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1.
Gan To Kagaku Ryoho ; 48(11): 1365-1368, 2021 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-34795128

RESUMO

Docetaxel and cyclophosphamide (TC) and epirubicin and cyclophosphamide (EC) therapies are postoperative chemotherapy regimens for breast cancer. However, a previous study reported on the development of adverse events, such as neutropenia, in Asian patients. In this study, we examined the occurrence of neutropenia during chemotherapy, assessed the symptoms, and investigated the dose-reduction/discontinuation of chemotherapy or admission in patients undergoing postoperative EC or TC therapy following breast cancer surgery at our hospital between April 2018 and March 2020. EC and TC therapies were performed in 29 and 23 patients, respectively. We observed a significant difference in the incidence of neutropenia between the two therapies, although this observation might have been influenced by the frequent use of pegfilgrastim. In the TC therapy group, edema and pain were frequently observed. We observed no significant differences in the dose-reduction/discontinuation of chemotherapy or admission. However, in the TC therapy group, 5 patients required admission.


Assuntos
Neoplasias da Mama , Neutropenia , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Neoplasias da Mama/tratamento farmacológico , Ciclofosfamida/efeitos adversos , Epirubicina/efeitos adversos , Feminino , Fator Estimulador de Colônias de Granulócitos/uso terapêutico , Hospitais Urbanos , Humanos , Neutropenia/induzido quimicamente , Neutropenia/tratamento farmacológico , Neutropenia/epidemiologia , Resultado do Tratamento
2.
Acta Biomed ; 92(S6): e2021419, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34739461

RESUMO

BACKGROUND: In Europe, Italy and Lombardy, in autumn 2020, there was a steep increase in reported cases due to the second epidemic wave of SARS-Cov-2 infection. We aimed to evaluate the appropriateness of COVID-19 patients' admissions to the ED of the San Raffaele Hospital. METHODS: We compared data between the inter-wave period (IWP, from 1st to 30th September) and the second wave period (WP, 1st October to 15th November) focusing on the ED presentation, discharge priority colour code and outcomes. RESULTS: Out of 977 admissions with a SARS-Cov-2 positive swab, 6% were in the IWP and 94% in the WP. Red, yellow and white code increased (these latter from 1.8% to 5.4%) as well as self-presented in yellow and white code. Discharges home increased from 1.8% to 5.4%, while hospitalizations decreased from 63% to 51%. DISCUSSION: We found a rise in white codes (among self-presented patients), indicating inappropriateness of admissions. The increase in discharges suggests that several patients did not require hospitalization. CONCLUSIONS: The pandemic brought out the fundamental role of primary care to manage patients with low-intensity needs. The important increase in ED admissions of COVID-19 patients caused a reduction of NO-COVID-19 patients, with possible inadequate treatment.


Assuntos
COVID-19 , Serviço Hospitalar de Emergência , Hospitalização , Hospitais Urbanos , Humanos , Itália/epidemiologia , Pandemias , SARS-CoV-2
3.
Ulster Med J ; 90(3): 157-161, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34815594

RESUMO

Background: During the COVID-19 pandemic of Spring 2020, Belfast City Hospital functioned as Belfast's Nightingale facility. Evidence published during this time focused mainly on the acute management of the condition. Guidance on follow up and long-term management for patients recovering from COVID-19 was sparse. A specialist COVID-19 follow up service was devised in Belfast City Hospital led by a respiratory physician with physiotherapy and psychology input. Methods: Data was collected on all patients admitted to Belfast Nightingale unit. Patients admitted to Intensive Care at any stage in their admission were followed up separately by Intensive Care. Initial consultation was via telephone call for all eligible patients six weeks post discharge, followed by face-to-face consultation for those with symptoms at next available appointment, and a further face-to-face consultation at twelve weeks post hospital discharge. Patients were seen by respiratory physician, physiotherapy and psychology at each appointment. All patients who had initial changes on chest radiograph had 12 week follow up radiograph requested as per British Thoracic Society guidelines. Results: 29 patients were followed up after hospitalisation with COVID-19. Of these, 10 were brought for face-to-face consultations. Patients at clinic were all functionally independent with a median Medical Research Council dyspnoea score of 2 and a subjective assessment of their current health of median 50, on a visual analogue scale 0-100. Fatigue was common with all patients. Depression, anxiety and post-traumatic stress disorder were all reported from psychological review. Chest radiograph showed signs of improvement in 100% of clinic attendees. 90% of patients seen in clinic had normal or chronic obstructive patterns on spirometry, with one patient having a reduced transfer factor. Conclusion: Majority of patients did not require face-to-face review and were recovering well. Of the 10 patients seen in the respiratory led clinic, the main issues reported were fatigue and psychological issues. Respiratory symptoms were significantly improving in 9 out of the 10 patients seen. All patients have been introduced to psychology service whilst at clinic and will continue to receive necessary support.


