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1.
Am J Cardiol ; 160: 40-45, 2021 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-34610872

RESUMO

The contemporary scope of practice of interventional cardiologists (ICs) in the United States and recent trends are unknown. Using Medicare claims from 2013 to 2017, we categorized ICs into 4 practice categories (only percutaneous coronary intervention [PCI], PCI with noninvasive imaging, PCI with specialized interventions [peripheral/structural], and all 3 services) and evaluated associations with region, hospital bed size and teaching status, gender, and graduation year. Of 6,083 ICs in 2017, 10.9% performed only PCI, 68.3% PCI with noninvasive imaging, 5.7% PCI with specialized interventions, and 15.1% all 3 services. A higher proportion of Northeast ICs (vs South ICs) were performing only PCI (24.8% vs 7.3%) and PCI with specialized interventions (12% vs 3.4%), but lower PCI and noninvasive imaging (53.8% vs 71.7%) and all 3 services (9.3% and 17.6%). Regarding ICs at larger hospitals (bed size >575 vs <218), a higher proportion was performing only PCI (23.8% vs 5.2%) or PCI with specialized interventions (13.5% vs 1.7%) and lower proportion was performing PCI with noninvasive imaging (48.8% vs 78%), similar to teaching hospitals. Female ICs (vs male ICs) more frequently performed only PCI (18.9% vs 10.6%) and less frequently all 3 services (8.3% vs 15.4%). A lower proportion of recent graduates (2001 to 2016) performed only PCI (9.8% vs 13.8%) and PCI with noninvasive imaging (66.3% vs 72.6%) but a higher proportion performed all 3 services (18% vs 8.4%) than earlier graduates (1959 to 1984). From 2013 to 2017, only PCI and PCI with noninvasive imaging decreased, whereas PCI and specialized interventions and all 3 services increased (all p <0.001). In conclusion, there is marked heterogeneity in practice responsibilities among ICs, which has implications for training and competency assessments.


Assuntos
Técnicas de Imagem Cardíaca/tendências , Cardiologistas/tendências , Cardiologia/tendências , Doença das Coronárias/cirurgia , Intervenção Coronária Percutânea/tendências , Doenças Vasculares Periféricas/cirurgia , Âmbito da Prática/tendências , Ecocardiografia/tendências , Teste de Esforço , Feminino , Tamanho das Instituições de Saúde , Humanos , Masculino , Medicare , Papel do Médico , Cintilografia/tendências , Estados Unidos
2.
J Am Heart Assoc ; 10(15): e021061, 2021 08 03.
Artigo em Inglês | MEDLINE | ID: mdl-34315234

RESUMO

Background There is a lack of contemporary data on cardiogenic shock (CS) in-hospital mortality trends. Methods and Results Patients with CS admitted January 1, 2004 to December 31, 2018, were identified from the US National Inpatient Sample. We reported the crude and adjusted trends of in-hospital mortality among the overall population and selected subgroups. Among a total of 563 949 644 hospitalizations during the period from January 1, 2004, to December 30, 2018, 1 254 358 (0.2%) were attributed to CS. There has been a steady increase in hospitalizations attributed to CS from 122 per 100 000 hospitalizations in 2004 to 408 per 100 000 hospitalizations in 2018 (Ptrend<0.001). This was associated with a steady decline in the adjusted trends of in-hospital mortality during the study period in the overall population (from 49% in 2004 to 37% in 2018; Ptrend<0.001), among patients with acute myocardial infarction CS (from 43% in 2004 to 34% in 2018; Ptrend<0.001), and among patients with non-acute myocardial infarction CS (from 52% in 2004 to 37% in 2018; Ptrend<0.001). Consistent trends of reduced mortality were seen among women, men, different racial/ethnic groups, different US regions, and different hospital sizes, regardless of the hospital teaching status. Conclusions Hospitalizations attributed to CS have tripled in the period from January 2004 to December 2018. However, there has been a slow decline in CS in-hospital mortality during the studied period. Further studies are necessary to determine if the recent adoption of treatment algorithms in treating patients with CS will further impact in-hospital mortality.


Assuntos
Mortalidade Hospitalar/tendências , Infarto do Miocárdio , Choque Cardiogênico , Grupos Étnicos/estatística & dados numéricos , Feminino , Tamanho das Instituições de Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Mortalidade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/mortalidade , Melhoria de Qualidade/organização & administração , Fatores Sexuais , Choque Cardiogênico/etiologia , Choque Cardiogênico/mortalidade , Choque Cardiogênico/terapia , Estados Unidos/epidemiologia
3.
Vet Dermatol ; 32(6): 668-e178, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34009720

