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1.
J Intensive Care Med ; 34(11-12): 1017-1022, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-28820039

RESUMO

BACKGROUND: Sepsis is a leading cause of hospitalization, and subsequent readmissions are frequent and costly. There is an expanding body of literature describing risk factors for readmissions in patients with sepsis. However, there are little data studying medically underserved patients who typically receive their care at a safety net hospital. METHODS: In a retrospective cohort study, we evaluated 1355 sepsis survivors at risk of hospital readmission in fiscal year 2013 at a safety net hospital. We described patient characteristics during their initial and readmission hospitalizations and analyzed risk factors associated with 30-day readmission. RESULTS: The 30-day readmission rate among sepsis survivors was 22.6%. Comorbid conditions associated with readmissions included end-stage renal disease (odds ratio [OR], 1.26; 95% confidence interval [CI], 1.17-1.36), malignancy (OR, 1.14; 95% CI, 1.08-1.21), and cirrhosis (OR, 1.11; 95% CI, 1.02-1.20). Bacteremia during the initial hospitalization (OR, 1.07; 95% CI, 1.01-1.15) and being discharged with a vascular catheter (OR, 1.10; 95% CI, 1.01-1.20) were associated with readmission. Less severe sepsis during the initial hospitalization was associated with a reduced risk of 30-day readmission (OR, 0.91; 95% CI, 0.87-0.94). CONCLUSIONS: At a safety net hospital, patients who survived their initial sepsis hospitalization had a 30-day readmission rate to our institution of 22.6% that is comparable to rates described in prior studies. Readmission was commonly due to infection. Factors associated with readmission included multiple comorbid medical conditions, bacteremia, and being discharged with a vascular catheter. Further studies in this population are needed to determine potential modifiability of these risk factors in an attempt to reduce sepsis readmissions.


Assuntos
Área Carente de Assistência Médica , Readmissão do Paciente/estatística & dados numéricos , Provedores de Redes de Segurança/estatística & dados numéricos , Sepse/epidemiologia , Adulto , Comorbidade , Feminino , Humanos , Falência Renal Crônica/epidemiologia , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Retrospectivos , Fatores de Risco , Texas/epidemiologia
2.
J Aging Health ; 30(9): 1482-1494, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-28863724

RESUMO

OBJECTIVE: To evaluate the relationship between back pain severe enough to restrict activity (restricting back pain) and subsequent disability in essential (e) and instrumental (i) activities of daily living (ADL) among community-living older adults. METHOD: In this prospective cohort study, we evaluated 754 adults, aged ≥70 years who were initially nondisabled in eADL. Restricting back pain and disability were assessed during monthly interviews for up to 159 months. Associations between restricting back pain and subsequent eADL and iADL disability were evaluated using recurrent events Cox models, adjusted for fixed-in-time and time-varying covariates. RESULTS: Strong associations were found between restricting back pain and eADL and iADL disability, with hazard ratios (95% confidence intervals) of 3.47 [3.01, 3.90] and 2.33 [2.08, 2.61], respectively. DISCUSSION: Restricting back pain was independently associated with subsequent disability in eADL and iADL. Interventions focused on decreasing restricting back pain in older adults may have the potential to reduce the subsequent burden of disability.


Assuntos
Atividades Cotidianas , Dor nas Costas/complicações , Avaliação da Deficiência , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Vida Independente , Masculino
3.
Case Rep Med ; 2015: 814269, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26421018

RESUMO

Introduction. A number of viruses have been implicated in viral myocarditis; however, there has been no previous report of human metapneumovirus (hMPV) causing this condition. Discovered in 2001, hMPV is typically associated with upper respiratory illness, mainly affecting children. Case Presentation. We report the case of a 25-year-old man with acute systolic heart failure from viral myocarditis secondary to the hMPV. The patient was initially admitted to the general medical ward but developed increasing oxygen requirements resulting in transfer to the cardiac intensive care unit. Cardiac magnetic resonance imaging was used to help confirm the diagnosis. He was treated with intravenous diuretics, and afterload and preload agents, and he was subsequently discharged home after seven days of hospitalization. Discussion. hMPV is typically a respiratory pathogen; however, it was associated with in myocarditis in our patient. Due to the recent ability to detect this virus, we may see more cases of this, particularly during peak months of infection. Conclusion. This is the first case description of myocarditis associated with hMPV infection.

4.
Spine (Phila Pa 1976) ; 38(3): 223-8, 2013 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-22805344

RESUMO

STUDY DESIGN: Multivariate analysis of prospectively collected registry data. OBJECTIVE: Using multivariate analysis to determine significant risk factors for medical complication after cervical spine surgery. SUMMARY OF BACKGROUND DATA: Several studies have examined the occurrence of medical complication after spine surgery. However, many of these studies have been done using large national databases. While these allow for analysis of thousands of patients, potentially influential covariates are not accounted for in these retrospective studies. Furthermore, the accuracy of these retrospective data collection in these databases has been called into question. METHODS: The Spine End Results Registry (2003-2004) is a repository of prospectively collected data on all patients who underwent spine surgery at our 2 institutions. Extensive demographic and medical information was prospectively recorded. Complications were defined in detail a priori and were prospectively recorded for at least 2 years after surgery. We analyzed risk factors for medical complication after lumbar spine surgery, using univariate and multivariate analyses. RESULTS: We analyzed data from 582 patients who met our inclusion criteria. The cumulative incidences of complication after cervical spine surgery per organ system are as follows: cardiac, 8.4%; pulmonary, 13%; gastrointestinal, 3.9%; neurological, 7.4%; hematological, 10.8%; and urologic complications, 9.2%. The occurrence of cardiac or respiratory complication after cervical spine surgery was significantly associated with death within 2 years (relative risk, 4.32, 6.43, respectively). Relative risk values with 95% confidence intervals and P values are reported. CONCLUSION: Risk factors identified in this study can be beneficial to clinicians and patients alike when considering surgical treatment of the cervical spine. Future analyses and models that predict the occurrence of medical complication after cervical spine surgery may be of further benefit for surgical decision making.


Assuntos
Vértebras Cervicais/cirurgia , Procedimentos Ortopédicos/efeitos adversos , Complicações Pós-Operatórias/etiologia , Sistema de Registros/estatística & dados numéricos , Adulto , Idoso , Feminino , Gastroenteropatias/etiologia , Cardiopatias/etiologia , Doenças Hematológicas/etiologia , Humanos , Pneumopatias/etiologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Procedimentos Ortopédicos/métodos , Complicações Pós-Operatórias/classificação , Estudos Prospectivos , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Fatores de Tempo , Doenças Urológicas/etiologia , Adulto Jovem
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