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[PMID]:28818864
[Au] Autor:Singh T; Peters SR; Tirschwell DL; Creutzfeldt CJ
[Ad] Endereço:From the Department of Neurology, Harborview Medical Center, University of Washington, Seattle. nanites@uw.edu.
[Ti] Título:Palliative Care for Hospitalized Patients With Stroke: Results From the 2010 to 2012 National Inpatient Sample.
[So] Source:Stroke;48(9):2534-2540, 2017 Sep.
[Is] ISSN:1524-4628
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND PURPOSE: Substantial variability exists in the use of life-prolonging treatments for patients with stroke, especially near the end of life. This study explores patterns of palliative care utilization and death in hospitalized patients with stroke across the United States. METHODS: Using the 2010 to 2012 nationwide inpatient sample databases, we included all patients discharged with stroke identified by codes. Strokes were subclassified as ischemic, intracerebral, and subarachnoid hemorrhage. We compared demographics, comorbidities, procedures, and outcomes between patients with and without a palliative care encounter (PCE) as defined by the code V66.7. Pearson χ test was used for categorical variables. Multivariate logistic regression was used to account for hospital, regional, payer, and medical severity factors to predict PCE use and death. RESULTS: Among 395 411 patients with stroke, PCE was used in 6.2% with an increasing trend over time ( <0.05). We found a wide range in PCE use with higher rates in patients with older age, hemorrhagic stroke types, women, and white race (all <0.001). Smaller and for-profit hospitals saw lower rates. Overall, 9.2% of hospitalized patients with stroke died, and PCE was significantly associated with death. Length of stay in decedents was shorter for patients who received PCE. CONCLUSIONS: Palliative care use is increasing nationally for patients with stroke, especially in larger hospitals. Persistent disparities in PCE use and mortality exist in regards to age, sex, race, region, and hospital characteristics. Given the variations in PCE use, especially at the end of life, the use of mortality rates as a hospital quality measure is questioned.
[Mh] Termos MeSH primário: Grupos Étnicos/estatística & dados numéricos
Hospitais/estatística & dados numéricos
Seguro Saúde/estatística & dados numéricos
Cuidados Paliativos/utilização
Qualidade da Assistência à Saúde
Acidente Vascular Cerebral/terapia
[Mh] Termos MeSH secundário: Afroamericanos/estatística & dados numéricos
Idoso
Idoso de 80 Anos ou mais
Americanos Asiáticos/estatística & dados numéricos
Bases de Dados Factuais
Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos
Feminino
Tamanho das Instituições de Saúde/estatística & dados numéricos
Hispano-Americanos/estatística & dados numéricos
Hospitalização
Hospitais Privados/estatística & dados numéricos
Hospitais Públicos/estatística & dados numéricos
Hospitais Filantrópicos/estatística & dados numéricos
Seres Humanos
Índios Norte-Americanos/estatística & dados numéricos
Tempo de Internação/estatística & dados numéricos
Modelos Logísticos
Masculino
Meia-Idade
Análise Multivariada
Indicadores de Qualidade em Assistência à Saúde
Estudos Retrospectivos
Índice de Gravidade de Doença
Acidente Vascular Cerebral/mortalidade
Assistência Terminal
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[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:170819
[St] Status:MEDLINE
[do] DOI:10.1161/STROKEAHA.117.016893


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[PMID]:28796677
[Au] Autor:Wright JD; Chen L; Hou JY; Burke WM; Tergas AI; Ananth CV; Neugut AI; Hershman DL
[Ad] Endereço:Departments of Obstetrics and Gynecology and Medicine and the Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, the Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, and New York Presbyterian Hospital, New York, New York.
[Ti] Título:Association of Hospital Volume and Quality of Care With Survival for Ovarian Cancer.
[So] Source:Obstet Gynecol;130(3):545-553, 2017 Sep.