RESUMO

BACKGROUND: Antimicrobial resistance in Staphylococcus pseudintermedius (SP) and the prevalence of meticillin-resistant SP (MRSP) is increasing in dogs worldwide. OBJECTIVES: To evaluate the influence of hospital size on antimicrobial resistance of SP and whether restricted use of antimicrobials based on antibiograms could reduce the identification of antimicrobial resistance in SP from infected dogs. METHODS AND MATERIALS: In Study 1, a total of 2,294 SP isolates from dogs with pyoderma (n = 1,858, 52 hospitals) or otitis externa (OE; n = 436, 44 hospitals) taken between 2017 and 2019 were analysed. Clinics were categorised into small, medium and large based on numbers of practicing veterinary surgeons. In Study 2, a cumulative antibiogram was constructed for 12 antimicrobials from one large veterinary clinic from 2017 to 2018. Referring to this antibiogram, the clinic introduced strict antimicrobial selection criteria to treat dogs with pyoderma and OE, starting in 2018. RESULTS: MRSP was identified in 981 dogs (42.8%). In large clinics, the isolation rate of MRSP was 51.1% (404 of 791), which was significantly higher (P < 0.01) than in small clinics with less than two veterinary practitioners (34.0%, 154 of 453). In the antibiogram study, the susceptibility rates of oxacillin (MPIPC, 61.5%), cefpodoxime (CPDX, 55.8%) and minocycline (MINO, 55.8%) were significantly higher in 2019 (n = 52) than in 2017 to 2018 (n = 54; MPIPC, 37.0%; CPDX, 33.3%; MINO, 20.4%; P < 0.05). CONCLUSIONS AND CLINICAL RELEVANCE: Hospital size could affect the isolation rate of MRSP in dogs. Restricted use of antimicrobials for over a year based on cumulative antibiograms could reduce the resistance rate of multiple antimicrobials in SP isolated from dogs with pyoderma and OE.


Assuntos
Anti-Infecciosos , Doenças do Cão , Infecções Estafilocócicas , Animais , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Doenças do Cão/tratamento farmacológico , Doenças do Cão/epidemiologia , Cães , Farmacorresistência Bacteriana , Tamanho das Instituições de Saúde , Japão/epidemiologia , Resistência a Meticilina , Testes de Sensibilidade Microbiana/veterinária , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/veterinária , Staphylococcus
4.
BMC Health Serv Res ; 21(1): 63, 2021 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-33441139

RESUMO

BACKGROUND: Patient satisfaction studies have explored domains of patient satisfaction, the determinants of domains, and score differences of domains by patient/hospital structural measures but reports on the structure of patient satisfaction with respect to similarities among domains are scarce. This study is to explore by distance-based analysis whether similarities among patient-satisfaction domains are influenced by hospital structural measures, and to design a model evaluating relationships between the structure of patient satisfaction and hospital structural measures. METHODS: The Hospital Consumer Assessment of Healthcare Providers and Systems 2012 survey scores and their structural measures from the Hospital Compare website reported adjusted percentages of scale for each hospital. Contingency tables of nine measures and their ratings were designed based on hospital structural measures, followed by three different distance-based analyses - clustering, correspondence analysis, and ordinal multidimensional scaling - for robustness to identify homogenous groups with respect to similarities. RESULTS: Of 4,677 hospitals, 3,711 (79.3%) met the inclusion criteria and were analyzed. The measures were divided into three groups plus cleanliness. Certain combinations of these groups were shown to be dependent on hospital structural measures. High value ratings for communication and low value ratings for medication explanation, quietness and staff responsiveness were not influenced by hospital structural measures, but the varied-ratings domain group similarities, including items such as global evaluation and pain management, were affected by hospital structural measures. CONCLUSIONS: Distance-based analysis can reveal the hidden structure of patient satisfaction. This study suggests that hospital structural measures including hospital size, the ability to provide acute surgical treatment, and hospital interest in improving medical care quality are factors which may influence the structure of patient satisfaction.


Assuntos
Hospitais , Satisfação do Paciente , Comunicação , Pesquisas sobre Serviços de Saúde , Tamanho das Instituições de Saúde , Humanos , Qualidade da Assistência à Saúde
5.
J Am Med Dir Assoc ; 22(3): 489-493, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33516670

