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BACKGROUND: Mortality statistics about daily deaths might change on weekends due to delays in reporting, uneven staffing, a different mix of personnel, or decreased efficiency. We hypothesized that reported deaths for COVID-19 might increase on weekends compared to weekdays. METHODS: We collected data from the World Health Organization COVID-19 database. All deaths from March 7, 2020 to March 7, 2022 were included (two years). The primary analysis evaluated mean daily deaths on weekends compared to the preceding five workdays. Analyses were replicated in ten individual countries: United States, United Kingdom, France, Germany, Italy, Spain, Russia, India, Brazil, and Canada. RESULTS: The mean COVID-19 daily deaths was higher on weekends compared to weekdays (8,532 vs. 8,083 p < 0.001), equal to a 6% relative increase (95% confidence interval 3% to 8%). The highest absolute increase was in the United States (1,483 vs. 1,220 deaths, p < 0.001). The second highest absolute increase was in Brazil (1,061 vs. 823 deaths, p < 0.001). The increase in deaths on weekends remained significant during the earlier and later months of the pandemic, as well as during the greater and lesser weeks of the pandemic. CONCLUSIONS: The apparent increased COVID-19 deaths reported on weekends might potentially reflect patient care, confound community trends, and affect the public perception of risk.
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COVID-19 , Humanos , Brasil/epidemiología , Canadá , Bases de Datos Factuales , FranciaRESUMEN
BACKGROUND: Despite widespread restrictions on residents' mobility to limit the COVID-19 pandemic, controlled impact evaluations on such restrictions are rare. While Colombia imposed a National Lockdown, exceptions and additions created variations across municipalities and over time. METHODS: We analyzed how weekend and weekday mobility affected COVID-19 cases and deaths. Using GRANDATA from the United Nations Development Program (UNDP) we examined movement in 76 Colombian municipalities, representing 60% of Colombia's population, from March 2, 2020 through October 31, 2020. We combined the mobility data with Colombia's National Epidemiological Surveillance System (SIVIGILA) and other databases and simulated impacts on COVID-19 burden. RESULTS: During the study period, Colombians stayed at home more on weekends compared to weekdays. In highly dense municipalities, people moved less than in less dense municipalities. Overall, decreased movement was associated with significant reductions in COVID-19 cases and deaths two weeks later. If mobility had been reduced from the median to the threshold of the best quartile, we estimate that Colombia would have averted 17,145 cases and 1,209 deaths over 34.9 weeks, reductions of 1.63% and 3.91%, respectively. The effects of weekend mobility reductions (with 95% confidence intervals) were 6.40 (1.99-9.97) and 4.94 (1.33-19.72) times those of overall reductions for cases and deaths, respectively. CONCLUSIONS: We believe this is the first evaluation of day-of-the week mobility on COVID-19. Weekend behavior was likely riskier than weekday behavior due to larger gatherings and less social distancing or protective measures. Reducing or shifting such activities outdoors would reduce COVID-19 cases and deaths.
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COVID-19 , Humanos , COVID-19/epidemiología , Colombia/epidemiología , Incidencia , Pandemias/prevención & control , Ciudades , Control de Enfermedades Transmisibles , Política PúblicaRESUMEN
INTRODUCTION AND OBJECTIVES: Recently, interest in the relationship between weekend catch-up sleep (WCUS) and chronic diseases is increasing. We aimed to study the correlation between sleep duration and non-alcoholic fatty liver disease (NAFLD), an emerging metabolic disease. MATERIALS AND METHODS: Data on sleep duration from the Korea National Health and Nutrition Examination Survey was recorded. The subjects were divided into three groups according to the duration of WCUS: Group 1, those who slept for less than 7 hours in a week; Group 2, those who slept for less than 7 hours on weekdays but more than 7 hours on weekends (those with WCUS pattern); and Group 3, those who slept for more than 7 hours in a week. Multivariate logistic regression analysis was used to analyze the correlation between sleep duration and NAFLD. RESULTS: A mean sleep time of 7 hours or more showed a significant negative relationship with NAFLD (odds ratio [OR]: 0.84, 95% confidence interval [CI]: 0.79-0.89 in all; OR 0.91, 95%CI 0.84-0.99 in males; OR 0.86, 95%CI 0.79-0.94 in females). Groups 2 and 3 showed significant negative relationships with NAFLD when Group 1 was used as a reference (Group 2; OR: 0.80, 95%CI: 0.70-0.92, Group 3; OR: 0.73, 95%CI: 0.66-0.82). WCUS showed similar correlations with NAFLD, regardless of sex. CONCLUSIONS: WCUS and sleep duration are significantly associated with NAFLD. A prospective cohort study is needed to prove the causal effects.
