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1.
Zhonghua Yu Fang Yi Xue Za Zhi ; 54(1): 69-75, 2020 Jan 06.
Artigo em Chinês | MEDLINE | ID: mdl-31914572

RESUMO

Objective: To understand the consciousness of the cancer early treatment and its demographic and socioeconomic factors. Methods: A cross-sectional survey was conducted in 16 provinces covered by the Cancer Screening Program in Urban China (CanSPUC) from 2015 to 2017. A total of 32 257 local residents aged ≥18 years old who could understand the investigation procedure were included in the study by using the cluster sampling method and convenient sampling method. All local residents were categorized into four groups, which contained 15 524 community residents, 8 016 cancer risk assessment/screening population, 2 289 cancer patients and 6 428 occupational population, respectively. The questionnaire collected personal information, the consciousness of the cancer early treatment and relevant factors. The Chi square test was used to compare the difference between the consciousness of the cancer early treatment and relevant factors among the four groups. The logistic regression model was used to analyze the influencing factors related to the consciousness of the cancer early treatment. Results: With the assumption of being diagnosed as precancer or cancer, 89.97% of community residents, 91.84% of cancer risk assessment/screening population, 93.00% of cancer patients and 91.52% of occupational population would accept active treatments (P<0.001). If the immediate family members were diagnosed as precancer or cancer, people who would encourage their family members to receive early treatment in the four groups accounted for 91.96%, 91.94%, 92.44% and 91.55%, respectively (P<0.001). The company employees, annual household income with 40 000 yuan and more and other three groups had a relatively better consciousness of the cancer early treatment (P<0.05). Male, widowed, unemployed and from the central and western regions had a relatively worse consciousness of the cancer early treatment (P<0.05). Conclusion: Residents in urban China participants had a good consciousness of the cancer early treatment. The marital status, occupation, annual household income and residential regions were major factors related to the consciousness of the cancer early treatment.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Neoplasias/terapia , Tempo para o Tratamento/estatística & dados numéricos , População Urbana , Adolescente , Adulto , China , Estudos Transversais , Feminino , Humanos , Masculino , Fatores Socioeconômicos , População Urbana/estatística & dados numéricos
2.
BMC Neurol ; 19(1): 265, 2019 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-31684901

RESUMO

BACKGROUND: Intravenous thrombolysis (IVT) plays a prominent role in the treatment of acute ischemic stroke (AIS). The sooner IVT is administered, the higher the odds of a good outcome. Therefore, registering the in-hospital time to treatment with IVT, i.e. the door-to-needle time (DNT), is a powerful way to measure quality improvement. The aim of this study was to identify determinants that are associated with extended DNT. METHODS: Patients receiving IVT in 2015 and 2016 registered in the Dutch Acute Stroke Audit were included. DNT and onset-to-door time (ODT) were dichotomized using the median (i.e. extended DNT) and the 90th percentile (i.e. severely extended DNT). Logistic regression was performed to identify determinants associated with (severely) extended DNT/ODT and its effect on in-hospital mortality. A linear model with natural spline was used to investigate the association between ODT and DNT. RESULTS: Included were 9518 IVT treated patients from 75 hospitals. Median DNT was 26 min (IQR 20-37). Determinants associated with a higher likelihood of extended DNT were female sex (OR 1.17, 95% CI 1.05-1.31) and admission during off-hours (OR 1.12, 95% CI 1.01-1.25). Short ODT correlated with longer DNT, whereas longer ODT correlated with shorter DNT. Young age (OR 1.38, 95% CI 1.07-1.76) and admission to a comprehensive stroke center (OR 1.26, 1.10-1.45) were associated with severely extended DNT, which was associated with in-hospital mortality (OR 1.54, 95%CI 1.19-1.98). CONCLUSIONS: Even though DNT in the Netherlands is short compared to other countries, lowering the DNT may be achievable by focusing on specific subgroups.


Assuntos
Acidente Vascular Cerebral , Tempo para o Tratamento/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/epidemiologia , Terapia Trombolítica
3.
BMC Public Health ; 19(1): 1481, 2019 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-31703667

RESUMO

BACKGROUND: Treatment of drug-resistant tuberculosis is often more complex and toxic with longer treatment time and poor treatment outcomes including treatment failure or death. Monitoring drug-resistant tuberculosis therapy including early identification of prognostic factors and close monitoring of body weight in resource-limited settings is crucial to ensure successful treatment. Therefore, this study was conducted to assess time to poor treatment outcome which is defined as the proportion of all patients who died or failed treatment and its predictors among drug-resistant tuberculosis patients on second-line anti-tuberculosis treatment in Amhara region, Ethiopia. METHODS: A retrospective cohort study was conducted on all patients who started drug-resistant tuberculosis therapy from September 1, 2010 through December 31, 2017, at the University of Gondar Comprehensive Specialized Hospital, Boru-Meda Hospital, and Debre-Markos Referral Hospital in Amhara Region, Ethiopia. Data were entered using Epi-data Version 3.1 and analyzed using R version 3.41 software. The survival time was estimated using Kaplan-Meier survival curve and the survival time between different categorical variables were compared using the log rank test. Event time ratio with 95% confidence interval (CI) and p-value less than 0.05 were used to measure the strength of association and to declare statistically significant predictors respectively. RESULTS: A total of 508 patients with a median age of 28.5 [IQR: 22-40] years were included in this study. The overall cumulative survival probability of patients at the end of 24 months was 79% [95% CI,75,84%]. Rate of body weight change [Adjusted time ratio (ATR) = 5; 95% CI: 3.2, 7.7], secondary and above level of education [ATR = 2.3;95% CI:1.2,2.9], being non-anemic [ATR = 2.8,95% CI:1.2,3.8], being non-diabetic [ATR = 3.4;95% CI:1.3,8.8], without clinical complications [ATR = 7.6;95% CI:4.2,13.9], HIV negative [ATR = 1. 94:95% CI:1.35,2.35] and residing in rural [ATR = 0.51,95% CI:0.30,0.86] were predictors of time to poor treatment outcomes. CONCLUSION: The survival rate of tuberculosis patients was higher at end of follow up relative to other studies. However, poor treatment outcome was higher in early phase of therapy. Educational level, rural residence, HIV/AIDS, diabetes mellitus, previous treatment, clinical complication, rate of body weight change and smoking history were significant predictors of time to poor treatment outcome. Therefore, intervention programs should focus on the identified factors to improve survival time of drug-resistant tuberculosis patients.