RESUMO

OBJECTIVES: Green House and other small nursing home (NH) models are considered "nontraditional" due to their size (10-12 beds), universal caregivers, and other home-like features. They have garnered great interest regarding their potential benefit to limit Coronavirus Disease 2019 (COVID-19) infections due to fewer people living, working, visiting, and being admitted to Green House/small NHs, and private rooms and bathrooms, but this assumption has not been tested. If they prove advantageous compared with other NHs, they may constitute an especially promising model as policy makers and providers reinvent NHs post-COVID. DESIGN: This cohort study compared rates of COVID-19 infections, COVID-19 admissions/readmissions, and COVID-19 mortality, among Green House/small NHs with rates in other NHs between January 20, 2020 and July 31, 2020. SETTING AND PARTICIPANTS: All Green House homes that held a skilled nursing license and received Medicaid or Medicare payment were invited to participate; other small NHs that replicate Green House physical design and operational practices were eligible if they had the same licensure and payer sources. Of 57 organizations, 43 (75%) provided complete data, which included 219 NHs. Comparison NHs (referred to as "traditional NHs") were up to 5 most geographically proximate NHs within 100 miles that had <50 beds and ≥50 beds for which data were available from the Centers for Medicare and Medicaid Services (CMS). Because Department of Veterans Affairs organizations are not required to report to CMS, they were not included. METHODS: Rates per 1000 resident days were derived for COVID-19 cases and admissions, and per 100 COVID-19 positive cases for mortality. A log-rank test compared rates between Green House/small NHs and traditional NHs with <50 beds and ≥50 beds. RESULTS: Rates of all outcomes were significantly lower in Green House/small NHs than in traditional NHs that had <50 beds and ≥50 beds (log-rank test P < .025 for all comparisons). The median (middle value) rates of COVID-19 cases per 1000 resident days were 0 in both Green House/small NHs and NHs <50 beds, while they were 0.06 in NHs ≥50 beds; in terms of COVID-19 mortality, the median rates per 100 positive residents were 0 (Green House/small NHs), 10 (<50 beds), and 12.5 (≥50 beds). Differences were most marked in the highest quartile: 25% of Green House/small NHs had COVID-19 case rates per 1000 resident days higher than 0.08, with the corresponding figures for other NHs being 0.15 (<50 beds) and 0.74 (≥50 beds). CONCLUSIONS AND IMPLICATIONS: COVID-19 incidence and mortality rates are less in Green House/small NHs than rates in traditional NHs with <50 and ≥50 beds, especially among the higher and extreme values. Green House/small NHs are a promising model of care as NHs are reinvented post-COVID.


Assuntos
COVID-19/mortalidade , Tamanho das Instituições de Saúde , Casas de Saúde , Idoso , Bases de Dados Factuais , Hospitais com menos de 100 Leitos , Humanos , Admissão do Paciente/tendências , SARS-CoV-2 , Estados Unidos/epidemiologia
6.
Pancreatology ; 21(1): 25-30, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33341342

RESUMO

BACKGROUND: There is limited research in prognosticators of hospital transfer in acute pancreatitis (AP). Hence, we sought to determine the predictors of hospital transfer from small/medium-sized hospitals and outcomes following transfer to large acute-care hospitals. METHODS: Using the 2010-2013 Nationwide Inpatient Sample (NIS), patients ≥18 years of age with a primary diagnosis of AP were identified. Hospital size was classified using standard NIS Definitions. Multivariable analyses were performed for predictors of "transfer-out" from small/medium-sized hospitals and mortality in large acute-care hospitals. RESULTS: Among 381,818 patients admitted with AP to small/medium-sized hospitals, 13,947 (4%) were transferred out to another acute-care hospital. Multivariable analysis revealed that older patients (OR = 1.04; 95%CI 1.03-1.06), men (OR = 1.15; 95%CI 1.06-1.24), lower income quartiles (OR = 1.54; 95%CI 1.35-1.76), admission to a non-teaching hospital (OR = 3.38; 95%CI 3.00-3.80), gallstone pancreatitis (OR = 3.32; 95%CI 2.90-3.79), pancreatic surgery (OR = 3.14; 95%CI 1.76-5.58), and severe AP (OR = 3.07; 95%CI 2.78-3.38) were predictors of "transfer-out". ERCP (OR = 0.53; 95%CI 0.43-0.66) and cholecystectomy (OR = 0.14; 95%CI 0.12-0.18) were associated with decreased odds of "transfer-out". Among 507,619 patients admitted with AP to large hospitals, 31,058 (6.1%) were "transferred-in" from other hospitals. The mortality rate for patients "transferred-in" was higher than those directly admitted (2.54% vs. 0.91%, p < 0.001). Multivariable analysis revealed that being "transferred-in" from other hospitals was an independent predictor of mortality (OR = 1.47; 95% CI 1.22-1.77). CONCLUSIONS: Patients with AP transferred into large acute-care hospitals had a higher mortality than those directly admitted likely secondary to more severe disease. Early implementation of published clinical guidelines, triage, and prompt transfer of high-risk patients may potentially offset these negative outcomes.


Assuntos
Hospitalização , Pancreatite/mortalidade , Pancreatite/patologia , Feminino , Cálculos Biliares/complicações , Tamanho das Instituições de Saúde , Humanos , Tempo de Internação , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Pancreatite/complicações , Fatores Socioeconômicos , Fatores de Tempo
7.
Stroke ; 51(11): 3241-3249, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33081604

