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2.
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
3.
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
4.
Zhonghua Shao Shang Za Zhi ; 35(2): 81-85, 2019 Feb 20.
Artigo em Chinês | MEDLINE | ID: mdl-30798572

RESUMO

Objective: Burn rehabilitation medicine in China has made great progress in recent years. This article reviews the development history of burn rehabilitation medicine in China from three stages of the initial period, the starting stage, and the development period by looking back to the history. Besides, the article is written according to the milestone events in the development of burn rehabilitation medicine, such as article publishing, guideline making, monograph publication, establishment of rehabilitation association, rehabilitation conference holding. By summarizing successful experience in the past and analyzing the challenge we face, the authors wish all the colleagues committed to burn prevention and treatment work together to make the burn rehabilitation medicine in China better in the future.


Assuntos
Unidades de Queimados/história , Queimaduras/reabilitação , Queimaduras/terapia , Tratamento de Emergência/tendências , Aniversários e Eventos Especiais , Unidades de Queimados/tendências , China , Face , História do Século XX , História do Século XXI , Humanos , Reabilitação
5.
Am J Emerg Med ; 37(6): 1037-1043, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30177266

RESUMO

OBJECTIVES: To describe recent trends in advanced imaging and hospitalization of emergency department (ED) syncope patients, both considered "low-value", and examine trend changes before and after the publication of American College Emergency Physician (ACEP) syncope guidelines in 2007, compared to conditions that had no changes in guideline recommendations. METHODS: We analyzed 2002-2015 National Hospital Ambulatory Medical Care Survey data using an interrupted-time series with comparison series design. The primary outcomes were advanced imaging among ED visits with principal diagnosis of syncope and headache and hospitalization for ED visits with principal diagnosis of syncope, chest pain, dysrhythmia, and pneumonia. We adjusted annual imaging and hospitalization rates using survey-weighted multivariable logistic regression, controlling for demographic and visit characteristics. Using adjusted outcomes as datapoints, we compared linear trends and trend changes of annual imaging and hospitalization rates before and after 2007 with aggregate-level multivariable linear regression. RESULTS: From 2002 to 2007, advanced imaging rates for syncope increased from 27.2% to 42.1% but had no significant trend after 2007 (trend change: -3.1%; 95%CI -4.7, -1.6). Hospitalization rates remained at approximately 37% from 2002 to 2007 but declined to 25.7% by 2015 (trend change: -2.2%; 95%CI -3.0, -1.4). Similar trend changes occurred among control conditions versus syncope, including advanced imaging for headache (difference in trend change: -0.6%; 95%CI -2.8, 1.6) and hospitalizations for chest pain, dysrhythmia, and pneumonia (differences in trend changes: 0.1% [95%CI -1.9, 2.0]; -0.9% [95%CI -3.1, 1.3]; and -1.2% [95%CI -5.3, 2.9], respectively). CONCLUSIONS: Before and after the release of 2007 ACEP syncope guidelines, trends in advanced imaging and hospitalization for ED syncope visits had similar changes compared to control conditions. Changes in syncope care may, therefore, reflect broader practice shifts rather than a direct association with the 2007 ACEP guideline. Moreover, utilization of advanced imaging remains prevalent. To reduce low-value care, policymakers should augment society guidelines with additional policy changes such as reportable quality measures.


Assuntos
Diagnóstico por Imagem/tendências , Síncope/diagnóstico , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Diagnóstico por Imagem/métodos , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Tratamento de Emergência/normas , Tratamento de Emergência/estatística & dados numéricos , Tratamento de Emergência/tendências , Feminino , Guias como Assunto , Hospitalização/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade da Assistência à Saúde/normas , Qualidade da Assistência à Saúde/estatística & dados numéricos , Síncope/terapia , Estados Unidos
6.
Zhonghua Shao Shang Za Zhi ; 34(12): 847-851, 2018 Dec 20.
Artigo em Chinês | MEDLINE | ID: mdl-30585045

RESUMO

By looking back the sixty years' history of burn surgery in Hubei province, the achievements and experience of the development of burn discipline in the province were summarized, and the problems of development and trends in the future of burn surgery were discussed.


