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1.
BMC Health Serv Res ; 19(1): 792, 2019 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-31684952

RESUMO

BACKGROUND: There is little published data on brain imaging and intracranial haemorrhage after hospital inpatient falls. Imaging protocols for inpatient falls have been adopted from head injury guidelines developed from data in patients presenting to the Emergency Department. We sought to describe the use of brain computed tomography (CT) following inpatient falls, and determine the incidence and potential risk factors for intracranial haemorrhage. METHODS: We identified inpatient falls in acute medical wards at Monash Health, a large hospital network in the southeast region of Melbourne in Australia, from the incident reporting system during a 32 month period. We examined the post-fall medical assessment form, neurological observation chart and the diagnostic imaging system for details of the fall and brain CT findings. We used survival analysis to evaluate the timeliness of brain imaging and determined potential risk factors for intracranial haemorrhage by logistic regression. RESULTS: From 934 falls in 789 medical inpatients, 191 brain CT scans were performed. The median age of patients was 77 years. Only 55% of falls were from standing height and 24% experienced a head strike. Less than 10% of patients received an urgent scan within one hour, and timeliness of imaging was influenced by anticoagulation status rather than guideline determination of urgency. The overall incidence of intracranial haemorrhage was 0.9%. The factors associated with intracranial haemorrhage were head strike, anticoagulation, loss of consciousness or amnesia, drop in Glasgow Coma Scale and advanced chronic kidney disease. CONCLUSIONS: The incidence of intracranial haemorrhage was low as most inpatient falls were at low risk for head injury. Research is needed to determine if guidelines specific for hospital inpatients may reduce unnecessary scans without compromising case detection, and improve timeliness of urgent scans.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Unidades Hospitalares/estatística & dados numéricos , Hospitalização , Hemorragias Intracranianas/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Feminino , Humanos , Incidência , Hemorragias Intracranianas/epidemiologia , Masculino , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada por Raios X
2.
S Afr J Surg ; 57(3): 50-53, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31392865

RESUMO

BACKGROUND: Colorectal surgery has developed into an established surgical subspecialty in South Africa, however there is a paucity of data regarding the epidemiology and surgical outcomes of patients with colorectal disease in this country. The objective is to present the findings of a one-year audit of the Wits Donald Gordon Medical Centre (WDGMC) Colorectal Unit with specific reference to indications, surgical procedures and patient outcomes. METHOD: Patient files from December 2016 to November 2017 were included in a retrospective analysis. The Mann-Whitney U test was used to analyse continuous variables and the Chi-squared test was used to compare categorical variables. RESULTS: During the audit period, 1264 patients were admitted to the Colorectal Unit and a further 564 outpatient endoscopic procedures were performed. There were 306 emergency admissions. 139 elective colorectal resections took place, with a 16% major complication rate, a 12% anastomotic leak rate and no deaths. Rectal resections constituted 66% of the operations and 34% were colonic resections. The median length of stay for all patients undergoing resection was 9 days and there was no statistically significant difference in length of stay between open and laparoscopic cases. CONCLUSION: The WDGMC Colorectal Unit manages a high volume of patients presenting with the full spectrum of colorectal disease.


Assuntos
Colectomia/estatística & dados numéricos , Doenças do Colo/cirurgia , Complicações Pós-Operatórias/etiologia , Protectomia/estatística & dados numéricos , Doenças Retais/cirurgia , Centros Médicos Acadêmicos/estatística & dados numéricos , Fístula Anastomótica/etiologia , Colectomia/efeitos adversos , Endoscopia Gastrointestinal/efeitos adversos , Endoscopia Gastrointestinal/estatística & dados numéricos , Unidades Hospitalares/estatística & dados numéricos , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/estatística & dados numéricos , Tempo de Internação , Auditoria Médica , Readmissão do Paciente/estatística & dados numéricos , Protectomia/efeitos adversos , Estudos Retrospectivos
3.
BMC Infect Dis ; 19(1): 491, 2019 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-31159777

