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[PMID]:29211785
[Au] Autor:Ghith N; Frølich A; Merlo J
[Ad] Endereço:Research Unit for Chronic Conditions, Department of Clinical Epidemiology, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark.
[Ti] Título:The role of the clinical departments for understanding patient heterogeneity in one-year mortality after a diagnosis of heart failure: A multilevel analysis of individual heterogeneity for profiling provider outcomes.
[So] Source:PLoS One;12(12):e0189050, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: To evaluate the general contextual effect (GCE) of the hospital department on one-year mortality in Swedish and Danish patients with heart failure (HF) by applying a multilevel analysis of individual heterogeneity. METHODS: Using the Swedish patient register, we obtained data on 36,943 patients who were 45-80 years old and admitted for HF to the hospital between 2007 and 2009. From the Danish Heart Failure Database (DHFD), we obtained data on 12,001 patients with incident HF who were 18 years or older and treated at hospitals between June 2010 and June2013. For each year, we applied two-step single and multilevel logistic regression models. We evaluated the general effects of the department by quantifying the intra-class correlation coefficient (ICC) and the increment in the area under the receiver operating characteristic curve (AUC) obtained by adding the random effects of the department in a multilevel logistic regression analysis. RESULTS: One-year mortality for Danish incident HF patients was low in the three audit years (around 11.1% -13.1%) and departments performed homogeneously (ICC ≈1.5% - 3.5%). The discriminatory accuracy of a model including age and gender was rather high (AUC≈ 0.71-0.73) but the increment in AUC after adding the department random effects into these models was only about 0.011-0.022 units in the three years. One-year mortality in Swedish patients with first hospitalization for heart failure, was relatively higher for 2007-2009 (≈21.3% - 22%) and departments performed homogeneously (ICC ≈ 1.5% - 3%). The discriminatory accuracy of a model including age, gender and patient risk score was rather high (AUC≈ 0.726-0.728) but the increment in AUC after adding the department random effects was only about 0.010-0.017 units in the three years. CONCLUSION: Using the DHFD standard benchmark for one-year mortality, Danish departments had a good, homogeneous performance. In reference to literature, Swedish departments had a homogeneous performance and the mortality rates for patients with first hospitalization for heart failure were similar to those reported since 2000. Considering this, if health authorities decide to further reduce mortality rates, a comprehensive quality strategy should focus on all Swedish hospitals. Yet, a complementary assessment for the period after the study period is required to confirm whether department performance is still homogeneous or not to determine the most appropriate action.
[Mh] Termos MeSH primário: Insuficiência Cardíaca/mortalidade
Departamentos Hospitalares
Avaliação de Resultados (Cuidados de Saúde)
[Mh] Termos MeSH secundário: Idoso
Estudos de Coortes
Dinamarca/epidemiologia
Feminino
Insuficiência Cardíaca/diagnóstico
Seres Humanos
Modelos Logísticos
Masculino
Suécia/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171229
[Lr] Data última revisão:
171229
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171207
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0189050


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[PMID]:28745687
[Au] Autor:Smirnov AV; Karunnaya AV; Dobronravov VA
[Ad] Endereço:I.P. Pavlov Saint Petersburg State Medical University, Ministry of Health of Russia, Saint Petersburg, Russia.
[Ti] Título:[Nephrological aspects of complement-mediated thrombotic microangiopathy].
[Ti] Título:Nefrologicheskie aspekty komplement-oposredovannoi tromboticheskoi mikroangiopatii..
[So] Source:Ter Arkh;89(6):34-40, 2017.