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Enfermedad del Hígado Graso no Alcohólico , Femenino , Humanos , Masculino , Enfermedad del Hígado Graso no Alcohólico/diagnóstico , Enfermedad del Hígado Graso no Alcohólico/epidemiología , Encuestas Nutricionales , Estudios Prospectivos , República de Corea/epidemiología , Factores de Riesgo , SueñoRESUMEN
Resumen Introducción y objetivos: el "efecto fin de semana" se define como un incremento en la mortalidad en pacientes que ingresan a centros asistenciales durante el fin de semana o días festivos. Este estudio se realizó para evaluar el posible "efecto fin de semana" en pacientes con hemorragia digestiva superior (HDS) con base en una experiencia de 3 años en un hospital de alta complejidad en Latinoamérica. Materiales y métodos: estudio observacional descriptivo realizado entre 2016 y 2018. Se describieron las características demográficas, factores de riesgo, síntomas de ingreso, hallazgos endoscópicos y diferentes intervenciones médicas. Además, se compararon los tiempos de realización de endoscopia, estancia hospitalaria y mortalidad entre los pacientes admitidos durante el fin de semana frente a días entre semana. Resultados: el análisis incluyó 274 pacientes en fines de semana y festivos (39,1 %) frente a pacientes en días entre semana (60,9 %). La mediana de edad fue de 68,5 años (rango intercuartílico [RIC]: 53-79), el 56,6 % fueron hombres. Las manifestaciones más comunes fueron melenas y hematemesis. La úlcera péptica fue el diagnóstico endoscópico más común (48,7 %). Los tiempos de estancia hospitalaria (7,38 ± 8,7 frente a 7,38 ± 7,1; p = 0,234) y mortalidad (1,9 % frente a 4,2 %; p = 0,274) fueron similares en ambos grupos. Se realizó una mayor cantidad de endoscopias después de las 24 horas en pacientes ingresados el fin de semana (19,6 % frente a 9,6 %; p = 0,041). Conclusiones: en esta cohorte no se presentó el "efecto fin de semana", no se observan diferencias en relación con la estancia hospitalaria, ni con la mortalidad en pacientes ingresados por HDS.
Abstract Introduction and Objectives: The "Weekend Effect" refers to an increase in mortality of patients admitted to health care centers on weekends or holidays. This study was performed to assess the impact of weekend admissions in patients with upper gastrointestinal bleeding (UGIB) based on a three year-experience in a high-complexity hospital in Latin America. Materials and Methods: A descriptive observational study was performed between 2016 and 2018. Data on demographic characteristics, risk factors, symptoms, endoscopic findings, and medical treatment was described. Moreover, the time to perform an endoscopy, the length of hospital stay, and the mortality level among patients admitted on weekends were compared with the same factors during the week. Results: The analysis included 274 patients admitted during the weekend and holidays (39.1%) versus patients admitted during the week (60.9%). The median age was 68.5 years old (interquartile range [IQR]: 53-79), and 56.6% were men. The most common conditions were tarry stools and hematemesis. Peptic ulcer was the most common endoscopic diagnosis (48.7%). Similar results were found in the length of hospital stay (7,38 ± 8,7 versus 7,38 ± 7,1; p = 0,234) and mortality groups (1,9 % versus 4,2 %; p = 0,274). A higher number of endoscopies 24 hours after the patient was admitted was performed (19,6 % versus 9,6 %; p = 0,041). Conclusions: The "Weekend Effect" was not present in the analyzed group, and there are no significant differences related to the length of hospital stay or the mortality of patients diagnosed with UGIB.