Assuntos
Unidades de Queimados/história , Queimaduras/terapia , Tratamento de Emergência/tendências , Aniversários e Eventos Especiais , Unidades de Queimados/tendências , Queimaduras/reabilitação , China , Medicina de Emergência , História do Século XX , História do Século XXI , Humanos
7.
Zhonghua Shao Shang Za Zhi ; 34(12): 852-854, 2018 Dec 20.
Artigo em Chinês | MEDLINE | ID: mdl-30585046

RESUMO

For 60 years, through the continuous efforts, the Department of Burns of the First Affiliated Hospital of Anhui Medical University has made many contributions to the treatment of burns in Chinese and Western medicine during the early phase of the establishment of the department. In recent years, we have also made some achievements in acute and chronic wound repair, burn immunonutrition, burn sepsis, and shock fluid recovery. In the future, we will work harder to make due contributions to the Chinese burn medicine.


Assuntos
Unidades de Queimados/história , Queimaduras/terapia , Cicatrização , Aniversários e Eventos Especiais , Unidades de Queimados/tendências , Queimaduras/reabilitação , Tratamento de Emergência/tendências , História do Século XX , História do Século XXI , Hospitais Universitários , Humanos
8.
Wilderness Environ Med ; 29(4): 463-470, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30293698

RESUMO

INTRODUCTION: Apostle Islands National Lakeshore (APIS) lies at the northern tip of Wisconsin and is home to a network of 21 islands along Lake Superior. The goal of this report is to investigate search and rescue (SAR) and emergency medical services (EMS) trends at APIS in an effort to improve visitor safety and resource allocation. METHODS: This study is a retrospective analysis reviewing APIS SAR reports and annual EMS summary reports from January 1, 2006, to December 31, 2015. Information related to incident type, incident date, individual demographic characteristics and activities, injury/illness type, cost, and contributing factors were recorded and analyzed in frequency tables. RESULTS: From 2006 to 2015, APIS SAR conducted 133 total missions assisting 261 individuals-200 not injured/ill, 57 injured/ill, and 4 fatalities. Median cost per SAR incident involving aircraft totaled $21,695 (range: $2,993-141,849), whereas incidents not involving aircraft had a median cost of $363 (range: $35-8,830). Nonmotorized boating was the most common activity resulting in SAR incidents. All 4 fatalities were attributed to drowning while kayaking or swimming. Cold-related injury/illness accounted for nearly half of all injuries/illnesses (45%) with the most commonly reported contributing factor being high winds. EMS responded to a total of 134 incidents. Trauma and first aid accounted for 43% and 34% of EMS workload, respectively. CONCLUSIONS: Overall, this study highlights the hazards associated with the frigid and rough conditions of Lake Superior. The reported results aim to help APIS personnel more saliently convey risks to visitors and plan appropriately in an effort to decrease the need for future rescues.


Assuntos
Serviços Médicos de Emergência/estatística & dados numéricos , Tratamento de Emergência/estatística & dados numéricos , Parques Recreativos/estatística & dados numéricos , Trabalho de Resgate/estatística & dados numéricos , Serviços Médicos de Emergência/economia , Serviços Médicos de Emergência/tendências , Tratamento de Emergência/economia , Tratamento de Emergência/tendências , Feminino , Humanos , Incidência , Masculino , Trabalho de Resgate/economia , Estudos Retrospectivos , Wisconsin/epidemiologia , Carga de Trabalho , Ferimentos e Lesões/economia , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/etiologia , Ferimentos e Lesões/mortalidade
9.
Zhonghua Shao Shang Za Zhi ; 34(10): 665-668, 2018 Oct 20.
Artigo em Chinês | MEDLINE | ID: mdl-30369131

RESUMO

Under the guidance of the predecessors and the efforts of the whole staff, Department of Burns and Plastic Surgery of Wuxi Third People's Hospital has grown into a well-known regional burn diagnosis and treatment center in China after about 30 years of development. Summarizing the experience, gain, and loss in the course of department growth, following and attaching importance to the discipline development law, consolidating the foundation, strengthening the skills, and being diligent in innovation are the most important. The future trend of discipline development is as follows: wound treatment is still fundamental, burn emergency treatment system should be further improved, interdisciplinary and multidisciplinary cooperation should be further strengthened, and basic scientific research should have the potential to transform to reality.