RESUMO

BACKGROUND: Medical masks are commonly used in health care settings to protect healthcare workers (HCWs) from respiratory and other infections. Airborne respiratory pathogens may settle on the surface of used masks layers, resulting in contamination. The main aim of this study was to study the presence of viruses on the surface of medical masks. METHODS: Two pilot studies in laboratory and clinical settings were carried out to determine the areas of masks likely to contain maximum viral particles. A laboratory study using a mannequin and fluorescent spray showed maximum particles concentrated on upper right, middle and left sections of the medical masks. These findings were confirmed through a small clinical study. The main study was then conducted in high-risk wards of three selected hospitals in Beijing China. Participants (n = 148) were asked to wear medical masks for a shift (6-8 h) or as long as they could tolerate. Used samples of medical masks were tested for presence of respiratory viruses in upper sections of the medical masks, in line with the pilot studies. RESULTS: Overall virus positivity rate was 10.1% (15/148). Commonly isolated viruses from masks samples were adenovirus (n = 7), bocavirus (n = 2), respiratory syncytial virus (n = 2) and influenza virus (n = 2). Virus positivity was significantly higher in masks samples worn for > 6 h (14.1%, 14/99 versus 1.2%, 1/49, OR 7.9, 95% CI 1.01-61.99) and in samples used by participants who examined > 25 patients per day (16.9%, 12/71 versus 3.9%, 3/77, OR 5.02, 95% CI 1.35-18.60). Most of the participants (83.8%, 124/148) reported at least one problem associated with mask use. Commonly reported problems were pressure on face (16.9%, 25/148), breathing difficulty (12.2%, 18/148), discomfort (9.5% 14/148), trouble communicating with the patient (7.4%, 11/148) and headache (6.1%, 9/148). CONCLUSION: Respiratory pathogens on the outer surface of the used medical masks may result in self-contamination. The risk is higher with longer duration of mask use (> 6 h) and with higher rates of clinical contact. Protocols on duration of mask use should specify a maximum time of continuous use, and should consider guidance in high contact settings. Viruses were isolated from the upper sections of around 10% samples, but other sections of masks may also be contaminated. HCWs should be aware of these risks in order to protect themselves and people around them.


Assuntos
Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Máscaras/virologia , Recursos Humanos em Hospital , Dispositivos de Proteção Respiratória/virologia , Infecções Respiratórias/prevenção & controle , Infecções Respiratórias/virologia , Vírus/isolamento & purificação , Adulto , China/epidemiologia , Feminino , Unidades Hospitalares/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Humanos , Controle de Infecções/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Recursos Humanos em Hospital/estatística & dados numéricos , Projetos Piloto , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/transmissão , Vírus/classificação , Adulto Jovem
4.
Ann Acad Med Singapore ; 48(5): 145-149, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31210251

RESUMO

INTRODUCTION: The National Early Warning Score (NEWS) is well established in acute medical units to identify acutely deteriorating patients and is shown to have good prognostic value. NEWS, however, has only been used in the Emergency Department as a triage tool. We aimed to evaluate the validity of NEWS in Acute Medical Ward (AMW) that treats predominantly acute infection-related conditions to the Internal Medicine service. MATERIALS AND METHODS: We undertook a retrospective cohort study and analysed NEWS records of all patients admitted to AMW at Singapore General Hospital between 1 August 2015 and 30 July 2017. The outcome was defined as deterioration that required transfer to Intermediate Care Area (ICA), Intensive Care Unit (ICU) or death within 24 hours of a vital signs observation set. RESULTS: A total of 298,743 vital signs observation sets were obtained from 11,300 patients. Area under receiver operating characteristic curve for any of the 3 outcomes (transfer to ICA, ICU or death) over a 24-hour period was 0.896 (95% confidence interval, 0.890-0.901). Event rate was noted to be high above 0.250 when the score was >9. In the medium-risk group (score of 5 or 6), event rate was <0.125. CONCLUSION: NEWS accurately triages patients according to the likelihood of adverse outcomes in infection-related acute medical settings.


Assuntos
Unidades Hospitalares/estatística & dados numéricos , Medição de Risco/métodos , Sepse/diagnóstico , Triagem , Feminino , Mortalidade Hospitalar , Humanos , /epidemiologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Sepse/epidemiologia , Sepse/etiologia , Sepse/terapia , Índice de Gravidade de Doença , Singapura/epidemiologia , Triagem/métodos , Triagem/normas
5.
Eur J Oncol Nurs ; 40: 71-77, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31229209

RESUMO

PURPOSE: The purpose of the study was to explore experiences of older people with cancer in ascertaining the attributes of a person-centred approach in sustaining hope and enabling human flourishing. This was a qualitative study comparing patients and professional experiences and perceptions of care across to ward settings. METHODS: Methods involved 10 semi-structured interviews conducted with patients and focus groups (n = 6) and 10 semi-structured interviews with health professionals. Three dissemination focus groups (n = 14) were also carried out with professionals to allow further analysis of the data. RESULTS: Two main themes were identified, including 'Emotional adaptations of hope: wants and expectations' and 'Hope through belittling their illness'. Findings highlight the way hope is conveyed and the emphasis' accorded to issues such as societal perceptions, knowledge, expectations of care, life stage, relationships, identity, and emotions. Findings also reinforce the importance of maintaining hope, recognising the different ways hope is used, and enabling patients to flourish. CONCLUSION: This study highlights how hope is facilitated through the interaction between patients and professionals and that the relational interactive stance. This current study establishes that hope seemed to be temporal, contextual and dynamic in nature, involving an ongoing process. Helping older people with cancer to understand their illness considering the situation of lives and experiences is essential to address expectations and wants.