[Is] ISSN:1873-233X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To assess whether strict adherence to quality metrics by hospitals could explain the association between hospital volume and survival for ovarian cancer. METHODS: We used the National Cancer Database to perform a retrospective cohort study of women with ovarian cancer from 2004 to 2013. Hospitals were stratified by annual case volume into quintiles (2 or less, 2.01-5, 5.01-9, 9.01-19.9, 20 cases or greater) and by adherence to ovarian cancer quality metrics into quartiles. Hospital-level adjusted 2- and 5-year survival rates were compared based on volume and adherence to the quality metrics. RESULTS: A total of 100,725 patients at 1,268 hospitals were identified. Higher volume hospitals were more likely to adhere to the quality metrics. Both 2- and 5-year survival increased with hospital volume and with adherence to the measured quality metrics. For example, 2-year survival increased from 64.4% (95% CI 62.5-66.4%) at low-volume to 77.4% (95% CI 77.0-77.8%) at high-volume centers and from 66.5% (95% CI 65.5-67.5%) at low-quality to 77.3% (95% CI 76.8-77.7%) at high-quality hospitals (P<.001 for both). For each hospital volume category, survival increased with increasing adherence to the quality metrics. For example, in the lowest volume hospitals (two or less cases annually), adjusted 2-year survival was 61.4% (95% CI 58.4-64.5%) at hospitals with the lowest adherence to quality metrics and rose to 65.8% (95% CI 61.2-70.8%) at the hospitals with highest adherence to the quality metrics (P<.001). However, lower volume hospitals with higher quality scores still had survival that was lower than higher volume hospitals. CONCLUSION: Although both hospital volume and adherence to quality metrics are associated with survival for ovarian cancer, low-volume hospitals that provide high-quality care still have survival rates that are lower than high-volume centers.
[Mh] Termos MeSH primário: Benchmarking
Hospitalização/estatística & dados numéricos
Neoplasias Ovarianas/mortalidade
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Bases de Dados Factuais
Feminino
Tamanho das Instituições de Saúde
Seres Humanos
Meia-Idade
Neoplasias Ovarianas/psicologia
Análise de Sobrevida
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:171022
[Lr] Data última revisão:
171022
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170811
[St] Status:MEDLINE
[do] DOI:10.1097/AOG.0000000000002164


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[PMID]:28483452
[Au] Autor:Lövestam E; Boström AM; Orrevall Y
[Ti] Título:Nutrition Care Process Implementation: Experiences in Various Dietetics Environments in Sweden.
[So] Source:J Acad Nutr Diet;117(11):1738-1748, 2017 Nov.
[Is] ISSN:2212-2672
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The Nutrition Care Process (NCP) and Nutrition Care Process Terminology (NCPT) are currently being implemented by nutrition and dietetics practitioners all over the world. Several advantages have been related to this implementation, such as consistency and clarity of dietetics-related health care records and the possibility to collect and research patient outcomes. However, little is known about dietitians' experiences of the implementation process. OBJECTIVE: The aim of this qualitative study was to explore Swedish dietitians' experiences of the NCP implementation process in different dietetics environments. METHOD: Thirty-seven Swedish dietitians from 13 different dietetics workplaces participated in seven focus group discussions that were audiotaped and carefully transcribed. A thematic secondary analysis was performed, after which all the discussions were re-read, following the implementation narrative from each workplace. In the analysis, The Promoting Action on Research Implementation in Health Services implementation model was used as a framework. RESULTS: Main categories identified in the thematic analysis were leadership and implementation strategy, the group and colleagues, the electronic health record, and evaluation. Three typical cases are described to illustrate the diversity of these aspects in dietetics settings: Case A represents a small hospital with an inclusive leadership style and discussion-friendly culture where dietitians had embraced the NCP/NCPT implementation. Case B represents a larger hospital with a more hierarchical structure where dietitians were more ambivalent toward NCP/NCPT implementation. Case C represents the only dietitian working at a small multiprofessional primary care center who received no dietetics-related support from management or colleagues. She had not started NCP/NCPT implementation. CONCLUSIONS: The diversity of dietetics settings and their different prerequisites should be considered in the development of NCP/NCPT implementation strategies. Tailored implementation strategies should be considered in relation to context, such as increased dietetics support and facilitation where management does not lead or support the implementation process.