Assuntos
COVID-19 , Pandemias , Assistência ao Convalescente , Seguimentos , Hospitais Urbanos , Humanos , Alta do Paciente , SARS-CoV-2
4.
BMC Surg ; 21(1): 404, 2021 Nov 23.
Artigo em Inglês | MEDLINE | ID: mdl-34814898

RESUMO

BACKGROUND: Open reduction internal fixation (ORIF) of closed fractures is a required indication for surgical antimicrobial prophylaxis (SAP). Guidelines contain recommendations on how best to prescribe SAP, however, adherence to SAP guidelines remains suboptimal. The Australian Therapeutic Guidelines: Antibiotic v16 (updated April 2019) advocates for single dose prophylaxis for ORIF procedures. There is a paucity of information on how SAP is prescribed for ORIF of closed fractures in Australian hospitals. The aim of this study was to identify prescribing practice and to evaluate guideline adherence pre- and post-guideline update. METHODS: A retrospective audit was conducted for patients undergoing an ORIF of closed fractures at a metropolitan teaching hospital in a 6-month period during 2018 (pre-guideline update) and 2019 (post-guideline update). Data were collected on prescribing practice (perioperative antibiotics prescribed, dose, time and route of administration and duration of prophylaxis) and compared to SAP recommendations in Therapeutic Guidelines: Antibiotic v15 (2018) and v16 (2019). Descriptive statistics and Chi square tests were used to report categorical variables. Binary logistic regression was used to identify factors associated with guideline adherence. A p-value < 0.05 was deemed statistically significant. RESULTS: Data were collected for a total of 390 patients (n = 185, 2018; n = 205, 2019). Cefazolin was the most commonly prescribed antibiotic as per guideline recommendations, with variable, yet appropriate doses observed across the two audit periods. While 78.3% of patients received SAP for the correct duration in 2018, only 20.4% of patients received single dose prophylaxis in 2019. Overall adherence to guidelines was 63.2% in the 2018, and 18.0% in the 2019 audit periods respectively. Patient age was significantly associated with an increase in overall guideline adherence, while lower limb fractures, an American Society of Anesthesiologists (ASA) score of 3 and emergency admissions were associated with decreased overall adherence to SAP guidelines. CONCLUSION: Adherence to guidelines was greater with v15 (2018) compared with v16 (2019). Patient factors, including limb fracture site and ASA score, had little impact on guideline adherence. Further research is required to understand what influences guideline adherence in the orthopaedic setting.


Assuntos
Anti-Infecciosos , Antibioticoprofilaxia , Antibacterianos/uso terapêutico , Austrália , Fidelidade a Diretrizes , Hospitais Urbanos , Humanos , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/tratamento farmacológico , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/prevenção & controle
5.
BMJ Open ; 11(10): e051045, 2021 10 26.
Artigo em Inglês | MEDLINE | ID: mdl-34702729

RESUMO

OBJECTIVE: Dynamics of humoral immune responses to SARS-CoV-2 antigens following infection suggest an initial decay of antibody followed by subsequent stabilisation. We aim to understand the longitudinal humoral responses to SARS-CoV-2 nucleocapsid (N) protein and spike (S) protein and to evaluate their correlation to clinical symptoms among healthcare workers (HCWs). DESIGN: A prospective longitudinal study. SETTING: This study was conducted in a New York City public hospital in the South Bronx, New York. PARTICIPANTS: HCWs participated in phase 1 (N=500) and were followed up 4 months later in phase 2 (N=178) of the study. They underwent SARS-CoV-2 PCR and serology testing for N and S protein antibodies, in addition to completion of an online survey in both phases. Analysis was performed on the 178 participants who participated in both phases of the study. PRIMARY OUTCOME MEASURE: Evaluate longitudinal humoral responses to viral N (qualitative serology testing) and S protein (quantitative Mount Sinai Health System ELISA to detect receptor-binding domain and full-length S reactive antibodies) by measuring rate of decay. RESULTS: Anti-N antibody positivity was 27% and anti-S positivity was 28% in phase 1. In phase 1, anti-S titres were higher in symptomatic (6754 (5177-8812)) than in asymptomatic positive subjects (5803 (2825-11 920)). Marginally higher titres (2382 (1494-3797)) were seen in asymptomatic compared with the symptomatic positive subgroup (2198 (1753-2755)) in phase 2. A positive correlation was noted between age (R=0.269, p<0.01), number (R=0.310, p<0.01) and duration of symptoms (R=0.434, p<0.01), and phase 1 anti-S antibody titre. A strong correlation (R=0.898, p<0.001) was observed between phase 1 titres and decay of anti-S antibody titres between the two phases. Significant correlation with rate of decay was also noted with fever (R=0.428, p<0.001), gastrointestinal symptoms (R=0.340, p<0.05), and total number (R=0.357, p<0.01) and duration of COVID-19 symptoms (R=0.469, p<0.001). CONCLUSIONS: Higher initial anti-S antibody titres were associated with larger number and longer duration of symptoms as well as a faster decay between the two time points.


