RESUMEN
INTRODUCTION: Following a carotid endarterectomy (CEA) procedure, patients are discharged to their homes or other locations than home such as an acute care facility or skilled nursing facility based on their functional status and level of medical attention needed. Decision-making for discharge destination following a CEA to home or nonhome locations is important due to the differences in survival and postoperative complications. While primary outcomes such as mortality and occurrence of stroke following CEA have been extensively studied, there is a paucity of information characterizing outcomes of discharge destination and the factors associated. The purpose of this study was to explore the factors associated with discharge to nonhome destinations after CEA, and outcomes after discharge. METHODS: Using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, we identified patients who underwent CEA from 2011 to 2018. Patients were divided into two groups based on their discharge destination (home versus nonhome). Univariate and multivariate analysis were performed for preoperative and intraoperative factors associated with different discharge destinations. Postoperative complications associated with discharge to nonhome destinations were analyzed and mortality after discharge from hospital was compared between the 2 groups. RESULTS: A total of 25,094 patients met the criteria for inclusion in the study, of which 39% were females and 61% were males; median age was 71 years. Twenty four thousand one hundred twenty-five patients (93.13%) were discharged to home (Group I) and 1,779 (6.87%) were discharged to nonhome destinations (Group II). Following preoperative and intraoperative factors were associated with discharge to nonhome locations: older age, diabetes mellitus, functional independent status, transfer from other hospitals, symptomatic status, need for preoperative blood transfusions, severe ipsilateral carotid stenosis, elective CEA, need for intraoperative shunt and general anesthesia (all P< 0.05). Following postoperative complications had statistically significant association with discharge to nonhome destinations: postoperative blood transfusion, pneumonia, unplanned intubation, longer than 48 hours on ventilator, development of stroke, myocardial infarction, deep vein thrombosis, and sepsis (all P< 0.05). Mortality after discharge from hospital was 0.39% (nâ¯=â¯100). Mortality among those who were discharged to home was 0.29% vs. 1.63% for those who were discharged to nonhome locations (P< 0.05). CONCLUSIONS: Majority of the patients after CEA are discharged back to their homes. This study identifies the factors which predispose patients discharged to locations, other than home. Patients who are not discharged home have higher mortality as compared to those who are discharged to their homes.
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Estenosis Carotídea/cirugía , Endarterectomía Carotidea/tendencias , Evaluación de Procesos y Resultados en Atención de Salud/tendencias , Alta del Paciente/tendencias , Anciano , Anciano de 80 o más Años , Estenosis Carotídea/mortalidad , Estudios Transversales , Bases de Datos Factuales , Endarterectomía Carotidea/efectos adversos , Endarterectomía Carotidea/mortalidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
OBJECTIVE: We sought to elicit patients', caregivers', and health care providers' perceptions of home recovery to inform care personalization in the learning health system. SUMMARY BACKGROUND DATA: Postsurgical care has shifted from the hospital into the home. Daily care responsibilities fall to patients and their caregivers, yet stakeholder concerns in these heterogeneous environments, especially as they relate to racial inequities, are poorly understood. METHODS: Surgical oncology patients, caregivers, and clinicians participated in freelisting; an open-ended interviewing technique used to identify essential elements of a domain. Within 2 weeks after discharge, participants were queried on 5 domains: home independence, social support, pain control, immediate, and overall surgical impact. Salience indices, measures of the most important words of interest, were calculated using Anthropac by domain and group. RESULTS: Forty patients [20 whites and 20 African-Americans (AAs)], 30 caregivers (17 whites and 13 AAs), and 20 providers (8 residents, 4 nurses, 4 nurse practitioners, and 4 attending surgeons) were interviewed. Patients and caregivers attended to the personal recovery experience, whereas providers described activities and individuals associated with recovery. All groups defined surgery as life-changing, with providers and caregivers discussing financial and mortality concerns. Patients shared similar thoughts about social support and self-care ability by race, whereas AA patients described heterogeneous pain management and more hopeful recovery perceptions. AA caregivers expressed more positive responses than white caregivers. CONCLUSIONS: Patients live the day-to-day of recovery, whereas caregivers and clinicians also contemplate more expansive concerns. Incorporating relevant perceptions into traditional clinical outcomes and concepts could enhance the surgical experience for all stakeholders.
