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1.
Rev. Odontol. Araçatuba (Impr.) ; 45(2): 58-64, maio-ago. 2024. tab
Artigo em Português | LILACS, BBO - Odontologia | ID: biblio-1553299

RESUMO

A assistência odontológica é imprescindível para a prevenção de doenças infecciosas e para a manutenção da integridade da cavidade oral de pacientes internatos em unidades de terapia intensiva. O objetivo deste estudo foi avaliar o conhecimento e as práticas de higiene oral dos acadêmicos do curso de Enfermagem de uma instituição de ensino superior, que realizam estágio em hospital, no controle de higiene bucal de pacientes internados em ambiente hospitalar. Participaram do estudo 40 alunos, que responderam 14 perguntas com o intuito de avaliar o conhecimento e as práticas no controle de higiene bucal, realizadas por eles, em pacientes internados em ambiente hospitalar. Os resultados demonstraram que os acadêmicos entrevistados tinham idade média de 25,8 anos, sendo 95% do sexo feminino e apenas 5% do sexo masculino. Destes, 42,5% afirmaram não haver presença de um Cirurgião-Dentista em ambiente hospitalar e 82,5% responderam que o responsável pela saúde bucal dos pacientes é do técnico de enfermagem. Quanto aos cuidados em pacientes internados em UTI, 52,5% dos entrevistados relataram que estes pacientes recebem higienização bucal, porém 30% alegaram que esta pratica não era realizada e 17,5% não sabiam responder. Além disso, 47,5% dos entrevistados afirmam ter insegurança ao realizar os procedimentos de higiene bucal dos pacientes. Pode-se concluir que os acadêmicos entrevistados possuem bom conhecimento acerca da importância dos cuidados com a saúde bucal dos pacientes internados em ambiente hospitalar. No entanto, ainda existem muitas dúvidas relacionadas ao manejo clínico de procedimentos de promoção de saúde bucal, que poderiam ser solucionados com a presença de um profissional de Odontologia inserido em uma equipe multidisciplinar(AU)


Oral care is essential for the prevention of infectious diseases and for maintaining the integrity of the oral cavity of patients hospitalized in intensive care units. The objective of this study is to evaluate the knowledge and oral hygiene practices of Nursing students at a higher education institution, who carry out internships in a hospital, in controlling the oral hygiene of patients admitted to a hospital environment. 40 students participated in the study, who answered 14 questions with the aim of evaluating the knowledge and practices in controlling oral hygiene, carried out by them, on patients hospitalized in a hospital environment. The results demonstrated that the academics interviewed had an average age of 25.8 years, with 95% being female and only 5% being male. Of these, 42.5% stated that there was no presence of a Dental Surgeon in a hospital environment and 82.5% responded that the nursing technician is responsible for the patients' oral health. Regarding care for patients admitted to the ICU, 52.5% of those interviewed reported that these patients receive oral hygiene, however 30% claimed that this practice was not performed and 17.5% did not know how to answer. Furthermore, 47.5% of those interviewed say they are insecure when carrying out oral hygiene procedures for patients. It can be concluded that the academics interviewed have good knowledge about the importance of oral health care for patients hospitalized in a hospital environment. However, there are still many doubts related to the clinical management of oral health promotion procedures, which could be resolved with the presence of a dentistry professional within a multidisciplinary team(AU)


Assuntos
Humanos , Masculino , Feminino , Inquéritos e Questionários , Pacientes Internados
2.
Nutrients ; 16(11)2024 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-38892665