Assuntos
Antituberculosos/uso terapêutico , Tempo para o Tratamento/estatística & dados numéricos , Tuberculose Resistente a Múltiplos Medicamentos/mortalidade , Adulto , Etiópia , Feminino , Hospitais , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida , Fatores de Tempo , Falha de Tratamento , Resultado do Tratamento , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Adulto Jovem
4.
Anticancer Res ; 39(11): 6333-6337, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31704864

RESUMO

BACKGROUND/AIM: To characterize the demographics, tumor staging and treatment of African American (AA) patients diagnosed with melanoma in the United States. PATIENTS AND METHODS: The National Cancer Database was used to extrapolate data from patients with melanoma between January 1, 2004, and December 31, 2015. The patients were then further divided based on ethnicity (AAs vs. Caucasians) to compare patient efficacy of treatment. RESULTS: The mean time for AA patients to receive treatment was 20.37 days compared with 11.25 days for Caucasians (p<0.001), while time to surgery was 38.86 days compared to 31.12 days for Caucasians (p<0.001). Moreover, AA race was a predictor of American Joint Committee on Cancer stage greater than II, tumor diagnosed at autopsy, presence of ulceration, and distribution in the extremities. CONCLUSION: AA patients with melanoma are more likely to have worse tumor staging, treatment delay, treatment at an Integrated Cancer Program, and diagnosis at autopsy.


Assuntos
Afro-Americanos , Grupo com Ancestrais do Continente Europeu , Melanoma/etnologia , Melanoma/terapia , Neoplasias Cutâneas/etnologia , Neoplasias Cutâneas/terapia , Tempo para o Tratamento/estatística & dados numéricos , Distribuição por Idade , Autopsia , Bases de Dados Factuais , Diagnóstico Tardio , Feminino , Humanos , Masculino , Melanoma/patologia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Distribuição por Sexo , Neoplasias Cutâneas/patologia , Estados Unidos
5.
Medicine (Baltimore) ; 98(44): e17740, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689822

RESUMO

To identify independent factors associated with prolonged hospital length of stay (LOS) in elderly patients undergoing first-time elective open posterior lumbar fusion surgery.We retrospectively analyzed the data of 303 elderly patients (age range: 60-86 years) who underwent first-time elective open lumbar posterior fusion surgery at our center from December 2012 to December 2017. Preoperative and perioperative variables were extracted and analyzed for all patients, and multivariate stepwise regression analysis was used to determine the variables affecting the LOS and important predictors of LOS prolongation (P < .001).The mean age of the patients was 67.0 ±â€Š5.5 years, and the mean LOS was 18.5 ±â€Š11.8 days, ranging from 7 to 103 days. Of the total, 166 patients (54.8%) were men and 83 patients (27.4%) had extended LOS. Multiple linear regression analysis determined that age (P < .001), preoperative waiting time ≥7 days (P < .001), pulmonary comorbidities (P = .010), and diabetes (P = .010) were preoperative factors associated with LOS prolongation. Major complications (P = .002), infectious complications (P = .001), multiple surgeries (P < .001), and surgical bleeding (P = .018) were perioperative factors associated with LOS prolongation. Age (P < .001), preoperative waiting time ≥7 days (P < .001), infectious complications (P < .001), and multiple surgeries (P < .001) were important predictors of LOS prolongation.Extended LOS after first-time elective open posterior lumbar fusion surgery in elderly patients is associated with factors including age, preoperative waiting time, infectious complications, and multiple surgeries. Surgeons should recognize and note these relevant factors while taking appropriate precautions to optimize the modifiable factors, thereby reducing the LOS as well as hospitalization costs.