Assuntos
Unidades de Queimados/história , Queimaduras , Tratamento de Emergência/tendências , Cirurgia Plástica/história , Unidades de Queimados/organização & administração , Queimaduras/reabilitação , Queimaduras/terapia , China , História do Século XX , História do Século XXI , Humanos , Procedimentos Cirúrgicos Reconstrutivos/tendências
11.
PLoS One ; 13(7): e0199879, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29969468

RESUMO

BACKGROUND: This study aims to examine the costs associated with a Hospital in the Nursing Home (HiNH) program in Queensland Australia directed at patients from residential aged care facilities (RACFs) with emergency care needs. METHODS: A cost analysis was undertaken comparing the costs under the HiNH program and the current practice, in parallel with a pre-post controlled study design. The study was conducted in two Queensland public hospitals: the Royal Brisbane and Women's Hospital (intervention hospital) and the Logan Hospital (control hospital). Main outcome measures were the associated incremental costs or savings concerning the HiNH program provision and the acute hospital care utilisation over one year after intervention. RESULTS: The initial deterministic analysis calculated the total induced mean costs associated with providing the HiNH program over one year as AU$488,116, and the total induced savings relating to acute hospital care service utilisation of AU$8,659,788. The total net costs to the health service providers were thus calculated at -AU$8,171,671 per annum. Results from the probabilistic sensitivity analysis (based on 10,000 simulations) showed the mean and median annual net costs associated with the HiNH program implementation were -AU$8,444,512 and-AU$8,202,676, and a standard deviation of 2,955,346. There was 95% certainty that the values of net costs would fall within the range from -AU$15,018,055 to -AU$3,358,820. CONCLUSIONS: The costs relating to implementing the HiNH program appear to be much less than the savings in terms of associated decreases in acute hospital service utilisation. The HiNH service model is likely to have the cost-saving potential while improving the emergency care provision for RACF residents.


Assuntos
Moradias Assistidas/economia , Custos e Análise de Custo , Serviços Médicos de Emergência/economia , Serviço Hospitalar de Emergência/economia , Tratamento de Emergência/tendências , Hospitalização/economia , Casas de Saúde/economia , Idoso , Idoso de 80 Anos ou mais , Austrália , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino
14.
Int Clin Psychopharmacol ; 33(4): 197-203, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29664808

RESUMO

Patients suffering from schizophrenia are often treated in locked psychiatric units because of psychomotor agitation, hostility and aggressive behavior, or suicidality. Because of legal conditions, investigations on these acutely ill patients are difficult, and many studies do not represent 'real-life psychiatry'. This retrospective survey was conducted at the Department of Psychiatry, Psychotherapy and Psychosomatics of the Medical University, Innsbruck, Austria. Data were collected from the records of all adult inpatients suffering from a schizophrenia spectrum disorder according to the International Classification of Diseases, 10th ed. (ICD-10) (F2x) who had been admitted to a locked unit in 1997, 2002, 2007, and 2012. In addition to demographic data, diagnoses at the time of admission, length of stay at the locked unit, and psychopharmacological treatment (3 h before and following admission) were recorded. The mean length of stay at a locked unit decreased significantly from 11.8±4.43 days (mean±SD) in 1997 to 8.5±12.96 days (mean±SD) in 2012. The use of antipsychotics decreased nonsignificantly from 1997 to 2012. Despite an increasing use of second compared with first-generation antipsychotic drugs over the course of time, haloperidol was the most frequently used single compound in all investigated years except 2012. The majority of medications were administered orally. The use of benzodiazepines did not change substantially over the course of time. All in all, pharmacological emergency treatment of patients suffering from schizophrenia spectrum disorders in locked units was in line with current treatment guidelines, which recommend the use of second-generation antipsychotic drugs, monotherapy, oral application, and cautious dosing.