RESUMO

BACKGROUND: The variation in body mass index (BMI) of inpatients with anorexia nervosa has not been analyzed across the age span. A positive correlation between BMI and age has been reported in adolescent inpatients aged 15 years and younger that levels off at 15 to 18 years. BMIs standardized for age and sex (standard deviation scores, SDSs) were negatively correlated with age in these inpatients aged 8 to 18 years. METHODS: The aims of the current retrospective study were threefold: first, to confirm the relationships of BMI, BMI-SDS and age in adolescent inpatients in a larger sample; second, to systematically assess the relationship of BMI, BMI-SDS, body height-SDS and age in adult inpatients at the time of referral; and third, to assess body height-SDSs and age to evaluate stunting. RESULTS: We included 1001 girls (aged 12-17.9 years) and 1371 women (aged 18-73 years) admitted to inpatient treatment between 2014 and 2021. Mean BMI at admission was 14.95 kg/m2 (SD = 1.43; range 10.67-18.47) in adolescents and 14.63 kg/m2 (SD = 2.02; range 8.28-18.47) in adults. None of the adolescent patients but 20 adults had very low BMI values below 10 kg/m2. Adolescents showed a small but significant positive correlation between age and BMI (r = 0.12; p = 2.4 × 10-4). In adults, BMI was not correlated with age (r = -0.03; p = 0.3). BMI-SDSs was negatively correlated with age in adolescents and less so in adults (r = -0.35; p < 0.001 and r = -0.09; p = 0.001). Curve fit analyses for all patients indicated that there was a quadratic (age × age) relationship between age and BMI-SDS. Height correlated positively with BMI in adult (r = 0.1; p < 0.001) and adolescent (r = 0.09 p = 0.005) patients and we detected no evidence for stunting. CONCLUSIONS: In conclusion, the BMI of inpatients seems to be relatively stable across the age span with mean values between 14 and 15 kg/m2. BMI values initially increase with age in younger patients, drop between ages 18 and 23 and then slowly decline with age.


Assuntos
Anorexia Nervosa , Índice de Massa Corporal , Pacientes Internados , Humanos , Adolescente , Feminino , Estudos Retrospectivos , Criança , Adulto , Adulto Jovem , Pacientes Internados/estatística & dados numéricos , Pessoa de Meia-Idade , Idoso , Fatores Etários , Estatura
3.
BMJ Open ; 14(6): e084653, 2024 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-38889940

RESUMO

OBJECTIVES: The main aim of this study was to demonstrate how ordered network analysis of video-recorded interactions combined with verbal response mode (VRM) coding (eg, edification, disclosure, reflection and interpretation) can uncover specific communication patterns that contribute to the development of shared understanding between physicians and nurses. The major hypothesis was that dyads that reached shared understanding would exhibit different sequential relationships between VRM codes compared with dyads that did not reach shared understanding. DESIGN: Observational study design with the secondary analysis of video-recorded interactions. SETTING: The study was conducted on two oncology units at a large Midwestern academic health care system in the USA. PARTICIPANTS: A total of 33 unique physician-nurse dyadic interactions were included in the analysis. Participants were the physicians and nurses involved in these interactions during patient care rounds. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was the development of shared understanding between physicians and nurses, as determined by prior qualitative analysis. Secondary measures included the frequencies, orders and co-occurrences of VRM codes in the interactions. RESULTS: A Mann-Whitney U test showed that dyads that reached shared understanding (N=6) were statistically significantly different (U=148, p=0.00, r=0.93) from dyads that did not reach shared understanding (N=25) in terms of the sequential relationships between edification and disclosure, edification and advisement, as well as edification and questioning. Dyads that reached shared understanding engaged in more edification followed by disclosure, suggesting the importance of this communication pattern for reaching shared understanding. CONCLUSIONS: This novel methodology demonstrates a robust approach to inform interventions that enhance physician-nurse communication. Further research could explore applying this approach in other healthcare settings and contexts.


Assuntos
Comunicação , Relações Médico-Enfermeiro , Gravação em Vídeo , Humanos , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , Pacientes Internados/psicologia
4.
BMC Infect Dis ; 24(1): 597, 2024 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-38890575

RESUMO

BACKGROUND: There is an urgent need for therapeutic strategies for inpatients with severe or critical COVID-19. The evaluation of the clinical benefits of nirmatrelvir and ritonavir (Nmr/r) for these patients beyond five days of symptom onset is insufficient. METHODS: A new propensity score-matched cohort was constructed by using multicenter data from 6695 adult inpatients with COVID-19 from December 2022 to February 2023 in China after the epidemic control measures were lifted across the country. The severity of disease of the inpatients was based on the tenth trial edition of the Guidelines on the Diagnosis and Treatment of COVID-19 in China. The symptom onset of 1870 enrolled severe or critical inpatients was beyond five days, and they received either Nmr/r plus standard treatment or only standard care. The ratio of patients whose SOFA score improved more than 2 points, crucial respiratory endpoints, changes in inflammatory markers, safety on the seventh day following the initiation of Nmr/r treatment, and length of hospital stay were evaluated. RESULTS: In the Nmr/r group, on Day 7, the number of patients with an improvement in SOFA score ≥ 2 was much greater than that in the standard treatment group (P = 0.024) without a significant decrease in glomerular filtration rate (P = 0.815). Additionally, the rate of new intubation was lower (P = 0.004) and the no intubation days were higher (P = 0.003) in the first 7 days in the Nmr/r group. Other clinical benefits were limited. CONCLUSIONS: Our study may provide new insight that inpatients with severe or critical COVID-19 beyond five days of symptom onset benefit from Nmr/r. Future studies, particularly randomized controlled trials, are necessary to verify the above findings.


