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[PMID]:27770828
[Au] Autor:Álvarez-Lerma F; Marín-Corral J; Vila C; Masclans JR; González de Molina FJ; Martín Loeches I; Barbadillo S; Rodríguez A; H1N1 GETGAG/SEMICYUC Study Group
[Ad] Endereço:Service of Intensive Care Medicine, Hospital del Mar, Passeig Marítim 25-29, E-08003, Barcelona, Spain. FAlvarez@parcdesalutmar.cat.
[Ti] Título:Delay in diagnosis of influenza A (H1N1)pdm09 virus infection in critically ill patients and impact on clinical outcome.
[So] Source:Crit Care;20(1):337, 2016 Oct 23.
[Is] ISSN:1466-609X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Patients infected with influenza A (H1N1)pdm09 virus requiring admission to the ICU remain an important source of mortality during the influenza season. The objective of the study was to assess the impact of a delay in diagnosis of community-acquired influenza A (H1N1)pdm09 virus infection on clinical outcome in critically ill patients admitted to the ICU. METHODS: A prospective multicenter observational cohort study was based on data from the GETGAG/SEMICYUC registry (2009-2015) collected by 148 Spanish ICUs. All patients admitted to the ICU in which diagnosis of influenza A (H1N1)pdm09 virus infection had been established within the first week of hospitalization were included. Patients were classified into two groups according to the time at which the diagnosis was made: early (within the first 2 days of hospital admission) and late (between the 3rd and 7th day of hospital admission). Factors associated with a delay in diagnosis were assessed by logistic regression analysis. RESULTS: In 2059 ICU patients diagnosed with influenza A (H1N1)pdm09 virus infection within the first 7 days of hospitalization, the diagnosis was established early in 1314 (63.8 %) patients and late in the remaining 745 (36.2 %). Independent variables related to a late diagnosis were: age (odds ratio (OR) = 1.02, 95 % confidence interval (CI) 1.01-1.03, P < 0.001); first seasonal period (2009-2012) (OR = 2.08, 95 % CI 1.64-2.63, P < 0.001); days of hospital stay before ICU admission (OR = 1.26, 95 % CI 1.17-1.35, P < 0.001); mechanical ventilation (OR = 1.58, 95 % CI 1.17-2.13, P = 0.002); and continuous venovenous hemofiltration (OR = 1.54, 95 % CI 1.08-2.18, P = 0.016). The intra-ICU mortality was significantly higher among patients with late diagnosis as compared with early diagnosis (26.9 % vs 17.1 %, P < 0.001). Diagnostic delay was one independent risk factor for mortality (OR = 1.36, 95 % CI 1.03-1.81, P < 0.001). CONCLUSIONS: Late diagnosis of community-acquired influenza A (H1N1)pdm09 virus infection is associated with a delay in ICU admission, greater possibilities of respiratory and renal failure, and higher mortality rate. Delay in diagnosis of flu is an independent variable related to death.
[Mh] Termos MeSH primário: Influenza Humana/diagnóstico
[Mh] Termos MeSH secundário: Adulto
Idoso
Distribuição de Qui-Quadrado
Estado Terminal/epidemiologia
Diagnóstico Tardio
Feminino
Mortalidade Hospitalar
Seres Humanos
Vírus da Influenza A Subtipo H1N1/patogenicidade
Unidades de Terapia Intensiva/organização & administração
Unidades de Terapia Intensiva/estatística & dados numéricos
Tempo de Internação
Modelos Logísticos
Masculino
Meia-Idade
Razão de Chances
Estudos Prospectivos
Fatores de Risco
Espanha/epidemiologia
Estatísticas não Paramétricas
[Pt] Tipo de publicação:JOURNAL ARTICLE
[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:161025
[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]:28465301
[Au] Autor:Ritchey MD; Loustalot F; Wall HK; Steiner CA; Gillespie C; George MG; Wright JS
[Ad] Endereço:Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA hha7@cdc.gov.
[Ti] Título:Million Hearts: Description of the National Surveillance and Modeling Methodology Used to Monitor the Number of Cardiovascular Events Prevented During 2012-2016.
[So] Source:J Am Heart Assoc;6(5), 2017 May 02.