RESUMO

BACKGROUND AND PURPOSE: More than half of patients with acute ischemic stroke have minor neurological deficits; however, the frequency and outcomes of reperfusion therapy in regular practice has not been well-delineated. METHODS: Analysis of US National Inpatient Sample of hospitalizations with acute ischemic stroke and mild deficits (National Institutes of Health Stroke Scale [NIHSS] score 0-5) from October 1, 2016, to December 31, 2017. Patient- and hospital-level characteristics associated with use and outcome of reperfusion therapies were analyzed. Primary outcomes included excellent discharge disposition (discharge to home without assistance); poor discharge disposition (discharge to facility or death); in-hospital mortality; and radiological intracranial hemorrhage. RESULTS: Among 179 710 acute ischemic stroke admissions with recorded NIHSS during the 15-month study period, 103 765 (57.7%) had mild strokes (47.3% women; median age, 69 [interquartile range, 59-79] years; median NIHSS score of 2 [interquartile range, 1-4]). Considering reperfusion therapies among strokes with documented NIHSS, mild deficit hospitalizations accounted for 40.0% of IVT and 10.7% of mechanical thrombectomy procedures. Characteristics associated with IVT and with mechanical thrombectomy utilization were younger age, absence of diabetes, higher NIHSS score, larger/teaching hospital status, and Western US region. Excellent discharge outcome occurred in 48.2% of all mild strokes, and in multivariable analysis, was associated with younger age, male sex, White race, lower NIHSS score, absence of diabetes, heart failure, and kidney disease, and IVT use. IVT was associated with increased likelihood of excellent outcome (odds ratio, 1.90 [95% CI, 1.71-2.13], P<0.001) despite an increased risk of intracranial hemorrhage (odds ratio, 1.41 [95% CI, 1.09-1.83], P<0.001). CONCLUSIONS: In national US practice, more than one-half of acute ischemic stroke hospitalizations had mild deficits, accounting for 4 of every 10 IVT and 1 of every 10 mechanical thrombectomy treatments, and IVT use was associated with increased discharge to home despite increased intracranial hemorrhage.


Assuntos
Mortalidade Hospitalar , Hospitais/estatística & dados numéricos , AVC Isquêmico/terapia , Trombectomia/estatística & dados numéricos , Terapia Trombolítica/estatística & dados numéricos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Diabetes Mellitus/epidemiologia , Serviço Hospitalar de Emergência , Procedimentos Endovasculares/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Feminino , Tamanho das Instituições de Saúde , Hospitalização , Hospitais Rurais , Hospitais de Ensino , Hospitais Urbanos , Humanos , AVC Isquêmico/epidemiologia , AVC Isquêmico/fisiopatologia , Masculino , Pessoa de Meia-Idade , Alta do Paciente/estatística & dados numéricos , Transferência de Pacientes , Recuperação de Função Fisiológica , Insuficiência Renal Crônica/epidemiologia , Reperfusão/estatística & dados numéricos , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento , Estados Unidos
8.
BMC Health Serv Res ; 20(1): 967, 2020 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-33087106

RESUMO

BACKGROUND: Nation-wide adoption of electronic health records (EHRs) in hospitals has become a Turkish policy priority in recognition of their benefits in maintaining the overall quality of clinical care. The electronic medical record maturity model (EMRAM) is a widely used survey tool developed by the Healthcare Information and Management Systems Society (HIMSS) to measure the rate of adoption of EHR functions in a hospital or a secondary care setting. Turkey completed many standardizations and infrastructural improvement initiatives in the health information technology (IT) domain during the first phase of the Health Transformation Program between 2003 and 2017. Like the United States of America (USA), the Turkish Ministry of Health (MoH) applied a bottom-up approach to adopting EHRs in state hospitals. This study aims to measure adoption rates and levels of EHR use in state hospitals in Turkey and investigate any relationship between adoption and use and hospital size. METHODS: EMRAM surveys were completed by 600 (68.9%) state hospitals in Turkey between 2014 and 2017. The availability and prevalence of medical information systems and EHR functions and their use were measured. The association between hospital size and the availability/prevalence of EHR functions was also calculated. RESULTS: We found that 63.1% of all hospitals in Turkey have at least basic EHR functions, and 36% have comprehensive EHR functions, which compares favourably to the results of Korean hospitals in 2017, but unfavorably to the results of US hospitals in 2015 and 2017. Our findings suggest that smaller hospitals are better at adopting certain EHR functions than larger hospitals. CONCLUSION: Measuring the overall adoption rates of EHR functions is an emerging approach and a beneficial tool for the strategic management of countries. This study is the first one covering all state hospitals in a country using EMRAM. The bottom-up approach to adopting EHR in state hospitals that was successful in the USA has also been found to be successful in Turkey. The results are used by the Turkish MoH to disseminate the nation-wide benefits of EHR functions.


Assuntos
Registros Eletrônicos de Saúde/organização & administração , Tamanho das Instituições de Saúde/estatística & dados numéricos , Hospitais Estaduais/organização & administração , Registros Eletrônicos de Saúde/estatística & dados numéricos , Hospitais Estaduais/estatística & dados numéricos , Humanos , Inquéritos e Questionários , Turquia
9.
J Am Geriatr Soc ; 68(12): 2727-2734, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32955107

