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2.
J Surg Res ; 246: 300-304, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31648068

RESUMO

BACKGROUND: The National Emergency Laparotomy Audit (NELA) highlights the importance of identifying high-risk patients due to the potential for significant morbidity and mortality. The NELA risk prediction calculator (NRPC) was developed from data in England and Wales and is one of several calculators available. We seek to determine the utility of NRPC in the Australian population and compare it with Portsmouth Physiological and Operative Severity Score for the enumeration of mortality and Morbidity (P-POSSUM) and American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) calculators. METHODS: A retrospective review of all emergency laparotomies undertaken at four Australian centers was performed between January 2016 and December 2017. Data extracted from patient records were used to calculate NRPC, ACS-NSQIP, and P-POSSUM scores for 30-day mortality risk. The sensitivity of NRPC was assessed using the NELA high-risk cohort score of ≥10% and this was compared with the other two calculators. RESULTS: There were 562 (M = 261, mean age = 66 [±17] y) patient charts reviewed in the study period. 59 patients died within 30 d (10.5%). NRPC was able to identify 52 (sensitivity = 88.1%) of these as being within the high-risk group. Using the NELA high-risk cutoff, NRPC identified 52 deaths of 205 (25.4%) high-risk patients, P-POSSUM identified 46 of 245 (18.8%), and ACS-NSQIP identified 46 of 201 (22.9%). Using the McNemar test, no significant difference was noted between NRPC and P-POSSUM (P = 0.07) or NRPC and ACS-NSQIP (P = 0.18). CONCLUSIONS: In the Australian context, the NRPC is a highly sensitive and useful tool for predicting 30-day mortality in high-risk emergency laparotomy patients and is comparable with P-POSSUM and ACS-NSQIP calculators.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Tratamento de Emergência/efeitos adversos , Laparotomia/efeitos adversos , Auditoria Médica/normas , Complicações Pós-Operatórias/mortalidade , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/normas , Tratamento de Emergência/estatística & dados numéricos , Feminino , Humanos , Laparotomia/estatística & dados numéricos , Masculino , Auditoria Médica/estatística & dados numéricos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Melhoria de Qualidade , Estudos Retrospectivos , Medição de Risco/métodos , Medição de Risco/normas
3.
J Surg Res ; 245: 119-126, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31415933

RESUMO

BACKGROUND: Data on outcomes after surgery for sigmoid volvulus is limited. The aim of this study was to develop a model to predict need for emergent surgery and mortality after resection for sigmoid volvulus. METHODS: The NSQIP database was queried from 2012 to 2016 to identify patients undergoing segmental resection for sigmoid volvulus. Pre-, intra-, and post-operative variables were compared. Primary and secondary outcomes were emergent surgery and risk of mortality, respectively. Chi-square and Fischer's test for categorical variables and the Mann-Whitney test for continuous variables were used. Significant variables for each outcome were entered into a logistic regression model to predict the outcomes. RESULTS: 2086 patients met inclusion criteria. Factors associated with emergency surgery included female gender, relative hematocrit elevation, relative leukocytosis, acute kidney injury, preoperative sepsis, prior functional independence, and bleeding disorders. Laparoscopic resection and mechanical bowel preparation were more commonly used in the nonemergent setting. Patients having emergent resection were more likely to suffer from postoperative superficial surgical site infection, pneumonia, cardiac arrest, septic shock, myocardial infarction, and receive perioperative transfusion. No difference was seen in ileus, readmission or reoperation rates in the emergent and nonemergent groups. Factors predictive of postoperative mortality included increased age, systemic sepsis, and emergent surgery. Independence before illness, higher albumin levels, and lower BMI were shown to be protective. CONCLUSIONS: Emergent resection is independently associated with poor postoperative outcomes and mortality. Predictors of need for emergent resection and mortality identified in this study can be used to aid in shared decision-making for patients with sigmoid volvulus.


Assuntos
Tratamento de Emergência/efeitos adversos , Volvo Intestinal/cirurgia , Complicações Pós-Operatórias/mortalidade , Doenças do Colo Sigmoide/cirurgia , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais/estatística & dados numéricos , Tratamento de Emergência/estatística & dados numéricos , Feminino , Mortalidade Hospitalar , Humanos , Volvo Intestinal/mortalidade , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Período Perioperatório , Complicações Pós-Operatórias/etiologia , Medição de Risco/métodos , Fatores Sexuais , Doenças do Colo Sigmoide/mortalidade
4.
J Surg Res ; 245: 315-320, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31421379