[Is] ISSN:2047-9980
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: This study describes the national surveillance and modeling methodology developed to monitor achievement of the Million Hearts initiative's aim of preventing 1 million acute myocardial infarctions, strokes, and other related cardiovascular events during 2012-2016. METHODS AND RESULTS: We calculate sex- and age-specific cardiovascular event rates (combination of emergency department, hospitalization, and death events) among US adults aged ≥18 from 2006 to 2011 and, based on log-linear models fitted to the rates, calculate their annual percent change. We describe 2 baseline strategies to be used to compare observed versus expected event totals during 2012-2016: (1) assume no rate changes, with modeled 2011 rates held constant through 2016; and (2) assume 2006-2011 rate trends will continue, with the annual percent changes applied to the modeled 2011 rates to calculate expected 2012-2016 rates. Events prevented estimates during 2012-2013 were calculated using available data: 115 210 (95% CI, 60 858, 169 562) events were prevented using stable baselines and an excess of 43 934 (95% CI, -14 264, 102 132) events occurred using trend baselines. Women aged ≥75 had the most events prevented (stable, 76 242 [42 067, 110 417]; trend, 39 049 [1901, 76 197]). Men aged 45 to 64 had the greatest number of excess events (stable, 22 912 [95% CI, 855, 44 969]; trend, 38 810 [95% CI, 15 567, 62 053]). CONCLUSIONS: Around 115 000 events were prevented during the initiative's first 2 years compared with what would have occurred had 2011 rates remained stable. Recent flattening or reversals in some event rate trends were observed supporting intensifying national action to prevent cardiovascular events.
[Mh] Termos MeSH primário: Doenças Cardiovasculares/prevenção & controle
Serviços Preventivos de Saúde/tendências
[Mh] Termos MeSH secundário: Adolescente
Adulto
Distribuição por Idade
Idoso
Idoso de 80 Anos ou mais
Doenças Cardiovasculares/diagnóstico
Doenças Cardiovasculares/mortalidade
Bases de Dados Factuais
Feminino
Pesquisas sobre Serviços de Saúde
Mortalidade Hospitalar/tendências
Seres Humanos
Masculino
Meia-Idade
Prognóstico
Fatores de Proteção
Fatores de Risco
Distribuição por Sexo
Fatores de Tempo
Estados Unidos/epidemiologia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[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:170504
[St] Status:MEDLINE


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Monte, Júlio Cesar Martins
Batista, Marcelo Costa
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[PMID]:28464841
[Au] Autor:de Souza Oliveira MA; Dos Santos TOC; Monte JCM; Batista MC; Pereira VG; Dos Santos BFC; Santos OFP; de Souza Durão M
[Ad] Endereço:Nephrology Division of Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627, Morumbi, São Paulo, 05652-900, Brazil.
[Ti] Título:The impact of continuous renal replacement therapy on renal outcomes in dialysis-requiring acute kidney injury may be related to the baseline kidney function.
[So] Source:BMC Nephrol;18(1):150, 2017 May 03.
[Is] ISSN:1471-2369
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Many controversies exist regarding the management of dialysis-requiring acute kidney injury (D-AKI). No clear evidence has shown that the choice of dialysis modality can change the survival rate or kidney function recovery of critically ill patients with D-AKI. METHODS: We conducted a retrospective study investigating patients (≥16 years old) admitted to an intensive care unit with D-AKI from 1999 to 2012. We analyzed D-AKI incidence, and outcomes, as well as the most commonly used dialysis modality over time. Outcomes were based on hospital mortality, renal function recovery (estimated glomerular filtration rate-eGFR), and the need for dialysis treatment at hospital discharge. RESULTS: In 1,493 patients with D-AKI, sepsis was the main cause of kidney injury (56.2%). The comparison between the three study periods, (1999-2003, 2004-2008, and 2009-2012) showed an increased in incidence of D-AKI (from 2.56 to 5.17%; p = 0.001), in the APACHE II score (from 20 to 26; p < 0.001), and in the use of continuous renal replacement therapy (CRRT) as initial dialysis modality choice (from 64.2 to 72.2%; p < 0.001). The mortality rate (53.9%) and dialysis dependence at hospital discharge (12.3%) remained unchanged over time. Individuals who recovered renal function (33.8%) showed that those who had initially undergone CRRT had a higher eGFR than those in the intermittent hemodialysis group (54.0 × 46.0 ml/min/1.73 m2, respectively; p = 0.014). In multivariate analysis, type of patient, sepsis-associated AKI and APACHE II score were associated to death. For each additional unit of the APACHE II score, the odds of death increased by 52%. The odds ratio of death for medical patients with sepsis-associated AKI was estimated to be 2.93 (1.81-4.75; p < 0.001). CONCLUSION: Our study showed that the incidence of D-AKI increased with illness severity, and the use of CRRT also increased over time. The improvement in renal outcomes observed in the CRRT group may be related to the better baseline kidney function, especially in the dialysis dependence patients at hospital discharge.
