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  1 / 9417 MEDLINE  
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[PMID]:25816387
[Au] Autor:Bazuin D; Martinez J; Harper K; Okland K; Bergquist P; Kumar S
[Ad] Endereço:Herman Miller, Inc., Holland, MI, USA doug_bazuin@hermanmiller.com.
[Ti] Título:If I were a band-aid, where would I be? Researching the use and location of supplies on two patient units.
[So] Source:HERD;8(2):110-22, 2015.
[Is] ISSN:1937-5867
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: The purpose of this study was to gain insight into the use and storage of supplies in the neonatal intensive care and women's health units of Parkland Hospital in Dallas, Texas. BACKGROUND: Construction of a new Parkland Hospital is underway, with completion of the 862-bed, 2.5-million square feet hospital in 2014. Leaders from the hospital and representatives from one of its major vendors collaborated on a research study to evaluate the hospital's current supply management system and develop criteria to create an improved system to be implemented at the new hospital. METHOD: Approach includes qualitative and quantitative methods, that is, written survey, researcher observations, focus groups, and evaluation of hospital supply reports. RESULTS: Approaching the ideal location of supplies can be best approached by defining a nurse's activity at the point of care. Determining an optimal supply management system must be approached by understanding the "what" of caregivers' activities and then determining the "where" of the supplies that support those activities. CONCLUSIONS: An ideal supply management system locates supplies as close as possible to the point of use, is organized by activity, and is standardized within and across units.
[Mh] Termos MeSH primário: Equipamentos e Provisões Hospitalares
Unidades de Terapia Intensiva Neonatal/organização & administração
Decoração de Interiores e Mobiliário/normas
Administração de Materiais no Hospital/normas
Recursos Humanos de Enfermagem no Hospital/organização & administração
Serviços de Saúde da Mulher/organização & administração
[Mh] Termos MeSH secundário: Eficiência Organizacional
Estudos de Avaliação como Assunto
Grupos Focais
Pesquisas sobre Serviços de Saúde
Pesquisa sobre Serviços de Saúde/métodos
Pesquisa sobre Serviços de Saúde/organização & administração
Unidades Hospitalares/organização & administração
Seres Humanos
Decoração de Interiores e Mobiliário/métodos
Administração de Materiais no Hospital/métodos
Recursos Humanos de Enfermagem no Hospital/psicologia
Pesquisa Qualitativa
Texas
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180126
[Lr] Data última revisão:
180126
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:150328
[St] Status:MEDLINE
[do] DOI:10.1177/1937586714566409


  2 / 9417 MEDLINE  
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[PMID]:25816381
[Au] Autor:Pati D; Harvey TE; Redden P; Summers B; Pati S
[Ad] Endereço:Department of Design, Texas Tech University, Lubbock, TX, USA d.pati@ttu.edu.
[Ti] Título:An empirical examination of the impacts of decentralized nursing unit design.
[So] Source:HERD;8(2):56-70, 2015.
[Is] ISSN:1937-5867
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: The objective of the study was to examine the impact of decentralization on operational efficiency, staff well-being, and teamwork on three inpatient units. BACKGROUND: Decentralized unit operations and the corresponding physical design solution were hypothesized to positively affect several concerns-productive use of nursing time, staff stress, walking distances, and teamwork, among others. With a wide adoption of the concept, empirical evidence on the impact of decentralization was warranted. METHODS: A multimethod, before-and-after, quasi-experimental design was adopted for the study, focusing on five issues, namely, (1) how nurses spend their time, (2) walking distance, (3) acute stress, (4) productivity, and (5) teamwork. Data on all five issues were collected on three older units with centralized operational model (before move). The same set of data, with identical tools and measures, were collected on the same units after move in to new physical units with decentralized operational model. Data were collected during spring and fall of 2011. RESULTS: Documentation, nurse station use, medication room use, and supplies room use showed consistent change across the three units. Walking distance increased (statistically significant) on two of the three units. Self-reported level of collaboration decreased, although assessment of the physical facility for collaboration increased. CONCLUSIONS: Decentralized nursing and physical design models potentially result in quality of work improvements associated with documentation, medication, and supplies. However, there are unexpected consequences associated with walking, and staff collaboration and teamwork. The solution to the unexpected consequences may lie in operational interventions and greater emphasis on culture change.