RESUMO

BACKGROUND: Transplant patients are at the risk of serious sequelae from medical and surgical intervention. The incidence and burden of emergency general surgery (EGS) in transplant patients are scarcely known. This study aims to identify predictors of outcomes in transplant patients with EGS needs. METHODS: The Nationwide Inpatient Sample (2007-2011) was queried for adult patients (aged ≥16 y) who underwent abdominal visceral transplantation. These were further queried for a secondary diagnosis of an American Association for the Surgery of Trauma-defined EGS condition. Outcome measures included mortality, complications, length of stay, and cost of care. Propensity scores were used to match patients across baseline characteristics. Multivariate analysis was used to further adjust propensity score quintiles and hospital-level characteristics. RESULTS: A total of 35,573 transplant patients were identified. Of these, 30% (n = 10,676) developed an EGS condition. Most common EGS conditions were resuscitation (7.7%), intestinal obstruction (7.3%), biliary conditions (3.9%), and hernias (3.2%). Patients with public insurance, those in the highest income quartile, and those treated at larger hospitals had a lower likelihood of developing an EGS condition (P < 0.05). Patients with an EGS condition had a ninefold higher likelihood of mortality and a threefold higher likelihood of developing complications (odds ratio [95% confidence interval (CI)]: 9.21 [1.80-10.89] and 3.17 [3.02-3.34], respectively). Transplant patients after EGS had a longer risk-adjusted length of stay and cost of index hospitalization (Absolute difference [95% CI]: 12.70 [12.14-13.26] and $57,797 [55,415-60,179], respectively]). CONCLUSIONS: Transplant patients fare poorly after developing an EGS condition. The results of this study will help in identifying at-risk patients and determining outcomes.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Tratamento de Emergência/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Transplantados/estatística & dados numéricos , Adulto , Idoso , Bases de Dados Factuais/estatística & dados numéricos , Tratamento de Emergência/efeitos adversos , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Pontuação de Propensão , Estudos Retrospectivos , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Estados Unidos
5.
J Surg Res ; 245: 629-635, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31522036

RESUMO

BACKGROUND: Emergency general surgery (EGS) accounts for more than 2 million U.S. hospital admissions annually. Low-income EGS patients have higher rates of postoperative adverse events (AEs) than high-income patients. This may be related to health care segregation (a disparity in access to high-quality centers). The emergent nature of EGS conditions and the limited number of EGS providers in rural areas may result in less health care segregation and thereby less variability in EGS outcomes in rural areas. The objective of this study was to assess the impact of income on AEs for both rural and urban EGS patients. MATERIALS AND METHODS: The National Inpatient Sample (2007-2014) was queried for patients receiving one of 10 common EGS procedures. Multivariate regression models stratified by income quartiles in urban and rural cohorts adjusting for sociodemographic, clinical, and other hospital-based factors were used to determine the rates of surgical AEs (mortality, complications, and failure to rescue [FTR]). RESULTS: 1,687,088 EGS patients were identified; 16.60% (n = 280,034) of them were rural. In the urban cohort, lower income quartiles were associated with higher odds of AEs (mortality OR, 1.21 [95% CI, 1.15-1.27], complications, 1.07 [1.06-1.09]; FTR, 1.17 [1.10-1.24] P < 0.001). In the rural context, income quartiles were not associated with the higher odds of AE (mortality OR, 1.14 [0.83-1.55], P = 0.42; complications, 1.06 [0.97-1,16], P = 1.17; FTR, 1.12 [0.79-1.59], P = 0.52). CONCLUSIONS: Lower income is associated with higher postoperative AEs in the urban setting but not in a rural environment. This socioeconomic disparity in EGS outcomes in urban settings may reflect health care segregation, a differential access to high-quality health care for low-income patients.


Assuntos
Tratamento de Emergência/efeitos adversos , Disparidades em Assistência à Saúde/economia , Renda/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Adolescente , Adulto , Serviço Hospitalar de Emergência/estatística & dados numéricos , Tratamento de Emergência/estatística & dados numéricos , Falha da Terapia de Resgate/estatística & dados numéricos , Feminino , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Mortalidade Hospitalar , Hospitais Rurais/estatística & dados numéricos , Hospitais Urbanos/estatística & dados numéricos , Humanos , Pacientes Internados/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , População Rural/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Estados Unidos/epidemiologia , População Urbana/estatística & dados numéricos , Adulto Jovem
6.
BMC Health Serv Res ; 19(1): 968, 2019 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-31842853

RESUMO

BACKGROUND: Basic and comprehensive emergency obstetric care services in Pakistan remain a challenge considering continued high burden of maternal and newborn mortality. This study aimed to assess the availability of emergency obstetric and newborn care in Sindh Province of Pakistan. METHODS: This cross-sectional survey was conducted in twelve districts of the Sindh province in Pakistan. The districts were selected based on the maternal neonatal and child health indicators. Data were collected from 63 public-sector health facilities including district, Taluka (subdistrict) headquarters hospitals and rural health centers. Basic and comprehensive emergency obstetric newborn care services were assessed through direct observations and interviews with the heads of the health facilities by using a World Health Organization pretested and validated data collection tool. Participants interviewed in this study included the managers and auxiliary staff and in health facilities. RESULTS: Availability of caesarean section (23, 95% C.I. 14.0-35.0) and blood transfusion services (57, 95% CI. 44.0-68.0), the two components of comprehensive emergency obstetric and newborn care, was poor in our study. However, assessment of the seven components of basic emergency obstetric and newborn services showed that 92% of the health facilities (95% C.I. 88.0-96.0) had parenteral antibiotics, 90%, (95% C.I. 80.0-95.0) had oxytocin, 92% (95% CI 88.0-96.0) had manual removal of the placenta service, 87% (95%, C.I. 76.0-93.0) of the facilities had staff who could remove retained products of conception, 82% (95% C.I. 71.0-89.0) had facilities for normal birth and 80% (95% C.I. 69.0-88.0) reported presence of neonatal resuscitation service. CONCLUSION: Though the basic obstetric and newborn services were reasonably available, comprehensive obstetric and newborn services were not available as per the World Health Organization's standards in the surveyed public health facilities. Ensuring the availability of caesarean section and blood transfusion services within these facilities may improve population's access to these essential services around birth.


