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1.
Medicine (Baltimore) ; 99(1): e18687, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895836

RESUMO

The impact of time of day or day of week on the survival of emergency trauma patients is still controversial. The purpose of this study was to evaluate the outcomes of these patients according to time of day or day of week of emergency admission by using data from the nationwide Japan Trauma Data Bank (JTDB).This study enrolled 236,698 patients registered in the JTDB database from 2004 to 2015, and defined daytime as 09:00 AM to 16:59 PM and nighttime as 17:00 PM to 08:59 AM, weekdays as Monday to Friday, and weekends as Saturday, Sunday, and national holidays. The outcome measures were death in the emergency room (ER) and discharge to death.In total, 170,622 patients were eligible for our analysis. In a multivariable logistic regression adjusted for confounding factors, both death in the ER and death at hospital discharge were significantly lower during the daytime than at nighttime (623/76,162 [0.82%] vs 954/94,460 [1.01%]; adjusted odds ratio [AOR] 0.79; 95% confidence interval [CI] 0.71-0.88 and 5765/76,162 [7.57%] vs 7270/94,460 [7.70%]; AOR 0.88; 95% CI 0.85-0.92). In contrast, the weekdays/weekends was not significantly related to either death in the ER (1058/114,357 [0.93%] vs 519/56,265 [0.92%]; AOR 0.95; 95% CI 0.85-1.06) or death at hospital discharge (8975/114,357 [7.85%] vs 4060/56,265 [7.22%]; AOR 1.02; 95% CI 0.97-1.06).In this population of emergency trauma patients in Japan, both death in the ER and death at hospital discharge were significantly lower during the daytime than at night, but the weekdays/weekends was not associated with outcomes of these patients.


Assuntos
Serviços Médicos de Emergência/estatística & dados numéricos , Mortalidade Hospitalar/tendências , Adulto , Idoso , Serviços Médicos de Emergência/normas , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
3.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1048348

RESUMO

Objetivo: elaborar um bundle de cuidados para a prevenção e o controle das infecções hospitalares em unidade de emergência, com base no conhecimento e prática dos profissionais de saúde e nas evidências científicas disponíveis na literatura. Método: pesquisa convergente assistencial, realizada em um serviço de emergência adulto de um hospital geral universitário localizado em uma capital do Sul do Brasil com aplicação de um Survey para 52 trabalhadores da equipe multiprofissional e posterior discussão em grupos "Aqui e Agora". Foi aprovado pelo CEPSH/UFSC com CAAE: 56390616.0.0000.0121. Resultados: emergiram três aspectos mais significativos que compuseram o bundle de cuidados: higienização das mãos; uso de equipamentos de proteção individual; e assepsia de materiais e equipamentos. Conclusão: a utilização do bundle permite informar, orientar, melhorar hábitos e relembrar a equipe de saúde sobre a necessidade de aderir a atitudes que tornem o cuidado realizado mais qualificado e seguro, tanto para o paciente, quanto para o profissional


Objective: develop a care bundle in order to help preventing and controlling hospital infections in emergency care units, based on the knowledge and practice of health professionals, as well as on scientific evidences available in the literature. Method: The study was carried out through the application of a survey comprising 52 health professionals working in the multi-professional team of the aforementioned hospital. The data from the survey were discussed in "Here-and-Now" groups. It was approved by CEPSH / UFSC with CAAE: 56390616.0.0000.0121. Results: the three most significant aspects composing the care bundle were selected based on data derived from the survey, from the groups and from the literature, namely: hand hygiene; use of personal protection equipment; and asepsis of materials and equipment. Conclusion: using the bundle allows inform, guide, as well as to improve habits and remind health teams about the need to adhere to measures able to make the health care practice more qualified and safer for both the patients and the professionals


Objetivo: elaborar un bundle de cuidados para la prevención y el control de las infecciones hospitalarias en unidad de emergencia, con base en el conocimiento y práctica de los profesionales de salud y en las evidencias científicas disponibles en la literatura. Método: se realizó con aplicación de un Survey de que participaron 52 trabajadores del equipo multiprofesional. Los datos de Survey fueron discutidos posteriormente en grupos "Aquí y Ahora". Fue aprobado por el CEPSH / UFSC con CAAE: 56390616.0.0.0000.0121. Resultados: en base a los datos de Survey, de los grupos y de la literatura se seleccionaron los tres aspectos más significativos que compusieron el bundle de cuidados: higienización de las manos; uso de equipos de protección individual; y asepsia de materiales y equipos. Conclusión: la utilización del bundle permite informar, orientar, mejorar hábitos y recordar el equipo de salud sobre la necesidad de adherir a actitudes que hagan del cuidado realizado más calificado y seguro, tanto para el paciente, como para el profesional


