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[PMID]:29432461
[Au] Autor:Weenk M; van Goor H; van Acht M; Engelen LJ; van de Belt TH; Bredie SJH
[Ad] Endereço:Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands.
[Ti] Título:A smart all-in-one device to measure vital signs in admitted patients.
[So] Source:PLoS One;13(2):e0190138, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Vital sign measurements in hospitalized patients by nurses are time consuming and prone to operational errors. The Checkme, a smart all-in-one device capable of measuring vital signs, could improve daily patient monitoring by reducing measurement time, inter-observer variability, and incorrect inputs in the Electronic Health Record (EHR). We evaluated the accuracy of self measurements by patient using the Checkme in comparison with gold standard and nurse measurements. METHODS AND FINDINGS: This prospective comparative study was conducted at the Internal Medicine ward of an academic hospital in the Netherlands. Fifty non-critically ill patients were enrolled in the study. Time-related measurement sessions were conducted on consecutive patients in a randomized order: vital sign measurement in duplicate by a well-trained investigator (gold standard), a Checkme measurement by the patient, and a routine vital sign measurement by a nurse. In 41 patients (82%), initial calibration of the Checkme was successful and results were eligible for analysis. In total, 69 sessions were conducted for these 41 patients. The temperature results recorded by the patient with the Checkme differed significantly from the gold standard core temperature measurements (mean difference 0.1 ± 0.3). Obtained differences in vital signs and calculated Modified Early Warning Score (MEWS) were small and were in range with predefined accepted discrepancies. CONCLUSIONS: Patient-calculated MEWS using the Checkme, nurse measurements, and gold standard measurements all correlated well, and the small differences observed between modalities would not have affected clinical decision making. Using the Checkme, patients in a general medical ward setting are able to measure their own vital signs easily and accurately by themselves. This could be time saving for nurses and prevent errors due to manually entering data in the EHR.
[Mh] Termos MeSH primário: Desenho de Equipamento
Monitorização Fisiológica/instrumentação
Admissão do Paciente
Sinais Vitais
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Idoso de 80 Anos ou mais
Seres Humanos
Meia-Idade
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180213
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0190138


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[PMID]:29381720
[Au] Autor:van Loenhout JAF; Gil Cuesta J; Abello JE; Isiderio JM; de Lara-Banquesio ML; Guha-Sapir D
[Ad] Endereço:Centre for Research on the Epidemiology of Disasters (CRED), Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium.
[Ti] Título:The impact of Typhoon Haiyan on admissions in two hospitals in Eastern Visayas, Philippines.
[So] Source:PLoS One;13(1):e0191516, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: We investigated the short-term impact of Typhoon Haiyan, one of the strongest typhoons ever to make landfall, on the pattern of admissions in two hospitals in Eastern Visayas, the Philippines. METHODS: This study took place at Eastern Visayas Regional Medical Center (EVRMC) in Tacloban, and Ormoc District Hospital (ODH) in Ormoc. We determined whether there were differences in the pattern of admissions between the week before and the three weeks after Haiyan by using information on sex, age, diagnosis, ward and outcome at discharge from patient records. RESULTS: There was a drop in admissions in both hospitals after Haiyan as compared to before. Admissions climbed back to the baseline after ten days in EVRMC and after two weeks in ODH. When comparing the period after Haiyan to the period before, there was a relative increase in male versus female admissions in ODH (OR 2.8, 95%CI 1.7-4.3), but not in EVRMC. Patients aged ≥50 years and 0-14 years had the highest relative increase in admissions. There was a relative decrease in admissions for the ICD10 group 'Pregnancy, childbirth and the puerperium' (OR 0.4, 95%CI 0.3-0.6), and an increase in 'Certain infectious and parasitic diseases' (OR 2.1, 95%CI 1.2-3.5), mainly gastroenteritis, and 'Diseases of the respiratory system' (OR 1.8, 95%CI 1.0-3.0), mainly pneumonia, compared to all other diagnosis groups in ODH. Out of all reasons for admission within the study period, 66% belong to these three ICD-10 groups. Data on reasons for admission were not available for EVRMC. CONCLUSIONS: The observed reduction in patients after the Typhoon calls for ensuring that hospital accessibility should be protected and reinforced, especially for pregnant women, by trying to remove debris in the direct hospital vicinity. Hospitals in areas prone to tropical cyclones should be prepared to treat large numbers of patients with gastroenteritis and pneumonia, as part of their disaster plans.