Assuntos
COVID-19 , SARS-CoV-2 , Anticorpos Antivirais , Formação de Anticorpos , Pessoal de Saúde , Hospitais Urbanos , Humanos , Estudos Longitudinais , Cidade de Nova Iorque/epidemiologia , Estudos Prospectivos
6.
Int J Med Inform ; 156: 104603, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34628256

RESUMO

INTRODUCTION: Electronic nursing documentation is an essential aspect of inpatient care and multidisciplinary communication. Analysing data in electronic medical record (eMR) systems can assist in understanding clinical workflows, improving care quality, and promoting efficiency in the healthcare system. This study aims to assess timeliness of completion of an electronic nursing admission assessment form and identify patient and facility factors associated with form completion in three metropolitan hospitals. MATERIALS AND METHODS: Records of 37,512 adult inpatient admissions (November 2018-November 2019) were extracted from the hospitals' eMR system. A dichotomous variable descriptive of completion of the nursing assessment form (Yes/No) was created. Timeliness of form completion was calculated as the interval between date and time of admission and form completion. Univariate and multivariate multilevel logistic regression were used to identify factors associated with form completion. RESULTS: An admission assessment form was completed for 78.4% (n = 29,421) of inpatient admissions. Of those, 78% (n = 22,953) were completed within the first 24 h of admission, 13.3% (n = 3,910) between 24 and 72 h from admission, and 8.7% (n = 2,558) beyond 72 h from admission. Patient length of hospital stay, admission time, and admitting unit's nursing hours per patient day were associated with form completion. Patient gender, age, and admitting unit type were not associated with form completion. DISCUSSION: Form completion rate was high, though more emphasis needs to be placed on the importance of timely completion to allow for adequate patient care planning. Staff education, qualitative understanding of delayed form completion, and streamlined guidelines on nursing admission and eMR use are recommended.


Assuntos
Registros Eletrônicos de Saúde , Pacientes Internados , Admissão do Paciente , Austrália , Documentação , Eletrônica , Hospitais Urbanos , Humanos
7.
BMC Health Serv Res ; 21(1): 940, 2021 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-34503494

RESUMO

BACKGROUND: As healthcare systems strive for efficiency, hospital "length of stay outliers" have the potential to significantly impact a hospital's overall utilization. There is a tendency to exclude such "outlier" stays in local quality improvement and data reporting due to their assumed rare occurrence and disproportionate ability to skew mean and other summary data. This study sought to assess the influence of length of stay (LOS) outliers on inpatient length of stay and hospital capacity over a 5-year period at a large urban academic medical center. METHODS: From January 2014 through December 2019, 169,645 consecutive inpatient cases were analyzed and assigned an expected LOS based on national academic center benchmarks. Cases in the top 1% of national sample LOS by diagnosis were flagged as length of stay outliers. RESULTS: From 2014 to 2019, mean outlier LOS increased (40.98 to 45.11 days), as did inpatient LOS with outliers excluded (5.63 to 6.19 days). Outlier cases increased both in number (from 297 to 412) and as a percent of total discharges (0.98 to 1.56%), and outlier patient days increased from 6.7 to 9.8% of total inpatient plus observation days over the study period. CONCLUSIONS: Outlier cases utilize a disproportionate and increasing share of hospital resources and available beds. The current tendency to exclude such outlier stays in data reporting due to assumed rare occurrence may need to be revisited. Outlier stays require distinct and targeted interventions to appropriately reduce length of stay to both improve patient care and maintain hospital capacity.


Assuntos
Hospitais Urbanos , Melhoria de Qualidade , Humanos , Tempo de Internação , Estudos Retrospectivos
8.
PLoS One ; 16(9): e0257596, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34543323