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Cuidados Posteriores/métodos , Cuidadores/psicología , Alta del Paciente/tendencias , Pacientes/psicología , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Apoyo Social , Encuestas y Cuestionarios , Adulto JovenRESUMEN
Objetivo: Identificar as evidências acerca das orientações que devem ser oferecidas à pessoa com Insuficiência Cardíaca para a continuidade do tratamento. Método: Revisão integrativa, com busca nas bases de dados Lilacs, Pubmed, Cinahl, Web of Science e Scopus. Resultados: Dos 5422 títulos identificados, 31 artigos foram incluídos para análise. Apreendeu-se que os estudos abordaram, dentre outros aspectos, a importância da orientação da doença, dos sinais e sintomas e da detecção da agudização; no entanto, constatou-se a dificuldade na utilização de linguagem adequada para facilitar a compreensão pela pessoa e/ou pelos familiares. Conclusão: Sugere-se que mais estudos sejam realizados a respeito desse tema, a fim de possibilitar aos profissionais de saúde a formulação de um plano de cuidados coerente, com fundamentação nas melhores evidências científicas
Objective: to identify the evidence on the guidance that should be offered to people with heart failure to continue treatment. Method:integrative review, searching the databases Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), National Library of Medicine (PUBMED/MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science e Scopus. Results: of the 5422 titles identified, 32 articles were included for analysis. It was understood that the studies addressed, among other aspects, the importance of disease orientation, signs and symptoms, and acute detection; however, it was found that it was difficult to use adequate language to facilitate understanding by the person and/or family members. Conclusion: it is suggested that more studies be conducted on this topic, in order to enable health professionals to formulate a coherent care plan, based on the best scientific evidence
Objetivo: identificar la evidencia sobre las pautas que deberían ofrecerse a las personas con insuficiencia cardíaca para continuar el tratamiento. Método: revisión integrativa, búsqueda en las bases de datos Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), National Library of Medicine (PUBMED/MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science e Scopus.Resultados: de los 5422 títulos identificados, se incluyeron 32 artículos para su análisis. Se entendió que los estudios abordaron, entre otros aspectos, la importancia de la orientación de la enfermedad, los signos y síntomas, y la detección aguda; sin embargo, se descubrió que era difícil usar un lenguaje adecuada para facilitar la comprensión por parte de la persona y/o miembros de la familia. Conclusión: Se sugiere que se realicen más estudios sobre este tema, a fin de permitir a los profesionales de la salud formular un plan de atención coherente, basado en la mejor evidencia científica
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Humanos , Masculino , Femenino , Alta del Paciente/tendencias , Continuidad de la Atención al Paciente/tendencias , Insuficiencia Cardíaca/terapia , Educación en Salud , Cuidado de Transición/tendenciasRESUMEN
OBJECTIVES: To examine how infant and maternal factors, hospital factors, and neighborhood-level factors impact or modify racial/ethnic disparities in human milk intake at hospital discharge among very low birth weight infants. STUDY DESIGN: We studied 14 422 infants from 119 California Perinatal Quality Care Collaborative neonatal intensive care units born from 2008 to 2011. Maternal addresses were linked to 2010 census tract data, representing neighborhoods. We tested for associations with receiving no human milk at discharge, using multilevel cross-classified models. RESULTS: Compared with non-Hispanic whites, the adjusted odds of no human milk at discharge was higher among non-Hispanic blacks (aOR 1.33 [1.16-1.53]) and lower among Hispanics (aOR 0.83 [0.74-0.93]). Compared with infants of more educated white mothers, infants of less educated white, black, and Asian mothers had higher odds of no human milk at discharge, and infants of Hispanic mothers of all educational levels had similar odds as infants of more educated white mothers. Country of birth and neighborhood socioeconomic was also associated with disparities in human milk intake at discharge. CONCLUSIONS: Non-Hispanic blacks had the highest and Hispanic infants the lowest odds of no human milk at discharge. Maternal education and country of birth were the biggest drivers of disparities in human milk intake, suggesting the need for targeted approaches of breastfeeding support.
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Lactancia Materna/etnología , Etnicidad , Recién Nacido de muy Bajo Peso , Unidades de Cuidado Intensivo Neonatal/estadística & datos numéricos , Leche Humana , Grupos Raciales , Adulto , California/epidemiología , Femenino , Humanos , Recién Nacido , Masculino , Alta del Paciente/tendencias , Embarazo , Estudios RetrospectivosRESUMEN
Objetivo: levantar na literatura os critérios para preparo dos pais para alta do RNPT e propor um protocolo para este fim. Metodologia: revisão bibliográfica integrativa, qualitativa e exploratória. Resultados: Emergiram da busca três categorias: educação dos pais quanto aos cuidados ao recém-nascido; limitações e desafios enfrentados pela equipe para o preparo dos pais e estratégias utilizadas pela equipe para o preparo dos pais. Propôs-se o protocolo com orientações sobre alimentação, banho, sono, cuidados com a pele e sinais de alerta. Discussão: Os resultados apontam a importância do preparo dos pais para a alta do pré-termo, evidenciando que a manutenção da saúde quando em domicilio, terá direta relação com tal preparo. Considerações finais: Diante do discutido, há necessidade de se estabelecer um processo sistemático, para a implementação de tal ação
Objective: to raise in the literature the criteria for preparing the parents for discharge from the PTNB and to propose a protocol for this purpose. Methodology: qualitative and exploratory bibliographical review. Results: Three categories emerged from the search: parent education for newborn care, limitations and challenges faced by the parenting team and the strategies used by the parenting team. The protocol for the preparation of parents with guidelines on feeding, bathing, sleeping, skin care and warning signs was proposed. Discussion: The results point out the importance of parents' preparation for high preterm, evidencing that the maintenance of health when at home, will have a direct relation with such preparation. Final considerations: Before the discussion, there is a need to establish a systematic process for the implementation of such action