Assuntos
Serviços Médicos de Emergência/provisão & distribução , Instalações de Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Serviços de Saúde Materna/provisão & distribução , Serviços de Saúde da Criança/provisão & distribução , Estudos Transversais , Parto Obstétrico/estatística & dados numéricos , Serviços Médicos de Emergência/estatística & dados numéricos , Tratamento de Emergência/estatística & dados numéricos , Feminino , Humanos , Recém-Nascido , Serviços de Saúde Materna/estatística & dados numéricos , Paquistão , Gravidez
7.
Ulus Travma Acil Cerrahi Derg ; 25(6): 589-596, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31701493

RESUMO

BACKGROUND: Late diagnosis continues to be a significant problem in the treatment of colorectal cancer (CRC). Most cases require emergency surgical intervention due to acute intestinal obstruction or perforation. This retrospective study was formed from an assessment of the clinical presentation, treatment, early results, and survival of patients with CRC undergoing emergency surgery for acute obstruction or perforation. METHODS: Between 2012 and 2017, 612 patients underwent surgery for CRC. In all, 179 patients who required emergency treatment were retrospectively evaluated according to age, gender, significant comorbidities, physiological status, surgical indications, tumor location, tumor stage, perioperative blood transfusion rate, type of surgery, and the length of the operation and hospitalization. RESULTS: In total, 152 (85%) patients had a complete obstruction and 27 (15%) patients had a perforation. A major postoperative complication was identified nearly in half of the patients. The overall mortality rate was 12% (22 patients). Mortality was seen in 12% (18 patients) cases received surgery due to obstruction and in 15% (four patients) cases received surgery due to perforation. Perioperative blood transfusion and a high Acute Physiology and Chronic Health Evaluation II score were independent factors that predicted a major complication. Advanced age and perioperative blood transfusion were statistically independent prognostic factors for mortality. CONCLUSION: Consisted with the findings of studies in the literature, the results of this study also revealed a high perioperative morbidity and mortality rate in patients with CRC who required urgent surgery. Our findings suggest that early detection and treatment of CRC with screening programs can be life-saving.


Assuntos
Neoplasias Colorretais , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/patologia , Neoplasias Colorretais/cirurgia , Diagnóstico Tardio , Tratamento de Emergência/efeitos adversos , Tratamento de Emergência/estatística & dados numéricos , Humanos , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Complicações Pós-Operatórias , Estudos Retrospectivos
8.
Ulus Travma Acil Cerrahi Derg ; 25(6): 611-615, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31701494

RESUMO

BACKGROUND: Inguinal hernia affects 3-8% of the population. Femoral hernias are only a small number of groin hernias; however, femoral hernias are very important because these operations are generally emergency procedures, and bowel resections are frequently necessary. This study aims to compare surgical outcomes of patients with femoral hernias using different techniques under emergency or elective conditions. METHODS: Between April 2013 and November 2017, 52 patients with femoral hernias were admitted to the emergency department of the General Surgery Clinics at two university hospitals in Istanbul. The medical files of all the patients who underwent surgery with a diagnosis of a femoral hernia were retrospectively evaluated. The demographic data, hernia side information, sac contents, surgical technique, length of hospital stay, recurrence according to the last outpatient clinic and complications were retrospectively analyzed. RESULTS: The sex distribution of the cases was as follows: 88.5% (n=46) of the patients were female, and 11.5% (n=6) were male. The mean age was 62.9±16.49 years (31-91 years). There were no significant differences between the two groups, according to the hernia side (p=0.282). Thirteen of the elective cases (52%) were operated using open techniques, and 12 cases (48%) were operated using laparoscopic techniques. CONCLUSION: For the comparison of surgical techniques and outcomes, prospective randomized studies should be designed to standardize broad-based surgical techniques.