RESUMO

OBJECTIVE: To describe variations in COVID-19 confirmed cases and deaths among assisted living (AL) residents and examine their associations with key AL characteristics. DESIGN: Observational study employing data on confirmed COVID-19 cases and deaths in ALs from seven states, through May 29, 2020. SETTING: Information on COVID-19 cases/deaths in ALs was obtained from state government websites. A national inventory of ALs was used to identify communities with and without COVID-19 cases/deaths. Medicare Beneficiary Summary File identifying AL residents was employed to develop AL characteristics. County-level COVID-19 laboratory-confirmed cases/deaths were obtained from publicly available data. PARTICIPANTS: We found 4,865 ALs (2,647 COVID-19 cases and 777 deaths) in the seven states. After excluding missing data, the sample consisted of 3,994 ALs (82.1%) with 2,542 cases (96.0%) and 675 deaths (86.9%). MAIN OUTCOMES AND MEASURES: Outcomes were AL-level counts of cases and deaths. Covariates were AL characteristics and county-level confirmed COVID-19 cases/deaths. Multivariable two-part models determined the associations of independent variables with the likelihood of at least one case and death in the AL, and with the count of cases (deaths). RESULTS: State case fatality ranged from 3.32% in North Carolina to 9.26% in Connecticut, but for ALs in these states it was 12.89% and 31.59%, respectively. Among ALs with at least one case, midsize communities had fewer cases (incidence rate ratio (IRR) = 0.829; P = .004) than small ALs. ALs with higher proportions of racial/ethnic minorities had more COVID-19 cases (IRR = 1.08; P < .001), as did communities with higher proportions of residents with dementia, chronic obstructive pulmonary disease, and obesity. CONCLUSIONS AND RELEVANCE: ALs with a higher proportion of minorities had more COVID-19 cases. Many of the previously identified individual risk factors are also present in this vulnerable population. The impact of COVID-19 on ALs is as critical as that on nursing homes, and is worth equal attention from policy makers.


Assuntos
Moradias Assistidas/estatística & dados numéricos , COVID-19 , Medicare/estatística & dados numéricos , Casas de Saúde/estatística & dados numéricos , Medição de Risco/métodos , Idoso , COVID-19/diagnóstico , COVID-19/mortalidade , Comorbidade , Grupos Étnicos , Feminino , Tamanho das Instituições de Saúde , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Humanos , Masculino , Fatores de Risco , SARS-CoV-2/isolamento & purificação , Estados Unidos/epidemiologia , Populações Vulneráveis
10.
JNMA J Nepal Med Assoc ; 58(226): 447-452, 2020 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-32788769

RESUMO

Critical Care Medicine is a specialty dealing with the comprehensive management of patients having, or at risk of developing, acute, life threatening organ dysfunction. The glaring need of critical care services and human resources for critical care have become more evident in the face of the current COVID-19 Pandemic. At this juncture, when the world is facing threat to humanity with an increasing number of deaths due to COVID 19 pandemic, the discussion about the need for ICU beds and human resources for critical care management has re-surfaced and is being increasingly realized. In Nepal, as of 15th April, 2020, there are 194 hospitals with ICU facilities. The total ICU bed strength is 1595 in 194 hospitals (which is approximately 6% of all hospital beds) and only around 50% of them are equipped with ventilators (840). These figures indicate that Nepal has approximately 2.8 ICU beds per 100,000 population. As Nepal braces to contain a major COVID-19 outbreak, the hospital capacities of the country have already come under huge pressure. If the number of confirmed cases of COVID-19 continue to rise at the current pace, the shortage of critical care facilities will become more glaring than ever before. The current pandemic is a tremendous opportunity for health planners to accelerate action and ensure that the country is well-equipped to contain the COVID-19 pandemic. We need to be working towards infrastructure and human resource strengthening and expansion in critical care, in order to efficiently contain the pandemic.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Cuidados Críticos/organização & administração , Pneumonia Viral/terapia , COVID-19 , Infecções por Coronavirus/epidemiologia , Tamanho das Instituições de Saúde , Humanos , Nepal/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , SARS-CoV-2 , Capacidade de Resposta ante Emergências , Ventiladores Mecânicos
11.
Am J Health Syst Pharm ; 77(22): 1885-1892, 2020 10 30.
Artigo em Inglês | MEDLINE | ID: mdl-32712675

RESUMO

PURPOSE: Utilization of hydroxychloroquine, chloroquine, and supportive therapy drugs in hospitals in New York during the early weeks of the coronavirus disease 2019 (COVID-19) pandemic was analyzed. SUMMARY: Drug utilization trends for 7 medications used to treat patients with suspected or confirmed COVID-19 at 47 New York hospitals were identified. The data demonstrated sharp increases in aggregate utilization of hydroxychloroquine and chloroquine and the number of patients receiving either drug beginning on March 15, with a notable 20% median increase per day through March 31. The net quantity of drug charge units per day for midazolam, propofol, ketamine, cisatracurium, and fentanyl also increased during the study period. Following peak utilization, use of all study drugs decreased at different times throughout April 2020. The data were used to provide information to various stakeholders in the drug supply chain during the initial surge of the pandemic. CONCLUSION: This analysis describes the increased use, beginning in mid-March 2020, of hydroxychloroquine, chloroquine, midazolam, propofol, ketamine, cisatracurium, and fentanyl in 47 hospitals in New York State. The increased utilization of supportive therapy drugs was consistent with the surge in patients with presumed or confirmed COVID-19 during the study period. These data and observations can help clinicians, health-system leaders, manufacturers, wholesalers, and policymakers understand the impact of current and future pandemics on the drug supply chain.