[Mh] Termos MeSH primário: Dietética
Instalações de Saúde
Implementação de Plano de Saúde
Terapia Nutricional
[Mh] Termos MeSH secundário: Adulto
Registros Eletrônicos de Saúde
Grupos Focais
Tamanho das Instituições de Saúde
Implementação de Plano de Saúde/métodos
Implementação de Plano de Saúde/organização & administração
Administração Hospitalar
Hospitais
Seres Humanos
Nutricionistas
Atenção Primária à Saúde
Pesquisa Qualitativa
Suécia
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
171102
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170510
[St] Status:MEDLINE


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[PMID]:28412586
[Au] Autor:Haj Mohammad N; Bernards N; van Putten M; Lemmens VEPP; van Oijen MGH; van Laarhoven HWM
[Ad] Endereço:Department of Medical Oncology, Academic Medical Center, Amsterdam, The Netherlands; Department of Medical Oncology, University Medical Center Utrecht, The Netherlands. Electronic address: n.hajmohammad@umcutrecht.nl.
[Ti] Título:Volume-outcome relation in palliative systemic treatment of metastatic oesophagogastric cancer.
[So] Source:Eur J Cancer;78:28-36, 2017 Jun.
[Is] ISSN:1879-0852
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Palliative systemic therapy has been shown to improve survival in metastatic oesophagogastric cancer. Administration of palliative systemic therapy in metastatic oesophagogastric cancer varies between hospitals. We aimed to explore the association between the annual hospital volume of oesophagogastric cancer patients and survival. METHODS: Patients diagnosed in the Netherlands between 2005 and 2013 with metastatic oesophagogastric cancer were identified in the Netherlands Cancer Registry. Patients were attributed according to three definitions of high volume: (1) high-volume incidence centre, (2) high-volume treatment centre and (3) high-volume surgical centre. Independent predictors for administration of palliative chemotherapy were evaluated by means of multivariable logistic regression analysis, and multivariable Cox proportional hazard regression analysis was performed to assess the impact of high-volume centres on survival. RESULTS: Our data set comprised 4078 patients with metastatic oesophageal cancer, and 5425 patients with metastatic gastric cancer, with a median overall survival of 20 weeks (95% confidence interval [CI] 19-21 weeks) and 16 weeks (95% CI 15-17 weeks), respectively. Patients with oesophageal cancer treated in a high-volume surgical centre (adjusted hazard ratio [HR] 0.80, 95% CI 0.70-0.91) and a high-volume treatment centre (adjusted HR 0.88, 95% CI 0.78-0.99) exhibited a decreased risk of death. For gastric cancer, patients treated in a high-volume surgical centre (adjusted HR 0.83, 95% CI 0.74-0.92) had a superior outcome. CONCLUSION: Improved survival in patients undergoing palliative systemic therapy for oesophagogastric cancer was associated with treatment in high-volume treatment and surgical centres. Further research should be implemented to explore which specific factors of high-volume centres are associated with improved outcomes.
[Mh] Termos MeSH primário: Adenocarcinoma/cirurgia
Neoplasias Esofágicas/cirurgia
Neoplasias Gástricas/cirurgia
[Mh] Termos MeSH secundário: Adenocarcinoma/mortalidade
Adulto
Idoso
Idoso de 80 Anos ou mais
Neoplasias Esofágicas/mortalidade
Feminino
Tamanho das Instituições de Saúde/estatística & dados numéricos
Seres Humanos
Estimativa de Kaplan-Meier
Masculino
Meia-Idade
Metástase Neoplásica
Países Baixos/epidemiologia
Cuidados Paliativos/métodos
Sistema de Registros
Neoplasias Gástricas/mortalidade
Centros Cirúrgicos/estatística & dados numéricos
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170814
[Lr] Data última revisão:
170814
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170417
[St] Status:MEDLINE


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[PMID]:28302181
[Au] Autor:Cadilhac DA; Kilkenny MF; Andrew NE; Ritchie E; Hill K; Lalor E; Stroke Foundation National Advisory Committee: and the National Stroke Audit Collaborative
[Ad] Endereço:Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Department of Medicine, Monash University, Clayton, 3168, Vic, Australia. dominique.cadilhac@monash.edu.
[Ti] Título:Hospitals admitting at least 100 patients with stroke a year should have a stroke unit: a case study from Australia.
[So] Source:BMC Health Serv Res;17(1):212, 2017 Mar 16.