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente , Infecção Hospitalar/prevenção & controle , Serviços Médicos de Emergência , Conhecimentos, Atitudes e Prática em Saúde , Inquéritos e Questionários , Grupos Focais , Segurança do Paciente , Pacotes de Assistência ao Paciente
4.
Lancet ; 394(10216): 2255-2262, 2020 12 21.
Artigo em Inglês | MEDLINE | ID: mdl-31862250

RESUMO

BACKGROUND: More than 80% of public-access defibrillation attempts do not result in sustained return of spontaneous circulation in patients who have had an out-of-hospital cardiac arrest (OHCA) and a shockable heart rhythm before arrival of emergency medical service (EMS) personnel. Neurological and survival outcomes in such patients have not been evaluated. We aimed to assess the neurological status and survival outcomes in such patients. METHODS: This is a retropective analysis of a cohort study from a prospective, nationwide, population-based registry of 1 299 784 patients who had an OHCA event between Jan 1, 2005, and Dec 31, 2015 in Japan. The primary outcome was favourable neurological outcome (Cerebral Performance Category of 1 or 2) at 30 days after the OHCA and the secondary outcome was survival at 30 days following the OHCA. This study is registered with the University Hospital Medical Information Network Clinical Trials Registry, UMIN000009918. FINDINGS: We identified 28 019 patients with bystander-witnessed OHCA and shockable heart rhythm who had received CPR from a bystander. Of these, 2242 (8·0%) patients did not achieve return of spontaneous circulation with CPR plus public-access defibrillation, and 25 087 (89·5%) patients did not achieve return of spontaneous circulation with CPR alone before EMS arrival. The proportion of patients with a favourable neurological outcome was significantly higher in those who received public-access defibrillation than those who did not (845 [37·7%] vs 5676 [22·6%]; adjusted odds ratio [OR] after propensity score-matching, 1·45 [95% CI 1·24-1·69], p<0·0001). The proportion of patients who survived at 30 days after the OHCA was also significantly higher in those who received public-access defibrillation than those who did not (987 [44·0%] vs 7976 [31·8%]; adjusted OR after propensity score-matching, 1·31 [95% CI 1·13-1·52], p<0·0001). INTERPRETATION: Our findings support the benefits of public-access defibrillation and greater accessibility and availability of automated external defibrillators in the community. FUNDING: None.


Assuntos
Reanimação Cardiopulmonar/instrumentação , Cardioversão Elétrica/instrumentação , Doenças do Sistema Nervoso/etiologia , Parada Cardíaca Extra-Hospitalar/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Reanimação Cardiopulmonar/métodos , Desfibriladores , Cardioversão Elétrica/métodos , Serviços Médicos de Emergência , Feminino , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/epidemiologia , Razão de Chances , Parada Cardíaca Extra-Hospitalar/complicações , Parada Cardíaca Extra-Hospitalar/mortalidade , Pontuação de Propensão , Estudos Prospectivos , Logradouros Públicos , Recuperação de Função Fisiológica , Sistema de Registros , Estudos Retrospectivos
5.
Br J Anaesth ; 124(1): 73-83, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31860444

RESUMO

BACKGROUND: Socioeconomic circumstances can influence access to healthcare, the standard of care provided, and a variety of outcomes. This study aimed to determine the association between crude and risk-adjusted 30-day mortality and socioeconomic group after emergency laparotomy, measure differences in meeting relevant perioperative standards of care, and investigate whether variation in hospital structure or process could explain any difference in mortality between socioeconomic groups. METHODS: This was an observational study of 58 790 patients, with data prospectively collected for the National Emergency Laparotomy Audit in 178 National Health Service hospitals in England between December 1, 2013 and November 31, 2016, linked with national administrative databases. The socioeconomic group was determined according to the Index of Multiple Deprivation quintile of each patient's usual place of residence. RESULTS: Overall, the crude 30-day mortality was 10.3%, with differences between the most-deprived (11.2%) and least-deprived (9.8%) quintiles (P<0.001). The more-deprived patients were more likely to have multiple comorbidities, were more acutely unwell at the time of surgery, and required a more-urgent surgery. After risk adjustment, the patients in the most-deprived quintile were at significantly higher risk of death compared with all other quintiles (adjusted odds ratio [95% confidence interval]: Q1 [most deprived]: reference; Q2: 0.83 [0.76-0.92]; Q3: 0.84 [0.76-0.92]; Q4: 0.87 [0.79-0.96]; Q5 [least deprived]: 0.77 [0.70-0.86]). We found no evidence that differences in hospital-level structure or patient-level performance in standards of care explained this association. CONCLUSIONS: More-deprived patients have higher crude and risk-adjusted 30-day mortality after emergency laparotomy, but this is not explained by differences in the standards of care recorded within the National Emergency Laparotomy Audit.