Assuntos
Esperança , Unidades Hospitalares/estatística & dados numéricos , Neoplasias/psicologia , Relações Profissional-Paciente , Idoso , Idoso de 80 Anos ou mais , Emoções , Feminino , Grupos Focais , Humanos , Masculino , Neoplasias/terapia , Pesquisa Qualitativa
6.
Rev Gastroenterol Peru ; 39(1): 27-37, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31042234

RESUMO

Objetive: To describe our experience with single balloon enteroscopy in the management of small bowel disease in British American Hospital, Lima - Perú. MATERIAL AND METHODS: Descriptive and prospective study. We include all patients that come to perform a single balloon enteroscopy in small bowel unit of British American Hospital within December 2012 to December 2018. RESULTS: We performed 80 procedures of single balloon enteroscopy, 49 were done by oral approach, 31 by rectal approach. Mean age were 60.78 years-old (20 - 88 years). 48 patients (60%) were male. The mean insertion time for oral approach was 80 minutes (55-141 minutes), and for rectal approach was 110 minutes (55-180 minutes). The main indication for single balloon enteroscopy was obscure gastrointestinal bleeding. 6 enteroscopies were performed in patients with altered surgical anatomy (7.5%). 70 of 80 procedures (87.5%) were performed with gastroenterology-administered sedation, using midazolam, pethidine and propofol, without any respiratory or hemodinamic complication. Diagnostics achieved by single balloon enteroscopy were small bowel angiodysplasias (20%), yeyuno ileal ulcers (17.5%) and small bowel neoplasia (7.5%). Paralytic ileus was the most common complication of single balloon enteroscopy, 2 cases, and both cases were associated after no using carbon dioxide insufflation during procedure. CONCLUSION: Obscure gastrointestinal bleeding was the main indication for single balloon enteroscopy. Diagnostics achieved by single balloon enteroscopy were small bowel angiodysplasias (20%), yeyuno ileal ulcers (17.5%) and small bowel neoplasia (7.5%). Paralytic ileus was the most common complication of single balloon enteroscopy, 2 cases, and both cases were associated after no using carbon dioxide insufflation during procedure.


Assuntos
Enteropatias/diagnóstico , Intestino Delgado/patologia , Enteroscopia de Balão Único , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiodisplasia/complicações , Angiodisplasia/diagnóstico , Feminino , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiologia , Unidades Hospitalares/estatística & dados numéricos , Humanos , Cooperação Internacional , Enteropatias/terapia , Neoplasias Intestinais/complicações , Neoplasias Intestinais/diagnóstico , Pseudo-Obstrução Intestinal/etiologia , Masculino , Pessoa de Meia-Idade , Peru , Estudos Prospectivos , Estudos Retrospectivos , Enteroscopia de Balão Único/efeitos adversos , Adulto Jovem
7.
Cir Esp ; 97(5): 254-260, 2019 May.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30981466

RESUMO

INTRODUCTION: The technical, human, scientific and treatment characteristics of the Units that manage complex pathologies have not been studied in depth. METHODS: Multi-institutional descriptive study (survey) developed jointly by the Hepatobiliary-Pancreatic Division of the Spanish Association of Surgeons and the Spanish Chapter of the IHPBA (International Hepatopancreatobiliary Association) on the characteristics of the Units where pancreatic surgery is performed in Spain. RESULTS: 82 surveys were sent. 69 medical centers responded (84%), belonging to 16 autonomous regions of Spain. The total population of these regions was 23,183,262 (50% of the Spanish population). The average number of beds per hospital was 673. The unit that performs pancreatic surgery is a Hepatobiliary-Pancreatic Surgery Unit or HPB and Liver Transplant Surgery Unit in 56 hospitals (77%). The average number of surgeons is 4.5 per Unit. Fifty-five Units (80%) lack specific anesthetists. The number of pancreatectomies performed during 2017 at the hospitals surveyed was 1,315 pancreaticoduodenectomies (PD), 566 distal pancreatectomies (DP) and 178 total pancreaticoduodenectomies (TPD). The mean per hospital was 19.1 PD, 8.2 DP and 2.6 TPD. PD was usually performed using a classic approach, with pancreatojejunostomy, single-loop technique, antecolic gastrojejunostomy and using two drain tubes. Only 7 Units performed PD laparoscopically and only 13 units did not perform laparoscopic DP. CONCLUSIONS: This survey provides updated information about the majority of the Units where pancreatic surgery is performed in Spain and could also serve as a starting point for prospective multicenter studies.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/métodos , Pâncreas/cirurgia , Pancreatopatias/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/estatística & dados numéricos , Pesquisas sobre Serviços de Saúde , Unidades Hospitalares/organização & administração , Unidades Hospitalares/estatística & dados numéricos , Humanos , Prática Profissional/estatística & dados numéricos , Espanha
8.
Rev Esp Quimioter ; 32(3): 232-237, 2019 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-30950257