Assuntos
Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Fusão Vertebral/estatística & dados numéricos , Fatores de Tempo , Tempo para o Tratamento/estatística & dados numéricos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Procedimentos Cirúrgicos Eletivos/métodos , Feminino , Humanos , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Complicações Pós-Operatórias/etiologia , Período Pré-Operatório , Análise de Regressão , Estudos Retrospectivos , Fatores de Risco , Fusão Vertebral/efeitos adversos , Fusão Vertebral/métodos , Listas de Espera
6.
Spine (Phila Pa 1976) ; 44(22): 1578-1584, 2019 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-31689253

RESUMO

STUDY DESIGN: Retrospective review with qualitative phone interview. OBJECTIVE: This study aims to identify the factors leading to delayed diagnosis or referral to a spinal surgeon in patients who subsequently require surgery for adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA: AIS can be effectively treated with bracing to prevent curve progression in skeletally immature patients. Australia currently has in place a national self-detection screening program to diagnose AIS. METHODS: A retrospective review was performed for patients who underwent surgery for scoliosis at Princess Margaret Hospital for Children and Royal Perth Hospital between June 1, 2010 and May 27, 2014. Data were retrieved from the digital medical record and a semistructured phone interview was used to determine path to diagnosis and referral. RESULTS: Mean Cobb angle at first specialist review was 49.5°â€Š±â€Š14.0° for patients who subsequently required surgery for AIS. These patients experienced an average interval of 20.7 months from detection of symptoms to review in a specialist clinic. CONCLUSION: In a condition in which early detection and intervention may halt progression of disease, AIS is detected relatively late and there are specific delays to diagnosis and referral to specialist clinics. LEVEL OF EVIDENCE: 4.


Assuntos
Encaminhamento e Consulta/estatística & dados numéricos , Escoliose , Adolescente , Humanos , Entrevistas como Assunto , Estudos Retrospectivos , Escoliose/diagnóstico , Escoliose/epidemiologia , Escoliose/cirurgia , Coluna Vertebral/cirurgia , Tempo para o Tratamento/estatística & dados numéricos , Resultado do Tratamento , Austrália Ocidental
7.
Am Surg ; 85(10): 1146-1149, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657312

RESUMO

Cirrhosis is associated with adverse outcomes after emergency general surgery (EGS). The objective of this study was to determine the safety of laparoscopic cholecystectomy (LC) in EGS patients with cirrhosis. We performed a two-year retrospective cohort analysis of adult patients who underwent LC for symptomatic gallstones. The primary outcome was the incidence of intraoperative complications. Of 796 patients, 59 (7.4%) were cirrhotic, with a median model for end-stage liver disease (MELD) score of 15 (IQR, 7). On unadjusted analysis, patients with cirrhosis were older, more likely to be male (both P < 0.01), diabetic (P < 0.001), had a higher incidence of preadmission antithrombotic therapy use (P < 0.02), and experienced a longer time to surgery (3.2 vs 1.8 days, P < 0.001). Coarsened exact matching revealed no difference in intra- or postoperative complications between groups (P = 0.67). Operative duration was longer in patients with cirrhosis (162 vs 114 minutes, P = 0.001), who also had a nonsignificant increase in the rate of conversion to an open cholecystectomy (14% vs 4%, P = 0.07). The results of this study indicate that LC may be safely performed in EGS patients with cirrhosis.


Assuntos
Colecistectomia Laparoscópica/efeitos adversos , Tratamento de Emergência/efeitos adversos , Cálculos Biliares/cirurgia , Complicações Intraoperatórias/epidemiologia , Cirrose Hepática/complicações , Doença Aguda , Adulto , Fatores Etários , Ductos Biliares/lesões , Conversão para Cirurgia Aberta/estatística & dados numéricos , Tratamento de Emergência/métodos , Feminino , Fibrinolíticos/uso terapêutico , Cálculos Biliares/etiologia , Hemorragia/epidemiologia , Humanos , Incidência , Intestinos/lesões , Complicações Intraoperatórias/etiologia , Cirrose Hepática/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Segurança , Fatores Sexuais , Fatores de Tempo , Tempo para o Tratamento/estatística & dados numéricos
8.
Dis Colon Rectum ; 62(11): 1305-1315, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31567924