[Mh] Termos MeSH primário: Ergonomia
Unidades Hospitalares/organização & administração
Decoração de Interiores e Mobiliário
Satisfação no Emprego
Recursos Humanos de Enfermagem no Hospital/organização & administração
Postos de Enfermagem/organização & administração
Saúde do Trabalhador
Equipe de Assistência ao Paciente/organização & administração
[Mh] Termos MeSH secundário: Eficiência Organizacional
Feminino
Seres Humanos
Relações Interprofissionais
Masculino
Recursos Humanos de Enfermagem no Hospital/psicologia
Fatores de Tempo
Caminhada/estatística & dados numéricos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180126
[Lr] Data última revisão:
180126
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:150328
[St] Status:MEDLINE
[do] DOI:10.1177/1937586715568986


  3 / 9417 MEDLINE  
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[PMID]:28505059
[Au] Autor:Plamann JM; Zedreck-Gonzalez J; Fennimore L
[Ad] Endereço:St Cloud Hospital, St Cloud, Minnesota (Dr Plamann); and University of Pittsburgh, Pittsburgh, Pennsylvania (Drs Zedreck-Gonzalez and Fennimore).
[Ti] Título:Creation of an Adult Observation Unit: Improving Outcomes.
[So] Source:J Nurs Care Qual;33(1):72-78, 2018 Jan/Mar.
[Is] ISSN:1550-5065
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:A growing segment of patients in hospitals are considered outpatients, classified as observation. These patients neither have the severity of illness nor the intensity of service to qualify as inpatients, yet are not well enough to be discharged. Hospitals have created observation units to address the clinical needs of this growing patient type to provide care in the right setting by managing emergency department throughput and utilizing the most efficient staffing resources. This article describes the change processes and improvements in quality, length of stay, and patient satisfaction, which occurred following the implementation of an adult observation unit.
[Mh] Termos MeSH primário: Eficiência Organizacional
Serviço Hospitalar de Emergência/economia
Unidades Hospitalares/utilização
Observação/métodos
[Mh] Termos MeSH secundário: Adulto
Unidades Hospitalares/tendências
Seres Humanos
Tempo de Internação/estatística & dados numéricos
Admissão do Paciente/estatística & dados numéricos
Satisfação do Paciente
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180123
[Lr] Data última revisão:
180123
[Sb] Subgrupo de revista:IM; N
[Da] Data de entrada para processamento:170516
[St] Status:MEDLINE
[do] DOI:10.1097/NCQ.0000000000000267


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[PMID]:29228010
[Au] Autor:Heckel M; Geißdörfer W; Herbst FA; Stiel S; Ostgathe C; Bogdan C
[Ad] Endereço:Department of Palliative Medicine, Comprehensive Cancer Center CCC Erlangen-EMN, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Germany.
[Ti] Título:Nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) at a palliative care unit: A prospective single service analysis.