Assuntos
Tratamento Farmacológico da COVID-19 , Pontuação de Propensão , Ritonavir , SARS-CoV-2 , Humanos , Ritonavir/uso terapêutico , Masculino , Pessoa de Meia-Idade , Feminino , Estudos Retrospectivos , Idoso , China , Antivirais/uso terapêutico , Adulto , Índice de Gravidade de Doença , COVID-19 , Tempo de Internação/estatística & dados numéricos , Pacientes Internados , Resultado do Tratamento
5.
Am J Occup Ther ; 78(4)2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38861552

RESUMO

IMPORTANCE: Veterans receiving inpatient psychiatric services with limitations in activities of daily living (ADLs) benefit from occupational therapy, yet disparities in access are unknown. OBJECTIVE: To investigate whether ADL limitations, an indicator of occupational therapy need, was associated with inpatient psychiatric occupational therapy utilization in the Veterans Health Administration (VHA) and whether this relationship differs by facility characteristics. DESIGN: Secondary analysis of VHA data. Modified Poisson regression modeled occupational therapy utilization as a function of ADL limitations, facility characteristics, and covariates. Interactions estimated whether the relationship between ADL limitations and occupational therapy utilization differed across facility characteristics. SETTING: VHA inpatient psychiatric setting. PARTICIPANTS: Veterans receiving VHA inpatient psychiatric care from 2015 to 2020 (N = 133,844). OUTCOMES AND MEASURES: Occupational therapy utilization. RESULTS: Veterans with ADL limitations were more likely to receive occupational therapy. Veterans receiving care in facilities with higher complexity and greater inpatient psychiatric care quality were more likely to receive occupational therapy. Additionally, Black veterans were less likely to receive occupational therapy relative to their White, non-Hispanic counterparts. Interactions indicated that the extent to which ADL limitations drove access to occupational therapy utilization was weaker within facilities with higher complexity and care quality. CONCLUSIONS AND RELEVANCE: Veterans with ADL limitations were more likely to access inpatient psychiatric occupational therapy, suggesting that such services are generally allocated to veterans in need. However, findings indicate disparities in access across patient-level (e.g., Black race) and facility-level (e.g., facility complexity) factors, informing efforts to eliminate barriers to accessing these valuable services. Plain-Language Summary: This is the first study, to our knowledge, to examine disparities in access to inpatient psychiatric occupational therapy in the Veterans Health Administration (VHA). The study findings show that access to inpatient psychiatric occupational therapy is partly driven by the needs of the patient. However, nonclinical factors, such as a patient's race and the characteristics of the facility at which they receive care (complexity, number of psychiatric beds available, and the quality of psychiatric care), are also important drivers of access. Identifying factors influencing access to these valuable services is the first step in developing strategies that reduce barriers to access for veterans in need.


Assuntos
Atividades Cotidianas , Acessibilidade aos Serviços de Saúde , Disparidades em Assistência à Saúde , Terapia Ocupacional , United States Department of Veterans Affairs , Humanos , Estados Unidos , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Veteranos , Pacientes Internados , Transtornos Mentais/reabilitação , Idoso , Serviços de Saúde Mental/estatística & dados numéricos
6.
J Korean Acad Nurs ; 54(2): 151-161, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38863185

RESUMO

PURPOSE: Patients' perception of fall risk is a promising new indicator for fall prevention. Therefore, a fall risk perception questionnaire that can be used rapidly and repeatedly in acute care settings is required. This study aimed to develop a short version of the fall risk perception questionnaire (Short-FRPQ) for inpatients. METHODS: For the psychometric measurements, 246 inpatients were recruited from an acute care hospital. The construct (using confirmatory factor analysis and discriminant validity of each item), convergent, and known-group validities were tested to determine the validity of the Short-FRPQ. McDonald's omega coefficient was used to examine the internal consistency of reliability. RESULTS: In the confirmatory factor analysis, the fit indices of the Short-FRPQ, comprising 14 items and three factors, appeared to be satisfactory. The Short-FRPQ had a significantly positive correlation with the original scale, the Korean Falls Efficacy Scale-International, and the Morse Fall Scale. The risk of falls group, assessed using the Morse Fall Scale, had a higher score on the Short-FRPQ. McDonald's omega coefficient was .90. CONCLUSION: The Short-FRPQ presents good reliability and validity. As patient participation is essential in fall interventions, evaluating the fall risk perception of inpatients quickly and repeatedly using scales of acceptable validity and reliability is necessary.