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Humanos , Masculino , Femenino , Terapéutica , Endoscopía , Hemorragia , Factores de Riesgo , Mortalidad , HospitalesRESUMEN
INTRODUCTION AND OBJECTIVES: Weekend admissions has previously been associated with worse outcomes in conditions requiring specialists. Our study aimed to determine in-hospital outcomes in patients with ascites admitted over the weekends versus weekdays. Time to paracentesis from admission was studied as current guidelines recommend paracentesis within 24h for all patients admitted with worsening ascites or signs and symptoms of sepsis/hepatic encephalopathy (HE). PATIENTS: We analyzed 70 million discharges from the 2005-2014 National Inpatient Sample to include all adult patients admitted non-electively for ascites, spontaneous bacterial peritonitis (SBP), and HE with ascites with cirrhosis as a secondary diagnosis. The outcomes were in-hospital mortality, complication rates, and resource utilization. Odds ratios (OR) and means were adjusted for confounders using multivariate regression analysis models. RESULTS: Out of the total 195,083 ascites/SBP/HE-related hospitalizations, 47,383 (24.2%) occurred on weekends. Weekend group had a higher number of patients on Medicare and had higher comorbidity burden. There was no difference in mortality rate, total complication rates, length of stay or total hospitalization charges between the patients admitted on the weekend or weekdays. However, patients admitted over the weekends were less likely to undergo paracentesis (OR 0.89) and paracentesis within 24h of admission (OR 0.71). The mean time to paracentesis was 2.96 days for weekend admissions vs. 2.73 days for weekday admissions. CONCLUSIONS: We observed a statistically significant "weekend effect" in the duration to undergo paracentesis in patients with ascites/SBP/HE-related hospitalizations. However, it did not affect the patient's length of stay, hospitalization charges, and in-hospital mortality.
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Atención Posterior/tendencias , Ascitis/terapia , Cirrosis Hepática/terapia , Paracentesis/tendencias , Admisión del Paciente/tendencias , Tiempo de Tratamiento/tendencias , Atención Posterior/economía , Ascitis/diagnóstico , Ascitis/economía , Ascitis/mortalidad , Bases de Datos Factuales , Femenino , Precios de Hospital/tendencias , Mortalidad Hospitalaria/tendencias , Humanos , Pacientes Internos , Tiempo de Internación , Cirrosis Hepática/diagnóstico , Cirrosis Hepática/economía , Cirrosis Hepática/mortalidad , Masculino , Persona de Mediana Edad , Paracentesis/efectos adversos , Paracentesis/economía , Paracentesis/mortalidad , Admisión del Paciente/economía , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Tiempo de Tratamiento/economía , Resultado del Tratamiento , Estados Unidos/epidemiologíaRESUMEN
ABSTRACT BACKGROUND: Physical activity (PA) practices seem to differ between weekdays and weekends and these pattern changes can affect body fat differently. However, previous studies did not assess the mediation effect of weekday and weekend PA on maintenance of body fat using sophisticated statistical models. OBJECTIVE: To analyze the mediation effect of PA during weekdays and weekends on maintenance of fat mass over a 12-month follow-up. DESIGN AND SETTING: Longitudinal cohort study (12 months) conducted at a public university in Presidente Prudente, Brazil. METHODS: A sample of 225 adults (117 females) was used. Body fatness and fat mass were assessed using dual-energy X-ray absorptiometry. PA levels were assessed using a pedometer. The statistical analysis consisted of paired-sample t tests, independent-sample t tests, Pearson correlations and mediation models. RESULTS: After 12 months, weekend PA had decreased while body composition indicators remained stable (without changes). The correlation between fat mass at baseline and follow-up was high for both sexes (men: 0.966; women: 0.941; P-value = 0.001 for both). Moreover, PA indices were inversely but moderately related to fat mass at baseline and follow-up. Lastly, weekend PA mediated the association between fat mass at baseline and follow-up (P-value < 0.05) by around 2% and 4%. CONCLUSION: Weekend PA mediated the association between fat mass at baseline and fat mass after one year of follow-up among these adults. Further studies are required to investigate the association between physical activity, body fat and other variables such as dietary patterns and sleep time.