Objetivo: levantar en la literatura los criterios para la preparación de los padres para el alto del RNPT y proponer un protocolo para este fin. Metodología: revisión bibliográfica integrativa, cualitativa y exploratória. Resultados: emergieron de la búsqueda tres categorías: educación de los padres en cuanto a los cuidados al recién nacido; limitaciones y desafíos enfrentados por el equipo para la preparación de los padres y estrategias utilizadas por el equipo para la preparación de los padres. Se propuso el protocolo orientaciones sobre alimentación, baño, sueño, cuidados de la piel y señales de alerta. Discusión: Los resultados apuntan la importancia de la preparación de los padres para el alta del pre-término, evidenciando que el mantenimiento de la salud cuando en domicilio, tendrá una directa relación con tal preparación. Consideraciones finales: Ante la discusión, hay una necesidad de establecer un proceso sistemático, para la implementación de tal acción
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Humanos , Masculino , Femenino , Recién Nacido , Relaciones Padres-Hijo , Padres/educación , Padres/psicología , Alta del Paciente/tendencias , Recien Nacido Prematuro , Estrés Psicológico , Unidades de Cuidado Intensivo NeonatalAsunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Alta del Paciente/tendencias , Neumonía Viral/rehabilitación , Enfermedades Pulmonares Intersticiales/rehabilitación , Infecciones por Coronavirus/rehabilitación , Neumonía Viral/complicaciones , Calidad de Vida , Cuarentena/tendencias , Reacción en Cadena de la Polimerasa , Encuestas y Cuestionarios , Enfermedades Pulmonares Intersticiales/complicaciones , Infecciones por Coronavirus/complicaciones , Coronavirus Relacionado al Síndrome Respiratorio Agudo Severo/patogenicidad , Pandemias , Ventilación no Invasiva , Intubación Intratraqueal , ItaliaRESUMEN
OBJECTIVE: The primary objective of this study was to determine the survival to hospital discharge of patients who were treated with venovenous (VV) extracorporeal membrane oxygenation (ECMO) for respiratory failure after cardiac arrest. DESIGN: Retrospective chart review. SETTING: University-affiliated tertiary care hospitals. PARTICIPANTS: The study comprised 21 patients. INTERVENTIONS: Implementation of VV ECMO in patients with return of spontaneous circulation after cardiac arrest owing to respiratory insufficiency. MEASUREMENTS AND MAIN RESULTS: The most common etiology of arrest was pneumonia-associated acute respiratory distress syndrome (8/21 [38%]). Overall, 12/21(57%) patients survived to hospital discharge. Two of 12 (17%) patients required hemodialysis upon discharge. CONCLUSION: VV ECMO may be an appropriate alternative to venoarterial ECMO in select patients with return of spontaneous circulation after cardiac arrest owing to profound respiratory failure.
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Oxigenación por Membrana Extracorpórea/métodos , Paro Cardíaco/etiología , Paro Cardíaco/terapia , Síndrome de Dificultad Respiratoria/complicaciones , Síndrome de Dificultad Respiratoria/terapia , Adulto , Circulación Sanguínea/fisiología , Estudios de Cohortes , Femenino , Paro Cardíaco/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Alta del Paciente/tendencias , Síndrome de Dificultad Respiratoria/fisiopatología , Estudios Retrospectivos , Adulto JovenRESUMEN
INTRODUCTION AND AIM: Considered as a healthcare quality indicator, hospital readmissions in decompensated cirrhosis predispose the patients and the society to physical, social and economic distresses. Few studies involving North American cohorts have identified different predictors. The aim of this study was to determine and validate the predictors of 1-month and 3-months readmission in an Asian cohort. MATERIAL AND METHODS: We prospectively studied 281 hospitalised patients with decompensated cirrhosis at a large tertiary care public hospital in India between August 2014 and August 2016 and followed them for 3 months. Data regarding demographic, laboratory and disease related risk factors were compiled. We used multivariate logistic regression to determine predictors of readmission at 1-month and 3-months and receiver operating curves (ROC) for significant predictors to obtain the best cut-offs. RESULTS: 1-month and 3-months readmission rates in our study were 27.8% and 42.3%, respectively. Model for End stage Liver Disease (MELD) score at discharge (OR:1.24, p < 0.001) and serum sodium (OR:0.94, p-0.039) independently predicted 1-month and MELD score (OR:1.11, p-0.003), serum sodium (OR:0.94, p-0.027) and male gender (OR:2.19, p-0.008) independently predicted 3-months readmissions. Neither aetiology nor complications of cirrhosis emerged as risk factors. MELD score >14 at discharge and serum sodium < 133 mEq/L best predicted readmissions; MELD score being a better predictor than serum sodium (p - 0.0001). CONCLUSIONS: High rates of early and late readmissions were found in our study. Further, this study validated readmission predictors in Asian patients. Structured interventions targeting this risk factors may diminish readmissions in decompensated cirrhosis.
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Cirrosis Hepática/epidemiología , Readmisión del Paciente/tendencias , Medición de Riesgo/métodos , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Incidencia , India/epidemiología , Cirrosis Hepática/diagnóstico , Cirrosis Hepática/terapia , Masculino , Persona de Mediana Edad , Alta del Paciente/tendencias , Pronóstico , Estudios Prospectivos , Curva ROC , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores de TiempoRESUMEN
BACKGROUND: Hospitalisation rates for inflammatory bowel disease (IBD) vary across the world. We aimed to investigate temporal patterns of hospitalisation for IBD in member countries of the Organisation for Economic Co-operation and Development (OECD). METHODS: From the OECD database, we assessed IBD-related hospitalisation rates (expressed as annual rates per 100â000 inhabitants) for 34 countries from 1990 to 2016. We calculated mean hospitalisation rates for the period 2010-15 and used joinpoint regression models to calculate average annual percentage changes with 95% CIs. FINDINGS: Mean hospitalisation rates for IBD from 2010 to 2015 were highest in North America (eg, 33·9 per 100â000 in the USA), Europe (eg, 72·9 per 100â000 in Austria), and Oceania (eg, 31·5 per 100â000 in Australia). Hospitalisation rates for IBD were stabilising or decreasing over time in many countries in these regions but increasing in others. Countries in Asia and Latin America and the Caribbean had the lowest IBD-related hospitalisation rates but the greatest increases in rates over time. For example, Turkey had an annual hospitalisation rate of 10·8 per 100â000 inhabitants and an average annual percentage change of 10·4% (95% CI 5·2-15·9). Similarly, Chile had an annual hospitalisation rate of 9·0 per 100â000 inhabitants and an average annual percentage change of 5·9% (4·9-7·0). INTERPRETATION: Hospitalisation rates for IBD are high in western countries but are typically stabilising or decreasing, whereas rates in many newly industrialised countries are rapidly increasing, which reflects the known increase in IBD prevalence in these countries. Potential explanations for these trends include changes in the epidemiology of IBD, health-care delivery, and infrastructure in these countries, as well as overall country-specific patterns in hospitalisations and differences between countries in data collection methods. FUNDING: None.