Assuntos
Acidentes por Quedas , Pacientes Internados , Percepção , Psicometria , Humanos , Acidentes por Quedas/prevenção & controle , Inquéritos e Questionários , Feminino , Masculino , Pacientes Internados/psicologia , Pessoa de Meia-Idade , Idoso , Adulto , Hospitais , Idoso de 80 Anos ou mais , Análise Fatorial , Medição de Risco
8.
Clin Appl Thromb Hemost ; 30: 10760296241255959, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38831596

RESUMO

The purpose of the study was to investigate baseline inflammatory, hemostatic indicators and new-onset deep vein thrombosis (DVT) with the risk of mortality in COVID-19 inpatients. In this single-center study, a total of 401 COVID-19 patients hospitalized in Sir Run Run Shaw Hospital, Zhejiang University School of Medicine were enrolled from December 1, 2022 to January 31, 2023. The basic information, first laboratory examination results, imaging examination, and outcome-related indicators were compared between patients in the moderate and severe subgroups. We found that baseline D-dimer and baseline absolute neutrophil count (ANC) levels were associated with new-onset DVT and death in severe hospitalized patients with COVID-19. The odds ratio (OR) of baseline D-dimer and baseline ANC with mortality was 1.18 (95% confidence interval [CI], 1.08-1.28; P < .001) and 1.13 (95% CI, 1.06-1.21; P < .001). Baseline ANC was associated with the risk of death in severe hospitalized COVID-19 patients, irrespective of the DVT status. In addition, a significantly higher serum neutrophil activity was observed in severe COVID-19 inpatients with DVT or those deceased during hospital stay. New-onset DVT partially mediated the association between baseline D-dimer (indirect effect: 0.011, estimated mediating proportion: 67.0%), baseline ANC (indirect effect: 0.006, estimated mediating proportion: 48.7%), and mortality in severe hospitalized patients with COVID-19. In summary, baseline D-dimer and baseline absolute neutrophil count (ANC) levels were associated with the mortality in severe hospitalized patients with COVID-19, especially DVT inpatients. New-onset DVT partially mediated the association between baseline D-dimer, baseline ANC, and mortality in severe hospitalized patients with COVID-19.


Assuntos
COVID-19 , Produtos de Degradação da Fibrina e do Fibrinogênio , SARS-CoV-2 , Humanos , COVID-19/mortalidade , COVID-19/sangue , COVID-19/complicações , Masculino , Feminino , Estudos Retrospectivos , Pessoa de Meia-Idade , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Idoso , Neutrófilos , Trombose Venosa/sangue , Trombose Venosa/mortalidade , Inflamação/sangue , Fatores de Risco , Índice de Gravidade de Doença , Hemostasia , Pacientes Internados/estatística & dados numéricos , Contagem de Leucócitos , Adulto , China/epidemiologia
9.
PLoS One ; 19(6): e0303898, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38885257

