RESUMEN
BACKGROUND AND PURPOSE: There is little information about the desired place of death of nursing home residents because they are usually not interviewed in population-based representative surveys. In preparation of support services for advance care planning the kind of care and support that nursing home residents desire needs to be systematically determined. METHOD: From October 2016 to January 2017 the residents of 5 nursing homes, municipally owned by Würzburg, were interviewed face-to-face. RESULTS: Of the residents 42.7% could not be interviewed due to cognitive limitations or dementia. The legal guardians of 63 residents declined participation in the study and 68 residents took part in the survey. Of the respondents 43 stated they wanted to pass away in the nursing home (63.2%). If interviewees had a person of trust or felt at home there, the number of those wanting to pass away in a nursing home was significantly higher. A total of 25 interviewees had either a living will, power of attorney for care, or a health care proxy (36.7%) and 55.3% had informed a person of trust in the nursing home about their desired care, usually a nurse (52.8%) or co-resident (36.1%). A total of 50.0% of respondents had informed their general practitioner and 23.5% had not spoken to anyone about their desired care. Especially nurses were specifically mentioned as the appropriate contact person to record desired care (70.4%). DISCUSSION: Residents view their nursing home as the place for dying in a much more positive light compared to frequent discussions contrasting population surveys and actual places of death. End of life prearrangements should be designed as a dynamic process that include persons of trust, nurses and general practitioners.
Asunto(s)
Planificación Anticipada de Atención , Demencia/mortalidad , Voluntad en Vida , Cuidado Terminal , Anciano , Anciano de 80 o más Años , Demencia/psicología , Femenino , Humanos , Masculino , Casas de Salud , Encuestas y CuestionariosRESUMEN
AIM OF THE STUDY: Determining the pre-treatment prognostic factors in malignant pleural mesothelioma is important in terms of estimating the course of the disease and selecting patients who are candidate for multimodal therapy. The aim of the study was to determine the prognostic factors affecting survival in patients with malignant pleural mesothelioma. STUDY DESIGN: One hundred and twenty-five patients who had been diagnosed histologically as having malignant pleural mesothelioma over the past 5 years were evaluated retrospectively. Relationships of survival of the patients with their age, gender, exposure to asbestos, smoking history, platelet, hemoglobin, leukocyte (WBC) and serum LDH values, histology, performance score and stage of disease were examined. RESULTS: Advanced clinical stage, N2 nodal involvement and the presence of distant metastasis were found to be related to survival. Sarcomatous histology was found to be a poor prognostic factor independently of other factors. CONCLUSIONS: We showed that histological subtype and stage of disease were the most important parameters in planning the treatment, especially in determining the patients who were candidate for multimodal treatment and in estimating the prognosis.
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Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/patología , Mesotelioma/mortalidad , Mesotelioma/patología , Neoplasias Pleurales/mortalidad , Neoplasias Pleurales/patología , Factores de Edad , Anciano , Amianto/toxicidad , Exposición a Riesgos Ambientales/efectos adversos , Femenino , Humanos , Estimación de Kaplan-Meier , Neoplasias Pulmonares/sangre , Neoplasias Pulmonares/terapia , Metástasis Linfática , Masculino , Mesotelioma/sangre , Mesotelioma/terapia , Mesotelioma Maligno , Persona de Mediana Edad , Estadificación de Neoplasias , Neoplasias Pleurales/sangre , Neoplasias Pleurales/terapia , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales , Fumar/efectos adversos , Turquía/epidemiologíaRESUMEN
Although the sensitivity and specificity of nucleic acid amplification assays are high with smear-positive samples, the sensitivity with smear-negative and extrapulmonary samples for the diagnosis of tuberculosis in suspicious tuberculosis cases still remains to be investigated. This study evaluates the performance of the GenoType Mycobacteria Direct (GTMD) test for rapid molecular detection and identification of the Mycobacterium tuberculosis complex and four clinically important nontuberculous mycobacteria (M. avium, M. intracellulare, M. kansasii, and M. malmoense) in smear-negative samples. A total of 1,570 samples (1,103 bronchial aspiration, 127 sputum, and 340 extrapulmonary samples) were analyzed. When we evaluated the performance criteria in combination with a positive culture result and/or the clinical outcome of the patients, the overall sensitivity, specificity, and positive and negative predictive values were found to be 62.4, 99.5, 95.9, and 93.9%, respectively, whereas they were 63.2, 99.4, 95.7, and 92.8%, respectively, for pulmonary samples and 52.9, 100, 100, and 97.6%, respectively, for extrapulmonary samples. Among the culture-positive samples which had Mycobacterium species detectable by the GTMD test, three samples were identified to be M. intracellulare and one sample was identified to be M. avium. However, five M. intracellulare samples and an M. kansasii sample could not be identified by the molecular test and were found to be negative. The GTMD test has been a reliable, practical, and easy tool for rapid diagnosis of smear-negative pulmonary and extrapulmonary tuberculosis so that effective precautions may be taken and appropriate treatment may be initiated. However, the low sensitivity level should be considered in the differentiation of suspected tuberculosis and some other clinical condition until the culture result is found to be negative and a true picture of the clinical outcome is obtained.