[So] Source:PLoS One;12(12):e0188940, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The emergence of multidrug-resistant bacterial microorganisms is a particular challenge for the health care systems. Little is known about the occurrence of methicillin-resistant Staphylococcus aureus (MRSA) and multidrug-resistant Gram-negative bacteria (MDRGNB) in patients of palliative care units (PCU). AIM: The primary aim of this study was to determine the carriage of MRSA among patients of a PCU at a German University Hospital and to assess whether the positive cases would have been detected by a risk-factor-based screening-approach. DESIGN: Between February 2014 and January 2015 patients from our PCU were tested for MRSA carriage within 48 hours following admission irrespective of pre-existing risk factors. In addition, risk factors for MRSA colonization were assessed. Samples from the nostrils and, if applicable, from pre-existing wounds were analysed by standardized culture-based laboratory techniques for the presence of MRSA and of other bacteria and fungi. Results from swabs taken prior to admission were also recorded if available. RESULTS: 297 out of 317 patients (93.7%) fulfilled one or more MRSA screening criteria. Swabs from 299 patients were tested. The detection rate was 2.1% for MRSA. All MRSA cases would have been detected by a risk-factor-based screening-approach. Considering the detected cases and the results from swabs taken prior to admission, 4.1% of the patients (n = 13) were diagnosed with MRSA and 4.1% with MDRGNB (n = 13), including two patients with MRSA and MDRGNB (0.6%). The rate of MRSA carriage in PCU patients (4.1%) was elevated compared to the rate seen in the general cohort of patients admitted to our University Hospital (2.7%). CONCLUSIONS: PCU patients have an increased risk to carry MRSA compared to other hospitalized patients. Although a risk factor-based screening is likely to detect all MRSA carriers amongst PCU patients, we rather recommend a universal screening to avoid the extra effort to identify the few risk factor-negative patients (<7%). As we did not perform a systematic MDRGNB screening, further studies are needed to determine the true prevalence of MDRGNB amongst PCU patients.
[Mh] Termos MeSH primário: Unidades Hospitalares
Staphylococcus aureus Resistente à Meticilina/isolamento & purificação
Cavidade Nasal/microbiologia
Cuidados Paliativos
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Portador Sadio
Feminino
Seres Humanos
Masculino
Meia-Idade
Estudos Prospectivos
Fatores de Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180104
[Lr] Data última revisão:
180104
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171212
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0188940


  5 / 9417 MEDLINE  
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[PMID]:29187937
[Au] Autor:Akbari N; Malek M; Ebrahimi P; Haghani H; Aazami S
[Ad] Endereço:Faculty of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.
[Ti] Título:Safety culture in the maternity unit of hospitals in Ilam province, Iran: a census survey using HSOPSC tool.
[So] Source:Pan Afr Med J;27:268, 2017.
[Is] ISSN:1937-8688
[Cp] País de publicação:Uganda
[La] Idioma:eng
[Ab] Resumo:Introduction: Improving quality of maternal care as well as patients' safety are two important issues in health-care service. Therefore, this study aimed to assess the culture of patient safety at maternity units. Methods: This cross-sectional study was conducted among staffs working at maternity units in seven hospitals of Ilam city, Iran. The staffs included in this study were gynecologists and midwifes working in different positions including matron, supervisors, head of departments and staffs. Data were collected using the Hospital Survey on Patient Safety Culture (HSOPSC). Results: This study indicated that 59.1% of participants reported fair level of overall perceptions of safety and 67.1% declared that no event was reported during the past 12 months. The most positively perceived dimension of safety culture was teamwork within departments in view of managers (79.41) and personnel (81.10). However, the least positively perceived dimensions of safety culture was staffing levels. Conclusion: The current study revealed areas of strength (teamwork within departments) and weakness (staffing, punitive responses to error) among managers and personnel. In addition, we found that staffs in Ilam's hospitals accept the patient safety culture in maternity units, but, still are far away from excellent culture of patient safety. Therefore, it is necessary to promote culture of patient's safety among professions working in the maternity units of Ilam's hospitals.
[Mh] Termos MeSH primário: Ginecologia/normas
Serviços de Saúde Materna/normas
Qualidade da Assistência à Saúde
[Mh] Termos MeSH secundário: Adulto
Estudos Transversais
Feminino
Pesquisas sobre Serviços de Saúde
Unidades Hospitalares
Seres Humanos
Irã (Geográfico)
Masculino
Tocologia/normas
Tocologia/estatística & dados numéricos
Equipe de Assistência ao Paciente/organização & administração
Recursos Humanos em Hospital/normas
Gravidez
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171219
[Lr] Data última revisão:
171219
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171201
[St] Status:MEDLINE
[do] DOI:10.11604/pamj.2017.27.268.9776


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[PMID]:29215475
[Au] Autor:Gorgun E; Rencuzogullari A; Ozben V; Stocchi L; Fraser T; Benlice C; Hull T
[Ad] Endereço:Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio.