RESUMO

Non-traumatic orthopedic conditions are pathological conditions involving musculoskeletal system that includes muscles, tendons, bone and joints and associated with frequent medical and surgical care and high treatment costs. There is paucity of information on the pattern of non-traumatic orthopedic conditions in low and middle income countries. The purpose of this study was to determine the epidemiology of non-traumatic orthopedic conditions among inpatients at the Kenyatta National Hospital in Kenya. This was a cross-sectional study with a sample of 175 charts reviewed. Approximately, 70.3% of the inpatients were aged between 25 to 64 years of age with the mean age of 39.97 years (STD 18.78). Ever married tended to be older 53.5 (95% CI: 46.8-60.2) years than other marital statuses. Approximately, 60.6% were males, 38.9% had comorbidities and 49.1% were casuals or unemployed. All inpatients were Kenyans with Nairobi County comprising 52.6% of all inpatients. Approximately, 77.7% were self-referrals. The commonest non-trauma orthopaedic conditions were infection and non-union (35.4%) and spinal degenerative diseases (20.60%) and the least was limb deformities (1.70%). Compared to females, males were 3.703 (p<0.001) times more likely to have infection and non-union. Patients with primary, secondary and tertiary education were 88.2% (p<0.001), 75.6% (p<0.001) and 68.1% (p = 0.016) less likely to have infection and non-union compared to those with no or preschool education. Widows were 8.500 (p = 0.028) times more likely to have spinal degenerative disease than married. Males were 70.8% (p = 0.031) less likely to have osteoarthritis than females. Inpatients with secondary education were 5.250 (p = 0.040) times more likely to have osteoarthritis than those with no or preschool education. In conclusion, majority of inpatients were young and middle aged adults. Infection and non-union and spinal degenerative diseases were the most common non-trauma orthopedic conditions. While males and those with low education were more likely to have infection and non-union, married were more likely to have spinal degenerative disease. Osteoarthritis was more likely among female admissions.


Assuntos
Pacientes Internados , Humanos , Quênia/epidemiologia , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Estudos Transversais , Pacientes Internados/estatística & dados numéricos , Centros de Atenção Terciária/estatística & dados numéricos , Adulto Jovem , Hospitais de Ensino/estatística & dados numéricos , Adolescente , Idoso , Doenças Musculoesqueléticas/epidemiologia , Encaminhamento e Consulta/estatística & dados numéricos
10.
Urolithiasis ; 52(1): 95, 2024 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-38896137

RESUMO

To evaluate the impact of frailty on perioperative outcomes of older patients undergoing PCNL, utilizing the US Nationwide Inpatient Sample (NIS) database. Data of hospitalized patients ≥ 60 years who received PCNL were extracted from the 2010 to 2020 NIS database, and included demographics, clinical, and hospital-related information. Patients were assigned to low (< 5), medium (5-15), and high frailty risk (> 15) groups based on the hospital frailty risk score (HFRS). Associations between frailty risk and perioperative outcomes including total hospital cost were determined using population-weighted linear and logistic regression analyses. Data of 30,829 hospitalized patients were analyzed (mean age 72.5 years; 55% male; 78% white). Multivariable analyses revealed that compared to low frailty risk, increased frailty risk was significantly associated with elevated in-hospital mortality (adjusted odds ratio (aOR) = 10.70, 95% confidence interval (CI): 6.38-18.62), higher incidence of unfavorable discharge (aOR = 5.09, 95% CI: 4.43-5.86), prolonged hospital length of stay (LOS; aOR = 7.67, 95% CI: 6.38-9.22), increased transfusion risk (aOR = 8.05, 95% CI: 6.55-9.90), increased total hospital costs (adjusted Beta = 37.61, 95% CI: 36.39-38.83), and greater risk of complications (aOR = 8.52, 95% CI: 7.69-9.45). Frailty is a significant prognostic indicator of adverse perioperative outcomes in older patients undergoing PCNL, underscoring importance of recognizing and managing frailty in older patients.


Assuntos
Fragilidade , Mortalidade Hospitalar , Tempo de Internação , Nefrolitotomia Percutânea , Complicações Pós-Operatórias , Humanos , Masculino , Feminino , Idoso , Estados Unidos/epidemiologia , Nefrolitotomia Percutânea/efeitos adversos , Nefrolitotomia Percutânea/estatística & dados numéricos , Fragilidade/complicações , Fragilidade/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Tempo de Internação/estatística & dados numéricos , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Custos Hospitalares/estatística & dados numéricos , Cálculos Renais/cirurgia , Cálculos Renais/complicações , Resultado do Tratamento , Medição de Risco , Bases de Dados Factuais , Pacientes Internados/estatística & dados numéricos , Estudos Retrospectivos
11.
Hum Vaccin Immunother ; 20(1): 2355683, 2024 Dec 31.
Artigo em Inglês | MEDLINE | ID: mdl-38862181