Assuntos
Serviços Médicos de Emergência , Laparotomia/mortalidade , Complicações Pós-Operatórias/economia , Complicações Pós-Operatórias/mortalidade , Fatores Socioeconômicos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Inglaterra/epidemiologia , Feminino , Hospitais/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Assistência Perioperatória/economia , Assistência Perioperatória/normas , Pobreza , Risco Ajustado , Medicina Estatal , Adulto Jovem
6.
FP Essent ; 487: 27-33, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31799818

RESUMO

Volunteering during a disaster is helpful only if there is a need for assistance. Clinicians should not self-deploy to disaster areas. Disaster responders should understand the incident command system, know how to perform reverse triage, and be familiar with the three commonly used mass casualty triage algorithms. The medical supplies needed and types of injuries expected depend on the disaster type and severity. The safety of responders is a priority. As such, they may be required to receive appropriate vaccinations, take prophylactic antibiotics, use personal protective equipment, and take measures to minimize the risk of injury and manage stress. Law enforcement should ensure the safety of a disaster scene before responders enter the area. Patients with life-threatening injuries require immediate stabilization and evacuation to a health care facility. Trauma complications, vector-borne diseases, and mental disorders should be addressed the first day after a disaster and should be managed continuously.


Assuntos
Medicina de Desastres , Planejamento em Desastres , Serviços Médicos de Emergência , Incidentes com Feridos em Massa , Humanos , Triagem
7.
Rev Saude Publica ; 53: 99, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31800916

RESUMO

OBJECTIVE: To evaluate the performance of the Mobile Emergency Medical Services (SAMU) in the ABC Region, using myocardial infarction as tracer condition. METHODS: The analysis of interrupted time series was the approach chosen to test immediate and gradual effects of the intervention on the study population. The research comprised adjusted monthly time series of the hospital mortality rate by myocardial infarction in the period between 2000 and 2011. Data were extracted from the Mortality Information System (SIM), using segmented regression analysis to evaluate the level and trend of the intervention before and after its implementation. To strengthen the internal validity of the study, a control region was included. RESULTS: The analysis of interrupted time series showed a reduction of 0.04 deaths per 100,000 inhabitants in the mortality rate compared to the underlying trend since the implementation of the Emergency Medical Services (p = 0.0040; 95%CI: -0.0816 - -0.0162) and a reduction in the level of 2.89 deaths per 100,000 inhabitants (p = 0.0001; 95%CI: -4.3293 - -1.4623), both with statistical significance. Regarding the control region, Baixada Santista, the difference in the result trend between intervention outcome and post-intervention control of -0.0639 deaths per 100,000 inhabitants was statistically significant (p = 0.0031; 95%CI: -0.1060 - -0.0219). We cannot exclude confounders, but we limited their presence in the study by including control region series. CONCLUSIONS: Although the analysis of interrupted time series has limitations, this modeling can be useful for analyzing the performance of policies and programs. Even though the intervention studied is not a condition that in itself implies effectiveness, the latter would not be present without the former, which, integrated with other conditions, generates a positive result. SAMU is a strategy that must be expanded when formulating and consolidating policies focusing on emergency care.


