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1.
Postgrad Med J ; 94(1116): 546-550, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30301835

RESUMO

INTRODUCTION: Reducing long length of stay (LLOS, or inpatient stays lasting over 30 days) is an important way for hospitals to improve cost efficiency, bed availability and health outcomes. Discharge delays can cost hundreds to thousands of dollars per patient, and LLOS represents a burden on bed availability for other potential patients. However, most research studies investigating discharge barriers are not LLOS-specific. Of those that do, nearly all are limited by further patient subpopulation focus or small sample size. To our knowledge, our study is the first to describe LLOS discharge barriers in an entire Department of Medicine. METHODS: We conducted a chart review of 172 LLOS patients in the Department of Medicine at an academic tertiary care hospital and quantified the most frequent causes of delay as well as factors causing the greatest amount of delay time. We also interviewed healthcare staff for their perceptions on barriers to discharge. RESULTS: Discharge site coordination was the most frequent cause of delay, affecting 56% of patients and accounting for 80% of total non-medical postponement days. Goals of care issues and establishment of follow-up care were the next most frequent contributors to delay. CONCLUSION: Together with perspectives from interviewed staff, these results highlight multiple different areas of opportunity for reducing LLOS and maximising the care capacity of inpatient hospitals.


Assuntos
Doença Iatrogênica/prevenção & controle , Tempo de Internação/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Centros de Atenção Terciária , Adulto , Idoso , Idoso de 80 Anos ou mais , Ocupação de Leitos , Análise Custo-Benefício , Feminino , Humanos , Doença Iatrogênica/economia , Tempo de Internação/economia , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Alta do Paciente/economia , Centros de Atenção Terciária/economia , Centros de Atenção Terciária/organização & administração , Fatores de Tempo , Adulto Jovem
2.
Alcohol Clin Exp Res ; 40(2): 246-55, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26842243

RESUMO

BACKGROUND: Alcoholic hepatitis (AH) is an inflammatory disorder of the liver characterized clinically by jaundice, hepatomegaly, and abdominal pain, and histologically by macrovesicular steatosis and necroinflammation. METHODS: This clinical review will cover what is known about the pathogenesis, clinical presentation, current treatments, and novel therapies for AH. RESULTS: The pathogenesis and treatment of AH remain areas of active research. Although abstinence is the cornerstone of therapy for all stages of alcoholic liver disease, corticosteroids have shown modest short-term benefits in treatment of severe AH. CONCLUSIONS: Improved understanding of the pathogenesis of AH has expanded the range of potential treatments for this devastating disease. Several novel therapies are also currently in various stages of testing through clinical trials.


Assuntos
Hepatite Alcoólica/etiologia , Fígado Gorduroso Alcoólico/complicações , Hepatite Alcoólica/diagnóstico , Hepatite Alcoólica/patologia , Hepatite Alcoólica/terapia , Humanos , Fígado/patologia , Prognóstico , Fatores de Risco
3.
Cardiol Ther ; 7(2): 197-204, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30367446

RESUMO

In this case report, we describe a young athletic male with a family history of early sudden cardiac death who presented with atypical chest pain and was found to have a positive serum troponin. Although his symptoms resolved without intervention, workup revealed hypertension, hyperlipidemia, mild left ventricular hypertrophy, non-obstructive coronary artery disease, and the presence of serum heterophile antibodies. Ultimately, it was concluded that his rigorous exercise regimen as well as the presence of heterophile antibodies may have contributed to his positive serum troponin. This case serves as a reminder of the nonspecific diagnostic value of modern troponin assays, and that the results of these tests should always be incorporated into the clinical context.

4.
Science ; 344(6179): 55-8, 2014 04 04.
Artigo em Inglês | MEDLINE | ID: mdl-24674868

RESUMO

Rapid advances in DNA synthesis techniques have made it possible to engineer viruses, biochemical pathways and assemble bacterial genomes. Here, we report the synthesis of a functional 272,871-base pair designer eukaryotic chromosome, synIII, which is based on the 316,617-base pair native Saccharomyces cerevisiae chromosome III. Changes to synIII include TAG/TAA stop-codon replacements, deletion of subtelomeric regions, introns, transfer RNAs, transposons, and silent mating loci as well as insertion of loxPsym sites to enable genome scrambling. SynIII is functional in S. cerevisiae. Scrambling of the chromosome in a heterozygous diploid reveals a large increase in a-mater derivatives resulting from loss of the MATα allele on synIII. The complete design and synthesis of synIII establishes S. cerevisiae as the basis for designer eukaryotic genome biology.


Assuntos
Cromossomos Fúngicos , Saccharomyces cerevisiae/genética , Biologia Sintética/métodos , Sequência de Bases , Cromossomos Fúngicos/genética , Cromossomos Fúngicos/metabolismo , DNA Fúngico/genética , Genes Fúngicos , Aptidão Genética , Genoma Fúngico , Instabilidade Genômica , Íntrons , Dados de Sequência Molecular , Mutação , Reação em Cadeia da Polimerase , RNA Fúngico/genética , RNA de Transferência/genética , Saccharomyces cerevisiae/citologia , Saccharomyces cerevisiae/fisiologia , Análise de Sequência de DNA , Deleção de Sequência , Transformação Genética
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