[Mh] Termos MeSH primário: Tempestades Ciclônicas
Hospitais
Admissão do Paciente
[Mh] Termos MeSH secundário: Seres Humanos
Filipinas
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180131
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0191516


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[PMID]:28454768
[Au] Autor:Kotkowski K; Ellison RT; Barysauskas C; Barton B; Allison J; Mack D; Finberg RW; Reznek M
[Ad] Endereço:Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA. Electronic address: kevin.kotkowski@umassmemorial.org.
[Ti] Título:Association of hospital contact precaution policies with emergency department admission time.
[So] Source:J Hosp Infect;96(3):244-249, 2017 Jul.
[Is] ISSN:1532-2939
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Contact precautions are a widely accepted strategy to reduce in-hospital transmission of meticillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). However, these practices may have unintended deleterious effects on patients. AIM: To evaluate the effect of a modification in hospital-wide contact precaution practices on emergency department (ED) admission times. METHODS: During the study period, the hospital changed its contact precaution policy from requiring contact precautions for all patients with a history of MRSA or VRE to only those who presented with clinical conditions likely to contaminate the environment with pathogens. An interrupted time series analysis of ED admission times for adults for one year preceding and one year following this change was performed at a two-campus hospital. The main outcome was admission time, defined as time from decision to admit to arrival in an inpatient bed, for patients with MRSA or VRE compared with all other patients. The in-hospital MRSA and VRE acquisition rates were evaluated over the same period and have been published previously. FINDINGS: At one campus, admission time decreased immediately by 161min for MRSA patients (P=0.008) and 135min for VRE patients (P=0.003), and both continued to decrease over the duration of the study. There was no significant change in admission time at the second campus. CONCLUSIONS: Modifying contact precaution requirements for MRSA and VRE may be associated with improved ED admission time without significantly altering in-hospital MRSA and VRE acquisition.
[Mh] Termos MeSH primário: Infecção Hospitalar/prevenção & controle
Medicina de Emergência/métodos
Infecções por Bactérias Gram-Positivas/diagnóstico
Controle de Infecções/métodos
Staphylococcus aureus Resistente à Meticilina/isolamento & purificação
Admissão do Paciente
Enterococos Resistentes à Vancomicina/isolamento & purificação
[Mh] Termos MeSH secundário: Adulto
Portador Sadio/diagnóstico
Serviço Hospitalar de Emergência
Hospitais
Seres Humanos
Política Organizacional
Estudos Retrospectivos
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170430
[St] Status:MEDLINE


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[PMID]:29489684
[Au] Autor:Mongaret C; Quillet P; Vo TH; Aubert L; Fourgeaud M; Michelet-Huot E; Bonnet M; Bedouch P; Slimano F; Gangloff SC; Drame M; Hettler D
[Ad] Endereço:Pharmacy Department, University Hospital of Reims, Rue du General Koenig.
[Ti] Título:Predictive factors for clinically significant pharmacist interventions at hospital admission.
[So] Source:Medicine (Baltimore);97(9):e9865, 2018 Mar.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Pharmaceutical care activities at hospital admission have a significant impact on patient safety. The objective of this study was to identify predictive factors for clinically significant pharmacist interventions (PIs) performed during medication reconciliation and medication review at patient hospital admission.A 4-week prospective study was conducted in 4 medicine wards. At hospital admission, medication reconciliation and medication review were conducted and PIs were performed by the pharmaceutical team. The clinical impact of PIs was determined using the clinical economic and organizational (CLEO) tool. Clinical characteristics, laboratory results, and medication data for each patient were collected and analyzed as potential predictive factors of clinically significant PIs. Univariate and multivariate binary logistic regression were subsequently used to identify independent predictive factors for clinically relevant PIs.Among 265 patients admitted, 150 patients were included. Among 170 PIs performed at hospital admission, 71 were related to unintentional discrepancies (41.8%) during medication reconciliation, and 99 were related to drug-related problems (DRPs) (58.8%) during medication review. Overall, 115 PIs (67.7%) were considered to have a clinical impact. By multivariate analysis, number of medications ≥5 (P = .01) based on the best possible medication history, and Charlson comorbidity index score ≥2 (P < .01) were found to be independent predictive factors of clinically significant PIs at hospital admission.Identifying predictive factors of clinically significant PIs is valuable to optimize clinical pharmacist practices at hospital admission during both medication reconciliation and medication review. These 2 steps of the pharmaceutical care process improve medication safety at hospital admission.