RESUMO

OBJECTIVE: To assess hand hygiene compliance covertly in medical students in a university teaching hospital. METHODS: Cross-sectional study. Hand hygiene compliance in medical students was assessed in the units of Neonatology, Paediatrics, Neurology and Orthopaedic surgery. The five moments were covertly observed so as the hand rub technique. Hand hygiene compliance was described with the compliance percentages of the five moments. RESULTS: We studied 456 opportunities of hand hygiene. Global compliance was 44.3%. The most registered unit was Orthopaedic surgery (59.6%). According to the different moments, global compliance was better "after touching a patient" (60.2%). The unit with the highest hand hygiene compliance was Neonatology (60%). Hand hygiene compliance was better in the different hospitalisation units (50%) than in the office rooms (33%) (P<0.05) and the mean duration of hand hygiene was 22 seconds. CONCLUSIONS: Most of the moments were registered in the unit of Orthopaedic surgery and the moment with the highest hand hygiene compliance was "after touching a patient". The most hand hygiene compliance percentage was observed in Neonatology. Hand hygiene compliance was moderate, and it could and must be improved.


Assuntos
Antibacterianos/uso terapêutico , Higiene das Mãos/normas , Estudantes de Medicina , Adulto , Antibacterianos/administração & dosagem , Estudos Transversais , Feminino , Fidelidade a Diretrizes , Desinfecção das Mãos , Unidades Hospitalares/estatística & dados numéricos , Humanos , Controle de Infecções , Masculino , Neonatologia , Procedimentos Ortopédicos , Soluções , Adulto Jovem
9.
Diabetes Care ; 42(5): 832-840, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30923164

RESUMO

OBJECTIVE: To investigate if early electronic identification and bedside management of inpatients with diabetes improves glycemic control in noncritical care. RESEARCH DESIGN AND METHODS: We investigated a proactive or early intervention model of care (whereby an inpatient diabetes team electronically identified individuals with diabetes and aimed to provide bedside management within 24 h of admission) compared with usual care (a referral-based consultation service). We conducted a cluster randomized trial on eight wards, consisting of a 10-week baseline period (all clusters received usual care) followed by a 12-week active period (clusters randomized to early intervention or usual care). Outcomes were adverse glycemic days (AGDs) (patient-days with glucose <4 or >15 mmol/L [<72 or >270 mg/dL]) and adverse patient outcomes. RESULTS: We included 1,002 consecutive adult inpatients with diabetes or new hyperglycemia. More patients received specialist diabetes management (92% vs. 15%, P < 0.001) and new insulin treatment (57% vs. 34%, P = 0.001) with early intervention. At the cluster level, incidence of AGDs decreased by 24% from 243 to 186 per 1,000 patient-days in the intervention arm (P < 0.001), with no change in the control arm. At the individual level, adjusted number of AGDs per person decreased from a mean 1.4 (SD 1.6) to 1.0 (0.9) days (-28% change [95% CI -45 to -11], P = 0.001) in the intervention arm but did not change in the control arm (1.8 [2.0] to 1.5 [1.8], -9% change [-25 to 6], P = 0.23). Early intervention reduced overt hyperglycemia (55% decrease in patient-days with mean glucose >15 mmol/L, P < 0.001) and hospital-acquired infections (odds ratio 0.20 [95% CI 0.07-0.58], P = 0.003). CONCLUSIONS: Early identification and management of inpatients with diabetes decreased hyperglycemia and hospital-acquired infections.


Assuntos
Infecção Hospitalar/prevenção & controle , Diabetes Mellitus/terapia , Intervenção Médica Precoce/métodos , Hospitalização , Hiperglicemia/epidemiologia , Hiperglicemia/terapia , Adulto , Idoso , Glicemia/metabolismo , Análise por Conglomerados , Infecção Hospitalar/epidemiologia , Diabetes Mellitus/sangue , Diabetes Mellitus/epidemiologia , Feminino , Unidades Hospitalares/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Hiperglicemia/sangue , Hiperglicemia/prevenção & controle , Pacientes Internados/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade
10.
Infez Med ; 27(1): 17-25, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30882374