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Humanos , Masculino , Femenino , Adulto , Composición Corporal , Ejercicio Físico , Brasil , Estudios de Cohortes , Estudios LongitudinalesRESUMEN
Rationale: Compliance with sepsis bundles is associated with better outcomes, but information to support structural actions that might improve compliance is scarce. Few studies have evaluated bundle compliance in different time periods, with conflicting results.Objectives: To evaluate the association of sepsis identification during the daytime versus during the nighttime and on weekdays versus weekends with 3-hour sepsis treatment bundle compliance.Methods: This was an observational, multicenter study including patients with sepsis admitted between 2010 and 2017 to 10 hospitals in Brazil. Our exposures of interest were daytime (7:00 a.m.-6:59 p.m.) versus nighttime (7:00 p.m.-6:59 a.m.) and weekdays (Monday 7:00 a.m.-Friday 6:59 p.m.) versus weekends (Friday 7:00 p.m.-Monday 6:59 a.m.). Our primary outcome was full compliance with the 3-hour sepsis treatment bundles. We adjusted by potential confounding factors with multivariable logistic regression models.Results: Of 11,737 patients (8,733 sepsis and 3,004 septic shock), 3-hour bundle compliance was 79.1% and hospital mortality was 24.7%. The adjusted odds ratio (adjOR) for 3-hour full bundle compliance for patients diagnosed during the daytime versus during the nighttime was 1.35 (95% confidence interval [CI], 1.23-1.49; P < 0.001) and was more pronounced in the emergency department (adjOR, 1.55; 95% CI, 1.35-1.77; P < 0.001) than in nonemergency areas (adjOR, 1.19; 95% CI, 1.04-1.37; P = 0.014). Overall, there was no association between diagnosis on the weekends versus on weekdays and 3-hour full bundle compliance (adjOR, 1.08; 95% CI, 0.98-1.19; P = 0.115), although there was an association among those diagnosed in nonemergency areas (adjOR, 1.15; 95% CI, 1.00-1.32; P = 0.047). The lower compliance observed for sepsis diagnosed during the nighttime was more evident 2 years after implementation of the quality improvement initiative.Conclusions: Compliance with sepsis bundles was associated with the moment of sepsis diagnosis. The place of diagnosis and the time from campaign implementation were factors modifying this association. Our results support areas for better design of quality improvement initiatives to mitigate the influence of the period of sepsis diagnosis on treatment compliance.
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Evaluación de Procesos y Resultados en Atención de Salud/métodos , Admisión del Paciente , Sepsis/mortalidad , Choque Séptico/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Estudios de Cohortes , Femenino , Adhesión a Directriz/normas , Mortalidad Hospitalaria , Hospitales Privados/organización & administración , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Mejoramiento de la Calidad , Sepsis/diagnóstico , Choque Séptico/diagnósticoRESUMEN
Abstract Objective: To know the distribution of births of very low birth weight infants by day of the week, and whether this distribution affects the morbidity and mortality in this group of patients. Methods: This was a retrospective analysis of data collected prospectively in the Spanish SEN1500 network (2002-2011). Outborn infants, patients with major congenital anomalies, and those who died in the delivery room were excluded. Births were grouped into "weekdays" and "weekends." A multivariate logistic regression analysis was conducted to evaluate the independent effect of the birth moment on outcomes, and Cox regression for survival. Results: Out of a total of 27,205 very low birth weight infants born at and/or admitted to the participating centers, 22,961 (84.4%) met inclusion criteria. A reduction of 24% in the number of births was observed during the "weekends" compared with "weekdays". In the raw analysis, patients born on weekends exhibited higher morbidity and mortality (mortality rate: 14.2% vs. 16.5%, p < 0.001), but differences were no longer significant after adjusting for confounding factors. Conclusions: The present results suggest that current care practices reduce the proportion of births during the weekends and tend to cluster some high-risk births during this period, increasing crude morbidity and mortality. However, after adjusting for confounding factors, the differences disappear, suggesting that overall care coverage in these centers is appropriate.
Resumo Objetivo: Conhecer a distribuição dos partos de neonatos com muito baixo peso ao nascer durante a semana e se essa distribuição afeta a morbidez e a mortalidade nesse grupo de pacientes. Método: Esta é uma análise retrospectiva de dados coletados prospectivamente na rede espanhola SEN1500 (2002-2011). Foram excluídos neonatos nascidos em outro local, pacientes com grandes anomalias congênitas e pacientes falecidos na sala de parto. Os partos foram agrupados em "Dias úteis" e "Final de semana". Foi realizada uma análise de regressão logística multivariada para avaliar o efeito independente do parto sobre os resultados e uma regressão de Cox para avaliar a sobrevida. Resultados: Do total de 27.205 neonatos com muito baixo peso ao nascer nascidos e/ou internados nos centros participantes, 22.961 (84,4%) atenderam aos critérios de inclusão. Houve uma redução de 24% no número de partos no "Final de semana" em comparação com os "Dias úteis". Na análise bruta, os pacientes nascidos em finais de semana apresentaram maior morbidez e mortalidade (Taxa de mortalidade: 14,2% em comparação a 16,5%, p < 0,001), porém as diferenças não eram mais significativas após o ajuste aos fatores de confusão. Conclusões: Nossos resultados sugerem que as práticas atuais de atendimento reduzem a proporção de partos em finais de semana e tendem a agrupar alguns partos de alto risco nesse período, aumentando a morbidez e mortalidade brutas. Contudo, após o ajuste aos fatores de risco, as diferenças desaparecem, sugerindo que a cobertura de atendimento geral em nossos centros é adequada.