[Ti] Título:An Effective Bundled Approach Reduces Surgical Site Infections in a High-Outlier Colorectal Unit.
[So] Source:Dis Colon Rectum;61(1):89-98, 2018 Jan.
[Is] ISSN:1530-0358
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Surgical site infections are the most common hospital-acquired infection after colorectal surgery, increasing morbidity, mortality, and hospital costs. OBJECTIVE: The purpose of this study was to investigate the impact of preventive measures on colorectal surgical site infection rates in a high-volume institution that performs inherent high-risk procedures. DESIGN: This was a prospective cohort study. SETTINGS: The study was conducted at a high-volume, specialized colorectal surgery department. PATIENTS: The Prospective Surgical Site Infection Prevention Bundle Project included 14 preoperative, intraoperative, and postoperative measures to reduce surgical site infection occurrence after colorectal surgery. Surgical site infections within 30 days of the index operation were examined for patients during the 1-year period after the surgical site infection prevention bundle was implemented. The data collection and outcomes for this period were compared with the year immediately before the implementation of bundle elements. All of the patients who underwent elective colorectal surgery by a total of 17 surgeons were included. The following procedures were excluded from the analysis to obtain a homogeneous patient population: ileostomy closure and anorectal and enterocutaneous fistula repair. MAIN OUTCOME MEASURES: Surgical site infection occurring within 30 days of the index operation was measured. Surgical site infection-related outcomes after implementation of the bundle (bundle February 2014 to February 2015) were compared with same period a year before the implementation of bundle elements (prebundle February 2013 to February 2014). RESULTS: Between 2013 and 2015, 2250 abdominal colorectal surgical procedures were performed, including 986 (43.8%) during the prebundle period and 1264 (56.2%) after the bundle project. Patient characteristics and comorbidities were similar in both periods. Compliance with preventive measures ranged between 75% and 99% during the bundle period. The overall surgical site infection rate decreased from 11.8% prebundle to 6.6% at the bundle period (P < 0.001). Although a decrease for all types of surgical site infections was observed after the bundle implementation, a significant reduction was achieved in the organ-space subgroup (5.5%-1.7%; P < 0.001). LIMITATION: We were unable to predict the specific contributions the constituent bundle interventions made to the surgical site infection reduction. CONCLUSIONS: The prospective Surgical Site Infection Prevention Bundle Project resulted in a substantial decline in surgical site infection rates in our department. Collaborative and enduring efforts among multiple providers are critical to achieve a sustained reduction See Video Abstract at http://links.lww.com/DCR/A438.
[Mh] Termos MeSH primário: Cirurgia Colorretal/efeitos adversos
Pacotes de Assistência ao Paciente/métodos
Infecção da Ferida Cirúrgica/prevenção & controle
[Mh] Termos MeSH secundário: Adulto
Idoso
Feminino
Unidades Hospitalares/estatística & dados numéricos
Seres Humanos
Masculino
Meia-Idade
Equipe de Assistência ao Paciente
Estudos Prospectivos
Infecção da Ferida Cirúrgica/economia
Infecção da Ferida Cirúrgica/etiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171215
[Lr] Data última revisão:
171215
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171208
[St] Status:MEDLINE
[do] DOI:10.1097/DCR.0000000000000929


  7 / 9417 MEDLINE  
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[PMID]:29088237
[Au] Autor:Haines TP; Bowles KA; Mitchell D; O'Brien L; Markham D; Plumb S; May K; Philip K; Haas R; Sarkies MN; Ghaly M; Shackell M; Chiu T; McPhail S; McDermott F; Skinner EH
[Ad] Endereço:Department of Physiotherapy, Monash University, Frankston, Victoria, Australia.
[Ti] Título:Impact of disinvestment from weekend allied health services across acute medical and surgical wards: 2 stepped-wedge cluster randomised controlled trials.
[So] Source:PLoS Med;14(10):e1002412, 2017 Oct.