[Mh] Termos MeSH primário: Lesão Renal Aguda/mortalidade
Lesão Renal Aguda/terapia
Taxa de Filtração Glomerular
Mortalidade Hospitalar
Diálise Peritoneal Ambulatorial Contínua/mortalidade
Diálise Peritoneal Ambulatorial Contínua/utilização
[Mh] Termos MeSH secundário: Lesão Renal Aguda/diagnóstico
Brasil/epidemiologia
Cuidados Críticos/métodos
Cuidados Críticos/utilização
Feminino
Seres Humanos
Masculino
Meia-Idade
Alta do Paciente
Diálise Peritoneal Ambulatorial Contínua/métodos
Prevalência
Estudos Retrospectivos
Fatores de Risco
Taxa de Sobrevida
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[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:170504
[St] Status:MEDLINE
[do] DOI:10.1186/s12882-017-0564-z


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[PMID]:28460438
[Au] Autor:Chen X; Zhu W; Tan J; Nie H; Liu L; Yan D; Zhou X; Sun X
[Ad] Endereço:Chinese Cochrane Centre, Chinese Evidence-Based Medicine Centre, West China Hospital, Sichuan University, Chengdu, Sichuang, China.
[Ti] Título:Early outcome of early-goal directed therapy for patients with sepsis or septic shock: a systematic review and meta-analysis of randomized controlled trials.
[So] Source:Oncotarget;8(16):27510-27519, 2017 Apr 18.
[Is] ISSN:1949-2553
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Various trials and meta-analyses have reported conflicting results concerning the application of early goal-directed therapy (EGDT) for sepsis and septic shock. The aim of this study was to update the evidence by performing a systematic review and meta-analysis. Multiple databases were searched from initial through August, 2016 for randomized controlled trials (RCTs) which investigated the associations between the use of EGDT and mortality in patients with sepsis or septic shock. Meta-analysis was performed using random-effects model and heterogeneity was examined through subgroup analyses. The primary outcome of interest was patient all-cause mortality including hospital or ICU mortality. Seventeen RCTs including 6207 participants with 3234 in the EGDT group and 2973 in the control group were eligible for this study. Meta-analysis showed that EGDT did not significantly reduce hospital or intensive care unit (ICU) mortality (relative risk [RR] 0.89, 95% CI 0.78 to 1.02) compared with control group for patients with sepsis or septic shock. The findings of subgroup analyses stratified by study region, number of research center, year of enrollment, clinical setting, sample size, timing of EGDT almost remained constant with that of the primary analysis. Our findings provide evidence that EGDT offers neutral survival effects for patients with sepsis or septic shock. Further meta-analyses based on larger well-designed RCTs or individual patient data meta-analysis are required to explore the survival benefits of EDGT in patients with sepsis or septic shock.
[Mh] Termos MeSH primário: Sepse/terapia
Choque Séptico/terapia
Tempo para o Tratamento
[Mh] Termos MeSH secundário: Terapia Combinada
Gerenciamento Clínico
Mortalidade Hospitalar
Seres Humanos
Unidades de Terapia Intensiva
Razão de Chances
Viés de Publicação
Ensaios Clínicos Controlados Aleatórios como Assunto
Sepse/diagnóstico
Sepse/mortalidade
Choque Séptico/diagnóstico
Choque Séptico/mortalidade
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[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:170503
[St] Status:MEDLINE
[do] DOI:10.18632/oncotarget.15550


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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]:29465589
[Au] Autor:Geng TT; Xu X; Huang M
[Ad] Endereço:Department of General Intensive Care Unit, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China.