RESUMO

BACKGROUND: Delayed initiation of adjuvant chemotherapy negatively impacts long-term survival in patients with colorectal cancer. Colorectal enhanced recovery protocols result in decreased complications and length of stay; however, the impact of enhanced recovery on the timing of adjuvant chemotherapy remains unknown. OBJECTIVE: This study aimed to identify factors associated with on-time delivery of adjuvant chemotherapy after colorectal cancer surgery, hypothesizing that implementation of an enhanced recovery protocol would result in more patients receiving on-time chemotherapy. DESIGN: This was a retrospective cohort study comparing the rate of on-time adjuvant chemotherapy delivery after colorectal cancer resection before and after implementation of an enhanced recovery protocol. SETTINGS: The study was conducted at a large academic medical center. PATIENTS: All of the patients who underwent nonemergent colorectal cancer resections for curative intent from January 2010 to June 2017, excluding patients who had no indication for adjuvant chemotherapy, had received preoperative systemic chemotherapy, or did not have medical oncology records available were included. MAIN OUTCOME MEASURES: Patients before and enhanced recovery were compared, with the rate of on-time adjuvant chemotherapy delivery as the primary outcome. Adjuvant chemotherapy delivery was considered on time if initiated ≤8 weeks postoperatively, and treatment was considered delayed or omitted if initiated >8 weeks postoperatively (delayed) or never received (omitted). Multivariable logistic regression identified predictors of on-time chemotherapy delivery. RESULTS: A total of 363 patients met inclusion criteria, with 189 patients (52.1%) undergoing surgery after enhanced recovery implementation. Groups differed in laparoscopic approach and median procedure duration, both of which were higher after enhanced recovery. Significantly more patients received on-time chemotherapy after enhanced recovery implementation (p = 0.007). Enhanced recovery was an independent predictor of on-time adjuvant chemotherapy (p = 0.014). LIMITATIONS: The study was limited by its retrospective and nonrandomized before-and-after design. CONCLUSIONS: Enhanced recovery was associated with receiving on-time adjuvant chemotherapy. As prompt initiation of adjuvant chemotherapy improves survival in colorectal cancer, future investigation of long-term oncologic outcomes is necessary to evaluate the potential impact of enhanced recovery on survival. See Video Abstract at http://links.lww.com/DCR/B21. LA IMPLEMENTACIÓN DE UN PROTOCOLO DE RECUPERACIÓN ACELERADA SE ASOCIA CON EL INICIO A TIEMPO DE QUIMIOTERAPIA ADYUVANTE EN CÁNCER COLORRECTAL:: El inicio tardío de la quimioterapia adyuvante afecta negativamente la supervivencia a largo plazo en pacientes con cáncer colorrectal. Los protocolos de recuperación acelerada colorrectales dan lugar a una disminución de las complicaciones y la duración de estancia hospitalaria; sin embargo, el impacto de la recuperación acelerada en el momento de inicio de quimioterapia adyuvante sigue siendo desconocido.Este estudio tuvo como objetivo identificar los factores asociados con la administración a tiempo de la quimioterapia adyuvante después de la cirugía de cáncer colorrectal, con la hipótesis de que la implementación de un protocolo de recuperación acelerada daría lugar a que más pacientes reciban quimioterapia a tiempo.Estudio de cohorte retrospectivo que compara la tasa de administración de quimioterapia adyuvante a tiempo después de la resección del cáncer colorrectal antes y después de la implementación de un protocolo de recuperación acelerada.Centro médico académico grande.Todos los pacientes que se sometieron a resecciones de cáncer colorrectal no emergentes con intención curativa desde enero de 2010 hasta junio de 2017, excluyendo a los pacientes que no tenían indicación de quimioterapia adyuvante, que recibieron quimioterapia sistémica preoperatoria o no tenían registros médicos de oncología disponibles.Los pacientes se compararon antes y después de la implementación de la recuperación acelerada, con la tasa de administración de quimioterapia adyuvante a tiempo como el resultado primario. La administración de quimioterapia adyuvante se consideró a tiempo si se inició ≤8 semanas después de la operación, y el tratamiento se consideró retrasado / omitido si se inició> 8 semanas después de la operación (retrasado) o nunca fue recibido (omitido). La regresión logística multivariable identificó predictores de administración de quimioterapia a tiempo.363 pacientes cumplieron con los criterios de inclusión, con 189 (52.1%) pacientes sometidos a cirugía después de la implementación de recuperación acelerada. Los grupos difirieron en el abordaje laparoscópico y la duración media del procedimiento; ambos factores fueron mayores después de la recuperación acelerada. Significativamente más pacientes recibieron quimioterapia a tiempo después de la implementación de recuperación acelerada (p = 0.007). La recuperación acelerada fue un factor predictivo independiente de quimioterapia adyuvante a tiempo (p = 0.014).Diseño retrospectivo, tipo ¨antes y después¨ no aleatorizado.La recuperación acelerada se asoció con la recepción de quimioterapia adyuvante a tiempo. Debido a que el inicio rápido de la quimioterapia adyuvante mejora la supervivencia en el cáncer colorrectal, en el futuro será necesario investigar los resultados oncológicos a largo plazo para evaluar el impacto potencial de la recuperación acelerada en la supervivencia. Vea el Resumen en Video en http://links.lww.com/DCR/B21.


Assuntos
Antineoplásicos/uso terapêutico , Quimioterapia Adjuvante/métodos , Colectomia/reabilitação , Neoplasias Colorretais , Complicações Pós-Operatórias/prevenção & controle , Recuperação de Função Fisiológica/efeitos dos fármacos , Sobreviventes/estatística & dados numéricos , Tempo para o Tratamento , Protocolos Clínicos/normas , Colectomia/métodos , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/patologia , Neoplasias Colorretais/reabilitação , Neoplasias Colorretais/terapia , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tempo para o Tratamento/normas , Tempo para o Tratamento/estatística & dados numéricos , Estados Unidos/epidemiologia
9.
BMC Health Serv Res ; 19(1): 673, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533711

RESUMO

BACKGROUND: To investigate timely access to and the time needed to complete the diagnostic path of children and adolescents with suspected attention deficit hyperactivity disorder (ADHD) in the 18 Italian Lombardy Region ADHD reference centers. METHODS: Data of children and adolescents enrolled in the Regional ADHD disease-oriented Registry for suspected ADHD who requested their first visit in 2013-2017 were analyzed. RESULTS: The sample comprised 2262 children and adolescents aged 5-17 years who accessed the ADHD centers for diagnostic classification and management. The median waiting time was of 177 days (range 66-375) from the request for the initial appointment to the completion of the diagnostic path, with a three - fold difference between centers. In addition to the center, the strongest significant predictors of long waiting times were age comorbidities, the severity of the disorder, and having already completed some diagnostic procedures provided by the common standard path. CONCLUSIONS: To guarantee an equal standard of care in ADHD centers for all children and adolescents there is a pressing need to reduce the times to complete the diagnostic path. It is the task of both policymakers and each center to optimize the quality of the service and of the care delivered.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Tempo para o Tratamento/normas , Adolescente , Análise de Variância , Criança , Pré-Escolar , Comorbidade , Feminino , Humanos , Itália , Masculino , Encaminhamento e Consulta , Sistema de Registros , Tempo para o Tratamento/estatística & dados numéricos , Listas de Espera
10.
Bone Joint J ; 101-B(9): 1129-1137, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31474142