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Humanos , Masculino , Femenino , Recién Nacido , Lactante , Factores de Tiempo , Mortalidad Infantil , Morbilidad , Recién Nacido de muy Bajo Peso , Factores Socioeconómicos , Brasil/epidemiología , Estudios Retrospectivos , Factores de RiesgoRESUMEN
OBJECTIVE: To know the distribution of births of very low birth weight infants by day of the week, and whether this distribution affects the morbidity and mortality in this group of patients. METHODS: This was a retrospective analysis of data collected prospectively in the Spanish SEN1500 network (2002-2011). Outborn infants, patients with major congenital anomalies, and those who died in the delivery room were excluded. Births were grouped into "weekdays" and "weekends." A multivariate logistic regression analysis was conducted to evaluate the independent effect of the birth moment on outcomes, and Cox regression for survival. RESULTS: Out of a total of 27,205 very low birth weight infants born at and/or admitted to the participating centers, 22,961 (84.4%) met inclusion criteria. A reduction of 24% in the number of births was observed during the "weekends" compared with "weekdays". In the raw analysis, patients born on weekends exhibited higher morbidity and mortality (mortality rate: 14.2% vs. 16.5%, p<0.001), but differences were no longer significant after adjusting for confounding factors. CONCLUSIONS: The present results suggest that current care practices reduce the proportion of births during the weekends and tend to cluster some high-risk births during this period, increasing crude morbidity and mortality. However, after adjusting for confounding factors, the differences disappear, suggesting that overall care coverage in these centers is appropriate.
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Mortalidad Infantil , Recién Nacido de muy Bajo Peso , Morbilidad , Factores de Tiempo , Brasil/epidemiología , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Estudios Retrospectivos , Factores de Riesgo , Factores SocioeconómicosRESUMEN
AIM: To examine the association between weekend alcohol consumption and the biochemical and histological alterations at two different concentrations of alcohol in both genders in rats. METHODS: Wistar rats weighing 170-200 g were divided into groups as follows: (1) Control groups; and (2) weekend alcohol-consumption group: 2 d/weekly per 12 wk, at two different concentrations: (1) Group of males or females with a consumption of a solution of alcohol at 40%; and (2) group of males or females with a consumption of a solution of alcohol at 5%. At the end of the experiment, serum and liver samples were obtained. The following enzymes and metabolites were determined in serum: Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST), Lactate Dehydrogenase, and Gamma-Glutamyltransferase, and glucose, triglycerides, cholesterol, bilirubin, and albumin. Liver samples from each group were employed to analyze morphological abnormalities by light microscopy. RESULTS: In all of the weekend alcohol-consumption groups, AST activity presented a significant, 10-fold rise. Regarding ALT activity, the groups with weekend alcohol consumption presented a significant increase that was six times greater. Bilirubin levels increased significantly in both groups of females. We observed a significant increase in the parameters of fatty change and inflammation due to weekend alcohol consumption. Only the group of females that consumed alcohol at 40% presented slight hepatocellular disorganization. CONCLUSION: The results obtained herein provide solid evidence that weekend alcohol consumption gives rise to liver damage, demonstrated by biochemical and histological alterations, first manifested acutely, and prolonged weekend alcohol consumption can cause greater, irreversible damage.