Assuntos
Infecções por Coronavirus , Uso de Medicamentos/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Pandemias , Pneumonia Viral , Antivirais/uso terapêutico , COVID-19 , Infecções por Coronavirus/epidemiologia , Indústria Farmacêutica , Tamanho das Instituições de Saúde , Hospitalização/estatística & dados numéricos , Humanos , Hidroxicloroquina/uso terapêutico , New York/epidemiologia , Cidade de Nova Iorque/epidemiologia , Pneumonia Viral/epidemiologia
13.
Artigo em Inglês | MEDLINE | ID: mdl-32664583

RESUMO

Because of the nature of their work, physical and occupational therapists are at high risk of burnout, which is associated with decreased job satisfaction, medical errors, and mental wellbeing in healthcare professionals. To well manage and minimize potential impact of burnout, risk factors should be determined. This study examined burnout and job stress in physical and occupational therapists in various Korean hospital settings. Physical and occupational therapists from several rehabilitation facilities in South Korea completed a survey between March-May 2019. A set of questionnaires, including the Maslach Burnout Inventory and Job Content Questionnaire, were distributed to all participants. In total, 325 professionals (131 men and 194 women) were recruited. Burnout and work-related stress differed significantly according to several factors. Hospital size, gender, and age were the main contributory factors affecting at least two dimensions of the questionnaires. The more vulnerable group consisted of female therapists in their 20s at small- or medium-sized hospitals with low scores for quality of life. High levels of job stress and burnout were observed in female therapists in their 20s at small- or medium-sized hospitals. Hospitals and society should create suitable environments and understand the nature of therapists' work to improve healthcare.


Assuntos
Esgotamento Profissional/psicologia , Esgotamento Psicológico/psicologia , Estresse Ocupacional/psicologia , Terapeutas Ocupacionais/psicologia , Qualidade de Vida/psicologia , Fatores Etários , Esgotamento Profissional/epidemiologia , Esgotamento Psicológico/epidemiologia , Criança , Estudos Transversais , Feminino , Tamanho das Instituições de Saúde , Humanos , Satisfação no Emprego , Masculino , Estresse Ocupacional/epidemiologia , República da Coreia/epidemiologia , Fatores Sexuais , Inquéritos e Questionários
14.
Surg Today ; 50(11): 1515-1523, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32474641

RESUMO

PURPOSES: The purpose of this study was to investigate the outcomes after appendectomy in children according to hospital size. METHODS: The records of 11,565 patients with the diagnosis-related group code for appendectomy were extracted from HIRA-Pediatric Patient Sample from 2012 to 2016. The number of hospital visits and the length of stay in hospital within 30 days after appendectomy were analyzed. RESULTS: Patients who were treated at large-sized hospitals were more likely to be younger, more likely to reside in metropolitan areas, and tended to receive laparoscopic surgery. The number of hospital visits within 30 days in patients managed by medium- and large-sized hospitals decreased in comparison to small-sized hospitals. The length of hospital stay in large-sized hospitals was decreased in comparison to small- and medium-sized hospitals. A subgroup analysis revealed that complicated appendectomy did not have a significant impact on the difference in the length of hospital stay between hospital sizes. CONCLUSION: The number of hospital visits and the length of hospital stay was higher in small-sized hospitals in comparison to large-sized hospitals. Appendectomy performed in the larger hospital showed better outcomes in pediatric patients. We recommend that pediatric surgical procedures be performed in large hospitals, and that proper incentives be given for procedures to be performed by pediatric specialists.


Assuntos
Apendicectomia , Apendicite/cirurgia , Conjuntos de Dados como Assunto , Avaliação de Resultados em Cuidados de Saúde , Adolescente , Fatores Etários , Criança , Pré-Escolar , Análise de Dados , Feminino , Tamanho das Instituições de Saúde , Hospitais , Humanos , Tempo de Internação , Masculino , Programas Nacionais de Saúde , Qualidade da Assistência à Saúde
15.
Workplace Health Saf ; 68(9): 422-431, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32469688

RESUMO

Background: Percutaneous injuries and blood-borne-related infections pose occupational hazards to healthcare professionals. However, the prevalence and associated factors for these hazards among midwives in Hunan Province, China are poorly documented. Methods: A cross-sectional study was conducted among a sample of 1,282 eligible midwives in the cities of Yongzhou, Chenzhou, Hengyang, and Changsha in Hunan Province, China, from January 2017 to July 2017. The association of selected independent variables with percutaneous injuries was investigated using binary logistic regression. Results: 992 participants responded (77.3%), and within the previous 12 months, 15.7% experienced percutaneous injuries. In multivariate analysis, hospital size, age, length of employment as a midwife, weekly working hours, and three aspects of Hospital Safety Climate Scale were associated with percutaneous injuries. The risk of percutaneous injuries among the midwives working in hospitals with ≤399 beds was higher than that among those working in hospitals with ≥400 beds by nearly 3 times. Furthermore, the percutaneous injury prevalence of midwives decreased as age increased. Moreover, the probability of percutaneous injuries among the midwives with weekly working hours of >40 was 4.35 times higher compared with that among midwives with weekly working hours of ≤40. Conclusion/Application to practice: The prevalence of percutaneous injuries among midwives in the study hospitals was substantial. Our results further proved that risk mitigation strategies tailored to midwives are needed to reduce this risk. These strategies include ensuring a positive organizational climate, providing highly safe devices, and reducing the workload.