RESUMO

BACKGROUND: To describe factors associated with severe sepsis in diarrheal adults and their outcomes and offender in blood and stool to understand their interplay as clinical features of sepsis and severe diarrhea often overlap. METHODS AND RESULTS: We used this retrospective chart analysis employing an unmatched case-control design to study critically ill diarrheal adults aged ≥18 years treated in ICU of Dhaka hospital, icddr,b between January 2011 to December 2015. Of 8,863 in-patient diarrheal adults, 350 having severe sepsis were cases and an equal number of randomly selected non-septic patients were the controls. Cases died significantly more (14.9% vs 4.6%, p = <0.001) than controls. 69% of the cases progressed to septic shock. In logistic regression analysis, steroid intake, ileus, acute kidney injury (AKI), metabolic acidosis, and hypocalcemia were significantly associated with severe sepsis in diarrheal adults (all, p<0.05). 12% of cases (40/335) had bacteremia. Streptococcus pneumoniae [9 (22.5%)] was the single most common pathogen and gram-negatives [27 (67.5%)] were prevailing as a group. CONCLUSION: Diarrheal adults who had ileus, AKI, metabolic acidosis, hypocalcemia, and also took steroids were found to have an association with severe sepsis. Strikingly, gram-negative were the predominant bacteria among the diarrheal adults having severe sepsis.


Assuntos
Diarreia/patologia , Sepse/complicações , Injúria Renal Aguda/complicações , Injúria Renal Aguda/patologia , Adulto , Bacteriemia/complicações , Bacteriemia/microbiologia , Bacteriemia/patologia , Bangladesh , Diarreia/complicações , Feminino , Hospitais Urbanos , Humanos , Unidades de Terapia Intensiva , Contagem de Leucócitos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Retrospectivos , Streptococcus pneumoniae/isolamento & purificação
9.
Sex Reprod Healthc ; 30: 100656, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34521028

RESUMO

OBJECTIVE: HIV seroconversion during pregnancy disproportionately affects urban, minority pregnant individuals. In order to prevent perinatal HIV transmission, it is essential that individuals are aware of HIV risk factors and effective transmission prevention strategies are employed. Thus, we aimed to examine knowledge about HIV transmission and attitudes about HIV among low-income, minority pregnant individuals and their partners living in a high HIV prevalence area. METHODS: In this qualitative study, pregnant participants were HIV-seronegative individuals receiving publicly-funded prenatal care in an urban academic center in the United States. Pregnant individuals and their partners were recruited to participate in a quality improvement program offering HIV testing to partners of pregnant people. Semi-structured guides were used to conduct individual interviews about participant sources of information about HIV, knowledge about transmission, and attitudes regarding those living with HIV. Transcripts were analyzed using the constant comparative method to determine themes and subthemes. RESULTS: Of 51 participants, 29 were pregnant individuals and 22 were non-pregnant partners. We found that inaccurate knowledge about perinatal HIV transmission was prevalent. Sources of information about HIV included reputable literary information or educational experiences, broadcast media, and word-of-mouth sources. Participants held dichotomous perceptions of people living with HIV. CONCLUSIONS: Among low-income, minority pregnant people and their partners in a high HIV prevalence area, inaccuracies and lack of knowledge about HIV transmission were common. Efforts to educate pregnant individuals and their partners about HIV and perinatal HIV transmission should address common misconceptions and use popular sources of information.


Assuntos
Infecções por HIV , Complicações Infecciosas na Gravidez , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Hospitais Urbanos , Humanos , Transmissão Vertical de Doenças Infecciosas , Gravidez , Cuidado Pré-Natal , Parceiros Sexuais
10.
West J Emerg Med ; 22(5): 1051-1059, 2021 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-34546880

RESUMO

INTRODUCTION: Diverse coronavirus disease 2019 (COVID-19) mortalities have been reported but focused on identifying susceptible patients at risk of more severe disease or death. This study aims to investigate the mortality variations of COVID-19 from different hospital settings during different pandemic phases. METHODS: We retrospectively included adult (≥18 years) patients who visited emergency departments (ED) of five hospitals in the state of Texas and who were diagnosed with COVID-19 between March-November 2020. The included hospitals were dichotomized into urban and suburban based on their geographic location. The primary outcome was mortality that occurred either during hospital admission or within 30 days after the index ED visit. We used multivariable logistic regression to investigate the associations between independent variables and outcome. Generalized additive models were employed to explore the mortality variation during different pandemic phases. RESULTS: A total of 1,788 adult patients who tested positive for COVID-19 were included in the study. The median patient age was 54.6 years, and 897 (50%) patients were male. Urban hospitals saw approximately 59.5% of the total patients. A total of 197 patients died after the index ED visit. The analysis indicated visits to the urban hospitals (odds ratio [OR] 2.14, 95% confidence interval [CI], 1.41, 3.23), from March to April (OR 2.04, 95% CI, 1.08, 3.86), and from August to November (OR 2.15, 95% CI, 1.37, 3.38) were positively associated with mortality. CONCLUSION: Visits to the urban hospitals were associated with a higher risk of mortality in patients with COVID-19 when compared to visits to the suburban hospitals. The mortality risk rebounded and showed significant difference between urban and suburban hospitals since August 2020. Optimal allocation of medical resources may be necessary to bridge this gap in the foreseeable future.