Assuntos
Ambulâncias/estatística & dados numéricos , Mortalidade Hospitalar/tendências , Unidades Móveis de Saúde/estatística & dados numéricos , Infarto do Miocárdio/mortalidade , Adulto , Ambulâncias/normas , Brasil , Serviços Médicos de Emergência , Estudos de Viabilidade , Feminino , Humanos , Análise de Séries Temporais Interrompida , Masculino , Unidades Móveis de Saúde/normas , Qualidade da Assistência à Saúde , Valores de Referência , Análise de Regressão , Estações do Ano , Fatores Socioeconômicos , Fatores de Tempo
9.
Z Geburtshilfe Neonatol ; 223(6): 337-349, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31801168

RESUMO

As far as prehospital but in part also clinical obstetrics is concerned, the acute nature of perinatal emergencies is overshadowed by limited diagnostic and therapeutic options. The need for acute and targeted intervention may result from both maternal and fetal indications. As common in emergency services for pregnant women, prehospital primary assessment and logistics management (e.g., transport time/type, choice of destination) define the prognosis. Non-specific emergencies coincident to pregnancy are to be distinguished from perinatal emergencies caused by expecting a child (hypertensive pregnancy disorders, perinatal bleeding, thrombosis, and embolism). In order to cope with rare and unpredictable emergencies, medical teams profit from standardized algorithms to support a high quality of prehospital care. Extensive information and training concepts are essential. The presented series on obstetric emergencies introduces the required knowledge and skills.


Assuntos
Emergências/epidemiologia , Serviços Médicos de Emergência/estatística & dados numéricos , Obstetrícia , Complicações na Gravidez/epidemiologia , Descolamento Prematuro da Placenta , Criança , Embolia Amniótica , Feminino , Humanos , Parto , Placenta Prévia , Pré-Eclâmpsia , Gravidez , Tromboembolia , Inércia Uterina
11.
Medicine (Baltimore) ; 98(49): e18200, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31804342

RESUMO

To determine the frequency of medication errors in prehospital care and to investigate the influencing factors - diagnostic agreement (DA), the medical educational status, the specialty, the approval for emergency medicine of the prehospital emergency physician, the patient age and sex and the time of deployment.We retrospectively reviewed 708 patients from 2013 to 2015, treated by the prehospital emergency physicians of the emergency medical service center Bad Belzig, Germany. The medication appropriateness was determined by a systematic comparison of the administered medication in prehospital deployments with the discharge diagnosis, according to current guidelines. The influencing factors were examined by univariate analysis of medication appropriateness (MA), using the χ, the Mann-Whtiney U and the Welch tests. We calculated a cut-off value with the Youden index to predict absent MA, according to patients age. The significance level was P = .05.MA was absent in 220 of 708 patients (31.1%). In the case of present DA, MA was absent in 103 of 491 patients (20.9%). In the case of absent DA, MA was absent in 117 of 217 patients (53.9%) (P = .01). MA was absent in 82 of 227 patients (36.1%), treated by specialist and in 138 of 481 patients (28.7%), treated by resident physicians (P = .04). The calculated cut-off value to predict absent MA was 75.5 years. MA was absent in 100 of 375 patients (26.7%) of the younger patient age group (≤75.5 years), MA was absent 120 of 333 patients (36.0%) of the older patient age group (>75.5 years) (P = .01). Absent MA showed peak values (46.7%-60%) at night from 3 to 6 AM (P = .01) The other investigated factors had no influence on MA.The correctness of medication as a quality feature in prehospital care shows a necessity for improvement with a proportion of 31.1% medication errors. The correct diagnosis by the prehospital emergency physician and his rapid accumulation of experience had an impact on the correctness of medication in prehospital care. Elderly patients (75+ years) and nighttime prehospital deployments (3-6 AM) were identified as high risk for medication errors by the emergency physicians.


Assuntos
Serviços Médicos de Emergência/estatística & dados numéricos , Erros de Medicação/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Alemanha , Humanos , Lactente , Masculino , Erros de Medicação/classificação , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Fatores de Tempo , Adulto Jovem
14.
Emergencias (Sant Vicenç dels Horts) ; 31(6): 377-384, dic. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-185134