RESUMO

Klebsiella pneumoniae is a common nosocomial pathogen involved in many infectious diseases such as bacteraemia, urinary and respiratory tract infections. It is responsible for the rise in morbidity and mortality rates since most clinical isolates exhibit resistance to several antibiotics. Moreover, the epidemiology of these nosocomial infections is variable across countries and regions. From January 2015 to December 2017 we retrospectively analysed the bloodstream infections caused by K. pneumoniae strains in hospitalised patients with the aim of studying the temporal trends of wild type (WT), multi-drug resistant (MDR), extended drug resistant (XDR), pan-drug resistant (PDR) and carbapenem-resistant (CR) strains. In all, 439 K. pneumoniae isolates from 356 patients were collected from all units of the Policlinico of Bari. The majority of clinical isolates were collected from the intensive care unit (125, 28.47%), haematology (34, 7.74%), rehabilitation (27, 6.15%) and cardiac surgery wards (25, 5.69%). Moreover, the majority of the isolates were classified as CR (325, 74.03%, 95%CI: 69.61-78.19) and XDR (255, 58.09%, 95%CI: 53.31-62.72). Annual prevalence rates and monthly counts were analysed using the Chi Squared test for trends and the Poisson regression with multiple p-value correction according to Benjamini and Hochberg's procedure. The annual relative frequencies of the XDR and CR K. pneumoniae isolates decreased significantly from 63.37% to 48.44% and from 78.48% to 63.28% respectively, while WT K. pneumoniae significantly increased from 13.95% to 23.44%. Poisson regression analysis confirmed the presence of a decreasing monthly trend for the XDR and CR K. pneumoniae count series. In order to control the spread of antibiotic resistance, more inclusive surveillance data will be needed to either confirm these results or improve antibiotic stewardship measures.


Assuntos
Bacteriemia/microbiologia , Infecção Hospitalar/microbiologia , Farmacorresistência Bacteriana Múltipla , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/efeitos dos fármacos , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Bacteriemia/tratamento farmacológico , Bacteriemia/epidemiologia , Criança , Pré-Escolar , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/epidemiologia , Feminino , Unidades Hospitalares/estatística & dados numéricos , Hospitais de Ensino , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva/estatística & dados numéricos , Itália , Infecções por Klebsiella/tratamento farmacológico , Infecções por Klebsiella/epidemiologia , Klebsiella pneumoniae/classificação , Klebsiella pneumoniae/isolamento & purificação , Masculino , Pessoa de Meia-Idade , Distribuição de Poisson , Prevalência , Estudos Retrospectivos , Distribuição por Sexo , Adulto Jovem
11.
J Plast Surg Hand Surg ; 53(2): 97-104, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30654678

RESUMO

Academic output is just one aspect of a successful career as a plastic surgeon. However, for those with a strong interest in academia, the academic output of a department will likely be a key factor when deciding how to rank jobs. The aim of this study was to quantify and rank the academic output of plastic surgery units across the UK and Ireland. The Institute for Scientific Information (ISI) Web of Science Bibliometric analysis tool was used to collate cumulative (1950-2016), 10 year (2006-2016) and 3 years (2013-2015) research output data for plastic surgery units in the UK and Ireland. Sixty-six plastic surgery units were identified. Departments were ranked for each time period according to the number of papers produced, number of citations (Nc) and h-index (a measure of the impact of scientific output). The top 3 departments for number of papers in the last 10 years were The Royal Free Hospital, London (226) Broomfield Hospital, Chelmsford (218), and Morriston Hospital and Swansea (188). The top 3 for h-number were The Royal Free Hospital (21) Wythenshawe Hospital, Manchester (18) and Morriston Hospital (17). Academic output varies across plastic surgery units in the UK and Ireland. A number of departments have consistently maintained high academic outputs across the years and will be of interest to surgeons hoping to pursue a career in academia.


Assuntos
Unidades Hospitalares/estatística & dados numéricos , Editoração/estatística & dados numéricos , Cirurgia Plástica , Bibliometria , Humanos , Irlanda , Reino Unido
12.
BMJ ; 364: l1, 2019 01 23.
Artigo em Inglês | MEDLINE | ID: mdl-30674465

RESUMO

OBJECTIVES: To investigate whether further centralisation of acute stroke services in Greater Manchester in 2015 was associated with changes in outcomes and whether the effects of centralisation of acute stroke services in London in 2010 were sustained. DESIGN: Retrospective analyses of patient level data from the Hospital Episode Statistics (HES) database linked to mortality data from the Office for National Statistics, and the Sentinel Stroke National Audit Programme (SSNAP). SETTING: Acute stroke services in Greater Manchester and London, England. PARTICIPANTS: 509 182 stroke patients in HES living in urban areas admitted between January 2008 and March 2016; 218 120 stroke patients in SSNAP between April 2013 and March 2016. INTERVENTIONS: Hub and spoke models for acute stroke care. MAIN OUTCOME MEASURES: Mortality at 90 days after hospital admission; length of acute hospital stay; treatment in a hyperacute stroke unit; 19 evidence based clinical interventions. RESULTS: In Greater Manchester, borderline evidence suggested that risk adjusted mortality at 90 days declined overall; a significant decline in mortality was seen among patients treated at a hyperacute stroke unit (difference-in-differences -1.8% (95% confidence interval -3.4 to -0.2)), indicating 69 fewer deaths per year. A significant decline was seen in risk adjusted length of acute hospital stay overall (-1.5 (-2.5 to -0.4) days; P<0.01), indicating 6750 fewer bed days a year. The number of patients treated in a hyperacute stroke unit increased from 39% in 2010-12 to 86% in 2015/16. In London, the 90 day mortality rate was sustained (P>0.05), length of hospital stay declined (P<0.01), and more than 90% of patients were treated in a hyperacute stroke unit. Achievement of evidence based clinical interventions generally remained constant or improved in both areas. CONCLUSIONS: Centralised models of acute stroke care, in which all stroke patients receive hyperacute care, can reduce mortality and length of acute hospital stay and improve provision of evidence based clinical interventions. Effects can be sustained over time.