Assuntos
Tocologia/estatística & dados numéricos , Ferimentos Penetrantes Produzidos por Agulha/epidemiologia , Traumatismos Ocupacionais/epidemiologia , Ferimentos e Lesões/epidemiologia , Adulto , Infecções Transmitidas por Sangue , China/epidemiologia , Estudos Transversais , Feminino , Tamanho das Instituições de Saúde , Humanos , Masculino , Recursos Humanos em Hospital , Prevalência , Pele/lesões , Inquéritos e Questionários
16.
South Med J ; 113(5): 254-260, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32358621

RESUMO

OBJECTIVES: Hospitalized patients with acute and chronic pancreatitis (AP and CP) are prone to frequent readmissions to different hospitals. The rate of care fragmentation and its impact on important outcomes are unknown. The aims of this study were to evaluate the rate and predictors of care fragmentation in patients hospitalized with AP and CP using a nationally representative sample, and to analyze the impact of care fragmentation on mortality, cost, and hospital readmissions. METHODS: We identified all adult hospitalizations with a primary diagnosis of AP or CP in the 2010-2014 National Readmissions Database, which captures statewide readmissions. We calculated 30- and 90-day readmission and care fragmentation rates. Readmission to a nonindex hospital was considered care fragmentation. Logistic regression was used to determine hospital and patient factors independently associated with 30-day care fragmentation. Patients readmitted within 30 days were followed for 60 days postdischarge from the first readmission. Mortality during the first readmission, hospitalization costs, and rates of 60-day readmission were compared between those with and without care fragmentation. RESULTS: There were 479,427 admissions with AP and 25,513 with CP. The rates of 30- and 90-day readmissions were 13.5% and 22.9% for AP and 26.9% and 44.7%% for CP. The rates of 30- and 90-day care fragmentation were 28% and 32% for AP and 33% and 38% for CP. Younger age (younger than 45 y), male patients, length of stay <5 days, ≥4 Elixhauser comorbidities, and self-pay or Medicaid insurance were associated with increased risk of 30-day care fragmentation. Large hospital size, routine discharge, and metropolitan location were associated with lower risk. Patients who had the first readmission to a nonindex hospital had a higher mortality (2% vs 1.6%, P = 0.005), length of stay (6.5 vs 5.6 days, P < 0.0001), mean hospitalization cost ($16,731 vs $13,368, P < 0.0001), and 60-day readmission (48.4% vs 42.9%) compared with those readmitted to the index hospital. CONCLUSIONS: In patients with AP and CP, one-third of 90-day readmissions occur at a nonindex hospital. Care fragmentation is associated with increased mortality, readmissions, and cost of care.


Assuntos
Continuidade da Assistência ao Paciente/estatística & dados numéricos , Mortalidade Hospitalar , Tempo de Internação/estatística & dados numéricos , Pancreatite Crônica/terapia , Pancreatite/terapia , Readmissão do Paciente/estatística & dados numéricos , Adulto , Fatores Etários , Idoso , Comorbidade , Feminino , Tamanho das Instituições de Saúde , Hospitalização , Hospitais Urbanos , Humanos , Modelos Logísticos , Masculino , Medicaid , Pessoas sem Cobertura de Seguro de Saúde , Pessoa de Meia-Idade , Fatores Sexuais , Estados Unidos , Adulto Jovem
18.
Phys Ther ; 100(8): 1307-1322, 2020 08 12.
Artigo em Inglês | MEDLINE | ID: mdl-32266383

RESUMO

People with stroke cite mobility deficits as one of the most burdensome limitations. National and international stroke guidelines recommend physical therapy based on task-oriented practice, with high numbers of repetitions to improve mobility. In the outpatient setting in Germany and Austria, these principles have not yet been established. The purpose of this study was to identify an evidence-based intervention that could help reduce this research-practice gap. A stepwise approach proposed by Voigt-Radloff and colleagues and Cochrane Germany was used. First, the specific health service problem in the German and Austrian physical therapy outpatient context was identified. Second, a promising intervention was identified using a systematic search in the Cochrane Library and by grading the quality of the evidence using the Grading of Recommendations Assessment, Development and Evaluation. Finally, the transferability of the promising intervention into the local context was evaluated using predefined questions from the Cochrane guide and reports from health insurances, professional organizations, and national stroke guidelines. Task-oriented circuit training reviewed by English and colleagues was chosen. The review showed clinically important improvements in walking distance and speed. The quality of the evidence was graded high for these 2 outcomes. We identified contextual challenges for implementation at the setting level (eg, insufficient reimbursement for group therapy by insurance companies), the participant and therapist level (eg, unknown motivation for group therapy due to the established 1:1 patient-therapist ratio), and the outcome measure level (eg, lack of standardized, cross-culturally translated manuals). Although task-oriented circuit training is scientifically well established, barriers to implementation into routine care in Germany and Austria can be expected. In a next step, research using knowledge translation methodology will focus on the detailed evaluation of barriers and facilitators with relevant stakeholders.