Assuntos
Tratamento de Emergência/tendências , Esquizofrenia/tratamento farmacológico , Adulto , Antipsicóticos/uso terapêutico , Áustria , Benzodiazepinas/uso terapêutico , Feminino , Haloperidol/uso terapêutico , Hospitalização/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Agitação Psicomotora/tratamento farmacológico , Estudos Retrospectivos
15.
Saudi J Gastroenterol ; 24(5): 282-288, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29676288

RESUMO

Background/Aim: Emergency surgeries have increased in Saudi Arabia. This study examines these surgeries and associated complications. Patients and Methods: This was a prospective multicenter cohort study of patients undergoing emergency intraperitoneal surgery from the eight health sectors of Saudi Arabia. Patients' data were collected over 14 days. Results: In total, 283 patients were included (163 men [54.06%]). The majority of cases were open surgery (204 vs. 79). The 24 h and 30-day mortality rates for the cohort were 0.7 and 2.47%, respectively. Twenty-nine patients (10.24%) required re-intervention, while 19 (8.12%) needed critical care admission. The median length of hospital stay was 3 days. Multivariate analysis showed American Society of Anesthesiologist (ASA) classification score (P = 0.0003), diagnosis (P < 0.0001), stoma formation (P = 0.0123), and anastomotic leak (P = 0.0015) to correlate significantly with 30-day mortality. Conclusion: American Society of Anesthesiologist score, diagnosis, stoma formation and anastomotic leak are associated with 30-day mortality after emergency surgery in Saudi Arabia.


Assuntos
Emergências/epidemiologia , Tratamento de Emergência/mortalidade , Tempo de Internação/estatística & dados numéricos , Complicações Pós-Operatórias/mortalidade , Adulto , Fístula Anastomótica/etiologia , Tratamento de Emergência/tendências , Feminino , Humanos , Masculino , Mortalidade/tendências , Valor Preditivo dos Testes , Estudos Prospectivos , Arábia Saudita/epidemiologia , Estomas Cirúrgicos
17.
World J Emerg Surg ; 13: 1, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29371878

RESUMO

A position paper (PP) should establish a unified voice in areas where controversy occurs based upon multiple practices and/or therapeutic choices. Typically, a position paper should elucidate the knowledge gap, followed by an evidence-based review of options, leading to an "endorsed position." A position paper should represent more than the opinion or consensus of the authors but should present current opinions and practices supported by the World Society of Emergency Surgery (WSES). Accordingly, position papers should require the approval of an expert group of WSES and in parallel be presented at an annual meeting prior to submission for publication. It is important that a unified approach for drafting of position papers be established and endorsed by WSES in order to establish credibility and prevent misunderstandings during a smooth transition to publication. The purpose of this article is to suggest a uniform process for the development of WSES guidelines.


Assuntos
Tratamento de Emergência/tendências , Cirurgia Geral/métodos , Sociedades Médicas/tendências , Medicina Baseada em Evidências/métodos , Medicina Baseada em Evidências/tendências , Cirurgia Geral/tendências , Saúde Global/tendências , Humanos , Editoração/organização & administração , Editoração/tendências
18.
J Urol ; 199(4): 1050-1055, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29113842