Assuntos
Procedimentos Cirúrgicos Eletivos , Tratamento de Emergência , Hérnia Femoral , Herniorrafia , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Tratamento de Emergência/efeitos adversos , Tratamento de Emergência/estatística & dados numéricos , Feminino , Hérnia Femoral/epidemiologia , Hérnia Femoral/cirurgia , Herniorrafia/efeitos adversos , Herniorrafia/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Recidiva , Estudos Retrospectivos , Turquia/epidemiologia
9.
Am Surg ; 85(10): 1142-1145, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657311

RESUMO

The ACS Committee on Trauma specifies prehospital criteria that trigger trauma team activation (TTA). The study aims to define the relationship between TTA and time of day, mechanism of injury, and need for operative intervention. All trauma patients presenting to LAC+USC (January 2008-July 2018) after triggering TTA were screened. Patients were excluded if time of ED arrival was undocumented. Demographics, injury data, and outcomes were analyzed. After exclusions (<1%), 54,826 patients were enrolled. The median age was 35 [IQR 23-53]. The median Injury Severity Score was 4 [1-10]. The most common mechanisms of injury were falls (n = 14,166; 31%), auto versus pedestrian collisions (n = 11,921; 26%), and motor vehicle collisions (n = 11,024; 24%). Penetrating trauma comprised 16 per cent (n = 8,686). The busiest hour for TTAs was 19:00 to 20:00, although penetrating trauma was most common between 23:00 and 01:00. Emergent surgical intervention in absolute numbers was most frequent between 20:00 and 01:00. As a proportion of the number of TTAs per hour, emergent operative intervention was most frequent between 23:00 and 06:00. In conclusion, the volume of TTAs and the triggering mechanism of injury vary significantly by time of day. The need for operative intervention is highest overnight. This information can be used to help increase hospital preparedness and allocate resources accordingly.


Assuntos
Serviços Médicos de Emergência/estatística & dados numéricos , Fatores de Tempo , Centros de Traumatologia/estatística & dados numéricos , Ferimentos não Penetrantes/etiologia , Ferimentos Penetrantes/etiologia , Escala Resumida de Ferimentos , Adulto , California/epidemiologia , Tratamento de Emergência/estatística & dados numéricos , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Triagem , Ferimentos não Penetrantes/epidemiologia , Ferimentos não Penetrantes/mortalidade , Ferimentos não Penetrantes/cirurgia , Ferimentos Penetrantes/epidemiologia , Ferimentos Penetrantes/mortalidade , Ferimentos Penetrantes/cirurgia , Adulto Jovem
10.
Rev. clín. esp. (Ed. impr.) ; 219(7): 390-393, oct. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-ET1-4056

RESUMO

Objetivo: Evaluar en pacientes diagnosticados de tuberculosis pulmonar la frecuencia de asistencias en Urgencias en los 6meses previos al diagnóstico, conocer los motivos de la asistencia, el grado de sospecha en Urgencias y los factores a los que se asociaba esta sospecha. Método: Estudio retrospectivo de los casos de tuberculosis pulmonar atendidos en un servicio de Urgencias generales entre 2011 y 2017. Resultados: De los 54 pacientes incluidos, 38 (70%) habían sido atendidos en el servicio de Urgencias en los 6meses previos al diagnóstico: 6 (16%) por procesos sin relación con la tuberculosis y 32 (84%) con relación potencial. En 12 (38%) de estos pacientes se sospechó en Urgencias la posibilidad del diagnóstico de tuberculosis pulmonar, y no se sospechó en los restantes 20 pacientes (62%). El grupo en el que se sospechó tenía más frecuencia de síntomas generales y respiratorios y más frecuencia de cavitación en la radiografía. Conclusiones: Un elevado porcentaje de pacientes con tuberculosis pulmonar han consultado en Urgencias en los 6meses previos al diagnóstico, y con mucha frecuencia esta posibilidad diagnóstica no se sospecha


Objective: To assess the frequency of care in an emergency department in the 6months prior to the diagnosis of tuberculosis and to determine the reasons for the care, the degree of suspicion in the emergency department and the factors associated with this suspicion. Method: A retrospective study was conducted on patients with pulmonary tuberculosis treated in the general emergency department between 2011 and 2017. Results: Of the 54 included patients, 38 (70%) had been treated in the emergency department in the 6months prior to the diagnosis: 6 (16%) patients had been treated for processes unrelated to the tuberculosis, and 32 (84%) were treated for processes that were potentially related to the tuberculosis. Pulmonary tuberculosis was suspected in the emergency department for 12 (38%) of these patients and not suspected in the remaining 20 patients (62%). The group in which pulmonary tuberculosis was suspected had a higher rate of general and respiratory symptoms and cavitation in the radiography. Conclusions: A high percentage of patients with pulmonary tuberculosis were admitted to the emergency department in the 6months prior to the diagnosis, and this diagnostic possibility was often not suspected


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Erros de Diagnóstico/estatística & dados numéricos , Mycobacterium tuberculosis/isolamento & purificação , Tratamento de Emergência/estatística & dados numéricos , Tuberculose Pulmonar/epidemiologia , Tuberculose/diagnóstico , Serviço Hospitalar de Emergência/estatística & dados numéricos , Estudos Retrospectivos
11.
Rev Col Bras Cir ; 46(4): e2211, 2019 Sep 09.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31508734

RESUMO

OBJECTIVE: to evaluate the applicability of the "Timing of Acute Care Surgery" (TACS) color classification system in a tertiary public hospital of a developing country. METHODS: we conducted a longitudinal, retrospective study in a single center, from March to August 2016 and the same period in 2017. We opted for the selection of four surgical specialties with high demand for emergencies, previously trained on the TACS system. For comparisons with the previous classifications, we considered emergencies as reds and oranges and urgencies, as yellow, with an ideal time interval for surgery of one hour and six hours, respectively. RESULTS: non-elective procedures accounted for 61% of the total number of surgeries. The red, orange and yellow classifications were predominant. There was a significant improvement in the time before surgery in the yellow color after the TACS system. Day and night periods influenced the results, with better ones during the night. CONCLUSION: this is the first study to use the TACS system in the daily routine of an operating room. The TACS system improved the time of attendance of surgeries classified as yellow.