Assuntos
Exercícios em Circuitos/métodos , Limitação da Mobilidade , Reabilitação do Acidente Vascular Cerebral/métodos , Velocidade de Caminhada , Assistência Ambulatorial/métodos , Áustria , Alemanha , Tamanho das Instituições de Saúde , Humanos , Avaliação de Resultados em Cuidados de Saúde , Seleção de Pacientes , Projetos de Pesquisa , Acidente Vascular Cerebral/complicações , Teste de Caminhada
19.
Rev Esp Quimioter ; 33(3): 200-206, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32345004

RESUMO

OBJECTIVE: Bloodstream Infections has become in one of the priorities for the antimicrobial stewardship teams due to their high mortality and morbidity rates. Usually, the first antibiotic treatment for this pathology must be empirical, without microbiology data about the microorganism involved. For this reason, the population studies about the etiology of bacteremia are a key factor to improve the selection of the empirical treatment, because they describe the main microorganisms associated to this pathology in each area, and this data could facilitate the selection of correct antibiotic therapy. METHODS: This study describes the etiology of bloodstream infections in the Southeast of Spain. The etiology of bacteremia was analysed by a retrospective review of all age-ranged patients from every public hospital in the Autonomous Community of Valencia (approximately 5,000,000 inhabitants) for five years. RESULTS: A total of 92,097 isolates were obtained, 44.5% of them were coagulase-negative staphylococci. Enterobacteriales was the most prevalent group and an increase in frequency was observed along the time. Streptococcus spp. were the second microorganisms more frequently isolated. Next, the most prevalent were Staphylococcus aureus and Enterococcus spp., both with a stable incidence along the study. Finally, Pseudomonas aeruginosa was the fifth microorganism more frequently solated. CONCLUSIONS: These data constitute a useful tool that can help in the choice of empirical treatment for bloodstream infections, since the knowledge of local epidemiology is key to prescribe a fast and appropriate antibiotic therapy, aspect capital to improve survival.


Assuntos
Sepse/etiologia , Sepse/microbiologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Gestão de Antimicrobianos , Criança , Pré-Escolar , Análise por Conglomerados , Feminino , Infecções por Bactérias Gram-Negativas/epidemiologia , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Positivas/epidemiologia , Infecções por Bactérias Gram-Positivas/microbiologia , Tamanho das Instituições de Saúde , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Prevalência , Estações do Ano , Sepse/epidemiologia , Fatores Sexuais , Espanha/epidemiologia , Adulto Jovem
20.
J Neurosurg ; 134(3): 1303-1315, 2020 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-32168482

RESUMO

OBJECTIVE: The nature of the volume-outcome relationship in cases with severe traumatic brain injury (TBI) remains unclear, with considerable interhospital variation in patient outcomes. The objective of this study was to understand the state of the volume-outcome relationship at different levels of trauma centers in the United States. METHODS: The authors queried the National Trauma Data Bank for the years 2007-2014 for patients with severe TBI. Case volumes for each level of trauma center organized into quintiles (Q1-Q5) served as the primary predictor. Analyzed outcomes included in-hospital mortality, total hospital length of stay (LOS), and intensive care unit (ICU) stay. Multivariable regression models were performed for in-hospital mortality, overall complications, and total hospital and ICU LOSs to adjust for possible confounders. The analysis was stratified by level designation of the trauma center. Statistical significance was established at p < 0.001 to avoid a type I error due to a large sample size. RESULTS: A total of 122,445 patients were included. Adjusted analysis did not demonstrate a significant relationship between increasing hospital volume of severe TBI cases and in-hospital mortality, complications, and nonhome hospital discharge disposition among level I-IV trauma centers. However, among level II trauma centers, hospital LOS was longer for the highest volume quintile (adjusted mean difference [MD] for Q5: 2.83 days, 95% CI 1.40-4.26 days, p < 0.001, reference = Q1). For level III and IV trauma centers, both hospital LOS and ICU LOS were longer for the highest volume quintile (adjusted MD for Q5: LOS 4.6 days, 95% CI 2.3-7.0 days, p < 0.001; ICU LOS 3.2 days, 95% CI 1.6-4.8 days, p < 0.001). CONCLUSIONS: Higher volumes of severe TBI cases at a lower level of trauma center may be associated with a longer LOS. These results may assist policymakers with target interventions for resource allocation and point to the need for careful prehospital decision-making in patients with severe TBI.


Assuntos
Lesões Encefálicas Traumáticas/cirurgia , Tamanho das Instituições de Saúde/estatística & dados numéricos , Centros de Traumatologia/estatística & dados numéricos , Adulto , Idoso , Lesões Encefálicas Traumáticas/mortalidade , Estudos de Coortes , Bases de Dados Factuais , Serviços Médicos de Emergência , Feminino , Escala de Coma de Glasgow , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Planejamento de Assistência ao Paciente , Complicações Pós-Operatórias/epidemiologia , Resultado do Tratamento , Estados Unidos
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