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INTRODUCTION: Higher mortality for patients admitted to intensive care units (ICUs) during the weekends has been occasionally reported with conflicting results that could be related to organisational factors. We investigated the effects of ICU organisational and staffing patterns on the potential association between weekend admission and outcomes in critically ill patients. METHODS: We included 59 614 patients admitted to 78 ICUs participating during 2013. We defined 'weekend admission' as any ICU admission from Friday 19:00 until Monday 07:00. We assessed the association between weekend admission with hospital mortality using a mixed logistic regression model controlling for both patient-level (illness severity, age, comorbidities, performance status and admission type) and ICU-level (decrease in nurse/bed ratio on weekend, full-time intensivist coverage, use of checklists on weekends and number of institutional protocols) confounders. We performed secondary analyses in the subgroup of scheduled surgical admissions. RESULTS: A total of 41 894 patients (70.3%) were admitted on weekdays and 17 720 patients (29.7%) on weekends. In univariable analysis, weekend admitted patients had higher ICU (10.9% vs 9.0%, P<0.001) and hospital (16.5% vs 13.5%, P<0.001) mortality. After adjusting for confounders, weekend admission was not associated with higher hospital mortality (OR 1.05, 95% CI 0.99 to 1.12, P=0.095). However, a 'weekend effect' was still observed in scheduled surgical admissions, as well as in ICUs not using checklists during the weekends. For unscheduled admissions, no 'weekend effect' was observed regardless of ICU's characteristics. For scheduled surgical admissions, a 'weekend effect' was present only in ICUs with a low number of implemented protocols and those with a reduction in the nurse/bed ratio and not applying checklists during weekends. CONCLUSIONS: ICU organisational factors, such as decreased nurse-to-patient ratio, absence of checklists and fewer standardised protocols, may explain, in part, increases in mortality in patients admitted to the ICU mortality on weekends.
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Enfermedad Crítica/mortalidad , Mortalidad Hospitalaria/tendencias , Unidades de Cuidados Intensivos , Admisión del Paciente/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Brasil , Enfermedad Crítica/terapia , Femenino , Humanos , Unidades de Cuidados Intensivos/organización & administración , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Puntaje de Propensión , Estudios Retrospectivos , Factores de Tiempo , Recursos HumanosRESUMEN
Operating room (OR) to intensive care unit (ICU) handoffs are complex and known to be associated with adverse events and patient harm. The authors hypothesized that handoff quality diminishes during nights/weekends and that bedside handoff practices are similar between ICUs of the same health system. Bedside OR-to-ICU handoffs were directly observed in 2 surgical ICUs with different patient volumes. Handoff quality measures were compared within the ICUs on weekdays versus nights/weekends as well as between the high- and moderate-volume ICUs. In the high-volume ICU, transmitter delivery scores were significantly better during off hours, while other measures were not different. High-volume ICU scores were consistently better than those in the moderate-volume ICU. Bedside handoff practices are not worse during off hours and may be better in ICUs used to a higher patient volume. Specific handoff protocols merit evaluation and training to ensure consistent practices in different ICU models and at different times.
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Unidades de Cuidados Intensivos , Pase de Guardia , Atención Posterior/estadística & datos numéricos , Humanos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Quirófanos/estadística & datos numéricos , Pase de Guardia/estadística & datos numéricos , Calidad de la Atención de SaludRESUMEN
OBJECTIVE: The purpose of this study was to evaluate the association between measures of patient arrival day (weekday or weekend day), day part (nighttime vs. daytime) and hour (regular hours vs. off hours) at the stroke unit of the Emergency Department of the Puerto Rico Medical Center and the following time-to-treatment measures: door-to-CT-scan, door-to-needle, and stroke-onset-to-treatment. METHODS: In this retrospective study, the data of 54 patients was obtained from the stroke unit of the Puerto Rico Medical Center through the Get With The Guidelines- Stroke Registry. Inclusion criteria were as follows: having an ischemic stroke within the period covering from August 2008 through February 2010 and being at least 18 years old. Associations between patient arrival time and timeliness of interventions were assessed using t-tests/Mann-Whitney tests and chi-square tests/Fisher's exact tests, as appropriate. RESULTS: The majority of the patients (74%) were men. The mean and standard deviation of age was 67±14 years. The median of times for door-to-CT-scan and onset to treatment were 15 minutes (interquartile range=15) and 2.7 hours (interquartile range=0.6), respectively. The mean and standard deviation for door-to-needle time was 77±18 minutes. No differences were found for any of the variables in terms of arrival date, day part or hour (p>0.05). The median time for door-to-CT- scan was shorter for patients receiving intravenous tissue plasminogen activator treatment than it was for those not receiving such treatment (12 minutes vs. 20 minutes; p=0.02). CONCLUSION: The timeliness of the stroke management interventions did not differ significantly in terms of arrival day, day part, or hour.