[Is] ISSN:1472-6963
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Establishing a stroke unit (SU) in every hospital may be infeasible because of limited resources. In Australia, it is recommended that hospitals that admit ≥100 strokes per year should have a SU. We aimed to describe differences in processes of care and outcomes among hospitals with and without SUs admitting at least 100 patients/year. METHODS: National stroke audit data of 40 consecutive patients per hospital admitted between 1/7/2010-31/12/2010 and organizational survey for annual admissions were used. Descriptive analyses and multilevel regression were used to compare patient outcomes. Sensitivity analysis including only hospitals meeting all of the Australian SU criteria (e.g., co-location of beds; inter-professional team; weekly meetings; regular training) was performed. RESULTS: Two thousand eight hundred ninety-eight patients from 72/108 eligible hospitals completing the audit (SU = 60; patients: 2,481 [mean age 76 years; 55% male] and non-SU patients: 417 [mean age 77; 53% male]). Hospitals with SUs had greater adherence to recommended care processes than non-SU hospitals. Patients treated in a SU hospital had fewer new strokes while in hospital (OR: 0.20; 95% CI 0.06, 0.61) and there was a borderline reduction in the odds of dying in hospital compared to patients in non-SU hospitals (OR 0.57 95%CI 0.33, 1.00). Among SU hospitals meeting all SU criteria (n = 59; 91%) the adjusted odds of having a poor outcome was further reduced compared with patients attending non-SU hospitals. CONCLUSION: Hospitals annually admitting ≥100 patients with acute stroke should be prioritized for establishment of a SU that meet all recommended criteria to ensure better outcomes.
[Mh] Termos MeSH primário: Unidades Hospitalares/provisão & distribuição
Acidente Vascular Cerebral/terapia
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Austrália
Feminino
Tamanho das Instituições de Saúde/estatística & dados numéricos
Recursos em Saúde/estatística & dados numéricos
Unidades Hospitalares/organização & administração
Hospitalização/estatística & dados numéricos
Hospitais/provisão & distribuição
Seres Humanos
Masculino
Inquéritos e Questionários
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL 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:170318
[St] Status:MEDLINE
[do] DOI:10.1186/s12913-017-2150-2


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[PMID]:27889596
[Au] Autor:Schwentner L; Helms G; Nekljudova V; Ataseven B; Bauerfeind I; Ditsch N; Fehm T; Fleige B; Hauschild M; Heil J; Kümmel S; Lebeau A; Schmatloch S; Schrenk P; Staebler A; Loibl S; Untch M; Von Minckwitz G; Liedtke C; Kühn T
[Ad] Endereço:Department of Gynecology and Obstetrics, University Ulm, Prittwitzstraße 43, 89075 Ulm, Germany.
[Ti] Título:Using ultrasound and palpation for predicting axillary lymph node status following neoadjuvant chemotherapy - Results from the multi-center SENTINA trial.
[So] Source:Breast;31:202-207, 2017 Feb.
[Is] ISSN:1532-3080
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: With the growing importance of neoadjuvant systemic therapy (NST) the assessment of post neoadjuvant axillary status is of increasing importance especially in patients who presented initially with suspicious nodes (cN1). This study aims to investigate the predictive value of palpation and axillary ultrasound of formerly cN1 patients following NST. PATIENTS AND METHODS: The SENTINA trial (SENTinel NeoAdjuvant) is a 4-arm prospective multicenter study designed to evaluate the role of sentinel node biopsy (SLNB) in the context of neoadjuvant systemic treatment (NST) of breast cancer patients. RESULTS: 1240 patients from 103 institutions entered the trial. 715 (arm C n = 592; arm D n = 123) patients, who presented initially cN1 underwent clinical evaluation of lymph node status following NST. Palpation alone demonstrated a sensitivity of 8.3%, specifity of 94.8% and a negative predictive value (NPV) of 46.6%. Ultrasound alone revealed a sensitivity of 23.9%, specificity 91.7%, and a NPV of 50.3%.The investigators combined classification (palpation and ultrasound) resulted in a sensitivity of 24.4%, specificity 91.4%, and a NPV of 50.3%. Investigators classified the axilla nodes as being unsuspicious (cN0) following NST in 592/715 patients; of them 298 (50.3%) were pN0, 151 (25.5%) had 1-2 histologically involved nodes and 143 (24.2%) had >2 histologically involved nodes. CONCLUSION: The diagnostic accuracy of ultrasound and palpation following NST is unacceptably low and additional tools for evaluation of the axillary lymph node status following NST are urgently needed.
