , Clopidogrel/efeitos adversos , Clopidogrel/economia , Comorbidade , Custos de Medicamentos , Medicamentos Genéricos/efeitos adversos , Medicamentos Genéricos/economia , Medicamentos Genéricos/farmacologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Quebeque , Análise de Regressão , Equivalência Terapêutica , Resultado do Tratamento
18.
Pediatrics ; 143(6)2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31138669

RESUMO

BACKGROUND: Adolescents and young adults are at high risk for opioid misuse after exposure from medical treatment. However, the epidemiology of opioid prescribing among outpatient adolescents and young adults remains poorly described. We aimed to characterize opioid prescribing in adolescents and young adults receiving care in emergency departments (EDs) and outpatient clinics. METHODS: We analyzed National Hospital Ambulatory Medical Care Survey and National Ambulatory Medical Care Survey data from 2005 to 2015. We included visits to EDs and outpatient clinics for adolescents (13-17 years old) and young adults (18-22 years old). Rates of opioid prescribing were calculated with 95% confidence intervals (CIs), and linear trends over time were examined with logistic regression models. RESULTS: Nearly 57 million visits (5.7%; 95% CI 5.4% to 6.0%) by adolescents and young adults were associated with an opioid prescription. The rate of opioid prescribing was 14.9% (95% CI 14.4% to 15.6%) for ED visits and 2.8% (95% CI 2.5% to 3.1%) for outpatient clinic visits. There was a small but significant decrease in the rate of opioid prescriptions among ED visits (odds ratio 0.96; 95% CI 0.95 to 0.98); no change was seen for outpatient clinic visits. Among ED visits, opioid-prescribing rates were highest among adolescents and young adults with dental disorders (59.7% and 57.9%, respectively), followed by adolescents with clavicle (47.0%) and ankle fractures (38.1%). CONCLUSIONS: Rates of opioid prescribing in EDs and outpatient clinics remain high for adolescents and young adults, especially for certain emergency conditions. These findings inform targeted educational campaigns aiming to ensure judicious use of opioids in this high-risk population.


Assuntos
Assistência Ambulatorial/tendências , Analgésicos Opioides/uso terapêutico , Prescrições de Medicamentos , Serviço Hospitalar de Emergência/tendências , Pesquisas sobre Serviços de Saúde/tendências , Adolescente , Feminino , Humanos , Masculino , Estudos Retrospectivos , Adulto Jovem
19.
Drug Alcohol Depend ; 200: 14-18, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-31071494

RESUMO

BACKGROUND: Opioid use disorder (OUD) among young adults from ages 18 to 25 years is increasing in the United States. Emergency departments (EDs) are recognized as major sources of care for patients with OUD, but questions remain about ED utilization among this population. We examined the demographics and ED utilization patterns at an urban safety-net hospital with a focus on young adults to inform intervention development. METHODS: We extracted demographic and clinical data from electronic medical records of patients ages 18 to 64 years diagnosed with OUD between 2013 and 2017. Descriptive statistics were assessed, including race/ethnicity, sex, insurance, other substance use disorder and mental health diagnoses, and ED utilization patterns by age group. Univariable and multivariable logistic regressions were performed to analyze the associations between age and ED utilization patterns. RESULTS: Among 12,025 OUD patients in the sample, 30% had an ED visit with a primary diagnosis of OUD. Among those who had an ED visit, 48% had at least one additional ED visit within a year. The probability of ED visits (adjusted odds ratio [AOR]:5.04; 95% confidence interval [CI]:4.14-6.13) and repeat ED visits (AOR:3.28; CI:2.53-4.26) were significantly higher among young adults (18-25 years) compared to the oldest age group (56-64 years). CONCLUSIONS: Compared to older adults, young adults with OUD are more likely to use the ED and to have repeat ED visits. The identification of youth-tailored interventions in the ED within broader efforts to address the opioid epidemic should be an urgent priority.


Assuntos
Serviço Hospitalar de Emergência/tendências , Hospitais Urbanos/tendências , Transtornos Relacionados ao Uso de Opioides/terapia , Aceitação pelo Paciente de Cuidados de Saúde , Provedores de Redes de Segurança/tendências , Adolescente , Adulto , Fatores Etários , Estudos Transversais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Provedores de Redes de Segurança/métodos , Estados Unidos , Adulto Jovem
20.
Cardiol Young ; 29(5): 553-563, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31046858

RESUMO

BACKGROUND: As a result of medical advances, the adult congenital heart disease population is rapidly expanding. Nonetheless, most patients remain prone to increased morbidity and mortality. Therefore, long-term medical resource use is required. This systematic review aims to present the trends over the past decades of medical resource utilization in adult congenital heart disease as well as its current status, with a focus on hospitalizations, emergency department visits, outpatient cardiology visits, and visits to other healthcare professionals. METHODS: MEDLINE (Pubmed), Embase, and Web of Science were searched for retrospective database research publications. The ISPOR checklist for retrospective database research was used for quality appraisal. Trends over time are explored. RESULTS: Twenty-one articles met the inclusion criteria. All but one of the studies was conducted in Western Europe and North America. The absolute number of hospitalizations has been increasing over the last several decades. This increase is highest in patients with mild lesions, although these numbers are largely driven by hospitalizations of patients with an atrial septal defect or a patent foramen ovale. Meanwhile, outpatient cardiology visits are increasing at an even higher pace, and occur most often in geriatric patients and patients with severe lesions. Conversely, the number of hospitalizations per 100 patients is decreasing over time. Literature is scarce on other types of healthcare use. CONCLUSION: A strong rise in healthcare utilization is noticed, despite the mitigating effect of improved efficiency levels. As the population continues to grow, innovative medical management strategies will be required to accommodate its increasing healthcare utilization.


Assuntos
Recursos em Saúde/tendências , Cardiopatias Congênitas/terapia , Hospitalização/tendências , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adulto , Assistência Ambulatorial/tendências , Serviço Hospitalar de Emergência/tendências , Humanos
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