[Mh] Termos MeSH primário: Erros de Medicação/estatística & dados numéricos
Reconciliação de Medicamentos/métodos
Admissão do Paciente/estatística & dados numéricos
Serviço de Farmácia Hospitalar/métodos
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Feminino
Seres Humanos
Modelos Logísticos
Masculino
Meia-Idade
Análise Multivariada
Estudos Prospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180307
[Lr] Data última revisão:
180307
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180301
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009865


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[PMID]:28459900
[Au] Autor:Gundareddy VP; Maruthur NM; Chibungu A; Bollampally P; Landis R; Eid SM
[Ad] Endereço:Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
[Ti] Título:Association Between Radiologic Incidental Findings and Resource Utilization in Patients Admitted With Chest Pain in an Urban Medical Center.
[So] Source:J Hosp Med;12(5):323-328, 2017 May.
[Is] ISSN:1553-5606
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Increasing use of testing among hospitalized patients has resulted in an increase in radiologic incidental findings (IFs), which challenge the provision of high-value care in the hospital setting. OBJECTIVE: To understand impact of radiologic incidental findings on resource utilization in patients hospitalized with chest pain. DESIGN: Retrospective observational cross sectional study. SETTING: Academic medical center. PARTICIPANTS: Adult patients hospitalized with principal diagnosis of chest pain. MEASUREMENTS: Demographic, imaging, and length of stay (LOS) data were abstracted from the medical charts. We used multiple logistic regression to evaluate factors associated with radiologic IFs and negative binomial regression to evaluate the association between radiologic IFs and LOS. RESULTS: 1811 consecutive admissions with chest pain were analyzed retrospectively over a period of 24 months; 376 patients were included in the study after exclusion criteria were applied and readmissions removed. Of these, 197 patients (52%) had 364 new radiologic IFs on imaging; most IFs were of minor (50%) or moderate clinical significance (42%), with only 7% of major significance. Odds of finding radiologic IFs increased with age (adjusted odds ratio, 1.04; 95% confidence interval [CI], 1.01-1.06) and was associated with a 26% increase in LOS (adjusted incidence rate ratio, 1.26; 95% CI, 1.07-1.49). CONCLUSION: Radiologic IFs were very common among patients hospitalized with chest pain of suspected cardiac origin and independently associated with an increase in the LOS. Interventions to address radiologic IFs may reduce LOS and, thereby, support high-value care. Journal of Hospital Medicine 2017;12:323-328.
[Mh] Termos MeSH primário: Dor no Peito/diagnóstico por imagem
Recursos em Saúde/utilização
Hospitais Urbanos/utilização
Achados Incidentais
Admissão do Paciente
Serviço Hospitalar de Radiologia/utilização
[Mh] Termos MeSH secundário: Adulto
Dor no Peito/terapia
Estudos Transversais
Feminino
Recursos em Saúde/tendências
Hospitais Urbanos/tendências
Seres Humanos
Masculino
Meia-Idade
Admissão do Paciente/tendências
Serviço Hospitalar de Radiologia/tendências
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE
[do] DOI:10.12788/jhm.2722


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[PMID]:28468784
[Au] Autor:Kalbaugh CA; Kucharska-Newton A; Wruck L; Lund JL; Selvin E; Matsushita K; Bengtson LGS; Heiss G; Loehr L
[Ad] Endereço:Department of Surgery, School of Medicine, The University of North Carolina at Chapel Hill, NC corey_kalbaugh@med.unc.edu.
[Ti] Título:Peripheral Artery Disease Prevalence and Incidence Estimated From Both Outpatient and Inpatient Settings Among Medicare Fee-for-Service Beneficiaries in the Atherosclerosis Risk in Communities (ARIC) Study.
[So] Source:J Am Heart Assoc;6(5), 2017 May 03.