[Is] ISSN:0040-3660
[Cp] País de publicação:Russia (Federation)
[La] Idioma:rus
[Ab] Resumo:AIM: To analyze cases of complement-mediated thrombotic microangiopathy (C-TMA) in the daily practice of a hospital nephrology department, relative to the general aspects of the clinical course, therapy, and short-term outcomes. SUBJECTS AND METHODS: The prospective study conducted in the period June 1, 2015 to June 1, 2016 included 10 patients with C-TMA newly diagnosed during hospitalization. Standard demographic parameters, generally accepted clinical data showing the severity of TMA and the involvement of vital organs were recorded at admission. Short-term outcomes of therapy (plasma therapy and/or eculizumab therapy), such as achievement of hematological remission and the need for maintenance therapy and renal replacement therapy (RRT), were evaluate. RESULTS: The median time from the onset of symptoms of the disease to diagnosis in the analyzed cases was 5 months (range 1 week to 26 months). The incidence of C-TMA among the inpatients of nephrology departments was 6.4 per 1,000 patients per year. Five patients were admitted to a clinic with symptoms of obvious extrarenal organ disorders; 4 of them had multiple organ dysfunction. Evident clinical symptoms of renal dysfunction were detected in all the patients, which necessitated RRT in 8 out of the 10 patients. Renal biopsy was performed in 7 patients. All were found to have typical morphological manifestations of acute and chronic TMA. All the patients received plasma therapy; most of them had plasma exchanges; 4 patients took eculizumab. There were no fatal outcomes. All achieved hematological remission. Three of the 8 cases could achieve varying recovery of kidney function and stop dialysis. CONCLUSION: Analysis of this series of cases confirms the idea about the severity of TMA due to multiple organ dysfunction and the high risk of end-stage renal failure at late diagnosis. The key points of better renal prognosis are the earliest detection and treatment of the disease.
[Mh] Termos MeSH primário: Anticorpos Monoclonais Humanizados/farmacologia
Transfusão de Sangue/métodos
Microangiopatias Trombóticas/diagnóstico
Microangiopatias Trombóticas/terapia
[Mh] Termos MeSH secundário: Adulto
Idoso
Anticorpos Monoclonais Humanizados/administração & dosagem
Terapia Combinada
Feminino
Departamentos Hospitalares/estatística & dados numéricos
Seres Humanos
Incidência
Masculino
Meia-Idade
Microangiopatias Trombóticas/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antibodies, Monoclonal, Humanized); A3ULP0F556 (eculizumab)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171129
[Lr] Data última revisão:
171129
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170727
[St] Status:MEDLINE
[do] DOI:10.17116/terarkh201789634-40


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[PMID]:28902385
[Au] Autor:Miljak T; Zaar P
[Ti] Título:[Standard Operating Procedures in Clinical Medicine].
[Ti] Título:Standards in der klinischen Medizin..
[So] Source:Dtsch Med Wochenschr;142(18):1390-1395, 2017 Sep.
[Is] ISSN:1439-4413
[Cp] País de publicação:Germany
[La] Idioma:ger
[Ab] Resumo:Standard operating procedures (SOP) in hospital care have the potential to improve treatment quality and transparency. However, after arriving at the decision to generate a SOP for the own hospital or ward, the upcoming question is often, how to start?The present article tries to give some interdisciplinary guidance about reasonable structures and contents of SOPs that could be understood as a basic matrix for individual work.
[Mh] Termos MeSH primário: Medicina Clínica
[Mh] Termos MeSH secundário: Medicina Clínica/métodos
Medicina Clínica/normas
Departamentos Hospitalares
Seres Humanos
Equipe de Assistência ao Paciente
Guias de Prática Clínica como Assunto
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170927
[Lr] Data última revisão:
170927
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170914
[St] Status:MEDLINE
[do] DOI:10.1055/s-0043-108436


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[PMID]:28624033
[Au] Autor:Tignanelli CJ; Embree GGR; Barzin A
[Ad] Endereço:Department of Surgery, University of North Carolina, Chapel Hill, North Carolina. Electronic address: ctignane@med.umich.edu.
[Ti] Título:House staff-led interdisciplinary morbidity and mortality conference promotes systematic improvement.
[So] Source:J Surg Res;214:124-130, 2017 Jun 15.
[Is] ISSN:1095-8673
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Improvements in patient safety are critical to improving clinical outcomes. We present a resident-led interdisciplinary morbidity and mortality (M&M) conference utilizing postconference task forces to identify unique system issues, classify key contributors to interdisciplinary complications, and implement systems solutions. The conference also served to facilitate resident involvement in quality improvement projects. MATERIALS AND METHODS: Members of the UNC Housestaff Council designed and implemented a hospital-wide M&M conference. Cases involving two or more service lines and resulting from systematic failures were selected for presentation by an interdisciplinary group of residents involved in the patient's care. Postconference task forces addressed problems and developed initiatives to improve care. RESULTS: Of the 15 cases presented, 60% were attributable to an error in judgment, 26% to an error in diagnosis, and 13% to an error in technique. Communication (67%), coordination/care utilization (47%), poor process/workflow (40%), and inadequate training (33%) were the main associated contributing factors. Poor communication contributed to all complications resulting from an error in judgment. Inadequate training and poor workflow were the most common contributing factors with an error in technique. Poor utilization of care and inadequate processes were most common with an error in diagnosis. Postconference task forces identified system-based improvement projects in 73% (11 of 15) of cases with 82% (9 of 11) of projects successfully implemented or in process. CONCLUSIONS: House staff-led interdisciplinary M&M conference utilizing postconference task forces is an ideal setting to identify unique system issues and implement system-based improvement strategies.