[Mh] Termos MeSH primário: Neoplasias da Mama/tratamento farmacológico
Neoplasias da Mama/patologia
Linfonodos/diagnóstico por imagem
Linfonodos/patologia
Palpação
Ultrassonografia
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Axila/diagnóstico por imagem
Quimioterapia Adjuvante
Feminino
Tamanho das Instituições de Saúde
Seres Humanos
Metástase Linfática
Meia-Idade
Terapia Neoadjuvante
Valor Preditivo dos Testes
Estudos Prospectivos
Biópsia de Linfonodo Sentinela
Adulto Jovem
[Pt] Tipo de publicação:CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1703
[Cu] Atualização por classe:170901
[Lr] Data última revisão:
170901
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161128
[St] Status:MEDLINE


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[PMID]:27768222
[Au] Autor:Ivanova V; Dikov T; Dimitrova N
[Ad] Endereço:Department of General and Clinical Pathology, Medical University, Sofia - Bulgaria.
[Ti] Título:Histologic subtypes of ovarian carcinoma: selected diagnostic and classification problems in Bulgaria: is low hospital volume an issue?
[So] Source:Tumori;103(2):148-154, 2017 Mar 24.
[Is] ISSN:2038-2529
[Cp] País de publicação:Italy
[La] Idioma:eng
[Ab] Resumo:PURPOSE: To provide an overview of the morphologic subtypes of ovarian carcinomas in Bulgaria in relation to current healthcare organization using Bulgarian National Cancer Registry data. Further, we investigated hospital volume as a factor influencing the quality of care for patients with ovarian cancer. METHODS: Bulgarian National Cancer Registry ovarian carcinoma data were retrieved (2009-2011) and distribution of histologic types was analyzed. Cases were divided and compared with respect to main treatment: no surgery, surgery at hospitals dealing with ≥30 ovarian cancer patients/year (high volume), and surgery at hospitals dealing with <30 ovarian cancer patients/year (low volume). We then estimated the odds of being diagnosed with adenocarcinoma and carcinoma not otherwise specified (NOS) vs specified morphologies (serous, endometrioid, clear cell, and mucinous), including age, grade, stage, and hospital volume, in a logistic regression model. RESULTS: A total of 2,041 ovarian carcinomas were distributed as follows: serous 47.7%, mucinous 11.9%, endometrioid 5.8%, clear cell 1.8%, and adenocarcinoma and carcinoma NOS 32.5%. More than half of cancer patients (n = 1,100, 53.9%) were surgically treated in low-volume hospitals and they had a larger proportion of cases with adenocarcinoma and carcinoma NOS: 33.3%, in comparison with 24.0% in high-volume hospitals (p<0.0001). The odds of being diagnosed with unspecified morphology, assumed as a proxy of suboptimal quality of care, are higher for patients surgically treated in low-volume hospitals (odds ratio 1.50 [95% confidence interval 1.21-1.87]) compared with high-volume hospitals after adjustment for age, stage, and grade. CONCLUSIONS: The results of our study may serve policymakers and healthcare professionals when optimizing diagnosis and treatment of ovarian cancer in Bulgaria.
[Mh] Termos MeSH primário: Carcinoma/diagnóstico
Carcinoma/patologia
Neoplasias Ovarianas/diagnóstico
Neoplasias Ovarianas/patologia
[Mh] Termos MeSH secundário: Adenocarcinoma/diagnóstico
Adenocarcinoma/patologia
Bulgária
Feminino
Tamanho das Instituições de Saúde
Seres Humanos
Modelos Logísticos
Meia-Idade
Assistência ao Paciente
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1703
[Cu] Atualização por classe:170331
[Lr] Data última revisão:
170331
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161022
[St] Status:MEDLINE
[do] DOI:10.5301/tj.5000571


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[PMID]:27663296
[Au] Autor:Rush B; Romano K; Ashkanani M; McDermid RC; Celi LA
[Ad] Endereço:Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, University of British Columbia, Room 2438, Jim Pattison Pavilion, 2nd Floor, 855 W 12th Ave, Vancouver, British Columbia, Canada V5Z 1M9; Harvard T.H. Chan School of Public Health, Harvard University, 677 Hunting
[Ti] Título:Impact of hospital case-volume on subarachnoid hemorrhage outcomes: A nationwide analysis adjusting for hemorrhage severity.