Assuntos
COVID-19/mortalidade , Serviço Hospitalar de Emergência/estatística & dados numéricos , Mortalidade Hospitalar , Hospitais Urbanos/estatística & dados numéricos , Pandemias , Serviços de Saúde Suburbana/estatística & dados numéricos , Adulto , Idoso , Humanos , Masculino , Medicare , Pessoa de Meia-Idade , Características de Residência , Estudos Retrospectivos , SARS-CoV-2 , Estados Unidos/epidemiologia
11.
Clin Nutr ; 40(10): 5355-5364, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34560606

RESUMO

BACKGROUND & AIMS: Sarcopenia elevates metabolic disorders in the elderly, and genetic and environmental factors influence the risk of sarcopenia. The purpose of the study was to examine the hypothesis that polygenetic variants for sarcopenic risk had interactions with metabolic disorders and lifestyles associated with sarcopenia risk in adults >50 years in a large urban hospital cohort. METHODS: Sarcopenia was defined as an appendicular skeletal muscle mass/body weight (SMI) < 29.0% for men and <22.8% for women estimated from participants aged 18-39 years in the KNHANES 2009-2010. Genetic variants were selected using a genome-wide association study for sarcopenia (sarcopenia, n = 1368; control, n = 15,472). The best model showing the gene-gene interactions was selected using a generalized multifactor dimensionality reduction. The polygenic risk scores (PRS) were generated by summing the selected SNP risk alleles in the best model. RESULTS: SMI was much higher in the control subjects than the sarcopenia subjects in both genders, and the fat mass index was opposite the SMI. The five-single nucleotide polymorphisms (SNPs) model included FADS2_rs97384, MYO10_rs31574 KCNQ5_rs6453647, DOCK5_rs11135857, and LRP1B_ rs74659977. Sarcopenia risk was positively associated with the PRS of the five-SNP model (ORs = 1.977, 95% CI = 1.634-2.393). The PRS interacted with age (P < 0.0001), metabolic syndrome (P = 0.01), grip strength (P = 0.007), and serum total cholesterol concentrations (P = 0.005) for the sarcopenia risk. There were no interactions of PRS with the lifestyle components except for exercise. CONCLUSION: The genetic impact may be offset in the elderly, having metabolic syndrome, high serum total cholesterol concentrations, and high grip strength, but only exercise in the lifestyle factors can overcome the genetic effect. Middle-aged and elderly participants with a genetic risk for sarcopenia may require regular exercise to maintain high grip strength and prevent metabolic syndrome.


Assuntos
Exercício Físico , Força da Mão , Síndrome Metabólica/epidemiologia , Polimorfismo de Nucleotídeo Único , Sarcopenia/epidemiologia , Sarcopenia/genética , Idoso , Estudos de Coortes , Ingestão de Energia , Ácidos Graxos Dessaturases/genética , Feminino , Fatores de Troca do Nucleotídeo Guanina/genética , Hospitais Urbanos , Humanos , Canais de Potássio KCNQ/genética , Masculino , Pessoa de Meia-Idade , Redução Dimensional com Múltiplos Fatores , Músculo Esquelético , Miosinas/genética , Receptores de LDL/genética , República da Coreia/epidemiologia , Fatores de Risco
12.
Am J Cardiol ; 159: 30-35, 2021 11 15.
Artigo em Inglês | MEDLINE | ID: mdl-34503823

RESUMO

Cardiovascular mortality is substantially higher in rural communities compared with urban communities. Understanding if disparities in inpatient percutaneous coronary intervention (PCI) persist in the United States will help inform initiatives to improve cardiovascular health. Of the more than 7 million hospitalizations in the National Inpatient Sample (2016), we identified 80,793 unweighted hospitalizations for PCI using ICD-10 procedure codes. Using survey weights, these hospitalizations projected 371,040 US admissions for inpatient PCI. For the primary analysis, we determined the association between hospital urban-rural designation and in-hospital mortality after inpatient PCI. In the secondary analysis, we evaluated the association between teaching status and this outcome. Multivariable logistic regression models, adjusted for multiple risk factors and patient characteristics, were used. Of the 371,430 hospitalizations for inpatient PCI, there were 108.9 (±2.2) admissions per 100,000 US population from urban hospitals and 152.9 (±6.3) from rural hospitals. Of the urban hospitals, there were 77.7 (±1.9) admissions per 100,000 US population at teaching hospitals (71.7%) and 30.7 (±1.0) at urban nonteaching hospitals (28.3%). In-hospital mortality did not differ between urban and rural hospitals (1.8% urban vs 1.9% rural, adjusted odds ratio for rural compared with urban: 1.15 [95% confidence interval 0.98, 1.34], p = 0.08). In urban hospitals, however, in-hospital mortality was higher in nonteaching hospitals than in teaching hospitals (2.0% nonteaching vs 1.7% teaching, adjusted odds ratio for teaching compared with nonteaching: 1.17 [95% confidence interval 1.01, 1.36], p = 0.04). In conclusion, in-hospital mortality rates after inpatient PCI were similar between urban and rural hospitals in the United States. However, among urban hospitals, nonteaching hospitals had higher rates of in-hospital mortality after PCI. In conclusion, solutions to address disparities for inpatient PCI outcomes between teaching and nonteaching hospitals are needed.