RESUMO

Objetivo. Analizar la evolución de las características epidemiológicas de las visitas atendidas de forma consecutiva en una unidad de dolor torácico (UDT) de un servicio de urgencias hospitalario (SUH) durante un periodo de 10 años. Método. Se incluyeron todas las visitas por dolor torácico no traumático (DTNT), analizándose la evolución temporal de las características epidemiológicas, de la clasificación diagnóstica inicial (evaluación clínica inicial y electrocardiograma) y final (al alta de la UDT), y los tiempos necesarios para alcanzar las mismas. Resultados. Se incluyeron 34.552 pacientes consecutivos con una edad media 59 (DE: 13) años, el 42% mujeres. Se observó un incrementó en el número anual de visitas a la UDT (p < 0,001), menor afluencia los meses de verano (p < 0,001), y mayor los días laborables (p < 0,001) y de 8-16 horas (p < 0,001). Se comprobó que progresivamente más pacientes eran mujeres (+0,29% anual, p < 0,05), menores de 50 años (+0,92%, p < 0,001), con más factores de riesgo cardiovascular, menos antecedentes de cardiopatía isquémica y con DTNT menos sugestivo de síndrome coronario agudo (SCA). La clasificación diagnóstica inicial y final descartó SCA en un 52,2% y un 80,4% de pacientes, respectivamente, hecho que aumentó progresivamente durante el periodo evaluado (+1,86%, p < 0,001; y +0,56%, p = 0,04; respectivamente). El tiempo de clasificación inicial no se modificó, pero se incrementó el necesario para la clasificación final (p < 0,001), que resultó superior en pacientes con diagnostico final de SCA (p < 0,001). Conclusión. Se observa un mayor uso de la UDT tras su creación, causado por un incremento de pacientes con DTNT de características no típicamente coronarias, disminuyendo el porcentaje de clasificados inicial y finalmente como debidos a SCA


Objective. To analyze changes in the characteristics of consecutively treated patients attended in the chest pain unit of a hospital emergency department over a 10-year period. Methods. All patients presenting with nontraumatic chest pain (NTCP) were included. We analyzed changes over time in epidemiologic characteristics, initial diagnostic classification (on clinical and electrocardiographic evaluation), final diagnosis (on discharge), and time until these diagnoses. Results. A total of 34 552 consecutive patients with a mean (SD) age of 59 (13) years were included; 42% were women. The annual number of visits rose over time. Visits were fewer in summer and more numerous on workdays and between the hours of 8 AM and 4 PM (P<.001, both comparisons). The number of women increased over time (up 0.29% annually, P<.05) as did the number of patients under the age of 50 years (up 0.92% annually, P<.001). With time, patients had fewer cardiovascular risk factors and less often had a history of ischemic heart disease. Fewer cases of NTCP had signs suggestive of acute coronary syndrome (ACS). ACS was ruled out at the time of initial and final diagnoses in 52.2% and 80.4%, respectively, and these percentages which rose over the 10-year period by 1.86% (P<.001) and 0.56% (P=.04). Time to initial diagnosis did not change. However, time to final diagnosis did increase (P<.001), and the delay was longer in patients diagnosed with ACS (P<.001). Conclusions. The chest pain unit was more active at the end of the period, in keeping with the increase in patients with NTCP whose characteristics were not typical of coronary disease. The percentages of patients initially and finally diagnosed with ACS decreased with time


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Dor no Peito/epidemiologia , Serviços Médicos de Emergência , Síndrome Coronariana Aguda/epidemiologia , Métodos Epidemiológicos , Assistência Ambulatorial/organização & administração , Assistência Ambulatorial/estatística & dados numéricos , Infarto do Miocárdio sem Supradesnível do Segmento ST , Infarto do Miocárdio com Supradesnível do Segmento ST , Estudos Retrospectivos , Fatores de Risco , Análise de Variância
15.
Emergencias (Sant Vicenç dels Horts) ; 31(6): 399-403, dic. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-185137

RESUMO

Objetivo. Valorar la variabilidad de la estacionalidad en los episodios de bacteriemia. Método. Estudio de cohortes retrospectivo de las bacteriemias significativas de los hemocultivos extraídos en un servicio de urgencias. Se analizó la incidencia, etiología, rentabilidad y pronóstico, así como las variaciones en función de las estaciones del año. Resultados. Se realizaron 4.384 solicitudes de hemocultivos, que representó una tasa de solicitud del 4,1%. La rentabilidad diagnóstica fue del 12,2%. La incidencia de bacteriemia fue de 490 episodios por cada 100.000 atenciones. En invierno, respecto a la media del resto de estaciones, resultaron significativos el incremento en la solicitud de hemocultivos (4,6% frente a 3,8%, p < 0,001), el descenso de la rentabilidad diagnóstica (10,2% frente a 13%, p = 0,01), el incremento en la tasa de contaminación (4,9 % frente a 3,8%, p = 0,02), una menor frecuencia de aislamientos de Escherichia coli (36,4% frente a 46,9%, p = 0,03) y mayor de Streptococcus pneumoniae (14,5% frente a 5,9%, p = 0,001). Conclusiones. Se identifica una variabilidad significativa en cuanto al perfil microbiológico, rentabilidad y contaminantes en los hemocultivos obtenidos durante la estación invernal