[Is] ISSN:1549-1676
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Disinvestment (removal, reduction, or reallocation) of routinely provided health services can be difficult when there is little published evidence examining whether the services are effective or not. Evidence is required to understand if removing these services produces outcomes that are inferior to keeping such services in place. However, organisational imperatives, such as budget cuts, may force healthcare providers to disinvest from these services before the required evidence becomes available. There are presently no experimental studies examining the effectiveness of allied health services (e.g., physical therapy, occupational therapy, and social work) provided on weekends across acute medical and surgical hospital wards, despite these services being routinely provided internationally. The aim of this study was to understand the impact of removing weekend allied health services from acute medical and surgical wards using a disinvestment-specific non-inferiority research design. METHODS AND FINDINGS: We conducted 2 stepped-wedge cluster randomised controlled trials between 1 February 2014 and 30 April 2015 among patients on 12 acute medical or surgical hospital wards spread across 2 hospitals. The hospitals involved were 2 metropolitan teaching hospitals in Melbourne, Australia. Data from n = 14,834 patients were collected for inclusion in Trial 1, and n = 12,674 in Trial 2. Trial 1 was a disinvestment-specific non-inferiority stepped-wedge trial where the 'current' weekend allied health service was incrementally removed from participating wards each calendar month, in a random order, while Trial 2 used a conventional non-inferiority stepped-wedge design, where a 'newly developed' service was incrementally reinstated on the same wards as in Trial 1. Primary outcome measures were patient length of stay (proportion staying longer than expected and mean length of stay), the proportion of patients experiencing any adverse event, and the proportion with an unplanned readmission within 28 days of discharge. The 'no weekend allied health service' condition was considered to be not inferior if the 95% CIs of the differences between this condition and the condition with weekend allied health service delivery were below a 2% increase in the proportion of patients who stayed in hospital longer than expected, a 2% increase in the proportion who had an unplanned readmission within 28 days, a 2% increase in the proportion who had any adverse event, and a 1-day increase in the mean length of stay. The current weekend allied health service included physical therapy, occupational therapy, speech therapy, dietetics, social work, and allied health assistant services in line with usual care at the participating sites. The newly developed weekend allied health service allowed managers at each site to reprioritise tasks being performed and the balance of hours provided by each professional group and on which days they were provided. Analyses conducted on an intention-to-treat basis demonstrated that there was no estimated effect size difference between groups in the proportion of patients staying longer than expected (weekend versus no weekend; estimated effect size difference [95% CI], p-value) in Trial 1 (0.40 versus 0.38; estimated effect size difference 0.01 [-0.01 to 0.04], p = 0.31, CI was both above and below non-inferiority margin), but the proportion staying longer than expected was greater with the newly developed service compared to its no weekend service control condition (0.39 versus 0.40; estimated effect size difference 0.02 [0.01 to 0.04], p = 0.04, CI was completely below non-inferiority margin) in Trial 2. Trial 1 and 2 findings were discordant for the mean length of stay outcome (Trial 1: 5.5 versus 6.3 days; estimated effect size difference 1.3 days [0.9 to 1.8], p < 0.001, CI was both above and below non-inferiority margin; Trial 2: 5.9 versus 5.0 days; estimated effect size difference -1.6 days [-2.0 to -1.1], p < 0.001, CI was completely below non-inferiority margin). There was no difference between conditions for the proportion who had an unplanned readmission within 28 days in either trial (Trial 1: 0.01 [-0.01 to 0.03], p = 0.18, CI was both above and below non-inferiority margin; Trial 2: -0.01 [-0.02 to 0.01], p = 0.62, CI completely below non-inferiority margin). There was no difference between conditions in the proportion of patients who experienced any adverse event in Trial 1 (0.01 [-0.01 to 0.03], p = 0.33, CI was both above and below non-inferiority margin), but a lower proportion of patients had an adverse event in Trial 2 when exposed to the no weekend allied health condition (-0.03 [-0.05 to -0.004], p = 0.02, CI completely below non-inferiority margin). Limitations of this research were that 1 of the trial wards was closed by the healthcare provider after Trial 1 and could not be included in Trial 2, and that both withdrawing the current weekend allied health service model and installing a new one may have led to an accommodation period for staff to adapt to the new service settings. Stepped-wedge trials are potentially susceptible to bias from naturally occurring change over time at the service level; however, this was adjusted for in our analyses. CONCLUSIONS: In Trial 1, criteria to say that the no weekend allied health condition was non-inferior to current weekend allied health condition were not met, while neither the no weekend nor current weekend allied health condition demonstrated superiority. In Trial 2, the no weekend allied health condition was non-inferior to the newly developed weekend allied health condition across all primary outcomes, and superior for the outcomes proportion of patients staying longer than expected, proportion experiencing any adverse event, and mean length of stay. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12613001231730 and ACTRN12613001361796.