Assuntos
Mortalidade Hospitalar , Intervenção Coronária Percutânea/mortalidade , Feminino , Hospitais Rurais , Hospitais de Ensino , Hospitais Urbanos , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos
13.
Breast ; 59: 301-307, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34385028

RESUMO

PURPOSE: To examine clinicodemographic determinants associated with breast cancer survivorship follow-up during COVID-19. METHODS: We performed a retrospective, population-based cohort study including early stage (Stage I-II) breast cancer patients who underwent resection between 2006 and 2018 in a New York City hospital system. The primary outcome was oncologic follow-up prior to and during the COVID-19 pandemic. Secondary analyses compared differences in follow-up by COVID-19 case rates stratified by ZIP code. RESULTS: A total of 2942 patients with early-stage breast cancer were available for analysis. 1588 (54%) of patients had attended follow-up in the year prior to the COVID-19 period but failed to continue to follow-up during the pandemic, either in-person or via telemedicine. 1242 (42%) patients attended a follow-up appointment during the COVID-19 pandemic. Compared with patients who did not present for follow-up during COVID-19, patients who continued their oncologic follow-up during the pandemic were younger (p = 0.049) more likely to have received adjuvant radiation therapy (p = 0.025), and have lower household income (p = 0.031) on multivariate modeling. When patients who live in Bronx, New York, were stratified by ZIP code, there was a modest negative association (r = -0.56) between COVID-19 cases and proportion of patients who continued to follow-up during the COVID-19 period. CONCLUSION: We observed a dramatic disruption in routine breast cancer follow-up during the COVID-19 pandemic. Providers and health systems should emphasize reintegrating patients who missed appointments during COVID-19 back into regular surveillance programs to avoid significant morbidity and mortality from missed breast cancer recurrences.


Assuntos
Neoplasias da Mama/mortalidade , COVID-19/psicologia , Sobreviventes de Câncer/psicologia , Sobrevivência , Adolescente , Adulto , Idoso , Neoplasias da Mama/tratamento farmacológico , COVID-19/epidemiologia , Estudos de Coortes , Feminino , Hospitais Urbanos , Humanos , Masculino , Mastectomia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Cidade de Nova Iorque/epidemiologia , Pandemias , Estudos Retrospectivos , SARS-CoV-2 , Adulto Jovem
14.
J Health Care Poor Underserved ; 32(3): 1160-1165, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34421020

RESUMO

Medically underserved patients experience significant barriers to affordable acute care. This brief report describes an innovative urban hospital-affiliated federally qualified health center urgent care clinic that successfully meets a medically underserved population's need for accessible, appropriate, and affordable acute care.


Assuntos
Instituições de Assistência Ambulatorial , Área Carente de Assistência Médica , Assistência Ambulatorial , Hospitais Urbanos , Humanos , Populações Vulneráveis
15.
Artigo em Inglês | MEDLINE | ID: mdl-34360462

RESUMO

BACKGROUND: Inpatient falls are common hospital adverse events. We aimed to determine inpatient fall rates in an urban public hospital and analyzed their characteristics across clinical departments. METHODS: The study was conducted in a 350-bed urban, multi-specialty public hospital in the 2013-2019 period. Patient data were retrieved from the hospital's standardized falls reporting system. Descriptive statistics and statistical tests: chi2 and ANOVA tests with multiple comparison tests (post-hoc analysis) were used. For fall incidence estimation a joint-point regression was applied. p-value of 0.05 was considered as statistically significant for all the calculations. RESULTS: The highest prevalence of falls was reported in the rehabilitation and internal medicine wards (1.915% and 1.181%, respectively), the lowest in the orthopedic (0.145%) and rheumatology wards (0.213%) (p < 0.001). The vast majority of falls took place in the late evening and during the night (56.711%) and were classified as bed falls (55.858%). The crude incidence rate (cIR) of falls was 6.484 per one thousand hospitalizations. In the 2013-2017 period, an increase in total cIR was observed, reaching the peak value in 2016; it was followed by a slight decline from 2017 to 2019, however, differences in changes were observed between the wards. CONCLUSION: Fall rates and trends as well as circumstances of inpatient falls varied significantly among clinical departments, probably due to differences in patient characteristics.