Objective. To assess seasonal variation in episodes of bacteremia. Methods. Retrospective cohort study of cases of significant bacteremia found in blood cultures ordered in a hospital emergency department. The incidence, etiology, diagnostic and prognostic yield were analyzed for each season of the year. Results. A total of 4384 blood cultures were ordered in 4.1% of the emergency patients attended. The diagnostic yield was 12.2% (incidence, 490 cases per 100 000 cases attended). Cultures were ordered more often in winter (in 4.6% of the patients vs in 3.8% in the other seasons on average, P<.001). The diagnostic yield was lower in winter than in the other seasons (10.2% vs 13%, P=.01), and the contamination rate was higher (4.9% vs 3.8%, P=.02). Escherichia coli was isolated in fewer cultures in winter than in other seasons (36.4% vs 46.9%, P=.03), and Streptococcus pneumoniae was isolated in more (14.5% vs 5.9%, P=.001). Conclusions. The microbiological profile of blood cultures, their diagnostic yield, and rate of contamination differ greatly in winter


Assuntos
Humanos , Masculino , Feminino , Idoso , Bacteriemia/epidemiologia , Prognóstico , Estudos de Coortes , Bacteriemia/etiologia , Estudos Retrospectivos , Hemocultura , Análise Estatística , Assistência Ambulatorial/métodos , Serviços Médicos de Emergência
16.
Emergencias (Sant Vicenç dels Horts) ; 31(6): 404-406, dic. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-185138

RESUMO

Objetivo. Evaluar la efectividad del tratamiento médico expulsivo con tamsulosina. Método. Ensayo clínico prospectivo aleatorizado doble ciego realizado en un servicio de urgencias. Se incluyen adultos con ureterolitiasis distal única no complicada, que fueron asignados aleatoriamente a tamsulosina 0,4 mg/día más antiinflamatorio no esteroideo (AINE) (grupo A), o con placebo más AINE (grupo B), durante 21 días. Resultados. No se observaron diferencias estadísticamente significativas en la tasa de expulsión de litiasis entre ambos grupos (p = 0,29) ni en el tiempo de expulsión de esta (p = 0,91). Conclusiones. La terapia expulsiva con tamsulosina no se asocia a una mayor tasa de expulsión de litiasis ureteral


Objective. To assess the effectiveness of medical expulsive therapy with tamsulosin. Methods. Randomized double-blind controlled trial in an emergency department. We enrolled adults with uncomplicated distal ureterolithiasis and no other complaint. Patients were randomized to take either tamsulosin (0.4 mg/d) plus a nonsteroidal anti-inflammatory drug (NSAID) or placebo plus the NSAID for 21 days. Results. The stone expulsion rate did not differ statistically between the 2 groups (P=.29). Time until expulsion was also similar (P=.91). Conclusion. Medical expulsive therapy with tamsulosin does not improve the rate of distal ureteral stone expulsion


Assuntos
Humanos , Masculino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Resultado do Tratamento , Tansulosina/administração & dosagem , Cálculos Ureterais/tratamento farmacológico , Serviços Médicos de Emergência , Chile , Estudos Prospectivos , Método Duplo-Cego , Ureterolitíase/tratamento farmacológico , Ureterolitíase/diagnóstico por imagem , Acetaminofen/administração & dosagem , Cetorolaco/administração & dosagem , Análise Estatística
17.
Emergencias (Sant Vicenç dels Horts) ; 31(6): 407-412, dic. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-185139