Assuntos
Tratamento de Emergência/classificação , Triagem/métodos , Brasil , Cor , Emergências , Tratamento de Emergência/estatística & dados numéricos , Humanos , Estudos Longitudinais , Sistemas de Informação em Salas Cirúrgicas , Salas Cirúrgicas , Estudos Retrospectivos , Especialidades Cirúrgicas/classificação , Especialidades Cirúrgicas/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/classificação , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Centros de Atenção Terciária , Fatores de Tempo
12.
BMC Health Serv Res ; 19(1): 609, 2019 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-31464616

RESUMO

BACKGROUND: There are a number of limitations to the present primary eye care system in the UK. Patients with minor eye conditions typically either have to present to their local hospital or GP, or face a charge when visiting eye care professionals (optometrists). Some areas of the UK have commissioned enhanced community services to alleviate this problem; however, many areas have not. The present study is a needs assessment of three areas (Leeds, Airedale and Bradford) without a Minor Eye Conditions Service (MECS), with the aim of determining whether such a service is clinically or economically viable. METHOD: A pro forma was developed for optometrists and practice staff to complete when a patient presented whose reason for attending was due to symptoms indicative of a problem that could not be optically corrected. This form captured the reason for visit, whether the patient was seen, the consultation funding, the outcome and where the patient would have presented to if the optometrists could not have seen them. Optometrists were invited to participate via Local Optical Committees. Results were submitted via a Google form or a Microsoft Excel document and were analysed in Microsoft Excel. RESULTS: Seventy-five percent of patients were managed in optometric practice. Nine and 16% of patients required subsequent referral to their General Practitioner or hospital ophthalmology department, respectively. Should they not have been seen, 34% of patients would have presented to accident and emergency departments and 59% to their general practitioner. 53% of patients paid privately for the optometrist appointment, 28% of patients received a free examination either through use of General Ophthalmic Service sight tests (9%) or optometrist good will (19%) and 19% of patients did not receive a consultation and were redirected to other providers (e.g. pharmacy, accident and emergency or General Practitioner). 88% of patients were satisfied with the level of service. Cost-analyses revealed a theoretical cost saving of £3198 to the NHS across our sample for the study period, indicating cost effectiveness. CONCLUSIONS: This assessment demonstrates that a minor eye condition service in the local areas would be economically and clinically viable and well received by patients.


Assuntos
Oftalmopatias/diagnóstico , Oftalmopatias/terapia , Determinação de Necessidades de Cuidados de Saúde , Análise Custo-Benefício , Emergências/economia , Serviço Hospitalar de Emergência/economia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Tratamento de Emergência/economia , Tratamento de Emergência/estatística & dados numéricos , Inglaterra , Oftalmopatias/economia , Clínicos Gerais/economia , Clínicos Gerais/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Humanos , Oftalmologia/estatística & dados numéricos , Optometria/estatística & dados numéricos , Satisfação do Paciente , Atenção Primária à Saúde/economia , Atenção Primária à Saúde/estatística & dados numéricos , Encaminhamento e Consulta/economia , Encaminhamento e Consulta/estatística & dados numéricos
13.
Emerg Med J ; 36(10): 620-624, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31292206

RESUMO

OBJECTIVES: The last decade has seen rapid expansion of emergency care systems across Africa, although they remain underdeveloped. In Zambia, the Ministry of Health has taken interest in improving the situation and data are needed to appropriately guide system strengthening efforts. The Emergency Care Assessment Tool (ECAT) provides a context-specific means of measuring capacity of healthcare facilities in low- and middle-income countries. We evaluated Zambian public hospitals using the ECAT to inform resource-effective improvements to the nation's healthcare system. METHODS: The ECAT was administered to the lead clinician in the emergency unit at 23 randomly sampled public hospitals across seven of Zambia's 10 provinces in March 2016. Data were collected regarding hospitals' perceived abilities to perform a number of predefined signal functions - life-saving procedures that encompass the need for both skills and resources. Signal functions (36 for intermediate facilities, 51 for advanced) related to six sentinel conditions that represent a large burden of morbidity and mortality from emergencies. We report the proportion of procedures that each level of hospital was capable of, along with barriers to delivery of care. RESULTS: Across all hospitals, most of the level-appropriate emergency care procedures could be performed. Intermediate level (district) hospitals were able to perform 75% (95% CI 73.2 to 76.8) of signal functions for the six conditions. Among advanced level hospitals, provincial hospitals were able to perform 68.6% (67.4% to 69.7%) and central hospitals 96.1% (95% CI 93.5 to 98.7) Main failures in delivery of care were attributed to a lack of healthcare worker training and availability of consumable resources, such as medicines or supplies. CONCLUSION: Zambian public hospitals have reasonable capacity to care for acutely ill and injured patients; however, there is a need for increased training and improved supply chains.