[So] Source:J Crit Care;37:240-243, 2017 Feb.
[Is] ISSN:1557-8615
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: There have been suggestions that patients with subarachnoid hemorrhage (SAH) have a better outcome when treated in high-volume centers. Much of the published literature on the subject is limited by an inability to control for severity of SAH. METHODS: This is a nationwide retrospective cohort analysis using the Nationwide Inpatient Sample (NIS). The NIS Subarachnoid Severity Scale was used to adjust for severity of SAH in multivariate logistic regression modeling. RESULTS: The records of 47 911 414 hospital admissions from the 2006-2011 NIS samples were examined. There were 11 607 patients who met inclusion criteria for the study. Of these, 7787 (67.0%) were treated at a high-volume center compared with 3820 (32.9%) treated at a low-volume center. Patients treated at high-volume centers compared with low-volume centers were more likely to receive endovascular aneurysm control (58.5% vs 51.2%, P=.04), be transferred from another hospital (35.4% vs 19.7%, P<.01), be treated in a teaching facility (97.3% vs 72.9%, P<.01), and have a longer length of stay (14.9 days [interquartile range 10.3-21.7] vs 13.9 days [interquartile range, 8.9-20.1], P<.01). After adjustment for all baseline covariates, including severity of SAH, treatment in a high-volume center was associated with an odds ratio for death of 0.82 (95% confidence interval, 0.72-0.95; P<.01) and a higher odds of a good functional outcome (odds ratio, 1.16; 95% confidence interval, 1.04-1.28; P<.01). CONCLUSION: After adjustment for severity of SAH, treatment in a high-volume center was associated with a lower risk of in-hospital mortality and a higher odds of a good functional outcome.
[Mh] Termos MeSH primário: Procedimentos Endovasculares
Mortalidade Hospitalar
Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos
Hospitais com Baixo Volume de Atendimentos/estatística & dados numéricos
Hemorragia Subaracnóidea/terapia
[Mh] Termos MeSH secundário: Adulto
Idoso
Bases de Dados Factuais
Feminino
Tamanho das Instituições de Saúde
Hospitalização
Hospitais Rurais
Hospitais de Ensino/estatística & dados numéricos
Hospitais Urbanos
Seres Humanos
Tempo de Internação
Modelos Logísticos
Masculino
Meia-Idade
Análise Multivariada
Razão de Chances
Transferência de Pacientes/estatística & dados numéricos
Estudos Retrospectivos
Índice de Gravidade de Doença
Hemorragia Subaracnóidea/mortalidade
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171110
[Lr] Data última revisão:
171110
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160925
[St] Status:MEDLINE


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[PMID]:28057315
[Au] Autor:Kim SJ; Park EC; Han KT; Kim SJ; Kim TH
[Ad] Endereço:Department of Public Health, Graduate School, Yonsei University, Seoul, South Korea; Institute of Health Services Research, Yonsei University, Seoul, South Korea.
[Ti] Título:Nurse Staffing and 30-day Readmission of Chronic Obstructive Pulmonary Disease Patients: A 10-year Retrospective Study of Patient Hospitalization.
[So] Source:Asian Nurs Res (Korean Soc Nurs Sci);10(4):283-288, 2016 Dec.
[Is] ISSN:2093-7482
[Cp] País de publicação:Korea (South)
[La] Idioma:eng
[Ab] Resumo:PURPOSE: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity in many countries, and it has high rate of hospital readmissions due to recurrent exacerbations of the disease. Many previous studies have suggested further examination of the factors that contribute to hospital readmissions of COPD patients. However, evidence on the effects of nurse staffing by registered nurses (RNs) on the readmission of COPD patients is lacking in Korea. The aim of our study was to evaluate the effects of nurse staffing on hospital readmissions of COPD patients. METHODS: We used National Health Insurance claim data from 2002 to 2012. A total of 1,070 hospitals and 339,379 hospitalization cases were included in the analysis. We divided the number of RNs per 100 beds and the proportion of RNs on staff to one of three groups (Q1: low; Q2: moderate; Q3: high). A generalized estimating equation model was used to evaluate the associations between readmission and nurse staffing. RESULTS: A higher number of RNs was associated with lower readmission rates of 8.9% (Q2) and 7.9% (Q3) respectively. A similar effect was observed as the proportion of RNs among the total nursing staff gradually increased, resulting in lower readmission rates of 7.7% (Q2) and 8.3% (Q3). CONCLUSIONS: Our results suggest notable positive effects of nurse staffing by RNs on patient outcomes. In addition, the magnitude of impact differed between different sizes of hospitals. Thus, human resource planning to solve staffing shortages should carefully consider the qualitative aspects of the nursing staff composition.