RESUMO

PURPOSE: We examined the ambulatory health care visit use of children with spina bifida, adults who transitioned to adult care and adults who continued to seek care in a pediatric setting. MATERIALS AND METHODS: We evaluated use during a 1-year period of patients with spina bifida who visited any outpatient medical clinic within an integrated health care system. Patients were categorized as pediatric (younger than 18 years) or adult (age 18 or older). Adults were divided into those who did not fully transition to adult care and patients who fully transitioned (adult). Frequency and type of health care use were compared. Subanalysis was performed for patients 18 to 25 years old to examine variables associated with successful complete transition to adult care. RESULTS: During 1 year 382 children, 88 patients who did not transition and 293 adult patients with spina bifida had 4,931 clinic visits. Children had greater ambulatory care use (7.25 visits per year) compared to fully transitioned adults (5.33 visits per year, p=0.046). Children more commonly visited surgical clinics (52.3% of visits) and adults more commonly visited medical clinics (48.9%) (p <0.005). Adult transitioned patients were more likely to be female (p=0.004). Of the patients 18 to 25 years old, those who did not transition to adult care had similar outpatient visit types but greater use of inpatient and emergency care than those who transitioned. CONCLUSIONS: Children with spina bifida used more ambulatory care than adults and were more likely to visit a surgical specialist. Adult patients with spina bifida who successfully transitioned to adult care were more likely to be female, and patients who failed to transition were more likely to receive more inpatient and emergency care.


Assuntos
Assistência Ambulatorial/tendências , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Disrafismo Espinal/terapia , Transição para Assistência do Adulto/tendências , Adolescente , Adulto , Fatores Etários , Assistência Ambulatorial/estatística & dados numéricos , Criança , Pré-Escolar , Prestação Integrada de Cuidados de Saúde/estatística & dados numéricos , Prestação Integrada de Cuidados de Saúde/tendências , Tratamento de Emergência/estatística & dados numéricos , Tratamento de Emergência/tendências , Feminino , Hospitalização/estatística & dados numéricos , Hospitalização/tendências , Humanos , Masculino , Michigan , Pessoa de Meia-Idade , Transição para Assistência do Adulto/estatística & dados numéricos , Adulto Jovem
19.
Eur Heart J ; 39(8): 676-684, 2018 02 21.
Artigo em Inglês | MEDLINE | ID: mdl-29253177

RESUMO

Aims: Life-threatening complications occur during transcatheter aortic valve implantation (TAVI) which can require emergent cardiac surgery (ECS). Risks and outcomes of patients needing ECS during or immediately after TAVI are still unclear. Methods and results: Incidence, risk factors, management, and outcomes of patients requiring ECS during transfemoral (TF)-TAVI were analysed from a contemporary real-world multicentre registry. Between 2013 and 2016, 27 760 patients underwent TF-TAVI in 79 centres. Of these, 212 (0.76%) patients required ECS (age 82.4 ± 6.3 years, 67.5% females, logistic EuroSCORE: 17.1%, STS-score 5.8%). The risk of ECS declined from 2013 (1.07%) to 2014 (0.70%) but remained stable since. Annual TF-TAVI numbers have more than doubled from 2013 to 2016. Leading causes for ECS were left ventricular perforation by the guidewire (28.3%) and annular rupture (21.2%). Immediate procedural mortality (<72 h) of TF-TAVI patients requiring ECS was 34.6%. Overall in-hospital mortality was 46.0%, and highest in case of annular rupture (62%). Independent predictors of in-hospital mortality following ECS were age > 85 years [odds ratio (OR) 1.87, 95% confidence interval (95% CI) (1.02-3.45), P = 0.044], annular rupture [OR 1.96, 95% CI (0.94-4.10), P = 0.060], and immediate ECS [OR 3.12, 95% CI (1.07-9.11), P = 0.037]. One year of survival of the 114 patients surviving the in-hospital period was only 40.4%. Conclusion: Between 2014 and 2016, the need for ECS remained stable around 0.7%. Left ventricular guidewire perforation and annular rupture were the most frequent causes, accounting for almost half of ECS cases. Half of the patients could be salvaged by ECS-nevertheless, 1 year of all-cause mortality was high even in those ECS patients surviving the in-hospital period.


Assuntos
Estenose da Valva Aórtica/cirurgia , Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Mortalidade Hospitalar/tendências , Substituição da Valva Aórtica Transcateter/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/mortalidade , Procedimentos Cirúrgicos Cardíacos/tendências , Tratamento de Emergência/tendências , Europa (Continente)/epidemiologia , Feminino , Humanos , Incidência , Masculino , Sistema de Registros , Medição de Risco
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