Asunto(s)
Técnicas Bacteriológicas/métodos , Técnicas de Diagnóstico Molecular/métodos , Infecciones por Mycobacterium/diagnóstico , Infecciones por Mycobacterium/microbiología , Mycobacterium/clasificación , Mycobacterium/aislamiento & purificación , ADN Bacteriano/genética , Genotipo , Humanos , Mycobacterium/genética , Valor Predictivo de las Pruebas , Sistema Respiratorio/microbiología , Sensibilidad y Especificidad , Esputo/microbiologíaRESUMEN
OBJECTIVES: To evaluate venous thromboembolism (VTE) risk and use of thromboprophylaxis in the acute care hospital setting. METHODS: A total of 1701 patients hospitalized for acute or exacerbated chronic medical illnesses or elective major surgery at 11 different hospitals across Turkey were included in the study. Patients at risk and VTE prophylaxis application were retrospectively identified based on medical charts. RESULTS: According to the American College of Chest Physicians (ACCP) criteria, overall 35.6% (606 of 1701) of the patients were identified to be at VTE risk. Venous thromboembolism-risk was observed in 64.9% of surgical and 23.8% of medical patients, the latter being lower than global Epidemiologic International Day for the Evaluation of Patients at Risk for Venous Thromboembolism in the Acute Hospital Care Setting (ENDORSE) study results; while prophylaxis was prescribed in 39.0% and 38.5% of them, respectively. Contraindication to anticoagulant prophylaxis was observed in 8.7% of medical and 8.8% of surgical patients. CONCLUSIONS: VTE remains a risk factor among patients hospitalized across Turkey, since identification as well as prophylaxis of patients at VTE risk seems to be neglected.
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Anticoagulantes/administración & dosificación , Hospitalización , Complicaciones Posoperatorias/prevención & control , Tromboembolia Venosa/prevención & control , Adulto , Anciano , Anticoagulantes/efectos adversos , Servicio de Urgencia en Hospital , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Riesgo , Factores de Riesgo , Turquía/epidemiología , Tromboembolia Venosa/epidemiologíaRESUMEN
Nontuberculous mycobacteria were identified from 45891 samples of 19553 patients with a prediagnosis of pulmonary tuberculosis between November 2004 and January 2009. Among 10041 (21.9%) culture positive samples, 208 (2.1%) pulmonary samples recovered from 77 individual patients were differentiated as mycobacteria other than tuberculosis (MOTT). Proportion of mycobacteria evaluated as causative agent for clinical infection were found as 0.16% (n = 31), mostly M. avium complex, M. abscessus and M. kansasii. Additionally, M. fortuitum-peregrinum complex, M. simiae, M. szulgai / intermedium and M. scrofulaceum were found as causative agent in 2, 2, 2 and 1 patient, respectively. Identification of infections caused by environmental or opportunistic pathogen mycobacteria is required in rapid and accurate diagnosis, infection control and treatment planning of infections caused by M. tuberculosis complex and/or MOTT.