[Mh] Termos MeSH primário: Enfermeiras e Enfermeiros/provisão & distribuição
Recursos Humanos de Enfermagem no Hospital/provisão & distribuição
Readmissão do Paciente/estatística & dados numéricos
Doença Pulmonar Obstrutiva Crônica/enfermagem
[Mh] Termos MeSH secundário: Idoso
Feminino
Tamanho das Instituições de Saúde/estatística & dados numéricos
Hospitais Gerais/estatística & dados numéricos
Seres Humanos
Masculino
Avaliação de Resultados da Assistência ao Paciente
Admissão e Escalonamento de Pessoal
Qualidade da Assistência à Saúde
Recidiva
República da Coreia
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1702
[Cu] Atualização por classe:170214
[Lr] Data última revisão:
170214
[Sb] Subgrupo de revista:IM; N
[Da] Data de entrada para processamento:170107
[St] Status:MEDLINE


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[PMID]:27780971
[Au] Autor:Patel KV; Darakhshan AA; Griffin N; Williams AB; Sanderson JD; Irving PM
[Ad] Endereço:IBD Centre, Department of Gastroenterology, First Floor College House, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK.
[Ti] Título:Patient optimization for surgery relating to Crohn's disease.
[So] Source:Nat Rev Gastroenterol Hepatol;13(12):707-719, 2016 Dec.
[Is] ISSN:1759-5053
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:The majority of patients with Crohn's disease require abdominal surgery during their lifetime, some of whom will require multiple operations. Postoperative complications are seen more frequently in patients requiring abdominal surgery for Crohn's disease than in patients requiring abdominal surgery for other conditions. In this article, we review the evidence supporting preoperative optimization, discussing strategies that potentially improve surgical outcomes and reduce perioperative morbidity and mortality. We discuss the roles of adequate cross-sectional imaging, nutritional optimization, appropriate adjustments of medical therapy, management of preoperative abscesses and phlegmons, smoking cessation and thromboembolic prophylaxis. We also review operation-related factors, and discuss their potential implications with respect to postoperative complications. Overall, the literature suggests that preoperative management has a major effect on postoperative outcomes.
[Mh] Termos MeSH primário: Doença de Crohn/cirurgia
Cuidados Pré-Operatórios
[Mh] Termos MeSH secundário: Abscesso Abdominal/cirurgia
Corticosteroides/uso terapêutico
Anastomose Cirúrgica
Anemia/etiologia
Fatores Biológicos/uso terapêutico
Celulite (Flegmão)/cirurgia
Testes de Química Clínica/normas
Doença de Crohn/diagnóstico
Doença de Crohn/tratamento farmacológico
Procedimentos Cirúrgicos Eletivos
Tratamento de Emergência
Teste de Esforço
Tamanho das Instituições de Saúde
Seres Humanos
Imunossupressores/uso terapêutico
Laparoscopia
Imagem por Ressonância Magnética
Margens de Excisão
Estado Nutricional
Seleção de Pacientes
Complicações Pós-Operatórias/etiologia
Complicações Pós-Operatórias/prevenção & controle
Cuidados Pré-Operatórios/métodos
Medição de Risco/métodos
Albumina Sérica/metabolismo
Fumar/efeitos adversos
Tromboembolia/prevenção & controle
Tomografia Computadorizada por Raios X
Ultrassonografia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Adrenal Cortex Hormones); 0 (Biological Factors); 0 (Immunosuppressive Agents); 0 (Serum Albumin)
[Em] Mês de entrada:1705
[Cu] Atualização por classe:170522
[Lr] Data última revisão:
170522
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161104
[St] Status:MEDLINE
[do] DOI:10.1038/nrgastro.2016.158



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