Assuntos
Acidentes por Quedas , Pacientes Internados , Hospitalização , Hospitais Urbanos , Humanos , Incidência , Fatores de Risco
16.
Medicine (Baltimore) ; 100(32): e26856, 2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34397894

RESUMO

ABSTRACT: Rapid response systems (RRS) have been introduced worldwide to reduce unpredicted in-hospital cardiac arrest (IHCA) and in-hospital mortality. The role of advance care planning (ACP) in the management of critical patients has not yet been fully determined in Japan.We retrospectively assessed the characteristics of all inpatients with unpredicted IHCA in our hospital between 2016 and 2018. Yearly changes in the number of RRS activations and the incidence of unpredicted IHCA with or without code status discussion were evaluated from 2014 to 2018. Hospital standardized mortality ratios were assessed from the data reported in the annual reports by the National Hospital Organization.A total of 81 patients (age: 70.9 ±â€Š13.3 years) suffered an unpredicted IHCA and had multiple background diseases, including heart disease (75.3%), chronic kidney disease (25.9%), and postoperative status (cardiovascular surgery, 18.5%). Most of the patients manifested non-shockable rhythms (69.1%); survival to hospital discharge rate was markedly lower than that with shockable rhythms (26.8% vs 72.0%, P < .001). The hospital standardized mortality ratios was maintained nearly constant at approximately 50.0% for 3 consecutive years. The number of cases of RRS activation markedly increased from 75 in 2014 to 274 patients in 2018; conversely, the number of unpredicted IHCA cases was reduced from 40 in 2014 to 18 in 2018 (P < .001). Considering the data obtained in 2014 and 2015 as references, the RRS led to a reduction in the relative risk of unpredicted IHCA from 2016 to 2018 (ie, 0.618, 95% confidence interval 0.453-0.843). The reduction in unpredicted IHCA was attributed partly to the increased number of patients who had discussed the code status, and a significant correlation was observed between these parameters (R2 = 0.992, P < .001). The reduction in the number of patients with end-stage disease, including congestive heart failure and chronic renal failure, paralleled the incidence of unpredicted IHCA.Both RRS and ACP reduced the incidence of unpredicted IHCA; RRS prevents progression to unpredicted IHCA, whereas ACP decreases the number of patients with no code status discussion and thus potentially reducing the patient subgroup progressing to an unpredicted IHCA.


Assuntos
Reanimação Cardiopulmonar , Estado Terminal , Parada Cardíaca , Equipe de Respostas Rápidas de Hospitais , Hospitais Urbanos , Planejamento Antecipado de Cuidados/organização & administração , Idoso , Reanimação Cardiopulmonar/métodos , Reanimação Cardiopulmonar/normas , Estado Terminal/mortalidade , Estado Terminal/terapia , Feminino , Parada Cardíaca/diagnóstico , Parada Cardíaca/etiologia , Parada Cardíaca/mortalidade , Mortalidade Hospitalar , Equipe de Respostas Rápidas de Hospitais/organização & administração , Equipe de Respostas Rápidas de Hospitais/normas , Hospitais Urbanos/organização & administração , Hospitais Urbanos/normas , Humanos , Incidência , Japão/epidemiologia , Masculino , Determinação de Necessidades de Cuidados de Saúde , Prognóstico , Medição de Risco
17.
ANZ J Surg ; 91(10): 2054-2059, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34405500

RESUMO

BACKGROUND: Globally, patients presenting with acute surgical disease in rural areas have poorer outcomes when compared to urban areas; little data are available regarding outcomes for New Zealand (NZ) rural patients. This study aimed to compare the surgical management of appendicitis in a large metropolitan centre with its regional referral centres. METHODS: In this retrospective cohort study, patient data were collated from the studied centres between November 2014 and October 2019. In addition to patient demographics, patterns of referral and presentation, the primary outcome was time to the theatre; secondary outcomes were perforation rates, length of stay and complications. Data are presented as medians (interquartile range). RESULTS: A total of 3533 patients underwent appendicectomy over the period studied. For those presenting directly to the metropolitan centre, the median wait-time to the theatre was 16 h (9.2-23.2); if patients were transferred, they waited for 20.8 h (13.6-27). Patients presenting to regional centres waited for 7.6 h (4.5-15.4, P < 0.001). Perforation rates for transferred patients were 31% which was greater than for those presenting to the metropolitan (20%) or regional centres (17%, P = 0.014). Complications were also highest in transferred patients (20%) when compared to the metropolitan (17%) or regional centres (10%, P < 0.001). CONCLUSION: Patients who were transferred to Christchurch Hospital from rural centres without surgical services had a longer wait-time than those who presented to Christchurch Hospital directly or were treated in regional centres. This was associated with higher rates of perforated appendicitis.