Assuntos
Serviços Médicos de Emergência/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Estudos Transversais , Países em Desenvolvimento , Serviços Médicos de Emergência/organização & administração , Tratamento de Emergência/estatística & dados numéricos , Recursos em Saúde/organização & administração , Recursos em Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Hospitais Públicos/organização & administração , Humanos , Zâmbia
14.
PLoS One ; 14(5): e0216551, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31112586

RESUMO

BACKGROUND: Prior acute coronary syndrome (ACS) registries in Saudi Arabia might not have accurately described the true demographics and cardiac care of patients with ACS. We aimed to evaluate the clinical characteristics, management, and outcomes of a representative sample of patients with acute myocardial infarction (AMI) in Saudi Arabia. METHODS: We conducted a 1-month snap-shot, prospective, multi-center registry study in 50 hospitals from various health care sectors in Saudi Arabia. We followed patients for 1 month and 1 year after hospital discharge. Patients with AMI included those with or without ST-segment elevation (STEMI or NSTEMI, respectively). This program survey will be repeated every 5 years. RESULTS: Between May 2015 and January 2017, we enrolled 2233 patients with ACS (mean age was 56 [standard deviation = 13] years; 55.6% were Saudi citizens, 85.7% were men, and 65.9% had STEMI). Coronary artery disease risk factors were high; 52.7% had diabetes mellitus and 51.2% had hypertension. Emergency Medical Services (EMS) was utilized in only 5.2% of cases. Revascularization for patients with STEMI included thrombolytic therapy (29%), primary percutaneous coronary intervention (PCI); (42.5%), neither (29%), or a pharmaco-invasive approach (3%). Non-Saudis with STEMI were less likely to undergo primary PCI compared to Saudis (35.8% vs. 48.7%; respectively, p <0.001), and women were less likely than men to achieve a door-to-balloon time of <90 min (42% vs. 65%; respectively, p = 0.003). Around half of the patients with NSTEMI did not undergo a coronary angiogram. All-cause mortality rates were 4%, 5.8%, and 8.1%, in-hospital, at 1 month, and at 1 year, respectively. These rates were significantly higher in women than in men. CONCLUSIONS: There is an urgent need for primary prevention programs, improving the EMS infrastructure and utilization, and establishing organized ACS network programs. AMI care needs further improvement, particularly for women and non-Saudis.


Assuntos
Síndrome Coronariana Aguda/epidemiologia , Tratamento de Emergência/estatística & dados numéricos , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/terapia , Adulto , Idoso , Gerenciamento Clínico , Serviços Médicos de Emergência , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/mortalidade , Estudos Prospectivos , Arábia Saudita/epidemiologia , Caracteres Sexuais
15.
Ir Med J ; 112(3): 895, 2019 03 14.
Artigo em Inglês | MEDLINE | ID: mdl-31045334

RESUMO

Introduction This study aimed to review the profile of women attending an out of hours emergency service (OHS) in a maternity hospital and compare it to a previous study. Methods Retrospective study. Demographic information was recorded including timing of presentation, reason and outcome. Results In 2017, 9,020 women attended the OHS, a 334% increase since 1993. On detailed review of 2,143 charts, most (84.7%, n=1,815) were antenatal. The most common reason for presenting to the OHS then was first trimester bleeding. In 2017, over half of antenatal women (51%, n=1,092) presented with "other" reasons, such as vomiting, hypertension or suspected pre-eclampsia. Admission rates significantly decreased from 1993 (38% (n=1,053) in 1993 vs. 16% (n=338) in 2017; p<0.05). Discussion Numbers attending for emergency maternity care have increased in both numbers and variety of presentations. It is important that women are seen and cared for in a compassionate, kind and evidence based manner.


Assuntos
Plantão Médico/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Tratamento de Emergência/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Maternidades/estatística & dados numéricos , Complicações na Gravidez/epidemiologia , Feminino , Humanos , Hipertensão/epidemiologia , Irlanda/epidemiologia , Pré-Eclâmpsia/epidemiologia , Gravidez , Estudos Retrospectivos , Fatores de Tempo , Hemorragia Uterina/epidemiologia , Vômito/epidemiologia
16.
Ir Med J ; 112(3): 896, 2019 03 14.
Artigo em Inglês | MEDLINE | ID: mdl-31045335

RESUMO

Introduction Elective and emergency paediatric general surgery is performed in numerous hospitals but with differing exclusion and transfer thresholds. Recent national guidelines detail necessary surgical, anaesthetic and nursing resources for safe and efficient delivery of services. Methods A retrospective review of paediatric surgical admissions was performed from January 2015 to December 2016. Charts of prolonged admissions or readmissions were reviewed. Results There was a total of 2,079 surgical admissions. 575 (27.2%) were elective and 1504 (71.2%) were emergency admissions. Significantly more surgical procedures were performed in 2016 (n=546, 56% versus n=433, 44.2%). Laparoscopic appendicectomy was the most commonly performed procedure. Re-admission rates were lower in 2016 (n=9, 0.8% versus n=21, 2.2%). All complications were Clavien-Dindo Grade I or II. Discussion Paediatric general surgery can be safely and efficiently performed by staffed and resourced Model III hospitals.