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Hospitalización/tendencias , Enfermedades Inflamatorias del Intestino/epidemiología , Organización para la Cooperación y el Desarrollo Económico/estadística & datos numéricos , Asia/epidemiología , Australia/epidemiología , Austria/epidemiología , Región del Caribe/epidemiología , Chile/epidemiología , Colitis Ulcerosa/epidemiología , Enfermedad de Crohn/epidemiología , Atención a la Salud/tendencias , Hospitalización/estadística & datos numéricos , Humanos , Enfermedades Inflamatorias del Intestino/economía , América Latina/epidemiología , Organización para la Cooperación y el Desarrollo Económico/organización & administración , Aceptación de la Atención de Salud/estadística & datos numéricos , Alta del Paciente/estadística & datos numéricos , Alta del Paciente/tendencias , Prevalencia , Factores de Tiempo , Turquía/epidemiología , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVE: In ST-elevation myocardial infarction, 7-15% of patients admitted as Killip I will develop symptomatic heart failure or decreased ejection fraction. However, available clinical scores do not predict the risk of severe outcomes well, such as heart failure, recurrent myocardial infarction, and sudden death in these Killip I individuals. Therefore, we evaluated whether one vs two measurements of BNP would improve prediction of adverse outcomes in addition to the GRACE score in ST-elevation myocardial infarction/Killip I individuals. METHODS: Consecutive patients with ST-elevation myocardial infarction/Killip I (n=167) were admitted and followed for 12 months. The GRACE score was calculated and plasma BNP levels were obtained in the first 12 h after symptom onset (D1) and at the fifth day (D5). RESULTS: Fifteen percent of patients admitted as Killip I developed symptomatic heart failure and/or decreased ejection fraction in 12 months. The risk of developing symptomatic heart failure or ejection fraction <40% at 30 days was increased by 8.7-fold (95% confidence interval: 1.10-662, p=0.046) per each 100 pg/dl increase in BNP-change. Both in unadjusted and adjusted Cox-regressions, BNP-change as a continuous variable was associated with incident sudden death/myocardial infarction at 30 days (odds ratio 1.032 per each increase of 10 pg/dl, 95% confidence interval: 1.013-1.052, p<0.001), but BNP-D1 was not. The GRACE score alone showed a moderate C-statistic=0.709 (p=0.029), but adding BNP-change improved risk discrimination (C-statistic=0.831, p=0.001). Net reclassification confirmed a significant improvement in individual risk prediction by 33.4% (95% confidence interval: 8-61%, p=0.034). However, GRACE +BNP-D1 did not improve risk reclassification at 30 days compared to GRACE (p=0.8). At 12 months, BNP-change was strongly associated with incident sudden death/myocardial infarction, but not BNP-D1. CONCLUSIONS: Only BNP-change following myocardial infarction was associated with poorer short- and long-term outcomes. BNP-change also improves risk reclassification in addition to the GRACE score.
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Electrocardiografía , Insuficiencia Cardíaca/epidemiología , Péptido Natriurético Encefálico/sangre , Alta del Paciente/tendencias , Medición de Riesgo/métodos , Infarto del Miocardio con Elevación del ST/sangre , Volumen Sistólico/fisiología , Biomarcadores/sangre , Brasil/epidemiología , Estudios de Seguimiento , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/fisiopatología , Humanos , Incidencia , Pronóstico , Estudios Prospectivos , Recurrencia , Infarto del Miocardio con Elevación del ST/complicaciones , Tasa de Supervivencia/tendencias , Factores de TiempoRESUMEN
BACKGROUND: Neuropsychiatric disorders represent one of the first causes of disability worldwide. Recognizing the main causes for hospitalization may allow the implementation of interventions to prevent hospitalization and promote ambulatory care. OBJECTIVE: To describe the trends of mental disorders requiring hospitalization in a neuropsychiatric referral center of a middle-income country. MATERIAL AND METHODS: Observational, cross-sectional, and analytic study. Information was obtained from dismissal letters and from the Department of Epidemiology database in a 16-year period at a neuropsychiatric referral center. Diagnoses and trends through this period were obtained using Spearman's correlation. RESULTS: Schizophrenia represented most of the cases (19%), followed by bipolar disorder (13%). Psychotic disorders (PD) were found to contribute the most to the length of stay (43.76%), followed by mood disorders (MD) (39.07%). Schizophrenia-related dismissals diminished through the years (r = -751; p = 0.001), whereas depression-related disorders increased (r = 0.857; p < 0.001). CONCLUSIONS: PD are the first cause of neuropsychiatric hospitalization. MD have an increasing frequency of hospitalization. Longer-stay disorders reflect global and economic burden of disease trends. These results might guide interventions that reduce hospital-based models of care, which represent a great burden in low and middle-income countries. Studies aiming to explain the trends reported are needed.