RESUMO

Objetivo. Identificar el patrón de práctica clínica habitual respecto al tratamiento crónico con sacubitrilo-valsartán (SV) durante los episodios de insuficiencia cardiaca aguda (ICA), sus determinantes y su efecto sobre la evolución. Método. Estudio exploratorio de pacientes con ICA incluidos en el Registro EAHFE-6 en tratamiento crónico con SV. Se recogieron características basales, del episodio y del tratamiento con SV, y se identificaron factores relacionados con la interrupción de SV y su asociación con eventos adversos 180 días postevento índice (mortalidad por cualquier causa) y postalta (reconsulta a urgencias u hospitalización por ICA, muerte o evento combinado). Resultados. Se incluyeron 50 pacientes (mediana desde inicio de SV: 81 días; RIC: 43-284) y SV se interrumpió en 19 casos (38%; 5 en urgencias, 14 en hospitalización). Se identificó un motivo de retirada en 16 casos (4 por insuficiencia renal; y 3 por hipotensión arterial, hiperpotasemia, debilidad/mareo y empeoramiento de ICA, respectivamente). La retirada de SV se asoció con edad avanzada, no estar en tratamiento con betabloqueantes e hiperpotasemia. No hubo diferencias significativas entre grupos en eventos adversos a los 180 días postevento índice o postalta. Conclusión. En los pacientes en tratamiento crónico con SV que presentan ICA, este es suspendido en más de un tercio de casos, si bien ello no se asocia con cambios evolutivos


Objectives. To describe the pattern of care usually given to patients with acute heart failure (AHF) who are taking sacubitril/valsartan (SV) and to explore the effects of care characteristics on clinical outcomes. Methods. Exploratory study of AHF cases in patients taking SV who were included in the register for the Epidemiology of Acute Heart Failure in Emergency Departments during the sixth period of data collection (EAHFE-6). We extracted baseline and episode variables and information related to SV treatment. We also analyzed associations between the discontinuation of SV therapy and adverse events within 180 days (all-cause mortality) and after discharge (emergency revisits, admission for AHF, death from any cause, or a composite event). Results. Fifty patients on SV were included. The median time on SV therapy was 81 days (interquartile range, 43-284 days). SV was discontinued in 19 cases (38%; 5 in the emergency department and 14 on the ward). Sixteen records specified the reason for discontinuing SV: renal insufficiency, 4 cases; arterial hypotension, 3; weakness/dizziness, 3; and exacerbated AHF, 3. SV discontinuation was associated with older age, absence of treatment with a betablocker, and hyperkalemia. The EAHFE-6 cases did not reveal significant differences related to SV discontinuation with respect to the rates of adverse events within 180 days or on discharge after the index event. Conclusions. Long-term SV therapy is discontinued in over a third of patients who present with exacerbated AHF even though no association with clinical outcomes could be identified


Assuntos
Humanos , Masculino , Feminino , Idoso , Insuficiência Cardíaca/tratamento farmacológico , Serviços Médicos de Emergência , Hospitalização , Valsartana/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Conhecimentos, Atitudes e Prática em Saúde , Antagonistas Adrenérgicos beta/uso terapêutico , Hiperpotassemia/tratamento farmacológico
18.
Emergencias (Sant Vicenç dels Horts) ; 31(6): 413-416, dic. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-185140

RESUMO

Objetivo. Estudiar la frecuencia de fragilidad física y si su presencia se asocia con la presencia de resultados adversos en el primer año en los pacientes mayores con insuficiencia cardiaca aguda (ICA) dados de alta desde urgencias. Método. Estudio observacional de cohortes prospectivo que incluyó a los pacientes de 75 o más años con ICA dados de alta desde un servicio de urgencias. Se definió la fragilidad física como la presencia de 7 puntos en el Short Physical Performance Battery. La variable de resultado fue la aparición de un evento compuesto (revisita o reingreso por insuficiencia cardiaca y mortalidad por cualquier causa) en los primeros 365 días tras el alta de urgencias. Resultados. Se incluyeron 86 pacientes [edad media: 84 (DE 6 años); 59,3% mujeres]. La presencia de fragilidad se documentó en 49 (57%) pacientes. La frecuencia de la variable de resultado compuesta a los 365 días tras el alta de urgencias fue de un 46,5%. La fragilidad física fue un factor pronóstico independiente de presentar la variable resultado (OR ajustada = 3,6; IC 95% 1,0-12,9; p = 0,047). Conclusiones. La presencia de fragilidad física en los pacientes mayores con ICA dados de alta desde urgencias podría ser un factor pronóstico de malos resultados durante el primer año