RESUMO

The ZF2001 vaccine has demonstrated high efficacy in preventing coronavirus disease 2019 (COVID-19). However, the clinical characteristics of breakthrough infections in vaccinated individuals and the risk factors for adverse outcomes in COVID-19 patients remain unclear. We conducted a retrospective single-center cohort study at Xiangya Hospital of Central South University, including 210 fully vaccinated COVID-19 inpatients from December 5, 2022, to January 31, 2023. Data on clinical characteristics, laboratory findings, disease severity, treatment, and prognosis were collected and analyzed. Our findings revealed that COVID-19 inpatients still experienced common symptoms at the onset of illness, but most laboratory findings were within the normal range, except for white blood cell count (WBC), lymphocyte count, and lactate dehydrogenase (LDH) levels. Following standard treatment, 95.7% of patients were discharged from the hospital. We identified seven variables significantly associated with a higher risk of adverse outcomes, including age over 65, elevated WBC count, reduced lymphocyte count, higher levels of blood urea nitrogen (BUN), LDH, troponin, D-dimer, and procalcitonin. This study supports the substantial clinical benefits of the ZF2001 vaccine for COVID-19 patients. Additionally, age over 65, elevated WBC count, reduced lymphocyte count, and higher blood levels of BUN, LDH, D-dimer, and procalcitonin may be used as predictive factors for disease progression in fully vaccinated COVID-19 inpatients.


Assuntos
COVID-19 , SARS-CoV-2 , Humanos , COVID-19/prevenção & controle , COVID-19/imunologia , Estudos Retrospectivos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Fatores de Risco , SARS-CoV-2/imunologia , Adulto , Pacientes Internados , Vacinas contra COVID-19/imunologia , Vacinas contra COVID-19/administração & dosagem , Vacinação , Idoso de 80 Anos ou mais , Infecções Irruptivas , Vacinas de Subunidades Antigênicas
12.
Int J Equity Health ; 23(1): 115, 2024 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-38840102

RESUMO

BACKGROUND: Since 2020, China has implemented an innovative payment method called Diagnosis-Intervention Packet (DIP) in 71 cities nationwide. This study aims to assess the impact of DIP on medical expenditure, efficiency, and quality for inpatients covered by the Urban Employee Basic Medical Insurance (UEBMI) and Urban and Rural Residents Basic Medical Insurance (URRBMI). It seeks to explore whether there are differences in these effects among inpatients of the two insurance types, thereby further understanding its implications for health equity. MATERIALS AND METHODS: We conducted interrupted time series analyses on outcome variables reflecting medical expenditure, efficiency, and quality for both UEBMI and URRBMI inpatients, based on a dataset comprising 621,125 inpatient reimbursement records spanning from June 2019 to June 2023 in City A. This dataset included 110,656 records for UEBMI inpatients and 510,469 records for URRBMI inpatients. RESULTS: After the reform, the average expenditure per hospital admission for UEBMI inpatients did not significantly differ but continued to follow an upward pattern. In contrast, for URRBMI inpatients, the trend shifted from increasing before the reform to decreasing after the reform, with a decline of 0.5%. The average length of stay for UEBMI showed no significant changes after the reform, whereas there was a noticeable downward trend in the average length of stay for URRBMI. The out-of-pocket expenditure (OOP) per hospital admission, 7-day all-cause readmission rate and 30-day all-cause readmission rate for both UEBMI and URRBMI inpatients showed a downward trend after the reform. CONCLUSION: The DIP reform implemented different upper limits on budgets based on the type of medical insurance, leading to varying post-treatment prices for UEBMI and URRBMI inpatients within the same DIP group. After the DIP reform, the average expenditure per hospital admission and the average length of stay remained unchanged for UEBMI inpatients, whereas URRBMI inpatients experienced a decrease. This trend has sparked concerns about hospitals potentially favoring UEBMI inpatients. Encouragingly, both UEBMI and URRBMI inpatients have seen positive outcomes in terms of alleviating patient financial burdens and enhancing the quality of care.


Assuntos
Gastos em Saúde , Pacientes Internados , Seguro Saúde , Humanos , Gastos em Saúde/estatística & dados numéricos , China , Seguro Saúde/economia , Pacientes Internados/estatística & dados numéricos , Qualidade da Assistência à Saúde/normas , Projetos Piloto , Análise de Séries Temporais Interrompida , Masculino , Feminino
13.
J Orthop Surg Res ; 19(1): 353, 2024 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-38877587