INTRODUCCIÓN: los trastornos neuropsiquiátricos son una de las primeras causas de discapacidad a nivel mundial. Reconocer las principales causas de hospitalización puede permitir implementar intervenciones para evitar la hospitalización y promover un mejor cuidado ambulatorio. OBJETIVO: describir las tendencias en trastornos mentales que requieren hospitalización en un centro de referencia neuropsiquiátrico en un país de ingresos medios. MATERIAL Y MÉTODOS: estudio observacional, transversal y analítico. Se obtuvo información de hojas de egreso y de la base de datos del Departamento de Epidemiología de un centro neuropsiquiátrico en un periodo de 16 años, y las tendencias con el coeficiente de correlación de Spearman. RESULTADOS: la esquizofrenia (ESQ) representó la mayoría de los casos (19%), seguida del trastorno bipolar (13%). Los tranos psicóticos (TP) (43.76%) y los trastornos afectivos (TA) (39.07%) contribuyeron a la mayoría de los días intrahospitalarios. Las hospitalizaciones por ESQ disminuyeron a lo largo de los años (r = −751; p = 0.001) y las relacionadas con depresión aumentaron (r = 0.857; p < 0.001). CONCLUSIONES: los TP son la primera causa de hospitalización neuropsiquiátrica. Los TA tienen una frecuencia de hospitalización ascendente. Los trastornos asociados con una estancia mayor reflejan tendencias globales de carga de enfermedad y económica. Estos resultados pueden guiar intervenciones que reduzcan modelos basados en hospitalización, que representan una carga en países de bajo a medio ingreso. Se requieren estudios que expliquen estas tendencias.
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Hospitalización/tendencias , Trastornos Mentales/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Trastorno Bipolar/epidemiología , Estudios Transversales , Depresión/epidemiología , Países en Desarrollo/estadística & datos numéricos , Femenino , Hospitalización/estadística & datos numéricos , Hospitales Psiquiátricos/estadística & datos numéricos , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , México/epidemiología , Persona de Mediana Edad , Trastornos del Humor/epidemiología , Alta del Paciente/estadística & datos numéricos , Alta del Paciente/tendencias , Estudios Retrospectivos , Esquizofrenia/epidemiología , Estadísticas no Paramétricas , Factores de Tiempo , Adulto JovenRESUMEN
OBJECTIVE: to report the nurses' experience in relation to the training of caregivers of infants with Isolated Robin Sequence (IRS) for maintaining care after hospital discharge from the perspective of Self-Care Theoretical Framework. METHOD: the following categories were considered in this experience report: self-care action, self-care capacity, therapeutic self-care demand, self-care deficit, and nursing system. The nursing system was wholly compensatory and supportive-educative. RESULTS: caregivers' training by nurses results in the acquisition of technical skills and specific knowledge related to the infant's positioning in elevated ventral decubitus, nasopharyngeal intubation, feeding-facilitating techniques and care with the feeding tube. FINAL CONSIDERATIONS: the continuity of home care is guaranteed from caregivers' training for the therapeutic demand.
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Cuidadores/educación , Educación del Paciente como Asunto/métodos , Síndrome de Pierre Robin/terapia , Educación/métodos , Métodos de Alimentación/enfermería , Humanos , Teoría de Enfermería , Alta del Paciente/tendencias , Educación del Paciente como Asunto/normas , Autocuidado/métodosRESUMEN
PURPOSE: Barriers to and clinical implications of patient nonadherence to filling discharge medication prescriptions from the emergency department (ED) were evaluated. METHODS: This was a retrospective, observational analysis of patients discharged from the ED from April 2013 through May 2015 with medication prescriptions. Patients age 18-89 years who were seen in the ED and did not retrieve discharge medication prescriptions from the onsite, 24-hour ED discharge pharmacy were included in this study. Patients who did not pick up prescriptions were called and asked about barriers to prescription filling. These charts were then retrospectively reviewed and categorized. The primary study outcome was the frequency of nonadherence to filling discharge medications prescribed during the ED visit at the ED outpatient pharmacy. Secondary outcomes included identifying barriers to medication adherence, the rate of return ED visits within 30 days of ED discharge, and the rate of 30-day hospital admissions. Associations between patient and medication variables and the rates of return ED visits within 30 days of discharge and 30-day hospital admissions were analyzed. RESULTS: Of the 4,444 patients discharged from the ED with a prescription to be filled at the satellite pharmacy, 510 were nonadherent. Of these patients, 505 had complete chart information available for evaluation. A large proportion of nonadherent patients revisited the ED within 30 days of ED discharge. Multivariate logistic regression found payer class, ethnicity, and sex were independently associated with return ED visits. CONCLUSION: The majority of patients who received a prescription during an ED visit filled their discharge medications. Sex, ethnicity, and payer class were independently associated with nonadherence.