RESUMO

AIMS: The aim of this study was to investigate mortality and risk of intraoperative medical complications depending on delay to hip fracture surgery by using data from the Norwegian Hip Fracture Register (NHFR) and the Norwegian Patient Registry (NPR). PATIENTS AND METHODS: A total of 83 727 hip fractures were reported to the NHFR between 2008 and 2017. Pathological fractures, unspecified type of fractures or treatment, patients less than 50 years of age, unknown delay to surgery, and delays to surgery of greater than four days were excluded. We studied total delay (fracture to surgery, n = 38 754) and hospital delay (admission to surgery, n = 73 557). Cox regression analyses were performed to calculate relative risks (RRs) adjusted for sex, age, American Society of Anesthesiologists (ASA) classification, type of surgery, and type of fracture. Odds ratio (OR) was calculated for intraoperative medical complications. We compared delays of 12 hours or less, 13 to 24 hours, 25 to 36 hours, 37 to 48 hours, and more than 48 hours. RESULTS: Mortality remained unchanged when total delay was less than 48 hours. Total delay exceeding 48 hours was associated with increased three-day mortality (RR 1.69, 95% confidence interval (CI) 1.23 to 2.34; p = 0.001) and one-year mortality (RR 1.06, 95% CI 1.04 to 1.22; p = 0.003). More intraoperative medical complications were reported when hospital delay exceeded 24 hours. CONCLUSION: Hospitals should operate on patients within 48 hours after fracture to reduce mortality and intraoperative complications. Cite this article: Bone Joint J 2019;101-B:1129-1137.


Assuntos
Artroplastia de Quadril/mortalidade , Fixação Interna de Fraturas/mortalidade , Fraturas do Quadril/mortalidade , Fraturas do Quadril/cirurgia , Complicações Intraoperatórias/mortalidade , Tempo para o Tratamento/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/estatística & dados numéricos , Feminino , Fixação Interna de Fraturas/estatística & dados numéricos , Hemiartroplastia/estatística & dados numéricos , Fraturas do Quadril/epidemiologia , Hospitalização/estatística & dados numéricos , Humanos , Complicações Intraoperatórias/epidemiologia , Complicações Intraoperatórias/etiologia , Masculino , Noruega/epidemiologia , Sistema de Registros/estatística & dados numéricos , Fatores de Risco
11.
Medicine (Baltimore) ; 98(33): e16800, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415389

RESUMO

BACKGROUND: The effects of early continuous renal replacement therapy (CRRT) on mortality in patients with septic acute kidney injury (AKI) remain controversial. A systematic review and meta-analysis was performed to investigate the impact of timing of CRRT on clinical outcomes in patients with septic AKI. METHODS: The PubMed, Cochrane, and Embase databases were searched from inception to the 31st of March 2019, to identify trials that assessed the timing of initiation of CRRT in patients with septic AKI. RESULTS: Five trials including 900 patients were included. The results of this meta-analysis showed that there was no significant difference between 28-day mortality (odds ratio = 0.76;95% CI, 0.58-1.00; P = .05) and 90-day mortality(odds ratio = 0.79;95% CI, 0.59-1.06; P = .12)of early and late initiation of CRRT group. In addition, compared with late initiation strategy, early initiation showed no significant advantage in length of stay in ICU (Mean difference = -0.9;95% CI, -2.37 to 0.57; P = .23) and length of stay in hospital (Mean difference = -1.43;95% CI, -5.28 to 2.41; P = .47). CONCLUSION: Our meta-analysis revealed that early initiation of CRRT could not reduce mortality in patients with septic AKI. The study also showed no significant difference in ICU length of stay or hospital length of stay between early and late CRRT group. To achieve optimal timing of CRRT for septic AKI, large multicenter randomized trials with better design are still needed.


Assuntos
Lesão Renal Aguda/mortalidade , Lesão Renal Aguda/terapia , Terapia de Substituição Renal/mortalidade , Sepse/mortalidade , Tempo para o Tratamento/estatística & dados numéricos , Lesão Renal Aguda/complicações , Adulto , Feminino , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Fatores de Risco , Sepse/etiologia , Fatores de Tempo
12.
N Z Med J ; 132(1500): 29-39, 2019 08 16.
Artigo em Inglês | MEDLINE | ID: mdl-31415497

RESUMO

AIMS: Red and Green Bed Days is a hospital management system designed to identify delays during in-patient stays. This study quantified days when no activity occurred to progress a patient towards discharge. METHODS: Starting June 2018, 100 consecutive in-patient stays were recorded within the vascular department at Waikato Hospital, New Zealand. A 'green day' occurred when the planned care for that day was achieved. A 'red day' occurred when a patient only received care that did not require an acute bed. The causes of red days were identified. RESULTS: There were 703 total in-patient days, with 37% red days. Patients aged between 60-79 years accounted for 57% of red days. Patients with peripheral arterial disease experienced 77.3% of the red days (severe chronic limb ischaemia 58.1% and acute limb ischaemia 19.2%). Awaiting wound dressing change, acute theatre (vascular and emergency theatre) and interventional procedure accounted for 31.9%, 11.2% and 9.2% of red days respectively. Delays to vascular ultrasound and rehabilitation review each resulted in 8.4% of red days. CONCLUSIONS: This study highlights significant delays during vascular surgery admissions and provides a focus to improve patient quality of life and hospital efficiency.