[Mh] Termos MeSH primário: Plantão Médico/organização & administração
Dietética/organização & administração
Serviços de Saúde
Unidades Hospitalares
Terapia Ocupacional/organização & administração
Fisioterapia/organização & administração
Serviço Social/organização & administração
[Mh] Termos MeSH secundário: Plantão Médico/economia
Pessoal Técnico de Saúde
Austrália
Dietética/economia
Hospitalização
Seres Humanos
Tempo de Internação/estatística & dados numéricos
Modelos Lineares
Análise Multinível
Terapia Ocupacional/economia
Readmissão do Paciente/estatística & dados numéricos
Fisioterapia/economia
Serviço Social/economia
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171110
[Lr] Data última revisão:
171110
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171101
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pmed.1002412


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[PMID]:28850314
[Au] Autor:Dubiel G; Rogozinski P; Zaloudik E; Brulinski K; Rózanska A; Wójkowska-Mach J
[Ad] Endereço:1 Center of Pulmonology and Toracic Surgery in Bystra , Bystra, Poland .
[Ti] Título:Identifying the Infection Control Areas Requiring Modifications in Thoracic Surgery Units: Results of a Two-Year Surveillance of Surgical Site Infections in Hospitals in Southern Poland.
[So] Source:Surg Infect (Larchmt);18(7):820-826, 2017 Oct.
[Is] ISSN:1557-8674
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Surgical site infection (SSI) is considered to be a priority in infection control. The objective of this study is the analysis of results of active targeted surveillance conducted over a two-year period in the Department of Thoracic Surgery at the Pulmonology and Thoracic Surgery Center in Bystra, in southern Poland. PATIENTS AND METHODS: The retrospective analysis was carried out on the basis of results of active monitoring of SSI in the 45-bed Department of Thoracic Surgery at the Pulmonology and Thoracic Surgery Center in Bystra between April 1, 2014 and April 30, 2016. Surgical site infections were identified based on the definitions of the European Centre for Disease Prevention and Control (ECDC) taking into account the time of symptom onset, specifically, whether the symptoms occurred within 30 d after the surgical procedure. Detection of SSI relied on daily inspection of incisions by a trained nurse, analysis of medical and nursing entries in the computer system, and analysis of all results of microbiologic tests taken in the unit and in the operating room. RESULTS: In the study period, data were collected regarding 1,387 treatment procedures meeting the registration criteria. Forty cases of SSI were detected yielding an incidence rate of 3%. Most cases (55%) were found in the course of hospitalization and 45% were detected after the patient's discharge. The SSIs were classified as follows: superficial, 37.5%; deep infections, 7.5%; and organ/space infection, 55%. Among patients who were diagnosed with SSI, most were male (77.5%). For patients with an American Society of Anesthesiologists (ASA) score I-II the incidence rate was 2%; ASA score III or more, 3.7%. The incidence rate varied from 0.3% in clean surgical site to 6.5% in clean-contaminated site. CONCLUSIONS: The study validated the usefulness of targeted surveillance in monitoring SSIs in patients hospitalized in thoracic surgery departments. Surgical site infection surveillance identified areas of care requiring modifications, namely, organization of post-discharge and microbiologic diagnostics of infection cases.