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Prescripciones de Medicamentos , Servicio de Urgencia en Hospital/tendencias , Cumplimiento de la Medicación , Alta del Paciente/tendencias , Adulto , Prescripciones de Medicamentos/normas , Servicio de Urgencia en Hospital/normas , Etnicidad , Femenino , Humanos , Cobertura del Seguro/normas , Masculino , Persona de Mediana Edad , Alta del Paciente/normas , Estudios Retrospectivos , Factores Sexuales , Adulto JovenRESUMEN
ABSTRACT Objective: to report the nurses' experience in relation to the training of caregivers of infants with Isolated Robin Sequence (IRS) for maintaining care after hospital discharge from the perspective of Self-Care Theoretical Framework. Method: the following categories were considered in this experience report: self-care action, self-care capacity, therapeutic self-care demand, self-care deficit, and nursing system. The nursing system was wholly compensatory and supportive-educative. Results: caregivers' training by nurses results in the acquisition of technical skills and specific knowledge related to the infant's positioning in elevated ventral decubitus, nasopharyngeal intubation, feeding-facilitating techniques and care with the feeding tube. Final considerations: the continuity of home care is guaranteed from caregivers' training for the therapeutic demand.
RESUMEN Objetivo: relatar la experiencia de los enfermeros en relación a la capacitación de los cuidadores de lactantes con Secuencia de Robin Aislada (SRA) para mantener los cuidados después del alta hospitalaria en la perspectiva del Referencial Teórico del Autocuidado. Método: las siguientes categorías se consideraron en este relato de experiencia: acción de autocuidado, capacidad de autocuidado, demanda terapéutica de autocuidado, déficit de autocuidado y sistema de enfermería. El sistema de enfermería fue del tipo totalmente compensador y por medio de apoyo-educación. Resultados: la capacitación de los cuidadores por el enfermero resulta en la adquisición de habilidades técnicas y conocimientos específicos relacionados al posicionamiento del lactante en decúbito ventral y elevado, intubación nasofaríngea, técnicas facilitadoras de la alimentación y cuidados con la sonda para alimentación. Consideraciones finales: la continuidad de los cuidados domiciliarios está garantizada a partir de la capacitación del cuidador para la demanda terapéutica.
RESUMO Objetivo: relatar a experiência dos enfermeiros em relação à capacitação dos cuidadores de lactentes com Sequência de Robin isolada (SRI) para manutenção dos cuidados após alta hospitalar na perspectiva do Referencial Teórico do Autocuidado. Método: as seguintes categorias foram consideradas neste relato de experiência: ação de autocuidado, capacidade de autocuidado, demanda terapêutica de autocuidado, déficit de autocuidado e sistema de enfermagem. O sistema de enfermagem foi do tipo totalmente compensatório e por meio de apoio educativo. Resultados: a capacitação do cuidador pelo enfermeiro resulta na aquisição de habilidades técnicas e conhecimentos específicos referentes ao posicionamento do lactente em decúbito ventral e elevado, intubação nasofaríngea, técnicas facilitadoras da alimentação e cuidados com a sonda alimentadora. Considerações finais: a continuidade dos cuidados domiciliares é garantida a partir da capacitação do cuidador para a demanda terapêutica.
Asunto(s)
Humanos , Síndrome de Pierre Robin/terapia , Educación del Paciente como Asunto/métodos , Cuidadores/educación , Alta del Paciente/tendencias , Autocuidado/métodos , Teoría de Enfermería , Educación del Paciente como Asunto/normas , Educación/métodos , Métodos de Alimentación/enfermeríaRESUMEN
The Ecuadorian hospital discharge system examined trends in hip fracture hospitalization rates among older adults. A significant upward trend in hip fracture rates occurred in both genders over the study period. INTRODUCTION: Previous research has reported increasing hip fracture rates in Ecuador. Thus, this study aimed to extend previous findings by examining the nationwide incidence of hip fractures among adults aged 65 years and older between 1999 and 2016. A secondary objective was to compare hip fracture trends among older Ecuadorians with their counterparts in the United States (U.S.). METHODS: The National Hospital Discharge System and the Healthcare Cost and Utilization Project net were assessed to identify older adults hospitalized with a principal diagnosis of hip fractures in Ecuador and the U.S., respectively. The Joinpoint regression analysis software was used to examine the average annual percent change in hip fracture rates. RESULTS: A total of 20,091 adults with a mean age of 82.3 (SD 8.1) years were hospitalized with a principal diagnosis of hip fractures during the study period. After an adjustment for age, hip fracture rates increased annually on average by 4.6% (95% CI 3.8%, 5.4%) from 96.4/100,000 in 1999 to 173.1/100,000 persons in 2016. Between 1999 and 2014, hip fracture age-adjusted rates decreased on average by - 2.5% (95% CI - 2.7%, - 2.3%) among older adults in the U.S. while hip fracture rates steadily increased by 4.6% (95% CI, 3.6%, 5.7%) per year in their Ecuadorian counterparts. CONCLUSIONS: Hip fracture rates markedly increased among older adults in Ecuador. The present findings should alert public health authorities to implement policies of osteoporosis awareness and prevention in Ecuador.