Asunto(s)
Enfermedades Pulmonares/microbiología , Infecciones por Mycobacterium no Tuberculosas/microbiología , Micobacterias no Tuberculosas/clasificación , Micobacterias no Tuberculosas/aislamiento & purificación , Diagnóstico Diferencial , Femenino , Humanos , Enfermedades Pulmonares/diagnóstico , Enfermedades Pulmonares/epidemiología , Masculino , Persona de Mediana Edad , Infecciones por Mycobacterium no Tuberculosas/diagnóstico , Infecciones por Mycobacterium no Tuberculosas/epidemiología , Micobacterias no Tuberculosas/genética , ARN Bacteriano/genética , ARN Ribosómico 16S/genética , ARN Ribosómico 23S/genética , Turquía/epidemiologíaRESUMEN
AIM: Early identification and characterization of rifampicin-resistant (R(r)) Mycobacterium tuberculosis isolates recovered from the samples of tuberculosis (TB) patients in the Aegean (West Anatolian) Region was intended. METHODS AND RESULTS: Sixty isolates [47 (78.3%) multidrug-resistant (MDR)], which were identified as M. tuberculosis complex and phenotypically resistant to rifampicin by both BACTEC mycobacteria growth indicator tube (MGIT) 960 and 460 systems were analysed by a commercial line probe assay (INNO-LiPA Rif TB). The concordance of LiPA with the in vitro susceptibility test was found as 98.3%. Among the isolates, S531L (R5 pattern; 46.7%) and L511P/R, S512T, Q513L/K (DeltaS1 pattern; 11.7%) were the most frequent mutation patterns. As compared with the BACTEC systems and conventional techniques for cultivation, identification and in vitro susceptibility testing, INNO-LiPA Rif TB after cultivation in BACTEC MGIT 960 system provided an average of 20 days early diagnosis of R(r)M. tuberculosis isolates. CONCLUSIONS: Rapid molecular identification and characterization of R(r)M. tuberculosis isolates after BACTEC MGIT 960 cultivation would be useful for faster diagnosis, infection control and planning of accurate treatment in MDR-TB patients. SIGNIFICANCE AND IMPACT OF THE STUDY: Patients with MDR-TB need a specified treatment and efficient follow-up strategies. Rapid and practical methodologies to diagnose and follow these patients should be applied in routine use.
Asunto(s)
Mycobacterium tuberculosis/genética , Rifampin/farmacología , Tuberculosis Resistente a Múltiples Medicamentos/diagnóstico , Farmacorresistencia Bacteriana Múltiple , Humanos , Pruebas de Sensibilidad Microbiana , Mutación , Mycobacterium tuberculosis/efectos de los fármacos , Tuberculosis Resistente a Múltiples Medicamentos/microbiologíaRESUMEN
The aim of this study was the identification of atypical mycobacteria isolated from various samples of patients prediagnosed as tuberculosis between November 2004 and June 2006 by a commercial polymerase chain reaction (PCR) based reverse hybridization kit (INNO-LiPA Mycobacteria v2, Innogenetics NV, Belgium). A total of 21,060 samples obtained from 9660 patients were included to the study. After decontamination and homogenization processes, the samples were cultivated in automated MGIT Bactec 960 system and the diagnosis of atypical mycobacteria was performed in 4532 (21.5%) culture positive samples with NAP test by using Bactec 460 TB system. After DNA isolation, PCR method was performed by using the primers specific for mycobacterial 16S-23S spacer region. PCR products were then hybridized with the probes specific for Mycobacterium species on nitrocellulose strips according to the recommendations of the manufacturer and evaluated. Additionally, two different versions of another commercial Line Probe Assay (LiPA) kit [GenoType Mycobacterium and GenoType Mycobacterium AS (Additional Species), Hain Lifescience, Germany] were used for the detection of unidentified mycobacterial strains. In our study period, 10 different Mycobacterium species were identified from 44 (1%) respiratory tract samples (sputum, bronchial aspiration fluid, bronchoalveolar lavage) belonging to 30 patients. While repeated atypical mycobacterial growth was found in 13 patients on different days, 17 patients showed atypical mycobacterial growth only in one sample or in separate multiple samples taken within the same day. The species distribution among patients were as follows; M. fortuitum-M. peregrinum complex (n=5), M. intracellulare (n=4), M. avium complex (n=4), M. chelonae complex (n=4), M. gordonae (n=4), M. kansasii (n=3), M. szulgailintermedium (n=2), M. simiae (n=1) and M. scrofulaceum (n=1). Two of four samples which were unidentified by INNO-LiPA and GenoType MTBC were identified as M. szulgai/intermedium by GenoType Mycobacterium AS and the other two were found as unidentified atypical mycobacteria (Mycobacterium spp.). As a result, the frequency of atypical mycobacteria isolated in our hospital was thought to be low, however, species-level identification might be useful for the planning of therapy in such patients. In addition, after NAP test, INNO-LiPA and GenoType Mycobacterium were useful tests in microbiological identification of atypical mycobacteria, and GenoType Mycobacterium AS test could be applied in mycobacterial strains which were not identified by the former assays.