Assuntos
Hospitalização/estatística & dados numéricos , Tempo para o Tratamento/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Organizacionais , Nova Zelândia , Doença Arterial Periférica/cirurgia , Qualidade da Assistência à Saúde , Qualidade de Vida , Procedimentos Cirúrgicos Vasculares , Adulto Jovem
13.
BMC Health Serv Res ; 19(1): 582, 2019 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-31426768

RESUMO

BACKGROUND: To examine the association between delay in planned diabetes care and quality of outcomes. METHODS: A retrospective analysis of primary care and inpatient records for 2567 Aboriginal patients, with diabetes, living in 49 remote communities in the Northern Territory of Australia. Poisson regression was used to estimate the association between delay from diagnosis to documented diabetes care plan and three outcome measures: mean HbA1c level, most recent blood pressure and number of diabetes-related hospital admissions. RESULTS: Compared with no delay (< 60 days), patients with delay had increased risk of elevated mean HbA1c: 60 days to < 2 years, incidence rate ratio (IRR), 1.2 (95% CI:1.07-1.39); 2 years to < 4 years, incidence rate ratio (IRR), 1.2 (95% CI:1.04-1.45); 4 years and over, incidence rate ratio (IRR), 1.3 (95% CI:1.12-1.52). There was no evidence of association between delay and optimal blood pressure control. Risk of diabetes-related admission increased with increased delay. Compared with no delay the IRRs for delay were: 60 days to < 2 years, 1.2 (95% CI:1.07-1.42); 2 to < 4 years, 1.3 (95% CI: 1.15-1.58): and 4 years and over, 2.6 (95% CI,2.28-3.08). CONCLUSION: The study found that a timely diabetes care plan was associated with better short-term blood glucose control and fewer diabetes-related admissions but not with improved blood pressure control. Delays may be a result of both patient and service-related factors.


Assuntos
Assistência à Saúde/normas , Diabetes Mellitus/terapia , Grupo com Ancestrais Oceânicos/etnologia , Atenção Primária à Saúde/normas , Tempo para o Tratamento/estatística & dados numéricos , Adolescente , Adulto , Idoso , Pressão Sanguínea/fisiologia , Assistência à Saúde/etnologia , Assistência à Saúde/estatística & dados numéricos , Diabetes Mellitus/etnologia , Feminino , Hemoglobina A Glicada/metabolismo , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Northern Territory/epidemiologia , Northern Territory/etnologia , Atenção Primária à Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde/normas , Qualidade da Assistência à Saúde/estatística & dados numéricos , Estudos Retrospectivos , Adulto Jovem
14.
Urology ; 133: 157-163, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31421144

RESUMO

OBJECTIVE: To determine if the timing of radical cystectomy for variant histology of urothelial carcinoma has an impact on survival. Variant histology has been associated with aberrant behavior compared to pure urothelial carcinoma, however the timing of surgery for these patients has not been studied. MATERIALS AND METHODS: We identified 363 patients with cT2-T4N0M0 urothelial carcinoma who underwent radical cystectomy without perioperative intravesical and/or systemic therapy from 2003 to 2014. Clinicopathologic data were compared between pure urothelial carcinoma and variant histology. The time from diagnosis to radical cystectomy was analyzed as a continuous variable and dichotomized at 4-, 8-, and 12-weeks to determine impact on oncologic outcomes. RESULTS: Patients with variant histology, when compared to those with pure urothelial carcinoma, were more likely to present with extravesical disease (P <.01), be upstaged (P <.01), have lymphovascular invasion (P <.01) and have lymph node metastasis at radical cystectomy (P = .02). The median days to radical cystectomy did not differ between pure urothelial and variant histology. On multivariable analysis controlling for age, comorbidities, tumor stage, lymph node status, lymphovascular invasion, and surgical margins, every month in delay was associated with a worse overall survival for variants (HR = 1.36, P = .003). At an 8-week delay or longer, those with variant histology had a statistically worse survival (P = .03). CONCLUSION: For patients with variant histology, delays in surgery were associated with an increased risk of death.


Assuntos
Carcinoma de Células de Transição/patologia , Carcinoma de Células de Transição/cirurgia , Cistectomia/métodos , Tempo para o Tratamento , Neoplasias da Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/cirurgia , Idoso , Carcinoma de Células de Transição/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida , Tempo para o Tratamento/estatística & dados numéricos , Neoplasias da Bexiga Urinária/mortalidade
15.
Urology ; 133: 211-215, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31408640

RESUMO

OBJECTIVE: To determine the importance of the duration of in-hospital management of patients with testicular torsion for testes survival. The time from onset of symptoms until surgery is a well-known factor determining testicular survival but there is no data regarding the contribution of in-hospital management duration to testicular survival. Unlike the time from onset of symptoms until seeking medical attention, the time from registration to the emergency department (ED) to the time of detorsion-"Door To Detorsion time" (DTD) is dependent on medical providers and should be minimized. MATERIALS AND METHODS: Data was retrieved on all patients who underwent surgery for testicular torsion in 1994-2014 (N = 219). We used multivariable logistic regression analysis to examine independent association between DTD time or duration of symptoms to testicular survival. RESULTS: Median DTD time was 135 minutes (range 23-546). Among patients with a viable testis, median DTD time was 107 minutes (range 35-381) compared to 160 minutes (range 23-546) among patients with a nonviable testis (P <.001). Logistic regression models showed that both DTD time (P = .04) and duration of symptoms (P <.001) are independent factors associated with testicular survival. Adjusted odds ratio was 1.0048 for a nonviable testis for every minute of delayed management in the ED (P = .04). Results suggest that every 10 minutes of delay in the ED increases the chance of having a nonviable testis in exploration by 4.8%. CONCLUSION: DTD is an independent factor predicting testicular survival. Institutional efforts should be made to decrease duration of DTD. DTD should be considered as a measure for quality of care.