Asunto(s)
Fracturas de Cadera/epidemiología , Aceptación de la Atención de Salud/estadística & datos numéricos , Alta del Paciente/tendencias , Anciano , Anciano de 80 o más Años , Ecuador/epidemiología , Femenino , Humanos , Incidencia , Masculino , Análisis de Regresión , Estados Unidos/epidemiologíaRESUMEN
Introducción. La diarrea aguda es uno de los problemas de salud pública más serios en los países en desarrollo por asociarse, generalmente, a condiciones de vida desfavorables. El objetivo de este trabajo es analizar la tendencia de los egresos hospitalarios por enfermedades infecciosas intestinales de los menores de 5 años en establecimientos oficiales del subsector público de Argentina en el período 2005-2013. Población y métodos. Se realizó un estudio ecológico de series temporales con datos provenientes de la Dirección de Estadísticas e Información en Salud, a nivel nacional y regional. Se calcularon las tasas de egresos específicas y se analizó el comportamiento estacional y la tendencia del evento. Resultados. En Argentina, se registraron 2 521 729 egresos en menores de 5 años, de los cuales el 9,0% presentó diagnóstico de enfermedad infecciosa intestinal. Los menores de 1 año representaron la tercera parte de las internaciones y el análisis de estacionalidad reveló dos picos anuales (verano e invierno). Globalmente, se observó una tendencia de tipo decreciente, con un leve aumento en el período 2007-2009. Las regiones del Noroeste y Noreste Argentino presentaron tasas de hasta 3-4 veces mayores que la región Pampeana. Conclusiones. Los egresos hospitalarios por enfermedades infecciosas intestinales en el subsector público representan alrededor del 10% del total de los egresos en los menores de 5 años. Este evento presenta un patrón estacional, con una tendencia levemente decreciente en los últimos años, a pesar de no distribuirse en forma homogénea en las diversas regiones.
Introduction. Acute diarrhea is one of the most serious public health problems in developing countries because it is generally associated with unfavorable living conditions. The objective of this study was to analyze trends in hospital discharges for intestinal infectious disease in children under age 5 recorded in official public hospitals from Argentina in the 2005-2013period. Population and methods. This was an ecological, time-series study based on data provided by the Health Statistics and Information Department, at a national and regional level. Specific hospital discharge rates were estimated, and seasonal behavior and trends were analyzed in relation to this event. Results. In Argentina, 2 521 729patients under age 5 were discharged in this period; of these, 9.0% were diagnosed with intestinal infectious disease. Children under age 1 accounted for a third of hospitalizations; two annual peaks (summer and winter) were observed in the seasonality analysis. Overall, a downward trend was observed, with a mild increase in the 2007-2009 period. Rates were up to 3 or 4 times higher in Northwest and Northeast Argentina than in the Pampa region. Conclusions. Hospital discharges for intestinal infectious disease in the public subsector account for approximately 10% of all discharges of children under age 5. This event shows a seasonal pattern, with a slightly downward trend over the past years in spite of its heterogeneous distribution across the different Argentine regions.
Asunto(s)
Humanos , Lactante , Preescolar , Alta del Paciente/tendencias , Enfermedades Intestinales/microbiología , Argentina , Factores de Tiempo , Epidemiología DescriptivaRESUMEN
INTRODUCTION: Acute diarrhea is one of the most serious public health problems in developing countries because it is generally associated with unfavorable living conditions. The objective of this study was to analyze trends in hospital discharges for intestinal infectious disease in children under age 5 recorded in official public hospitals from Argentina in the 2005-2013 period. POPULATION AND METHODS: This was an ecological, time-series study based on data provided by the Health Statistics and Information Department, at a national and regional level. Specific hospital discharge rates were estimated, and seasonal behavior and trends were analyzed in relation to this event. RESULTS: In Argentina, 2 521 729 patients under age 5 were discharged in this period; of these, 9.0% were diagnosed with intestinal infectious disease. Children under age 1 accounted for a third of hospitalizations; two annual peaks (summer and winter) were observed in the seasonality analysis. Overall, a downward trend was observed, with a mild increase in the 2007-2009 period. Rates were up to 3 or 4 times higher in Northwest and Northeast Argentina than in the Pampa region. CONCLUSION: Hospital discharges for intestinal infectious disease in the public subsector account for approximately 10% of all discharges of children under age 5. This event shows a seasonal pattern, with a slightly downward trend over the past years in spite of its heterogeneous distribution across the different Argentine regions.
INTRODUCCIÓN: La diarrea aguda es uno de los problemas de salud pública más serios en los países en desarrollo por asociarse, generalmente, a condiciones de vida desfavorables. El objetivo de este trabajo es analizar la tendencia de los egresos hospitalarios por enfermedades infecciosas intestinales de los menores de 5 años en establecimientos oficiales del subsector público de Argentina en el período 2005-2013. POBLACIÓN Y MÉTODOS: Se realizó un estudio ecológico de series temporales con datos provenientes de la Dirección de Estadísticas e Información en Salud, a nivel nacional y regional. Se calcularon las tasas de egresos específicas y se analizó el comportamiento estacional y la tendencia del evento. RESULTADOS: En Argentina, se registraron 2 521 729 egresos en menores de 5 años, de los cuales el 9,0% presentó diagnóstico de enfermedad infecciosa intestinal. Los menores de 1 año representaron la tercera parte de las internaciones y el análisis de estacionalidad reveló dos picos anuales (verano e invierno). Globalmente, se observó una tendencia de tipo decreciente, con un leve aumento en el período 2007-2009. Las regiones del Noroeste y Noreste Argentino presentaron tasas de hasta 3-4 veces mayores que la región Pampeana. CONCLUSIONES: Los egresos hospitalarios por enfermedades infecciosas intestinales en el subsector público representan alrededor del 10% del total de los egresos en los menores de 5 años. Este evento presenta un patrón estacional, con una tendencia levemente decreciente en los últimos años, a pesar de no distribuirse en forma homogénea en las diversas regiones.