Assuntos
Assistência à Saúde/estatística & dados numéricos , Medicina Baseada em Evidências/estatística & dados numéricos , Hospitais Urbanos/estatística & dados numéricos , Acidente Vascular Cerebral/mortalidade , Serviços Urbanos de Saúde/estatística & dados numéricos , Bases de Dados Factuais , Assistência à Saúde/organização & administração , Cuidado Periódico , Unidades Hospitalares/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Londres/epidemiologia , Mortalidade/tendências , Avaliação de Programas e Projetos de Saúde/estatística & dados numéricos , Estudos Retrospectivos , Acidente Vascular Cerebral/terapia , Serviços Urbanos de Saúde/organização & administração
13.
Reumatol Clin ; 15(2): 63-68, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30691949

RESUMO

We herein describe an inter-specialists unit for the monitoring and management of biological therapies and analyze the utilization of biological agents across specialties and diseases. Protocols and therapeutic objectives, as well as outcomes and protocol deviations, are shared and discussed periodically between specialists. All patients treated at one centre with any biological treatment from January 2000 by rheumatology, gastroenterology, dermatology, or neurology, regardless diagnosis, are identified by Clinical Pharmacy and included in an ongoing database that detects use and outcome. The drugs, survival, and reasons for discontinuation differ significantly across specialties. This approach has helped us recognizing the challenges and size of the problem of sharing expensive medications across specialties, and has served as a starting point to contribute to the better use of these compounds.


Assuntos
Fatores Biológicos/uso terapêutico , Terapia Biológica , Unidades Hospitalares/organização & administração , Comunicação Interdisciplinar , Adulto , Idoso , Benchmarking , Dermatologia , Uso de Medicamentos/estatística & dados numéricos , Feminino , Gastroenterologia , Unidades Hospitalares/estatística & dados numéricos , Hospitais Públicos/organização & administração , Hospitais Públicos/estatística & dados numéricos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Neurologia , Padrões de Prática Médica/estatística & dados numéricos , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Reumatologia , Espanha
14.
Clin Microbiol Infect ; 25(8): 1013-1020, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30641228

RESUMO

OBJECTIVES: Colonization and infection with third-generation cephalosporin-resistant Escherichia coli (3GCR-EC) are frequent in haematological and oncological patients. In this high-risk setting, German guidelines recommend single-room contact precautions (SCP) for patients with 3GCR-EC that are non-susceptible to fluoroquinolones (F3GCR-EC). However, this recommendation is controversial, as evidence is limited. METHODS: We performed a prospective, multicentre cohort study at four haematology and oncology departments assessing the impact of SCP on hospital-acquired colonization or bloodstream infection (BSI) with F3GCR-EC. Two sites performed SCP for F3GCR-EC patients including single rooms, gloves and gowns (SCP sites), and two did not (NCP sites). Active screening for 3GCR-EC was performed and isolates were characterized with molecular typing methods including whole genome sequencing and core genome multiple locus sequence typing to assess patient-to-patient transmission. Potential confounders were assessed by competing-risk regression analysis. RESULTS: Within 12 months, 1386 patients at NCP sites and 1582 patients at SCP sites were included. Hospital-acquisition of F3GCR-EC was observed in 22/1386 (1.59%) and 16/1582 (1.01%) patients, respectively (p 0.191). There were 3/1386 (0.22%) patients with BSI caused by F3GCR-EC at NCP sites and 4/1582 (0.25%) at SCP sites (p 1.000). Patient-to-patient transmission occurred in three cases at NCP and SCP sites each (p 1.000). The number of patients needed to screen in order to prevent one patient-to-patient transmission of F3GCR-EC was determined to be 3729. CONCLUSIONS: Use of SCP had no significant impact on hospital-acquisition or patient-to-patient transmission of F3GCR-EC in this high-risk setting.