Objective. To study the frequency of physical frailty and explore whether its presence in older patients with acute heart failure (AHF) is associated with adverse outcomes in the year after discharge from a emergency department (ED). Methods. Prospective observational cohort study in patients with AHF aged 75 years or older who were discharged from our ED. Physical frailty was defined by a score of 7 or less on the Short Physical Performance Battery. The outcome was the development of a composite event (ED revisit for AHF, hospital readmission for AHF, or all-cause mortality) within 365 days of discharge from the ED. Results. Eighty-six patients with a mean (SD) age of 84 (6) years were included; 59.3% were women. Frailty was identified in 49 patients (57%). The composite outcome was observed in 46.5% within 365 days. Physical fragility was an independent predictor of the outcome (adjusted odds ratio, 3.6; 95% CI, 1.0–12.9; P=.047). Conclusions. Frailty in older patients with AHF may predict a poor outcome during the year following discharge from an emergency department


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Insuficiência Cardíaca/diagnóstico , Idoso Fragilizado , Prognóstico , Alta do Paciente , Serviços Médicos de Emergência , Estudos de Coortes , Estudos Prospectivos
19.
Emergencias (Sant Vicenç dels Horts) ; 31(6): 429-434, dic. 2019. tab, mapas
Artigo em Espanhol | IBECS | ID: ibc-185142

RESUMO

El objetivo de este trabajo es comparar las legislaciones autonómicas españolas en materia de formación, utilización y obligatoriedad de la instalación de desfibriladores externos automatizados (DEA) fuera del ámbito sanitario y analizar la variabilidad territorial con que se han desarrollado las regulaciones. Llevamos a cabo una revisión de las normativas publicadas en los boletines oficiales de las 17 comunidades autónomas y las 2 ciudades autónomas de España hasta mayo de 2019, extrayendo datos referidos a la regulación de la formación, el uso y la instalación de los DEA fuera del ámbito sanitario. Observamos que médicos y enfermeros están autorizados a utilizar los DEA, salvo en Murcia, donde únicamente tienen autorizado su uso los médicos. En 14 comunidades autónomas también se consideran habilitados los técnicos en emergencias sanitarias. Excepto en el País Vasco, donde cualquier ciudadano puede utilizar un DEA previa alerta a los servicios de emergencia, es necesario realizar un curso inicial acreditado para estar habilitado en el uso de estos dispositivos (cuya duración varía, según la comunidad, entre 4 y 9 horas) y debe ser renovado con una periodicidad que oscila entre uno y 3 años. Sin embargo, 11 comunidades permiten que, en caso de emergencia y en ausencia de personal habilitado, cualquier ciudadano pueda utilizar un DEA, previa alerta a los servicios de emergencia. Once autonomías regulan la obligación de instalar DEA fuera del ámbito sanitario. Se concluye que si bien todas las comunidades autónomas de España disponen de una normativa reguladora del uso y la acreditación de DEA, el mapa legislativo es muy diverso, por lo que sería deseable una política armonizadora para unificar criterios e incentivar el uso de estos dispositivos en caso de necesidad


We compared Spanish autonomous communities' regulations affecting the use of semiautomatic external defibrillators (semi-AEDs), including requirements for training and providing devices outside health care settings. We analyzed differences in the development of regulations across the different geographic areas. Regulations published in the official bulletins of Spain’s 17 autonomous communities and 2 autonomous cities in effect in May 2019 were reviewed to extract directives affecting training, authorized use, and the provision of semi-AEDs outside health care centers. We found that both doctors and nurses are authorized to use the devices in most communities, with the exception of Murcia, where only doctors may use them. Fourteen communities also authorize emergency responders to operate semi-AEDs. Other individuals must call for emergency help before using one, and specific rules vary by community. In the Basque Country anyone may use them, but in other communities, only individuals who have taken a training course on how to use a semi-AED may. The duration of training programs varies from 4 to 9 hours in different parts of Spain, and retraining is required at intervals that vary from 1 to 3 years. However, in 11 communities any citizen may use a semi-AED in an emergency in which authorized persons are not present (after first calling for emergency responders). Eleven autonomous communities regulate the required provision of semi-AEDs outside health care centers. We conclude that although Spain’s autonomous communities have regulations in place for the use of these devices, the regulatory map is highly diverse. Therefore, we think that harmonization is desirable in the interest of unifying criteria and encouraging the use of semi-AEDs when they are needed


Assuntos
Humanos , Desfibriladores/normas , Parada Cardíaca Extra-Hospitalar/terapia , Reanimação Cardiopulmonar/instrumentação , Serviços Médicos de Emergência/legislação & jurisprudência , Serviços Médicos de Emergência/normas
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