[Is] ISSN:2047-9980
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Outpatient ascertainment of peripheral artery disease (PAD) is rarely considered in the measurement of PAD clinical burden; therefore, the clinical burden of PAD likely has been underestimated while contributing to a decreased awareness of PAD in comparison to other circulatory system disorders. METHODS AND RESULTS: The purpose of this study was to estimate the age-standardized annual period prevalence and incidence of PAD in the outpatient and inpatient settings using data from the Atherosclerosis Risk in Communities (ARIC) study linked with Centers for Medicare and Medicaid Services claims. The majority (>70%) of all PAD encounters occurred in the outpatient setting. The weighted mean age-standardized prevalence and incidence of outpatient PAD was 11.8% (95% CI 11.5-12.1) and 22.4 per 1000 person-years (95% CI 20.8-24.0), respectively. Black patients had higher weighted mean age-standardized prevalence (15.6%; 95% CI 14.6-16.4) compared with white patients (11.4%; 95% CI 11.1-11.7). Black women had the highest weighted mean age-standardized prevalence (16.9%; 95% CI 16.0-17.8). Black patients also had a higher incidence rate of PAD (31.3 per 1000 person-years; 95% CI 27.3-35.4) compared with white patients (25.4 per 1000 person-years; 95% CI 23.5-27.3). PAD prevalence and incidence did not differ by sex alone. CONCLUSIONS: This study provides comprehensive estimates of PAD in the inpatient and outpatient settings where the majority of PAD burden was found. PAD is an important circulatory system disorder similar in prevalence to stroke and coronary heart disease.
[Mh] Termos MeSH primário: Assistência Ambulatorial
Planos de Pagamento por Serviço Prestado
Medicare
Admissão do Paciente
Doença Arterial Periférica/epidemiologia
[Mh] Termos MeSH secundário: Demandas Administrativas em Assistência à Saúde
Afroamericanos
Distribuição por Idade
Idoso
Assistência Ambulatorial/economia
Comorbidade
Grupo com Ancestrais do Continente Europeu
Planos de Pagamento por Serviço Prestado/economia
Feminino
Custos Hospitalares
Seres Humanos
Incidência
Masculino
Medicare/economia
Admissão do Paciente/economia
Doença Arterial Periférica/diagnóstico
Doença Arterial Periférica/economia
Doença Arterial Periférica/etnologia
Prevalência
Fatores de Risco
Distribuição por Sexo
Fatores de Tempo
Estados Unidos/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180306
[Lr] Data última revisão:
180306
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170505
[St] Status:MEDLINE


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[PMID]:29351557
[Au] Autor:Mizuno S; Kunisawa S; Sasaki N; Fushimi K; Imanaka Y
[Ad] Endereço:Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Sakyo-ku, Japan.
[Ti] Título:Effects of night-time and weekend admissions on in-hospital mortality in acute myocardial infarction patients in Japan.
[So] Source:PLoS One;13(1):e0191460, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Patients admitted to hospital during off-hours may experience poorer quality of care and clinical outcomes. However, few studies have examined the variations in clinical processes and outcomes across admission times and days of the week in acute myocardial infarction (AMI) patients. This study aimed to comparatively analyze the effect of weekend and weekday admissions stratified by admission time on in-hospital mortality in AMI patients. METHODS AND RESULTS: Using a large nationwide administrative database, we analyzed 103,908 AMI patients admitted to 639 Japanese acute care hospitals between April 2011 and March 2015. We divided patients into the following 4 groups: weekday daytime admissions, weekday night-time admissions, weekend daytime admissions, and weekend night-time admissions. A hierarchical logistic regression model was used to comparatively examine in-hospital mortality among the groups after adjusting for age, sex, ambulance use, Killip class, comorbidities, and the number of cardiologists in the admitting hospital. In addition, we also calculated and compared the adjusted odds ratios of various AMI therapies among the groups. The in-hospital mortality rate of weekend daytime admissions was higher than those admitted during other times (weekday daytime: 6.8%; weekday night-time; 6.5%, weekend daytime; 7.6%; weekend night-time: 6.6%; P < 0.001), even after adjusting for the covariates (adjusted odds ratio for weekend daytime admissions: 1.10; 95% confidence interval: 1.03-1.19). The prescription rates of guideline-based medications provided on the first day of admission were higher in night-time admissions than in daytime admissions. CONCLUSIONS: In-hospital mortality rates were higher in AMI patients admitted during weekend daytime hours when compared with patients admitted during other times. Furthermore, patients admitted during daytime hours had lower prescription rates of guideline-based medications. Our findings indicate that weekend daytime admissions may be a potential target for improvement in the Japanese healthcare system.
