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[PMID]:29318267
[Au] Autor:Joynt Maddox KE; Orav EJ; Zheng J; Epstein AM
[Ad] Endereço:Washington University School of Medicine, St Louis, Missouri.
[Ti] Título:Participation and Dropout in the Bundled Payments for Care Improvement Initiative.
[So] Source:JAMA;319(2):191-193, 2018 01 09.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Hospitais/estatística & dados numéricos
Medicare/economia
Pacotes de Assistência ao Paciente/economia
Mecanismo de Reembolso/utilização
[Mh] Termos MeSH secundário: Centers for Medicare and Medicaid Services (U.S.)
Modelos Logísticos
Estatísticas não Paramétricas
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180311
[Lr] Data última revisão:
180311
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180111
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.14771


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[PMID]:29447291
[Au] Autor:Tanuseputro P; Beach S; Chalifoux M; Wodchis WP; Hsu AT; Seow H; Manuel DG
[Ad] Endereço:Bruyère Research Institute, Ottawa, Ontario, Canada.
[Ti] Título:Associations between physician home visits for the dying and place of death: A population-based retrospective cohort study.
[So] Source:PLoS One;13(2):e0191322, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: While most individuals wish to die at home, the reality is that most will die in hospital. AIM: To determine whether receiving a physician home visit near the end-of-life is associated with lower odds of death in a hospital. DESIGN: Observational retrospective cohort study, examining location of death and health care in the last year of life. SETTING/PARTICIPANTS: Population-level study of Ontarians, a Canadian province with over 13 million residents. All decedents from April 1, 2010 to March 31, 2013 (n = 264,754). RESULTS: More than half of 264,754 decedents died in hospital: 45.7% died in an acute care hospital and 7.7% in complex continuing care. After adjustment for multiple factors-including patient illness, home care services, and days of being at home-receiving at least one physician home visit from a non-palliative care physician was associated with a 47% decreased odds (odds-ratio, 0.53; 95%CI: 0.51-0.55) of dying in a hospital. When a palliative care physician specialist was involved, the overall odds declined by 59% (odds ratio, 0.41; 95%CI: 0.39-0.43). The same model, adjusting for physician home visits, showed that receiving palliative home care was associated with a similar reduction (odds ratio, 0.49; 95%CI: 0.47-0.51). CONCLUSION: Location of death is strongly associated with end-of-life health care in the home. Less than one-third of the population, however, received end-of-life home care or a physician visit in their last year of life, revealing large room for improvement.
[Mh] Termos MeSH primário: Hospitais/utilização
Visita Domiciliar/utilização
Assistência Terminal/métodos
[Mh] Termos MeSH secundário: Canadá
Estudos de Coortes
Morte
Feminino
Serviços de Assistência Domiciliar/tendências
Serviços de Assistência Domiciliar/utilização
Cuidados Paliativos na Terminalidade da Vida/tendências
Hospitalização/tendências
Hospitais/tendências
Seres Humanos
Masculino
Razão de Chances
Cuidados Paliativos
Médicos
Qualidade de Vida
Estudos Retrospectivos
Assistência Terminal/tendências
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180216
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0191322


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


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[PMID]:28449646
[Au] Autor:Lubbe W; Ten Ham-Baloyi W
[Ad] Endereço:North-West University, School of Nursing Science, Private Bag X6001, Potchefstroom, 2520, South Africa. welma.lubbe@nwu.ac.za.
[Ti] Título:When is the use of pacifiers justifiable in the baby-friendly hospital initiative context? A clinician's guide.
[So] Source:BMC Pregnancy Childbirth;17(1):130, 2017 04 27.
[Is] ISSN:1471-2393
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The use of pacifiers is an ancient practice, but often becomes a point of debate when parents and professionals aim to protect and promote breastfeeding as most appropriately for nurturing infants. We discuss the current literature available on pacifier use to enable critical decision-making regarding justifiable use of pacifiers, especially in the Baby-Friendly Hospital Initiative context, and we provide practical guidelines for clinicians. DISCUSSION: Suck-swallow-breathe coordination is an important skill that every newborn must acquire for feeding success. In most cases the development and maintenance of the sucking reflex is not a problem, but sometimes the skill may be compromised due to factors such as mother-infant separation or medical conditions. In such situations the use of pacifiers can be considered therapeutic and even provide medical benefits to infants, including reducing the risk of sudden infant death syndrome. The argument opposing pacifier use, however, is based on potential risks such as nipple confusion and early cessation of breastfeeding. The Ten Steps to Successful Breastfeeding as embedded in the Baby-Friendly Hospital Initiative initially prohibited the use of pacifiers in a breastfeeding friendly environment to prevent potential associated risks. This article provides a summary of the evidence on the benefits of non-nutritive sucking, risks associated with pacifier use, an identification of the implications regarded as 'justifiable' in the clinical use of pacifiers and a comprehensive discussion to support the recommendations for safe pacifier use in healthy, full-term, and ill and preterm infants. The use of pacifiers is justifiable in certain situations and will support breastfeeding rather than interfere with it. Justifiable conditions have been identified as: low-birth weight and premature infants; infants at risk for hypoglyceamia; infants in need of oral stimulation to develop, maintain and mature the sucking reflex in preterm infants; and the achievement of neurobehavioural organisation. Medical benefits associated with the use of pacifiers include providing comfort, contributing towards neurobehavioural organisation, and reducing the risk of sudden infant death syndrome. Guidelines are presented for assessing and guiding safe pacifier use, for specific design to ensure safety, and for cessation of use to ensure normal childhood development.
[Mh] Termos MeSH primário: Desenvolvimento Infantil/fisiologia
Hospitais/normas
Chupetas/normas
Comportamento de Sucção/fisiologia
[Mh] Termos MeSH secundário: Aleitamento Materno
Feminino
Seres Humanos
Recém-Nascido
Masculino
Guias de Prática Clínica como Assunto
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1186/s12884-017-1306-8