Assuntos
Infecção Hospitalar/prevenção & controle , Infecções por Escherichia coli/prevenção & controle , Controle de Infecções/métodos , Precauções Universais , Adulto , Idoso , Bacteriemia/prevenção & controle , Bacteriemia/transmissão , Infecção Hospitalar/microbiologia , Farmacorresistência Bacteriana Múltipla , Escherichia coli/isolamento & purificação , Feminino , Luvas Protetoras , Hematologia , Unidades Hospitalares/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Serviço Hospitalar de Oncologia , Estudos Prospectivos
16.
World J Surg ; 43(3): 910-919, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30465087

RESUMO

BACKGROUND: The effect of various hospital characteristics on failure to rescue (FTR) after liver surgery has not been well examined. We sought to examine the relationship between hospital characteristics and FTR after liver surgery. METHODS: The 2013-2015 Medicare-Provider Analysis and Review (MEDPAR) database was used to identify Medicare beneficiaries who underwent liver surgery. The effect of various hospital characteristics on FTR was compared among the highest mortality hospitals (HMH) and the lowest mortality hospitals (LMH). RESULTS: Among 4902 patients undergoing hepatectomy, patients treated at HMH had a higher risk of FTR (OR 3.08, 95% CI 2.03-4.66). Hospital factors such as total number of beds (OR 0.80, 95% 0.56-1.15), operating rooms (OR 0.81, 95% 0.57-1.14), and overall hospital surgical volume (OR 0.88, 95% 0.61-1.25) were not associated with FTR (all p > 0.05). In contrast, hospitals with a greater nurse-to-patient ratio had a markedly lower risk of FTR following a complication (OR 0.70, 95% CI 0.54-0.91; p = 0.007) (Table 3). As volume of liver operations and nurse-to-patient ratio decreased the risk of FTR increased (p > 0.001). After risk-adjusting for patient characteristics, both the effect of surgical volume (adjusted OR 0.66, 95% CI 0.46-0.94; p = 0.022) and nurse-to-patient ratio (adjusted OR 0.68, 95% CI 0.51-0.90; p = 0.008) remained strongly associated with FTR. CONCLUSION: FTR rates varied considerably among hospital performing hepatectomy. Higher procedure-specific hepatectomy volume, as well as a higher nurse-to-patient ratio, accounted for a reduction in the FTR rates. These data highlight the importance of not only procedure volume, but also adequate nurse staffing in reducing FTR and improving mortality following complex procedures such as hepatectomy.


Assuntos
Hepatectomia/estatística & dados numéricos , Número de Leitos em Hospital/estatística & dados numéricos , Mortalidade Hospitalar , Unidades Hospitalares/estatística & dados numéricos , Admissão e Escalonamento de Pessoal/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Idoso , Feminino , Humanos , Masculino , Medicaid/estatística & dados numéricos , Pessoa de Meia-Idade , Risco Ajustado , Fatores de Risco , Estados Unidos
17.
J Evid Based Med ; 12(1): 56-62, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30426707

RESUMO

OBJECTIVE: There are some studies on the prevalence of ectopic pregnancy (EP) in a different population of Iranian women. This study aimed to estimate the ectopic pregnancy prevalence in obstetrical clients and infertile patients treated by assisted reproductive technologies in Iran. METHODS: International and national databases including PubMed, Web of Science, Ovid, Scopus, ScienceDirect, Magiran, Iran doc, and Iran Medex were searched up to January 2016. Also, conference databases were searched. All studies in which, the ectopic pregnancy prevalence in Iranian obstetrical clients and infertile patients treated by assisted reproductive technologies were reported, included and reviewed. Data of studies were extracted into a standard data sheet. Meta-analysis was conducted by a random-effects model with 95% confidence interval. RESULTS: Eight studies were included, involving overall 571 826 women of whom 1446 had an ectopic pregnancy. The overall prevalence of ectopic pregnancy in obstetrical units of the hospitals and assisted reproductive technologies patients was 2.9 (95% CI: 2.1, 3.7) and 53 (95% CI: 20.4, 85.6) per 1000 clients, respectively. CONCLUSION: There is limited evidence on the ectopic pregnancy prevalence in Iranian obstetrical clients and assisted reproductive technologies patients. Furthermore, a significant heterogeneity existed between the results. So, more population-based studies on national data are needed for the exact estimation of the ectopic pregnancy prevalence in Iran.


Assuntos
Infertilidade Feminina/terapia , Tocologia/estatística & dados numéricos , Gravidez Ectópica/epidemiologia , Técnicas de Reprodução Assistida/estatística & dados numéricos , Feminino , Unidades Hospitalares/estatística & dados numéricos , Humanos , Irã (Geográfico)/epidemiologia , Obstetrícia/estatística & dados numéricos , Gravidez , Prevalência
18.
Brain Behav ; 9(1): e01175, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30474214