[Mh] Termos MeSH primário: Congressos como Assunto/organização & administração
Departamentos Hospitalares/organização & administração
Comunicação Interdisciplinar
Internato e Residência/organização & administração
Erros Médicos/prevenção & controle
Segurança do Paciente
Melhoria de Qualidade/organização & administração
[Mh] Termos MeSH secundário: Seres Humanos
Internato e Residência/métodos
North Carolina
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170919
[Lr] Data última revisão:
170919
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170619
[St] Status:MEDLINE


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[PMID]:28613991
[Au] Autor:Liu S; Wang M; Wang G; Wu X; Guan W; Ren J
[Ad] Endereço:1 Department of General Surgery, Nanjing Drum Tower Hospital , he Affiliated Hospital of Nanjing University Medical School, Nanjing, China .
[Ti] Título:Microbial Characteristics of Nosocomial Infections and Their Association with the Utilization of Hand Hygiene Products: A Hospital-Wide Analysis of 78,344 Cases.
[So] Source:Surg Infect (Larchmt);18(6):676-683, 2017 Aug/Sep.
[Is] ISSN:1557-8674
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Nosocomial infections are the main adverse events during health care delivery. Hand hygiene is the fundamental strategy for the prevention of nosocomial infections. Microbial characteristics of nosocomial infections in the Asia-Pacific region have not been investigated fully. Correlation between the use of hand hygiene products and the incidence of nosocomial infections is still unknown. This study investigates the microbial characteristics of nosocomial infections in the Asia-Pacific region and analyzes the association between the utilization of hand hygiene products and the incidence of nosocomial infections. PATIENTS AND METHODS: A total of 78,344 patients were recruited from a major tertiary hospital in China. Microbial characteristics of major types of nosocomial infections were described. The association between the utilization of hand hygiene products and the incidence of nosocomial infections was analyzed using correlation and regression models. RESULTS: The overall incidence of nosocomial infections was 3.04%, in which the incidence of surgical site infection was 1%. Multi-drug resistance was found in 22.8% of all pathogens, in which multi-drug-resistant Acinetobacter baumannii and methicillin-resistant Staphylococcus aureus were 56.6% and 54.9%, respectively. The utilization of hand hygiene products (including hand sanitizer, soap and paper towel) was associated negatively with the incidence of surgical site infection in surgical departments and the incidence of nosocomial infections in non-intensive care unit (ICU) departments (especially in surgical departments). Regression analysis further identified that higher utilization of hand hygiene products correlated with decreased incidence of major types of nosocomial infections. CONCLUSIONS: Multi-drug-resistant organisms are emerging in Asia-Pacific health care facilities. Utilization of hand hygiene products is associated with the incidence of nosocomial infections.
[Mh] Termos MeSH primário: Infecção Hospitalar/epidemiologia
Infecção Hospitalar/microbiologia
Higiene das Mãos/estatística & dados numéricos
Higienizadores de Mão
Infecção da Ferida Cirúrgica/epidemiologia
Infecção da Ferida Cirúrgica/microbiologia
[Mh] Termos MeSH secundário: Acinetobacter baumannii
China/epidemiologia
Farmacorresistência Bacteriana
Departamentos Hospitalares/estatística & dados numéricos
Seres Humanos
Incidência
Modelos Lineares
Staphylococcus aureus Resistente à Meticilina
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Hand Sanitizers)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171030
[Lr] Data última revisão:
171030
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170615
[St] Status:MEDLINE
[do] DOI:10.1089/sur.2017.037


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[PMID]:28441234
[Au] Autor:Weissman GE; Hubbard RA; Kohn R; Anesi GL; Manaker S; Kerlin MP; Halpern SD
[Ad] Endereço:1Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA.2Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.3Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
[Ti] Título:Validation of an Administrative Definition of ICU Admission Using Revenue Center Codes.
[So] Source:Crit Care Med;45(8):e758-e762, 2017 Aug.