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Isquemia Encefálica/terapia , Servicio de Urgencia en Hospital/estadística & datos numéricos , Accidente Cerebrovascular/terapia , Activador de Tejido Plasminógeno/administración & dosificación , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Fibrinolíticos/administración & dosificación , Humanos , Masculino , Persona de Mediana Edad , Puerto Rico , Estudios Retrospectivos , Estadísticas no Paramétricas , Factores de TiempoRESUMEN
Introducción: La estructura organizacional de las Unidades de Cuidados Intensivos está basada en turnos, con cambios en los equipos durante la noche y los fines de semana-festivos (FdS-F). Se ha descrito una mayor mortalidad en los ingresos realizados durante estos períodos. Nuestro objetivo es evaluar si la mortalidad de los pacientes ingresados a nuestra unidad se ve influenciada porel horario nocturno o los FdS-F. Metodología: Estudio retrospectivo de la cohorte de pacientes ingresados desde el 1 de enero al 31 de diciembre de 2011 en el Hospital Clínico Regional Valdivia. Se consideró turno día (TD)el comprendido entre las 08:00 AM y las 20:59 PM, y el turno noche (TN) entre las 21:00 y las 07:59 horas. Se asignó como horario de fin de semana al comprendido entre el día viernes a las21:00 horas y el lunes a las 07:59. Dentro de esta misma categoría se incluyeron los festivos, con el mismo rango horario descrito. Base de datos en Excel MAC y análisis estadístico con Vassar Stats. Resultados: Durante el año 2011, se produjeron 425 ingresos, con una mortalidad global de 25 por ciento, variando según el tipo de patología que motivó el ingreso a la unidad (sepsis 45 por ciento, cardiovascular 17 por ciento, respiratorio 30 por ciento, neurológico 26 por ciento, trauma 24 por ciento, digestivo 32 por ciento, renal 14 por ciento, otras 18 por ciento). Los principales motivos de ingreso fueron las patologías cardiovasculares (32 por ciento), sepsis (18 por ciento) y enfermedades respiratorias (14 por ciento). El 51 por ciento requirió de Ventilación Mecánica Invasiva. El tiempo de estadía fue una mediana de 3 días (0-80). El 48 por ciento de los pacientes ingresó en el horario de TD, 38 por ciento en TN, sin contar con la hora de ingreso en el 14 por ciento de los casos. La mortalidad de los pacientes ingresados en TN fue 30 por ciento y los ingresados en TD 25 por ciento (OR 1,29 IC 95 por ciento 0,8126-2,0393; p= 0,29)...
Introduction: The job in most of Intensive Care Units (ICU) is organized in shift work, this system includes the activities performed during nights and weekends or holidays (W-HD). Higher mortality has been described in patients admitted at nights and W-HD. We decided to study if mortality in our unit was related to the admission during these periods. Methods: We reviewed the clinical records of patients admitted at the ICU of Valdivia Hospital since January 31, 2011 to December 31, 2011. Day shift (DS) was defined between 8:00 and 20:59 hours, night shift (NS) between 21:00 and 7:59 hours, weekend was considered as the period between Friday at 21:00hours and Monday at 7:59 and finally, holiday was considered as the period between the previous date at 21:00 and next day at 7:59 hours of a non-laboral day. Data were analyzed with Microsoft EXCEL for Mac and Vassar stats software. Results: four hundred twenty five patients were admitted at the ICU during this period, the mortality was 25 percent. It was different according with type of disease (sepsis 45 percent, cardiovascular disease 17 percent, respiratory disease 30 percent, neurologic disease 26 percent, trauma 24 percent, gastrointestinal disease 32 percent, renal disease 14 percent, others 18 percent). The most frequent causes of admission were cardiovascular diseases (32 percent), sepsis (19 percent) and respiratory diseases (14 percent). 51 percent of patients were submitted to mechanical ventilation. The median of staying in the unit was 3 days (0-80 days). 48 percent of patients were entered at the unit at DS, 38 percent at NS and in 14 percent of cases the time of admission was not registered. Mortality of patients admitted was 30 percent in NS and 25 percent in DS (OR 1,29 CI 95 percent 0,8126-2,0393; p=0,29)...