[Mh] Termos MeSH primário: Infecção da Ferida Cirúrgica/epidemiologia
Infecção da Ferida Cirúrgica/microbiologia
Procedimentos Cirúrgicos Torácicos/efeitos adversos
[Mh] Termos MeSH secundário: Idoso
Bactérias/classificação
Bactérias/isolamento & purificação
Feminino
Unidades Hospitalares
Seres Humanos
Masculino
Meia-Idade
Polônia/epidemiologia
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171026
[Lr] Data última revisão:
171026
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170830
[St] Status:MEDLINE
[do] DOI:10.1089/sur.2017.010


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[PMID]:28837628
[Au] Autor:Hallengren M; Åstrand P; Eksborg S; Barle H; Frostell C
[Ad] Endereço:Department of Clinical Sciences, Division of Anaesthesia and Intensive Care, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
[Ti] Título:Septic shock and the use of norepinephrine in an intermediate care unit: Mortality and adverse events.
[So] Source:PLoS One;12(8):e0183073, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Septic shock is associated with high mortality. Aged and multimorbid patients are not always eligible for intensive care units. Norepinephrine is an accepted treatment for hypotension in septic shock. It is unknown whether norepinephrine has a place in treatment outside an intensive care unit and when given peripherally. OBJECTIVES: To describe mortality, Acute Physiology And Chronic Health Evaluation (APACHE-II), time to mean arterial pressure >65 mmHg, and adverse events in patients with septic shock receiving norepinephrine peripherally in an intermediate care unit. METHODS: From a retrospective chart review of 91 patients with septic shock treated with norepinephrine for hypotension, ward mortality, 30-, 60- and 90-day mortality, standardized mortality ratio (SMR) and adverse events (necrosis and arrhythmia) were analysed. Administration route via peripheral venous catheter or central venous catheter was registered. RESULTS: Median age was 81 (43-96) years and median APACHE-II score was 26 (12-42). Observed ward mortality was 27.5% (SMR 0.443, 95% CI: 0.287-0.654), and 30-day and 90-day mortality were 47.2% and 58.2%, respectively. CONCLUSIONS: Elderly patients with septic shock treated with norepinephrine displayed a better survival in the ward and at 30 days than expected. Our retrospective study did not indicate frequent complications when administering norepinephrine via a peripheral venous catheter.
[Mh] Termos MeSH primário: Unidades Hospitalares
Norepinefrina/efeitos adversos
Choque Séptico/tratamento farmacológico
Choque Séptico/mortalidade
[Mh] Termos MeSH secundário: APACHE
Adulto
Idoso
Idoso de 80 Anos ou mais
Feminino
Seres Humanos
Masculino
Meia-Idade
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
X4W3ENH1CV (Norepinephrine)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171023
[Lr] Data última revisão:
171023
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170825
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0183073


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[PMID]:28711132
[Au] Autor:Wheatley MA
[Ad] Endereço:Department of Emergency Medicine, Emory University School of Medicine, 49 Jesse Hill Jr. Drive Southeast, Atlanta, GA 30303, USA. Electronic address: mwheatl@emory.edu.
[Ti] Título:Additional Conditions Amenable to Observation Care.
[So] Source:Emerg Med Clin North Am;35(3):701-712, 2017 Aug.
[Is] ISSN:1558-0539
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:ED observation units (EDOUs) are designed for patients who require diagnostics or therapeutics beyond the initial ED visit to determine the need for hospital admission. Best evidence is that this care be delivered via ordersets or protocols. Occasionally, patients present with conditions that are amenable to EDOU care but fall outside the commonly used protocols. This article details a few of these conditions: abnormal uterine bleeding, allergic reaction, alcohol intoxication, acetaminophen overdose and sickle cell vaso-occlusive crisis. It is not meant to be exhaustive as patient care needs can vary hospital to hospital.
[Mh] Termos MeSH primário: Emergências
Unidades Hospitalares
Observação
[Mh] Termos MeSH secundário: Intoxicação Alcoólica/terapia
Anemia Falciforme/terapia
Overdose de Drogas/terapia
Serviço Hospitalar de Emergência/organização & administração
Feminino
Seres Humanos
Hipersensibilidade/terapia
Hemorragia Uterina/terapia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170823
[Lr] Data última revisão:
170823
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170717
[St] Status:MEDLINE



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