[Mh] Termos MeSH primário: Infarto do Miocárdio/mortalidade
[Mh] Termos MeSH secundário: Plantão Médico
Idoso
Feminino
Mortalidade Hospitalar
Seres Humanos
Japão/epidemiologia
Modelos Logísticos
Masculino
Meia-Idade
Admissão do Paciente
Fatores de Risco
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180120
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0191460


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[PMID]:28450414
[Au] Autor:Bohlouli B; Jackson TJ; Tonelli M; Hemmelgarn B; Klarenbach S
[Ad] Endereço:Department of Medicine, University of Alberta, Edmonton, Alberta.
[Ti] Título:Adverse Outcomes Associated with Preventable Complications in Hospitalized Patients with CKD.
[So] Source:Clin J Am Soc Nephrol;12(5):799-806, 2017 May 08.
[Is] ISSN:1555-905X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Patients with CKD are at risk of hospital-acquired complications (HACs). We sought to determine the association of preventable HACs with mortality, length of stay (LOS), and readmission. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: All adults hospitalized from April of 2003 to March of 2008 in Alberta were characterized by kidney function and occurrence of preventable HACs. CKD was defined by eGFR<60 ml/min per 1.73 m and/or albumin-to-creatinine ratio >3-30 mg/mmol for >3 months in the time frame from 365 to 90 days before admission. Regression models examined the association of HACs with outcomes. RESULTS: Of 536,549 hospitalizations, 8.5% ( =45,733) had CKD and 9.8% of patients with CKD had one or more potentially preventable HAC. In patients with potentially preventable HACs, proportions of death within index hospitalization and from discharge to 90 days were 17.7% and 6.8%, respectively. In patients with CKD, comparing with those hospitalizations without potentially preventable HACs, the adjusted odds ratio (OR) of mortality during index hospitalization and from hospital discharge to 90 days in patients with one or more preventable HAC was 4.67 (95% confidence interval [95% CI], 4.17 to 5.22) and 1.08 (95% CI, 0.94 to 1.25), respectively. Median incremental LOS in patients with one or more preventable HAC was 9.86 days (95% CI, 9.25 to 10.48). The OR for readmission with preventable HAC was 1.24 (95% CI, 1.15 to 1.34). In a cohort with and without CKD, the adjusted ORs of mortality during index hospitalization in patients with CKD and no preventable HACs, patients without CKD and with preventable HACs, and patients with CKD and preventable HACs were 2.22 (95% CI, 1.69 to 2.94), 5.26 (95% CI, 4.98 to 5.55), and 9.56 (95% CI, 7.23 to 12.56), respectively (referenced to patients without CKD or preventable HACs). CONCLUSIONS: Preventable HACs are associated with higher mortality, incremental LOS, and greater risk of readmission, especially in people with CKD. Targeted strategies to reduce complications should be a high priority.
[Mh] Termos MeSH primário: Doença Iatrogênica
Admissão do Paciente
Insuficiência Renal Crônica/complicações
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Alberta
Albuminúria/etiologia
Biomarcadores/urina
Creatinina/urina
Feminino
Taxa de Filtração Glomerular
Mortalidade Hospitalar
Seres Humanos
Doença Iatrogênica/prevenção & controle
Rim/fisiopatologia
Tempo de Internação
Masculino
Meia-Idade
Readmissão do Paciente
Serviços Preventivos de Saúde
Insuficiência Renal Crônica/diagnóstico
Insuficiência Renal Crônica/mortalidade
Insuficiência Renal Crônica/terapia
Medição de Risco
Fatores de Risco
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Biomarkers); AYI8EX34EU (Creatinine)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.2215/CJN.09410916


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[PMID]:27775982
[Au] Autor:Cai AR; Hodgman EI; Kumar PB; Sehat AJ; Eastman AL; Wolf SE
[Ad] Endereço:From the Division of Burns, Trauma, and Critical Care, Department of Surgery, University of Texas-Southwestern Medical Center, Dallas.
[Ti] Título:Evaluating Pre Burn Center Intubation Practices: An Update.
[So] Source:J Burn Care Res;38(1):e23-e29, 2017 Jan/Feb.