[Is] ISSN:1530-0293
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: Describe the operating characteristics of a proposed set of revenue center codes to correctly identify ICU stays among hospitalized patients. DESIGN: Retrospective cohort study. We report the operating characteristics of all ICU-related revenue center codes for intensive and coronary care, excluding nursery, intermediate, and incremental care, to identify ICU stays. We use a classification and regression tree model to further refine identification of ICU stays using administrative data. The gold standard for classifying ICU admission was an electronic patient location tracking system. SETTING: The University of Pennsylvania Health System in Philadelphia, PA, United States. PATIENTS: All adult inpatient hospital admissions between July 1, 2013, and June 30, 2015. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among 127,680 hospital admissions, the proposed combination of revenue center codes had 94.6% sensitivity (95% CI, 94.3-94.9%) and 96.1% specificity (95% CI, 96.0-96.3%) for correctly identifying hospital admissions with an ICU stay. The classification and regression tree algorithm had 92.3% sensitivity (95% CI, 91.6-93.1%) and 97.4% specificity (95% CI, 97.2-97.6%), with an overall improved accuracy (χ = 398; p < 0.001). CONCLUSIONS: Use of the proposed combination of revenue center codes has excellent sensitivity and specificity for identifying true ICU admission. A classification and regression tree algorithm with additional administrative variables offers further improvements to accuracy.
[Mh] Termos MeSH primário: Codificação Clínica/métodos
Administração Hospitalar/estatística & dados numéricos
Unidades de Terapia Intensiva/estatística & dados numéricos
Admissão do Paciente/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adulto
Idoso
Algoritmos
Codificação Clínica/normas
Feminino
Administração Hospitalar/normas
Preços Hospitalares/estatística & dados numéricos
Departamentos Hospitalares/economia
Departamentos Hospitalares/estatística & dados numéricos
Seres Humanos
Masculino
Meia-Idade
Dispositivo de Identificação por Radiofrequência
Estudos Retrospectivos
Sensibilidade e Especificidade
Fatores Socioeconômicos
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170816
[Lr] Data última revisão:
170816
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170426
[St] Status:MEDLINE
[do] DOI:10.1097/CCM.0000000000002374


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[PMID]:28428643
[Au] Autor:Sist L; Contini C; Bandini A; Bandini S; Massa L; Zanin R; Maricchio R; Gianesini G; Bassi E; Tartaglini D; Palese A; Ferraresi A
[Ad] Endereço:Coordinatore Infermieristico PARE, Dipartimento Medico della Continuità Assistenziale e delle Disabilità, Azienda Ospedaliero Universitaria Policlinico S.Orsola-Malpighi, Bologna, Italia.
[Ti] Título:[MISSCARE Survey - Italian Version: findings from an Italian validation study].
[Ti] Título:MISSCARE Survey - Versione Italiana: risultati dello studio di validazione di uno strumento per la rilevazione delle cure infermieristiche mancate..
[So] Source:Ig Sanita Pubbl;73(1):29-45, 2017 Jan-Feb.
[Is] ISSN:0019-1639
[Cp] País de publicação:Italy
[La] Idioma:ita
[Ab] Resumo:BACKGROUND: The Missed Nursing Care (MNC) refers to nursing interventions that are not completed, partially completed, or postponed. Despite the relevance of MNC, no assessment tools are available in the Italian context, and no data regarding the occurrence of this phenomenon has been documented on a large scale to date. OBJECTIVES: The study aims were: (1) to validate the Italian version of the MISSCARE Survey tool; (2) to measure the prevalence of missed interventions and reasons for missed care as perceived by clinical nurses working in Italian health care settings. METHODS: After having conducted the forward and backward translation, pre-pilot and pilot phases were developed to ensure face and content validity as well as semantic and conceptual equivalence of the Italian version with the original version. The MISSCARE survey questionnaire was then distributed to 1,233 clinical nurses of whom 1,003 completed the questionnaire. Overall, 979 questionnaires were analysed. The questionnaires were completed from January to March 2012, by nurses working in medical and surgical hospital departments in the Emilia Romagna region of Italy. Construct validity and internal consistency of the instrument were assessed. RESULTS: The face and content validity were ascertained by a group of experts. The instrument acceptability was good given that 79.4% of respondents replied to all items. Construct validity was investigated by an Exploratory Factor Analysis. Four factors explaining 64.18% of variance emerged: communication, lack of facilities/supplies, lack of staff, and unexpected events. Internal consistency, evaluated with Cronbach a, was 0.94. The nursing interventions omitted with greater frequency were, in order: ambulation (74.8%), passive mobilization (69.6%) and oral care (51.3%). The three main reasons for missed interventions were: an unexpected increase in the number of patients (90.5%), increased instability of the clinical condition (86.1%) and insufficient human resources (85.5%). CONCLUSIONS: The Italian version of the MISSCARE Survey was shown to have good psychometric properties. Therefore, it can be used to evaluate the missed nursing care phenomenon in Italy and will allow for international comparisons.