Assuntos
Torção do Cordão Espermático/cirurgia , Tempo para o Tratamento/estatística & dados numéricos , Adolescente , Adulto , Criança , Pré-Escolar , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Terapia de Salvação/métodos , Adulto Jovem
16.
N Z Med J ; 132(1499): 49-55, 2019 07 26.
Artigo em Inglês | MEDLINE | ID: mdl-31352474

RESUMO

BACKGROUND: Stroke rehabilitation often needs to continue following discharge from hospital. The New Zealand Stroke Network recommends community team review within seven calendar days of discharge and a minimum of three hours of therapy per specialty per week. International stroke guidelines make similar recommendations. The Wellington Community Older Adults, Rehabilitation and Allied Health team aimed to determine current local community stroke rehabilitation practice and compare this to guideline recommendations. METHOD: A prospective cohort of 50 patients with a new diagnosis of stroke, referred to a community rehabilitation team in Wellington, were included in this service audit. The amount of rehabilitation patients received in the first four weeks and first three months following hospital discharge was measured, as well as time to first appointment. In addition, a service satisfaction questionnaire was sent to the patients. RESULTS: The median (interquartile range, IQR) number of days from hospital discharge until first appointment with the community team was 10 (6.3-14.8) calendar days. In the first four weeks after hospital discharge, patients received from all health professionals an average (SD) of 1.1(0.4) rehabilitation sessions and 34.2 (43.6) minutes of rehabilitation per week. The average (SD) in the first three months or to point of discharge, whichever occurred first was 1.1 (1.1) sessions and 42.2 (49.3) minutes of rehabilitation per week. CONCLUSION: There were delays in providing an initial community rehabilitation appointment and insufficient therapy intensity when comparing audit results to New Zealand Guideline expectations. As a result of this audit, recommendations for service improvements have been made.


Assuntos
Reabilitação do Acidente Vascular Cerebral/estatística & dados numéricos , Humanos , Auditoria Médica , Nova Zelândia/epidemiologia , Estudos Prospectivos , Acidente Vascular Cerebral/epidemiologia , Tempo para o Tratamento/estatística & dados numéricos
17.
N Z Med J ; 132(1498): 41-59, 2019 07 12.
Artigo em Inglês | MEDLINE | ID: mdl-31295237

RESUMO

AIM: Prompt access to cardiac defibrillation and reperfusion therapy improves outcomes in patients with ST-segment elevation myocardial infarction (STEMI). The study aim was to describe the 'patient' and 'system' delay in patients who receive acute reperfusion therapy for ST-elevation myocardial infarction (STEMI) in New Zealand. METHODS: In 2015-17, 3,857 patients who received acute reperfusion therapy were captured in the All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) registry. 'Patient delay' is the time from symptom onset to first medical contact (FMC), and 'system delay' the time from FMC until reperfusion therapy (primary percutaneous coronary intervention (PCI) or fibrinolysis). RESULTS: Seventy percent of patients received primary PCI and 30% fibrinolysis. Of those receiving fibrinolysis, 122 (10.5%) received pre-hospital fibrinolysis. Seventy-seven percent were transported to hospital by ambulance. After adjustment, people who were older, male and presented to a hospital without a routine primary PCI service were less likely to travel by ambulance. Patient delay: The median delay was 45 minutes for ambulance-transported patients and 97 minutes for those self-transported to hospital, with a quarter delayed by >2 hours and >3 hours, respectively. Delay >1 hour was more common in older patients, Maori and Indian patients and those self-transported to hospital. System delay: For ambulance-transported patients who received primary PCI, the median time was 119 minutes. For ambulance-transported patients who received fibrinolysis, the median system delay was 86 minutes, with Maori patients more often delayed than European/Other patients. For patients who received pre-hospital fibrinolysis the median delay was 46 minutes shorter. For the quarter of patients treated with rescue PCI after fibrinolysis, the median needle-to-rescue time was prolonged-four hours. CONCLUSIONS: Nationwide implementation of the NZ STEMI pathway is needed to reduce system delays in delivery of primary PCI, fibrinolysis and rescue PCI. Ongoing initiatives are required to reduce barriers to calling the ambulance early after symptom onset.


Assuntos
Reperfusão Miocárdica , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Tempo para o Tratamento/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reperfusão Miocárdica/estatística & dados numéricos , Nova Zelândia , Melhoria de Qualidade , Sistema de Registros , Fatores de Risco , Fatores de Tempo , Transporte de Pacientes/estatística & dados numéricos
18.
J Glob Health ; 9(1): 010809, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31275569