[Is] ISSN:1559-0488
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:A significant proportion of patients appeared to arrive at our American Burn Association-verified burn center intubated without clear benefit. The current study aims to evaluate regional prehospital intubation practices and their outcomes. All consecutive admissions from November 2012 to June 2014 were reviewed for data points associated with intubation. Demographics and outcomes for patients who were intubated before arrival or within 24 hours of admission were compared using χ, Fisher's exact test, and the Kruskal-Wallis test as appropriate. During this period, 958 patients were admitted. Of these, 120 were intubated before arrival, and 91 survived their injuries. Of these 91 survivors, 45 were extubated within 2 days, suggesting unnecessary intubation rate in 37.5%. Intubation-related complications were roughly three times as common among those intubated before arrival (12.5% vs 4.4%). Patients intubated before arrival to our burn center had a shorter median duration of intubation (1.0 vs 4.0 days), median hospital LOS (5.0 vs 22.0 days), and median intensive care unit length of stay (3.0 vs 10.0 days). Furthermore, we found a significant difference in the pattern of ventilator support duration between those arriving intubated, with a median of 2.0 days, and those intubated at our burn center, with a median of 5.5 days. Patients intubated by pre burn center providers have shorter intubation durations and shorter hospitalizations, suggesting inappropriate use of resources. Impending loss of airway appears unlikely among patients with adequate gas exchange at the time of examination. The current criteria for prehospital intubation should be revised to more accurately identify those who truly benefit from advanced airway maneuvers.
[Mh] Termos MeSH primário: Queimaduras/terapia
Serviços Médicos de Emergência/métodos
Mortalidade Hospitalar
Intubação Intratraqueal/métodos
Admissão do Paciente
[Mh] Termos MeSH secundário: Adulto
Unidades de Queimados
Queimaduras/diagnóstico
Queimaduras/mortalidade
Estudos de Coortes
Feminino
Seguimentos
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Escala de Gravidade do Ferimento
Intubação Intratraqueal/estatística & dados numéricos
Tempo de Internação
Modelos Logísticos
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Respiração Artificial/efeitos adversos
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[Pt] Tipo de publicação:COMPARATIVE STUDY; EVALUATION STUDIES; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180302
[Lr] Data última revisão:
180302
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE
[do] DOI:10.1097/BCR.0000000000000457


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[PMID]:29394480
[Au] Autor:McBeth CL; Durbin-Johnson B; Siegel EO
[Ti] Título:Interprofessional Huddle: One Children's Hospital's Approach to Improving Patient Flow.
[So] Source:Pediatr Nurs;43(2):71-76, 2017 Mar-Apr.
[Is] ISSN:0097-9805
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Admitting pediatric patients promptly to the appropriate unit where they can receive specialty care is of critical importance to safe, quality care. A daily morning huddle was implemented at one children's hospital as a quality improvement project. The aim of this project was to improve patient flow throughout the children's hospital by improving interprofessional and interdepartmental communication and collaboration. This article reports on changes in patient flow before and after implementation of the daily huddle, as measured by pediatric emergency department (ED) boarding times. This retrospective, descriptive study was conducted at a regional children's hospital within an academic hospital. Data were collected from the electronic medical record over two separate time periods coinciding with pre/post-huddle implementation. Non-random, purposive sampling was used, resulting in a prehuddle sample (n = 450) and post-huddle sample (n = 329). Times were significantly shorter after huddle implementation compared to pre-huddle (p < 0.001) from admission orders in the ED to transfer to the PICU or pediatric ward. The median time decreased from 3.0 to 2.6 hours post-huddle implementation. These findings suggest huddles as one potential factor in the formula to improve patient flow from the ED by enhancing interprofessional and interdepartmental collaboration and communication. Findings from this study are of vital importance to pediatric patients, nurses, and physicians. Promptly admitting patients from the ED to the appropriate unit where they can receive needed specialty care that potentially improves the quality and safety of patient care is paramount. Further research is needed to determine what format and contexts the huddle can be utilized to facilitate efficient patient flow and improve patient outcomes.
[Mh] Termos MeSH primário: Eficiência Organizacional
Enfermagem em Emergência/normas
Serviço Hospitalar de Emergência/organização & administração
Hospitais Pediátricos/organização & administração
Admissão do Paciente/normas
Enfermagem Pediátrica/normas
Melhoria de Qualidade
[Mh] Termos MeSH secundário: Adolescente
Criança
Pré-Escolar
Registros Eletrônicos de Saúde
Feminino
Seres Humanos
Lactente
Recém-Nascido
Masculino
Estudos Retrospectivos
Listas de Espera
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:180203
[St] Status:MEDLINE



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