Assuntos
Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Tratamento de Emergência/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Pediatria/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Criança , Pré-Escolar , Feminino , Hospitais , Humanos , Lactente , Tempo de Internação , Masculino , Readmissão do Paciente/estatística & dados numéricos , Estudos Retrospectivos , Segurança , Fatores de Tempo
17.
Rev Saude Publica ; 53: 36, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31066814

RESUMO

OBJECTIVE: To analyze the emergency hospitalizations trend for ambulatory care sensitive conditions between 2011 and 2015 in a health insureance company of the Colombian Social Security General System. METHODS: A log-linear analysis based on age-adjusted hospitalization rates for ambulatory care sensitive conditions in the Entidad Promotora de Salud Sanitas was used to estimate the annual percentage change in these rates and to identify joinponts of the rates. Data was collected from administrative sources. RESULTS: There were 38,530 hospitalizations for ambulatory care sensitive conditions in 26,501 Entidad Promotora de Salud Sanitas enrollees, with a significant decrease in hospitalization rates. The annual percentage change estimated for the period was -9.5% with no significant joinpoints throughout the time interval. CONCLUSIONS: A significant reduction in hospital admissions due to ambulatory care sensitive conditions in Entidad Promotora de Salud Sanitas enrollees were reported for the last five years in this study.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Tratamento de Emergência/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Doença Aguda , Adolescente , Adulto , Distribuição por Idade , Idoso , Assistência Ambulatorial/tendências , Criança , Doença Crônica , Colômbia/epidemiologia , Tratamento de Emergência/tendências , Feminino , Hospitalização/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde/estatística & dados numéricos , Atenção Primária à Saúde/tendências , Estudos Retrospectivos , Fatores de Tempo , Adulto Jovem
18.
World Neurosurg ; 127: 541-548, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30902769

RESUMO

BACKGROUND: In conjunction with Vietnam's unparalleled economic growth over the past 20 years, our scope of neurosurgical interventions has considerably diversified throughout this time period. METHODS: Although still appreciably limited, healthcare resources and infrastructure have expanded and shifted the focus within neurosurgery at Ho Chi Minh City's Cho Ray Hospital from head trauma (which remains highly prevalent) to an equal proportion of elective cases for vascular lesions, tumors, and degenerative spine disease. Arguably the most significant progress throughout the new millennium has been achieved in the realm of neurosurgical oncology. RESULTS: About 1000 craniotomies are performed annually for brain tumors at our institution, most of which are for lower-grade lesions that result in excellent surgical outcomes. We continue to strive to improve the standard of care for patients with malignant brain tumors, as the first multidisciplinary neuro-oncology care team was founded recently in 2016. CONCLUSIONS: This article is the first in the English neurosurgical literature to report on the current state and outcomes of neuro-oncology in Vietnam, as we highlight our experiences in caring for patients with brain tumors at Cho Ray Hospital.


Assuntos
Neoplasias Encefálicas/cirurgia , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Adulto , Idoso , Neoplasias Encefálicas/tratamento farmacológico , Neoplasias Encefálicas/secundário , Craniotomia/estatística & dados numéricos , Craniotomia/tendências , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos/tendências , Tratamento de Emergência/estatística & dados numéricos , Tratamento de Emergência/tendências , Feminino , Glioblastoma/cirurgia , Humanos , Masculino , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Pessoa de Meia-Idade , Gradação de Tumores , Neuroma Acústico/cirurgia , Procedimentos Neurocirúrgicos/tendências , Equipe de Assistência ao Paciente , Estudos Prospectivos , Radiocirurgia/estatística & dados numéricos , Radiocirurgia/tendências , Vietnã , Adulto Jovem
19.
PLoS One ; 14(3): e0213362, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30835777