RESUMO

Background: Mozambique has one of the highest under-5 mortality rates in the world. Community health workers (CHWs) are deployed to increase access to care; in Mozambique they are known as agentes polivalentes elementares (APEs). This study aimed to investigate child deaths in an area served by APEs by analysing the causes, care seeking patterns, and the influence of social capital. Methods: Caregivers of children under-5 who died in 2015 in Inhambane province, Mozambique, were interviewed using Verbal Autopsy/Social Autopsy (VA/SA) tools with a social capital module. VA data were analysed using the WHO InterVA analytical tool to determine cause of death. SA was analysed using the INDEPTH SA framework for illnesses lasting no more than three weeks. Social capital scores were calculated. Results: 117 child deaths were reported; VA/SA was conducted for 115. Eighty-five had died from an acute illness lasting no more than three weeks, which in most cases could have been treated at community level; 50.6% died from malaria, 11.8% from HIV/AIDS, and 9.4% for each of diarrhoea and acute respiratory infections. In 35.3% the caregiver only noticed that the child was sick when symptoms of very severe illness developed. One in four children were never taken outside the home before dying. Sixteen children were first taken to an APE; of these 7 had signs of very severe illness. Caregivers who waited to seek care until the illness was very severe had a lower social capital score. The mean travel time to go to the APE was 2hrs 50min, which was not different from any other provider. Most received treatment from the APE, 3 were referred. The majority went to another provider after the APE; most to a health centre. Conclusions: The leading causes of death in children under-5 can be detected, treated or referred by APEs. Major care seeking delays took place in the home, largely due to lack of early disease recognition and late decision-making. Low social capital, distance to APEs and to referral facilities likely contribute to these delays. Increasing caregiver illness awareness is urgently needed, as well as stronger referral linkages. A review of the geographical coverage and scope of work of APEs should be conducted.


Assuntos
Causas de Morte/tendências , Mortalidade da Criança/tendências , Serviços de Saúde Comunitária/organização & administração , Agentes Comunitários de Saúde , Acesso aos Serviços de Saúde , Mortalidade Infantil/tendências , Pré-Escolar , Pesquisa sobre Serviços de Saúde , Humanos , Lactente , Moçambique/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Capital Social , Tempo para o Tratamento/estatística & dados numéricos
19.
BMC Infect Dis ; 19(1): 489, 2019 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-31151423

RESUMO

BACKGROUND: A delayed initiation of tuberculosis treatment results in high morbidity, mortality, and increased person-to-person transmissions. The aim of this study was to assess treatment delay and its associated factors among adult drug resistant tuberculosis patients in the Amhara Regional State, Ethiopia. METHODS: An institution based cross-sectional study was conducted on all adult drug resistant tuberculosis patients who initiated treatment from September 2010 to December 2017. Data were collected from patient charts, registration books, and computer databases using abstraction sheets. The data were entered using Epi-info version 7 and exported to SPSS version 20 for analysis. Summary statistics, like means, medians, and proportions were used to present it. Binary logistic regression was fitted; Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI) was also computed. Variables with p-value < 0.05 in the multi-variable logistic regression model was declared as significantly associated with treatment delay. RESULTS: The median time to commence treatment after drug resistant tuberculosis diagnosis was 8 (IQR: 3-37) days. Being diagnosed by Line probe assay [AOR = 5.59; 95% CI: 3.48-8.98], Culture [AOR = 5.15; 95% CI: 2.53-10.47], and history of injectable anti-TB drugs [AOR = 2.12; 95% CI: 1.41-3.19] were associated with treatment delays. CONCLUSION: Treatment delay was long, especially among patients diagnosed by Culture or LPA and those who had a prior history of injectable anti-TB drugs. That suggested that the need for universal accesses to rapid molecular diagnostic tests, such as Gene Xpert and the PMDT team were needed to promptly decide to minimize unnecessary delays.


Assuntos
Tempo para o Tratamento/estatística & dados numéricos , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Tuberculose Pulmonar/diagnóstico , Adulto , Estudos Transversais , Diagnóstico Tardio/estatística & dados numéricos , Etiópia/epidemiologia , Feminino , Instalações de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Tuberculose Resistente a Múltiplos Medicamentos/diagnóstico , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/epidemiologia , Adulto Jovem
20.
Neurology ; 93(2): e159-e166, 2019 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-31182508

RESUMO

OBJECTIVE: To conduct a systematic review and meta-analysis on the effect of earlier or later resective epilepsy surgery on seizure outcome. METHODS: We searched the electronic databases PubMed, EMBASE, and Cochrane Library for studies investigating the association of epilepsy duration and seizure freedom after resective surgery. Two reviewers independently screened citations for eligibility and assessed relevant studies for risk of bias. We combined data in meta-analyses using a random effects model. We assessed the certainty of evidence according to Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS: Twenty-five studies were included, 12 of which had data suitable for meta-analyses. Comparing seizure outcome if epilepsy surgery was performed before vs after 2, 5, 10, and 20 years of epilepsy duration, and comparing epilepsy duration <5 years to >10 years, we found significant effects favoring shorter duration with risk differences ranging from 0.15 to 0.21 and risk ratios ranging from 1.20 to 1.33 (p < 0.01 for all comparisons). According to GRADE, we found low certainty of evidence favoring shorter epilepsy duration before surgery. CONCLUSION: People with shorter epilepsy duration are more likely to be seizure-free at follow-up. Furthermore, there is a positive association between shorter duration and seizure freedom also for very long epilepsy durations. Patients who might benefit from epilepsy surgery should therefore be referred for presurgical assessments without further delay, regardless of epilepsy duration. The low certainty of evidence acknowledges concerns regarding study heterogeneity and possible residual confounding.


Assuntos
Epilepsia Resistente a Medicamentos/cirurgia , Tempo para o Tratamento/estatística & dados numéricos , Humanos , Encaminhamento e Consulta , Fatores de Tempo , Resultado do Tratamento
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