[Mh] Termos MeSH primário: Comunicação
Equipamentos e Provisões
Relações Enfermeiro-Paciente
Enfermeiras e Enfermeiros
Admissão e Escalonamento de Pessoal
Carga de Trabalho
[Mh] Termos MeSH secundário: Adulto
Idoso
Equipamentos e Provisões/estatística & dados numéricos
Feminino
Departamentos Hospitalares/estatística & dados numéricos
Seres Humanos
Itália
Masculino
Meia-Idade
Enfermeiras e Enfermeiros/estatística & dados numéricos
Admissão e Escalonamento de Pessoal/estatística & dados numéricos
Qualidade da Assistência à Saúde
Reprodutibilidade dos Testes
Estudos Retrospectivos
Inquéritos e Questionários
Carga de Trabalho/estatística & dados numéricos
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; VALIDATION STUDIES
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170829
[Lr] Data última revisão:
170829
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170422
[St] Status:MEDLINE


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[PMID]:28377253
[Au] Autor:Sollmann N; Meyer B; Krieg SM
[Ad] Endereço:Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; TUM Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
[Ti] Título:Implementing Functional Preoperative Mapping in the Clinical Routine of a Neurosurgical Department: Technical Note.
[So] Source:World Neurosurg;103:94-105, 2017 Jul.
[Is] ISSN:1878-8769
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Navigated transcranial magnetic stimulation (nTMS) is increasingly being used for mapping of various brain functions and in nTMS-based tractography in neurosurgical departments worldwide. When a department begins using nTMS data in the clinical workflow, smooth integration into the hospital's existing infrastructure is mandatory. Standardized approaches for this beyond the mapping or tractography procedures themselves have not yet been described. METHODS: To create an effective workflow for neurosurgical nTMS mapping, we present the findings of our 7 years of experience and progressive integration into the clinical routine. RESULTS: After indication for mapping is made, the workflow starts with patient admission and includes all preoperative steps until tumor resection. Importantly, only standard software and devices were used, enabling new centers to easily integrate data derived from nTMS mapping and nTMS-based tractography into their hospital's infrastructure. Registration of the patient, appointment planning, and documentation of results of the nTMS procedures within the hospital information system (HIS) can be achieved by a novel tailored software mask. As another important part of the workflow, nTMS data are imported into the picture archiving and communication system (PACS) via PACS integrator software. In addition, for surgical planning including nTMS-based tractography, nTMS data can be effectively included in surgical neuronavigation software. CONCLUSIONS: Optimized integration of nTMS data can be achieved using a standardized workflow. The seamless integration and availability of nTMS data are crucial to the acceptance of these data in the clinical routine. This optimized workflow can serve as a guide for centers beginning to use nTMS data in patient care.
[Mh] Termos MeSH primário: Mapeamento Encefálico
Neoplasias Encefálicas/diagnóstico por imagem
Encéfalo/diagnóstico por imagem
Departamentos Hospitalares/organização & administração
Neuronavegação
Neurocirurgia/organização & administração
Cuidados Pré-Operatórios/métodos
Estimulação Magnética Transcraniana/métodos
Fluxo de Trabalho
[Mh] Termos MeSH secundário: Encéfalo/cirurgia
Neoplasias Encefálicas/cirurgia
Imagem de Tensor de Difusão
Seres Humanos
Imagem Tridimensional
Imagem por Ressonância Magnética
Software
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170925
[Lr] Data última revisão:
170925
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170406
[St] Status:MEDLINE


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[PMID]:28374467
[Au] Autor:Jonsson AB; Perner A
[Ad] Endereço:Department of Intensive Care, Rigshospitalet, Copenhagen, Denmark.
[Ti] Título:Changes from 2012 to 2015 in intravenous fluid solutions issued to hospital departments.
[So] Source:Acta Anaesthesiol Scand;61(5):532-538, 2017 May.