Asunto(s)
Enfermedades Intestinales/microbiología , Alta del Paciente/tendencias , Argentina , Preescolar , Humanos , Lactante , Factores de TiempoRESUMEN
AIM: To determine the number of annual hospital discharges for inflammatory bowel diseases in Chile. The hypothesis is that there is a significant increase in the hospital discharges due to this disease from 2001 to 2012. MATERIALS AND METHODS: This is a descriptive study. Data were obtained from the Web site of the Department of Health Statistics. All hospital discharges from 2001 to 2012 were included. The following variables were analyzed: length of stay, hospital mortality, and eventual surgical procedure. Data are presented as descriptive statistics. The B-coefficient was calculated to establish the significance of the annual trend. RESULTS: There were 13,001 hospital discharges with the diagnosis of ulcerative colitis or Crohn's disease, corresponding to 0.067% of all hospital discharges in the whole period. Within these discharges, 31.2% were Crohn's disease and 68.8% were ulcerative colitis. At least one surgical procedure was performed in 12.9% of the hospitalizations. There was a significant increase in the annual rate of hospital discharges from 5.25 in 2001 to 8.64 per 100 thousand inhabitants in 2012. This increase was from 1.68 to 3.11 in Crohn's disease and from 3.58 to 5.53 in ulcerative colitis. However, a decrease was observed in length of stay, need of surgical treatment and in-hospital mortality. CONCLUSION: From 2001 until 2012, there has been a significant increase in hospital discharges for inflammatory bowel diseases in Chile, associated with a decrease in length of stay, need of surgery and in-hospital mortality.
Asunto(s)
Enfermedades Inflamatorias del Intestino/epidemiología , Enfermedades Inflamatorias del Intestino/terapia , Alta del Paciente/tendencias , Chile/epidemiología , Colitis Ulcerosa/diagnóstico , Colitis Ulcerosa/epidemiología , Colitis Ulcerosa/terapia , Enfermedad de Crohn/diagnóstico , Enfermedad de Crohn/epidemiología , Enfermedad de Crohn/terapia , Femenino , Mortalidad Hospitalaria/tendencias , Hospitalización/tendencias , Humanos , Enfermedades Inflamatorias del Intestino/diagnóstico , Masculino , Estudios RetrospectivosRESUMEN
BACKGROUND: Little is known about the characteristics, clinical course, and the disposition of sick children transferred from pediatricians' offices to the emergency department (ED). OBJECTIVES: The purpose of the study was to determine the clinical profile, ED course, and disposition of children transferred from a hospital-based pediatric clinic to the ED. METHODS: We conducted a retrospective cohort study involving all sick children transferred from a hospital-based clinic to the hospital's ED from January 2012 to December 2013. Data collected included demographics, acuity of illness, ED course, diagnoses, and disposition of all children. RESULTS: A total of 179 patients were transferred to and received care in the ED: boys, 56%; median age, 18 months; mean age, 58 months; 68% were younger than 60 months; African American, 83%; Hispanic, 12%. Sixty-eight percent of the patients were triaged as Emergency Severity Index 3 (urgent) and 13% were Emergency Severity Index 2 (high risk), with the rest categorized as nonurgent. Forty-three percent (78) were discharged home, and 57% were admitted. Age younger than 60 months, need for intravenous antibiotics, inhaled medications, plain x-rays, respiratory viral panel polymerase chain reaction (PCR), supplemental oxygen, and blood work in the ED were associated with being admitted (P < 0.05). The top 3 primary diagnoses were respiratory distress (40%), skin and soft tissue infections (15%), and other infections (10%). CONCLUSIONS: Children transferred from a hospital-based pediatric clinic to the ED at an urban academic medical center had a high level of acuity, and almost 60% were admitted for inpatient care. Improvement in the provision of pretransfer care can potentially decrease transfers to the ED.
Asunto(s)
Servicio de Urgencia en Hospital/estadística & datos numéricos , Alta del Paciente/estadística & datos numéricos , Transferencia de Pacientes/estadística & datos numéricos , Centros Médicos Académicos/estadística & datos numéricos , Niño , Preescolar , Femenino , Hospitalización/estadística & datos numéricos , Hospitales Pediátricos/estadística & datos numéricos , Humanos , Lactante , Masculino , Evaluación de Resultado en la Atención de Salud , Alta del Paciente/tendencias , Pediatras/organización & administración , Estudios Retrospectivos , Triaje/tendenciasRESUMEN
Background Adherence to prescribed drug therapy is associated with lower rates of cardiovascular causes of death. In view of the relevance for public health, it is important to understand the relation between medication adherence tools' scores, especially in low literacy patients discharged from a cardiology ward. Objectives We aimed to assess: (a) the association between number of controlled clinical conditions and adherence tools scores, and (b) the correlation between the scores of three instruments to assess adherence. Methods We conducted a prospective study and included patients discharged from a specialized cardiovascular ward in Brazil. The results of the Beliefs about Medicines questionnaire (BMQ), the Adherence to Refills and Medication Scale (ARMS) and the MedTake test were compared. Results Of 53 included patients, most of them were elderly, and did not complete primary school. On average, there were six health conditions per patient, where two of them were not controlled. ARMS was the only tool that was associated with number of controlled health conditions (r = -0.312, p < 0.05). Moreover, ARMS (average score 15.6 ± 3.4) had significant correlation with MEDTAKE (r = 0.535, p < 0.01) and BMQ (r = 0.38, p < 0.01). BMQ and MEDTAKE were also positively correlated (r = 0.311, p < 0.05). Conclusions Clinically, higher ARMS scores (>12) suggest assumed non-adherence. It is also negatively correlated with the number of controlled clinical conditions in low literacy elderlies with cardiovascular diseases.