RESUMO

BACKGROUND: Postoperative pulmonary complications (PPCs) are among the most severe complications following total hip arthroplasty revision (THAR), imposing significant burdens on individuals and society. This study examined the prevalence and risk factors of PPCs following THAR using the NIS database, identifying specific pulmonary complications (SPCs) and their associated risks, including pneumonia, acute respiratory failure (ARF), and pulmonary embolism (PE). METHODS: The National Inpatient Sample (NIS) database was used for this cross-sectional study. The analysis included patients undergoing THAR based on NIS from 2010 to 2019. Available data include demographic data, diagnostic and procedure codes, total charges, length of stay (LOS), hospital information, insurance information, and discharges. RESULTS: From the NIS database, a total of 112,735 THAR patients in total were extracted. After THAR surgery, there was a 2.62% overall incidence of PPCs. Patients with PPCs after THAR demonstrated increased LOS, total charges, usage of Medicare, and in-hospital mortality. The following variables have been determined as potential risk factors for PPCs: advanced age, pulmonary circulation disorders, fluid and electrolyte disorders, weight loss, congestive heart failure, metastatic cancer, other neurological disorders (encephalopathy, cerebral edema, multiple sclerosis etc.), coagulopathy, paralysis, chronic pulmonary disease, renal failure, acute heart failure, deep vein thrombosis, acute myocardial infarction, peripheral vascular disease, stroke, continuous trauma ventilation, cardiac arrest, blood transfusion, dislocation of joint, and hemorrhage. CONCLUSIONS: Our study revealed a 2.62% incidence of PPCs, with pneumonia, ARF, and PE accounting for 1.24%, 1.31%, and 0.41%, respectively. A multitude of risk factors for PPCs were identified, underscoring the importance of preoperative optimization to mitigate PPCs and enhance postoperative outcomes.


Assuntos
Artroplastia de Quadril , Bases de Dados Factuais , Complicações Pós-Operatórias , Embolia Pulmonar , Humanos , Artroplastia de Quadril/efeitos adversos , Fatores de Risco , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Masculino , Feminino , Estudos Retrospectivos , Incidência , Idoso , Pessoa de Meia-Idade , Estudos Transversais , Embolia Pulmonar/etiologia , Embolia Pulmonar/epidemiologia , Reoperação/estatística & dados numéricos , Tempo de Internação , Pneumopatias/etiologia , Pneumopatias/epidemiologia , Estados Unidos/epidemiologia , Pneumonia/epidemiologia , Pneumonia/etiologia , Adulto , Idoso de 80 Anos ou mais , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/epidemiologia , Pacientes Internados
15.
Hipertens. riesgo vasc ; 41(2): 132-134, abr.-jun2024. tab
Artigo em Espanhol | IBECS | ID: ibc-232398

RESUMO

La hipertrigliceridemia engloba un conjunto de trastornos lipídicos comunes en la práctica clínica, generalmente definidos como una concentración superior a 150mg/dL en ayunas. Existen diversas clasificaciones de la gravedad de la hipertrigliceridemia en función de sus valores séricos, considerándose por norma general moderada cuando los niveles son inferiores a 500mg/dL y severa cuando son mayores de 1.000mg/dL. Su importancia radica en su asociación con otras alteraciones del perfil lipídico, contribuyendo al aumento del riesgo cardiovascular y de pancreatitis aguda, fundamentalmente con concentraciones superiores a 500mg/dL.(AU)


Hypertriglyceridemia encompasses a set of lipid disorders common in clinical practice, generally defined as a fasting concentration above 150mg/dL. There are various classifications of the severity of hypertriglyceridaemia based on serum values, with levels generally considered moderate when below 500mg/dL and severe when above 1000mg/dL. Its importance lies in its association with other alterations in the lipid profile, contributing to increased cardiovascular risk and increased risk of acute pancreatitis, mainly with concentrations above 500mg/dL.(AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Hipertrigliceridemia/genética , Genética , Hiperlipidemias , Prevalência , Pacientes Internados , Exame Físico
16.
Hipertens. riesgo vasc ; 41(2): 135-138, abr.-jun2024. ilus
Artigo em Espanhol | IBECS | ID: ibc-232399

RESUMO

Presentamos el caso de un paciente con antecedentes de hipertensión arterial vasculorrenal tratada un año antes, que acude a urgencias por emergencia hipertensiva (HTA) y disnea. Descartada primera sospecha de reestenosis de arteria renal con angiografía por tomografía computarizada (angioTC), se completa el estudio confirmándose diagnóstico de cáncer de pulmón mediante prueba de imagen y anatomía patológica. En el estudio de hipertensión se detecta elevación de hormona adrenocorticótropa (ACTH), hipercortisolismo y datos analíticos de hiperaldosteronismo. Con el diagnóstico final de síndrome de Cushing secundario a producción ectópica de ACTH se inicia tratamiento médico, sin llegar a recibir nada más por fallecimiento del paciente a los pocos días.(AU)