[Is] ISSN:1399-6576
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: In recent years, large trials have increased the level of evidence for intravenous (IV) fluid therapy, at least in the intensive care setting. It is less clear whether this change in the evidence base has been associated with changes in IV fluid use in different hospital departments. METHODS: We obtained details from the regional pharmacy regarding IV fluids issued to hospital departments in the Danish Capitol Region from January 2012 to May 2015. We used paired Wilcoxon's signed-rank test to analyse changes in the issuing in different departments. RESULTS: Total regional issuing of IV fluids showed increase in crystalloid solutions (9%; P = 0.001) and decrease in colloid solutions (59%; P = 0.005). Subtype analysis showed increased issuing of buffered crystalloids (36%; P = 0.001), human albumin (30%; P < 0.0001) and decreased issuing in synthetic colloid solutions (82%; P < 0.0001) from Q1 2012 to Q2 2015. At the departmental level, the issuing of synthetic colloid solutions decreased markedly to all settings. The issuing of buffered crystalloids increased to orthopaedic (226%; P = 0.03) and to general surgery departments (686%; P = 0.002). Albumin solutions were increasingly issued to anaesthesia departments (63%; P = 0.005) and was rarely issued to general surgery and orthopaedic departments. CONCLUSIONS: The issuing of IV fluid solutions to hospital departments has changed markedly over the last years to less colloid, in particular the synthetic solutions, and relatively more issuing of crystalloids, in particular the buffered solutions.
[Mh] Termos MeSH primário: Albuminas/administração & dosagem
Coloides/administração & dosagem
Hidratação/métodos
Hidratação/estatística & dados numéricos
Departamentos Hospitalares
Soluções Isotônicas/administração & dosagem
Cloreto de Sódio/administração & dosagem
[Mh] Termos MeSH secundário: Administração Intravenosa
Dinamarca
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Albumins); 0 (Colloids); 0 (Isotonic Solutions); 0 (crystalloid solutions); 451W47IQ8X (Sodium Chloride)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171004
[Lr] Data última revisão:
171004
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170405
[St] Status:MEDLINE
[do] DOI:10.1111/aas.12887


  10 / 14528 MEDLINE  
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[PMID]:28327139
[Au] Autor:Langelaan M; Baines RJ; de Bruijne MC; Wagner C
[Ad] Endereço:NIVEL, Netherlands Institute for Health Services Research, Otterstraat 118-124, 3513 CR, Utrecht, The Netherlands. m.langelaan@nivel.nl.
[Ti] Título:Association of admission and patient characteristics with quality of discharge letters: posthoc analysis of a retrospective study.
[So] Source:BMC Health Serv Res;17(1):225, 2017 Mar 21.
[Is] ISSN:1472-6963
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: A complete, correct and timely discharge letter can communicate important information from the hospital to the general practitioner. The adequacy of the letter may vary with the patient and admission characteristics of the patient. Insight in the association between these characteristics and the presence and quality of the discharge letter will give rise to improvement activities for a better continuity of care after discharge. The objective was to determine the presence, correctness and timeliness of admission information in discharge letters and to determine the association between patient and admission characteristics, including unplanned readmissions and the quality of the discharge letter. METHODS: A post-hoc analysis of a two-staged retrospective patient record review study was performed in 4048 patient records in a random sample of 20 hospitals. RESULTS: Nearly ten percent of the discharge letters are lacking in patient records in Dutch hospitals. In 59.1% of the discharge letters, one or more relevant components are missing. Important laboratory results, relevant information about consultations, answers to the questions of the referrer, changes in medication and follow up are often lacking. Discharge letters are more likely to be missing in elective patient admissions to a hospital, with a shorter length of stay, less comorbidity, and in readmissions. There was a significant variation in missing discharge letters between hospitals and between hospital departments. CONCLUSIONS: The quality of discharge letters varies with patient and admission characteristics.
[Mh] Termos MeSH primário: Registros Médicos/normas
Alta do Paciente/normas
[Mh] Termos MeSH secundário: Medicina Geral/normas
Departamentos Hospitalares/normas
Departamentos Hospitalares/estatística & dados numéricos
Hospitalização/estatística & dados numéricos
Hospitais/normas
Hospitais/estatística & dados numéricos
Seres Humanos
Países Baixos
Admissão do Paciente/estatística & dados numéricos
Segurança do Paciente
Transferência de Pacientes/normas
Transferência de Pacientes/estatística & dados numéricos
Encaminhamento e Consulta/estatística & dados numéricos
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170828
[Lr] Data última revisão:
170828
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170323
[St] Status:MEDLINE
[do] DOI:10.1186/s12913-017-2149-8



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