Assuntos
Apendicite , Doença Aguda , Apendicectomia , Apendicite/epidemiologia , Apendicite/cirurgia , Hospitais Urbanos , Humanos , Estudos Retrospectivos
18.
Environ Monit Assess ; 193(8): 521, 2021 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-34313867

RESUMO

Hospitals host vulnerable people with potentially enhanced sensitivity to air pollutants. We measured particulate matter (PM) including PM1, PM2.5, and PM10 with a portable device in a hospital, a nearby reference building, and ambient air in Shiraz, Iran. Indoor/outdoor (I/O) ratio values were calculated to infer on the origin of size-fractioned PM. The mean hospital indoor concentrations of PM2.5 and PM10 (4.7 and 38.7 µg/m3, respectively) but not PM1 were higher than in the reference building and lower than in ambient air. The highest hospital PM10 mean concentrations were found in the radiotherapy ward (77.5 µg/m3) and radiology ward (70.4 µg/m3) while the lowest were found in the bone marrow transplantation (BMT) ward (18.5 µg/m3) and cardiac surgery ward (19.8 µg/m3). The highest PM2.5 concentrations were found in the radiology (8.7 µg/m3) and orthopaedic wards (7.7 µg/m3) while the lowest were found in the BMT ward (2.8 µg/m3) and cardiac surgery ward (2.8 µg/m3). The I/O ratios and the timing of peak concentrations during the day (7 a.m. to 4 p.m.) indicated the main roles of outdoor air and human activity on the indoor levels. These suggest the need for mechanical ventilation with PM control for a better indoor air quality (IAQ) in the hospital.


Assuntos
Poluentes Atmosféricos , Poluição do Ar em Ambientes Fechados , Poluentes Atmosféricos/análise , Poluição do Ar em Ambientes Fechados/análise , Monitoramento Ambiental , Hospitais Urbanos , Humanos , Irã (Geográfico) , Tamanho da Partícula , Material Particulado/análise
19.
Khirurgiia (Mosk) ; (7): 45-48, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34270193

RESUMO

OBJECTIVE: To report our experience in surgical treatment of patients with COVID-19. MATERIAL AND METHODS: There were 7815 patients with COVID-19 for the period from April 1, 2020 to December 31, 2020. During this period, 172 operations were performed in this group. RESULTS: The most common procedures were tracheostomy (n=86, 50.0%), pleural puncture and drainage (n=20, 11.6%), caesarean section (n=22, 12.7%). There were 24 (14.0%) abdominal surgeries including 11 laparoscopies, 5 appendectomies, 3 bowel resections and others. Six lower limb amputations were carried out. We should emphasize common soft tissue hematomas and effusions. This complication is associated with anticoagulation recommended for patients with COVID-19. CONCLUSION: Surgical interventions using personal protective equipment is a significant challenge. According to our experience, round-the-clock surgical care in a specialized hospital is required.


Assuntos
COVID-19 , Cesárea , Feminino , Hospitais Urbanos , Humanos , Equipamento de Proteção Individual , Gravidez , SARS-CoV-2
20.
ANZ J Surg ; 91(7-8): 1352-1357, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34224196

RESUMO

BACKGROUND: Worldwide, coronavirus disease 2019 (COVID-19) has significantly challenged the delivery of healthcare. New Zealand (NZ) faced similar potential challenges despite being geographically isolated. Given the rapid change in the COVID-19 pandemic, hospitals in NZ were tasked with formulating their own COVID-19 responses based on the Ministry of Health's (MoH) recommendations. METHODS: This paper evaluates how six metropolitan general surgical departments in NZ had responded to COVID-19 in terms of changes made to rosters, theatres, clinics, acute admissions as well as additional measures taken to reduce the risk of staff exposure. It also explores how NZ fared in comparison with international guidelines and recommendations. Data from each centre were provided by an appointed clinician. RESULTS: All centres had adapted new rosters and a restructuring of teams. Handovers, multidisciplinary team meetings and educational sessions were held virtually. Different strategies were implemented to ration hospital resources and reduce the risk of staff exposure. Non-urgent operations, endoscopies and clinics were deferred with allocation of dedicated COVID-19 operating theatres. Potential COVID-19 suspects were screened prior to admission and treated separately. Various admission and imaging pathways were utilised to increase efficiency. CONCLUSION: General surgical departments in NZ had implemented a comprehensive COVID-19 response but there is room to work towards a more unified national response. Our analysis shows that these centres across NZ had taken a similar approach which was aligned with international practices.


Assuntos
COVID-19 , Pandemias , Hospitais Urbanos , Humanos , Nova Zelândia , SARS-CoV-2 , Centros de Atenção Terciária
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