We present the case of a patient with a history of renal-vascular hypertension treated with stent one year previously, who attended the emergency room due to hypertensive emergency and dyspnea. Once the first suspicion of renal artery restenosis was ruled out with CT angiography, the study was completed, confirming the diagnosis of lung cancer through imaging and pathological anatomy. In the hormonal study, elevation of ACTH, hypercortisolism and analytical data of hyperaldosteronism were detected. With the final diagnosis of Cushing's syndrome secondary to ectopic production of ACTH, medical treatment was started, without being able to receive anything else due to the death of the patient after a few days.(AU)


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Síndrome de Cushing , Hipertensão , Carcinoma de Células Pequenas , Neoplasias Pulmonares , Hiperaldosteronismo , Alcalose , Pacientes Internados , Exame Físico , Doenças Cardiovasculares , Nefrologia
17.
Sleep Med Clin ; 19(2): 339-356, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38692757

RESUMO

An emerging body of literature describes the prevalence and consequences of hypercapnic respiratory failure. While device qualifications, documentation practices, and previously performed clinical studies often encourage conceptualizing patients as having a single "cause" of hypercapnia, many patients encountered in practice have several contributing conditions. Physiologic and epidemiologic data suggest that sleep-disordered breathing-particularly obstructive sleep apnea (OSA)-often contributes to the development of hypercapnia. In this review, the authors summarize the frequency of contributing conditions to hypercapnic respiratory failure among patients identified in critical care, emergency, and inpatient settings with an aim toward understanding the contribution of OSA to the development of hypercapnia.


Assuntos
Cuidados Críticos , Hipercapnia , Insuficiência Respiratória , Apneia Obstrutiva do Sono , Humanos , Hipercapnia/complicações , Insuficiência Respiratória/terapia , Insuficiência Respiratória/epidemiologia , Insuficiência Respiratória/etiologia , Apneia Obstrutiva do Sono/terapia , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/fisiopatologia , Cuidados Críticos/métodos , Pacientes Internados , Pacientes Ambulatoriais
20.
Front Public Health ; 12: 1347693, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38813407

RESUMO

Aims: In the year 2021, human brucellosis ranked fifth in terms of the number of cases among all statutorily notifiable infectious diseases in China, thus remaining a significant concern for public health. This study aims to provide insights into the financial burden of human brucellosis by examining hospital stays and associated costs for affected individuals. Methods: In this retrospective study, we gathered updated data from 467 inpatient cases primarily diagnosed with human brucellosis at eight major tertiary hospitals in Beijing, China, spanning from 2013 to 2023. To comprehensively explore the economic impact on individuals, we not only analyzed the duration of hospital stays and total costs but also examined various charge types, including drug, lab test, medical imaging, medical treatment, surgical procedures, medical supplies and consumables, inpatient bed care, nursing services, and other services costs. Statistical analysis was employed to compare differences among gender, age, ethnicity, type of health insurance, condition at admission, comorbidity index, the performance of surgery, and the site of infection. Results: Both the length of stay and total cost exhibited significant variations among insurance, surgery, and infection site groups. Utilization categories demonstrated significant differences between patients who underwent surgery and those who did not, as well as across different infection sites. Furthermore, multiple linear regression analysis revealed that the condition at admission, Elixhauser comorbidity index, infection site, and surgery influenced both hospital stay and total cost. In addition, age and insurance type were associated with total costs. Conclusion: By delving into various utilization categories, we have addressed a significant gap in the literature. Our findings provide valuable insights for optimizing the allocation and management of health resources based on the influencing factors identified in this study.


Assuntos
Brucelose , Tempo de Internação , Humanos , Feminino , Masculino , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Estudos Retrospectivos , Brucelose/economia , Brucelose/diagnóstico , Brucelose/epidemiologia , Pessoa de Meia-Idade , Adulto , Pequim , Idoso , Pacientes Internados/estatística & dados numéricos , Adolescente , Adulto Jovem , Custos de Cuidados de Saúde/estatística & dados numéricos , China/epidemiologia
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