RESUMO

INTRODUCTION: Delays in arrival and treatment at health facilities lead to negative health outcomes. Individual and external factors could be associated with these delays. This study aimed to assess common factors associated with arrival and treatment delays in the emergency departments (ED) of three hospitals in humanitarian settings. METHODOLOGY: This was a cross-sectional study based on routine data collected from three MSF-supported hospitals in Afghanistan, Haiti and Sierra Leone. We calculated the proportion of consultations with delay in arrival (>24 hours) and in treatment (based on target time according to triage categories). We used a multinomial logistic regression model (MLR) to analyse the association between age, sex, hospital and diagnosis (trauma and non-trauma) with these delays. RESULTS: We included 95,025 consultations. Males represented 65.2%, Delay in arrival was present in 27.8% of cases and delay in treatment in 27.2%. The MLR showed higher risk of delay in arrival for females (OR 1.2, 95% CI 1.2-1.3), children <5 (OR 1.4, 95% CI 1.4-1.5), patients attending to Gondama (OR 30.0, 95% CI 25.6-35.3) and non-trauma cases (OR 4.7, 95% CI 4.4-4.8). A higher risk of delay in treatment was observed for females (OR 1.1, 95% CI 1.0-1.1), children <5 (OR 2.0, 95% CI 1.9-2.1), patients attending to Martissant (OR 14.6, 95% CI 13.9-15.4) and non-trauma cases (OR 1.6, 95% CI 1.5-1.7). CONCLUSIONS: Women, children <5 and non-trauma cases suffered most from delays. These delays could relate to educational and cultural barriers, and severity perception of the disease. Treatment delay could be due to insufficient resources with consequent overcrowding, and severity perception from medical staff for non-trauma patients. Extended community outreach, health promotion and support to community health workers could improve emergency care in humanitarian settings.


Assuntos
Serviço Hospitalar de Emergência , Tratamento de Emergência , Tempo para o Tratamento , Adolescente , Adulto , Afeganistão , Idoso , Altruísmo , Criança , Pré-Escolar , Estudos Transversais , Serviço Hospitalar de Emergência/estatística & dados numéricos , Tratamento de Emergência/estatística & dados numéricos , Feminino , Haiti , Hospitais , Humanos , Lactente , Recém-Nascido , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Encaminhamento e Consulta , Serra Leoa , Tempo para o Tratamento/estatística & dados numéricos , Triagem , Adulto Jovem
20.
Rev. esp. med. legal ; 45(1): 12-17, ene.-mar. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-182341

RESUMO

Introducción: Los partes de lesiones son documentos médico-legales que contienen la comunicación a la autoridad judicial de cualquier lesión consecuencia de una conducta delictiva, accidental o autoinflingida. La experiencia diaria indica una elevada prevalencia de cumplimentación incompleta o errónea, lo que dificulta la tarea del médico forense y, con ello, la posterior reparación del daño producido a la víctima. El objetivo de este trabajo es evaluar la calidad de la cumplimentación de los partes de lesiones emitidos por Atención Primaria y Urgencias en el ámbito provincial de Córdoba mediante la propuesta de una escala e identificar los errores más prevalentes cometidos durante dicha cumplimentación. Material y métodos: Estudio descriptivo, transversal y retrospectivo. Se seleccionaron 127 partes de lesiones del archivo del Instituto de Medicina Legal y Ciencias Forenses de Córdoba, emitidos por los servicios de Urgencias y Atención Primaria entre 1 de enero y 30 de junio de 2015, mediante un muestreo consecutivo, y se les aplicó una escala de calidad de realización propia. Resultados: El 18,1% de los partes de lesiones son de baja o ínfima calidad, encuadrándose la mayoría (78,7%) como de calidad intermedia. No obstante, la generalidad de los partes son muy defectuosos en los apartados estrictamente médico-legales, que son los relacionados con la descripción de las lesiones (localización, tipo, dimensión y estado evolutivo de las mismas), que han obtenido las puntuaciones más bajas. Conclusiones: Se demuestra la deficiente calidad de los partes de lesiones emitidos por los servicios de Atención Primaria y Urgencias en nuestra provincia y se hace necesaria una estrategia para mejorar la cumplimentación de estos documentos médico-legales


Introduction: Injury reports are medico-legal documents containing the required information about injuries (from accidental, criminal or self-inflicted origin) to be delivered to the judicial authority. Nevertheless, forensic routine work suggests a high rate of inadequate or erroneous injury reports. This hinders forensic evaluation and, consequently, damage repair. The main objective of this paper is to evaluate the quality of the completion of injury reports issued by Primary Care and Emergency services in Córdoba, Spain, by using a new scale, as well as to identify the most prevalent mistakes made during that completion. Material and methods: Descriptive cross-sectional and retrospective study conducted on 127 injury reports issued by Primary Care and Emergency services selected from the archive of the Institute of Legal Medicine and Forensic Science of Córdoba, using consecutive sampling, between 1 January 2015 and 30 June 2015. A quality scale of our own creation was then applied to them. Results: The analysis showed that 18.1% of injury reports are of low or very low quality, while the majority (78.7%) are considered as intermediate quality. Nevertheless, most of them are very poorly described −with the lowest scores− in relation to strictly medico-legal parts; the description of the injury, including type, dimension and evolutionary stage. Conclusions: The study shows the poor quality of the injury reports issued by Primary Care and Emergency services within the province of Córdoba. Further strategies are needed in order to improve the completion of these medico-legal documents


Assuntos
Humanos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Registros Médicos/normas , Ferimentos e Lesões/epidemiologia , Tratamento de Emergência/estatística & dados numéricos , Controle de Qualidade , Controle de Formulários e Registros/normas , Índices de Gravidade do Trauma , Estudos Retrospectivos , Serviço Hospitalar de Emergência/estatística & dados numéricos
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