[Ti] Título:High-dose tigecycline for the treatment of nosocomial carbapenem-resistant Klebsiella pneumoniae bloodstream infections: A retrospective cohort study.
[So] Source:Medicine (Baltimore);97(8):e9961, 2018 Feb.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Carbapenem-resistant Klebsiella pneumoniae (CRKP) bloodstream infection (BSI) has become increasingly frequent threat recently, especially in the intensive care unit (ICU). High-dose tigecycline (TGC) regimen is proposed due to the limitation of treatment options. We investigated the efficacy and safety of high-dose TGC combination regimens for treating CRKP BSI. Furthermore, the risk factors for mortality were also determined.This was a single center retrospective cohort study conducted from 2014 to 2016. A total of 40 patients with nosocomial CRKP BSI admitted to the ICU were included; they were classified into two groups according to the treatment regimens with high-dose TGC (HD group) or not (non-HD group). In-hospital mortality rates and microbiologic responses from both groups were reviewed and compared. Besides, the survival and non-survival groups were compared to identify the risk factors of mortality.Twenty-three patients constituted the HD group (high-dosage TGC regimen was administered as 200 mg loading dose followed by 100 mg every 12 h) and 17 patients constituted the non-HD group (standard dose TGC therapy as 100 mg loading dose followed by 50 mg every 12 h and other antibiotics). The in-hospital mortality was 52.2% in the HD group and 76.5% in the non-HD group (P = .117). The Kaplan-Meier test showed significantly longer survival times in the HD group (mean: 83 days vs 28 days; P = .027). Microbiological eradication was observed in 13 patients (56.5%) in the HD group and 6 patients (36.3%) in the non-HD group (P = .184). A smaller fraction of patients in the HD group were subjected to vasoactive therapy (52.2% vs 88.2%; P = .016) compared to the non-HD group. There was no significant difference in the manifestation of adverse effects between the two groups. In the multivariate analysis, multiple organ dysfunction syndrome (MODS), vasoactive therapy, and exposure to carbapenems were regarded as the independent predictors of mortality.A therapeutic regimen consisting of a high dose of TGC was associated with significantly longer survival time and numerically lower mortality in CRKP BSI. Adverse events were not increased with the double dose therapy.
[Mh] Termos MeSH primário: Antibacterianos/administração & dosagem
Bacteriemia/tratamento farmacológico
Infecção Hospitalar/tratamento farmacológico
Infecções por Klebsiella/tratamento farmacológico
Minociclina/análogos & derivados
[Mh] Termos MeSH secundário: Idoso
Bacteriemia/microbiologia
Bacteriemia/mortalidade
Enterobacteriáceas Resistentes a Carbapenêmicos/efeitos dos fármacos
Infecção Hospitalar/microbiologia
Infecção Hospitalar/mortalidade
Feminino
Mortalidade Hospitalar
Seres Humanos
Estimativa de Kaplan-Meier
Infecções por Klebsiella/mortalidade
Klebsiella pneumoniae/efeitos dos fármacos
Masculino
Meia-Idade
Minociclina/administração & dosagem
Estudos Retrospectivos
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Bacterial Agents); 70JE2N95KR (tigecycline); FYY3R43WGO (Minocycline)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180302
[Lr] Data última revisão:
180302
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180222
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009961


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[PMID]:27775983
[Au] Autor:Strassle PD; Williams FN; Napravnik S; van Duin D; Weber DJ; Charles A; Cairns BA; Jones SW
[Ad] Endereço:From the *Department of Epidemiology, University of North Carolina at Chapel Hill; †Department of Surgery, University of North Carolina at Chapel Hill, ‡North Carolina Jaycee Burn Center, Chapel Hill; and §Division of Infectious Diseases, University of North Carolina, Chapel Hill.
[Ti] Título:Improved Survival of Patients With Extensive Burns: Trends in Patient Characteristics and Mortality Among Burn Patients in a Tertiary Care Burn Facility, 2004-2013.
[So] Source:J Burn Care Res;38(3):187-193, 2017 May/Jun.