RESUMO

OBJECTIVES: Treatment on organized stroke units (SUs) improves survival after stroke, and stroke mortality has decreased worldwide in recent decades; however, little is known of survival trends among SU patients specifically. This study investigates changes in survival and characteristics of older stroke patients receiving SU treatment. MATERIALS & METHODS: We compared 3-year all-cause mortality and baseline characteristics in two cohorts of stroke patients aged ≥60 consecutively admitted to the same comprehensive SU in 1994 (n = 271) and 2012 (n = 546). RESULTS: Three-year survival was 53.9% in 1994 and 56.0% in 2012, and adjusted hazard ratio (HR) was 0.99 (95% CI: 0.77-1.28). Adjusted 30-day case fatality was slightly higher in 2012, 18.9% versus 16.2%, HR 1.68 (95% CI: 1.14-2.47). There were no significant between-cohort differences in survival beyond 30 days. Patients in 2012 were older (mean age: 78.8 vs. 76.7 years) and more often admitted from nursing homes. There were higher rates of atrial fibrillation (33.7% vs. 21.4%) and malignancy (19.2% vs. 8.9%), and prescription of antiplatelets (46.9% vs. 26.2%) and warfarin (16.3% vs. 5.5%) at admission. Stroke severity was significantly milder in 2012, proportion with mild stroke 66.1% versus 44.3%. CONCLUSIONS: Three-year survival in older Norwegian stroke patients treated on an SU remained stable despite improved treatment in the last decades. Differences in background characteristics may explain this lack of difference; patients in 2012 were older, more often living in supported care, and had higher prestroke comorbidity; however, their strokes were milder and risk factors more often treated.


Assuntos
Fibrilação Atrial , Neoplasias/epidemiologia , Acidente Vascular Cerebral , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/uso terapêutico , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/epidemiologia , Estudos de Coortes , Comorbidade , Feminino , Unidades Hospitalares/organização & administração , Unidades Hospitalares/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Modelos de Riscos Proporcionais , Fatores de Risco , Índice de Gravidade de Doença , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/mortalidade , Acidente Vascular Cerebral/terapia , Análise de Sobrevida , Varfarina/uso terapêutico
19.
J Clin Neurosci ; 59: 84-88, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30409533

RESUMO

Given reported favourable outcomes of accountable care unit models of health care delivery (Taylor et al., 2017; Stein et al., 2015; Kara et al., 2015), the Clinical Excellence Commission of NSW has embraced "In Safe Hands" (ISH) to enhance coordination of care. ISH embraces the structured interdisciplinary bedside round (SIBR) component, for which reported outcomes include reduced length of stay (Taylor et al., 2017; Stein et al., 2015; Kara et al., 2015), possible reduction in overall costs of care (Kara et al., 2015), and enhanced patient and staff satisfaction (O'Leary et al., 2011). It is not yet clear whether the benefits of such a model are translatable to the Australian Health Care System (Hunyh et al., 2016) and/or established units with an already strong multi-disciplinary approach to patient care. The purpose of this prospective cohort study of 200 participants was to assess the effect(s) of implementation of ISH in a stroke unit of a tertiary hospital in Sydney, Australia. Data on length of stay, re-admission rates, adverse events, as well as patient and nursing satisfaction, were collected pre and post implementation. There was no significant difference in length of stay in median days (5 (IQR 2-7) versus 4 (IQR 2-6), P = 0.55) or incidence of adverse events (10% versus 12%, P = 0.82). Stroke outcome disability scores were not affected by the intervention. There were no significant differences overall in reported patient and nursing satisfaction. Implementation of the ISH program cost approximately AUD$ 1805/week (USD$ 1365) in wages. The ISH program was a costly intervention of limited benefit in a well-established acute stroke unit. We here discuss potential reasons for the failure of this intervention to achieve its primary aim in this setting.


Assuntos
Prestação Integrada de Cuidados de Saúde/economia , Prestação Integrada de Cuidados de Saúde/métodos , Acidente Vascular Cerebral/terapia , Austrália , Feminino , Unidades Hospitalares/estatística & dados numéricos , Humanos , Tempo de Internação , Masculino , Estudos Prospectivos , Centros de Atenção Terciária
20.
Australas Psychiatry ; 27(1): 32-35, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30293446

RESUMO

OBJECTIVES:: To evaluate the therapeutic security characteristics of the secure forensic mental health inpatient units in New South Wales, Australia. METHODS:: This study evaluated all eight secure inpatient units in New South Wales using a validated tool, the Security Needs Assessment Profile. RESULTS:: A pattern of decreasing therapeutic security across the secure units was found, consistent with their intended security levels, from high security through to open security. However, important inconsistencies across and between levels of security were highlighted. CONCLUSIONS:: This study clarifies the therapeutic security structure of the New South Wales forensic mental health service, which is an essential first step in service development and reform.


Assuntos
Psiquiatria Legal/estatística & dados numéricos , Unidades Hospitalares/estatística & dados numéricos , Hospitais Psiquiátricos/estatística & dados numéricos , Segurança do Paciente/estatística & dados numéricos , Medidas de Segurança/estatística & dados numéricos , Humanos , New South Wales
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