[Is] ISSN:1559-0488
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Classic determinants of burn mortality are age, burn size, and the presence of inhalation injury. Our objective was to describe temporal trends in patient and burn characteristics, inpatient mortality, and the relationship between these characteristics and inpatient mortality over time. All patients aged 18 years or older and admitted with burn injury, including inhalation injury only, between 2004 and 2013 were included. Adjusted Cox proportional hazards regression models were used to estimate the relationship between admit year and inpatient mortality. A total of 5540 patients were admitted between 2004 and 2013. Significant differences in sex, race/ethnicity, burn mechanisms, TBSA, inhalation injury, and inpatient mortality were observed across calendar years. Patients admitted between 2011 and 2013 were more likely to be women, non-Hispanic Caucasian, with smaller burn size, and less likely to have an inhalation injury, in comparison with patients admitted from 2004 to 2010. After controlling for patient demographics, burn mechanisms, and differential lengths of stay, no calendar year trends in inpatient mortality were detected. However, a significant decrease in inpatient mortality was observed among patients with extensive burns (≥75% TBSA) in more recent calendar years. This large, tertiary care referral burn center has maintained low inpatient mortality rates among burn patients over the past 10 years. While observed decreases in mortality during this time are largely due to changes in patient and burn characteristics, survival among patients with extensive burns has improved.
[Mh] Termos MeSH primário: Unidades de Queimados
Queimaduras/mortalidade
Queimaduras/terapia
Centros de Atenção Terciária
[Mh] Termos MeSH secundário: Adulto
Feminino
Mortalidade Hospitalar
Seres Humanos
Tempo de Internação/estatística & dados numéricos
Masculino
Meia-Idade
North Carolina
Sistema de Registros
Fatores de Risco
Taxa de Sobrevida
[Pt] Tipo de publicação: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.0000000000000456


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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
Seres Humanos
Escala de Gravidade do Ferimento
Intubação Intratraqueal/estatística & dados numéricos
Tempo de Internação
Modelos Logísticos
Masculino
Meia-Idade
Análise Multivariada
Respiração Artificial/efeitos adversos
Respiração Artificial/métodos
Ressuscitação/métodos
Ressuscitação/estatística & dados numéricos
Estudos Retrospectivos
Medição de Risco
Fatores de Tempo
Adulto Jovem
[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


  10 / 31583 MEDLINE  
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[PMID]:29428014
[Au] Autor:Fry DE; Pine M; Nedza SM; Reband AM; Huang CJ; Pine G
[Ti] Título:Comparison of Risk-Adjusted Outcomes in Medicare Open Laparoscopic Cholecystectomy.
[So] Source:Am Surg;84(1):12-19, 2018 Jan 01.
[Is] ISSN:1555-9823
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:More than 90 per cent of cholecystectomies are performed laparoscopically and this has resulted in concern that surgeons will not have sufficient experience to perform open procedures when clinical circumstances require it. We reviewed the open cholecystectomies (OCs) of Medicare patients from 2010 to 2012 in hospitals with 20 or more cases, created risk-adjusted models for adverse outcomes which were evaluated for 90-days after discharge, and compared the hospital-level outcomes with laparoscopic cholecystectomy performed in the same hospitals for the same period of time. Results demonstrated that inpatient deaths, inpatient prolonged length-of-stay outliers, 90-day postdischarge deaths without readmission, and 90-day readmissions were statistically the same with an overall adverse outcome rate of 21.6 per cent in OC versus 20.9 per cent in laparoscopic cholecystectomy. Conversion of laparoscopic to open procedures was not associated with increased adverse outcomes. Laparoscopic cholecystectomy provides patients with many advantages, but when clinical circumstances are necessary, OC continues to be performed with the same overall adverse outcome rates, and the conversion process is not associated with poorer results in this high-risk population of patients.
[Mh] Termos MeSH primário: Colecistectomia
Mortalidade Hospitalar
Tempo de Internação
Medicaid
Medicare
Alta do Paciente
Readmissão do Paciente
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Colecistectomia/efeitos adversos
Colecistectomia Laparoscópica/efeitos adversos
Conversão para Cirurgia Aberta
Seres Humanos
Estudos Retrospectivos
Medição de Risco
Fatores de Risco
Resultado do Tratamento
Estados Unidos
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180212
[St] Status:MEDLINE



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