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


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[PMID]:28460042
[Au] Autor:Walker DM; Sieck CJ; Menser T; Huerta TR; Scheck McAlearney A
[Ad] Endereço:Department of Family Medicine, College of Medicine, Ohio State University, Columbus, OH, USA.
[Ti] Título:Information technology to support patient engagement: where do we stand and where can we go?
[So] Source:J Am Med Inform Assoc;24(6):1088-1094, 2017 Nov 01.
[Is] ISSN:1527-974X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Objective: Given the strong push to empower patients and make them partners in their health care, we evaluated the current capability of hospitals to offer health information technology that facilitates patient engagement (PE). Materials and Methods: Using an ontology mapping approach, items from the American Hospital Association Information Technology Supplement were mapped to defined levels and categories within the PE Framework. Points were assigned for each health information technology function based upon the level of engagement it encompassed to create a PE-information technology (PE-IT) score. Scores were divided into tertiles, and hospital characteristics were compared across tertiles. An ordered logit model was used to estimate the effect of characteristics on the adjusted odds of being in the highest tertile of PE-IT scores. Results: Thirty-six functions were mapped to specific levels and categories of the PE Framework, and adoption of each item ranged from 23.5 to 96.7%. Hospital characteristics associated with being in the highest tertile of PE-IT scores included medium and large bed size (relative to small), nonprofit (relative to government nonfederal), teaching hospital, system member, Midwest and South regions, and urban location. Discussion: Hospital adoption of PE-oriented technology remains varied, suggesting that hospitals are considering how technology can create partnerships with patients. However, PE functionalities that facilitate higher levels of engagement are lacking, suggesting room for improvement. Conclusion: While hospitals have reached modest levels of adoption of PE technologies, consistent monitoring of this capacity can identify opportunities to use technology to facilitate engagement.
[Mh] Termos MeSH primário: Hospitais
Informática Médica
Participação do Paciente
[Mh] Termos MeSH secundário: Estudos Transversais
Registros Eletrônicos de Saúde
Gestão da Informação em Saúde
Hospitais/estatística & dados numéricos
Seres Humanos
Uso Significativo
Educação de Pacientes como Assunto
Portais do Paciente
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE
[do] DOI:10.1093/jamia/ocx043


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[PMID]:28453715
[Au] Autor:Pan B; Towne SD; Chen Y; Yuan Z
[Ad] Endereço:Department of Health Statistics, School of Public Health, Nanchang University, Nanchang, People' Republic of China.
[Ti] Título:The inequity of inpatient services in rural areas and the New-Type Rural Cooperative Medical System (NRCMS) in China: repeated cross sectional analysis.
[So] Source:Health Policy Plan;32(5):634-646, 2017 Jun 01.
[Is] ISSN:1460-2237
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Objective : The main aim of the New-type Rural Cooperative Medical System (NRCMS) put into effect in 2003 was to reduce financial barriers in accessing health care services among vulnerable populations. The aim of this study was to assess the association between NRCMS and income related inequality in hospital utilization among rural inhabitants in Jiangxi Province, China. Methods : A multistage stratified random cluster sampling method was adopted to select 1838, 1879, and 1890 households as participants in 2003/2004, 2008 and 2014, respectively. The Erreygers Concentration index (EI) of two measures of hospital inpatient care including admission to hospital and hospital avoidance, were calculated to measure income-related inequality. The decomposition of the EI was performed to characterize the contributions of socioeconomic and need factors to the measured inequality. Results : An affluent-focused (pro-rich) inequity was observed for hospital admission adjusting for need factors over time. The level of inequity for hospital admission decreased dramatically, while hospital avoidance decreased marginally, and with a high value (EI, -0.0176) in 2008. The implementation of the NRCMS was associated with decreased inequity in 2008 and in 2014, but the associations were limited. Income contributed the most to the inequality of hospital utilization each year. Conclusion : The coverage of the NRCMS expanded to cover nearly all rural inhabitants in Jiangxi province by 2014 and was associated with a very small reduction in inequalities in admission to hospital. In order to increase equitable access to health care, additional financial protections for vulnerable populations are needed. Improving the relatively low level of medical services in township hospitals, and low rate of reimbursement and financial assistance with the NRCMS is recommended.
[Mh] Termos MeSH primário: Disparidades em Assistência à Saúde/estatística & dados numéricos
Hospitais/utilização
Serviços de Saúde Rural/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adulto
China/epidemiologia
Estudos Transversais
Disparidades em Assistência à Saúde/economia
Seres Humanos
Seguro Saúde
Serviços de Saúde Rural/economia
População Rural/estatística & dados numéricos
Fatores Socioeconômicos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:H
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1093/heapol/czw175


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[PMID]:29325263
[Au] Autor:Yu L; Tang M; Fan XH; Du HM; Tang H; Chen P; Xing SL; Su CH; Chen DJ
[Ad] Endereço:Department of Obstetrics, the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, China.
[Ti] Título:[Analysis of 2 204 stillbirths in 11 hospitals of Guangdong province].
[So] Source:Zhonghua Fu Chan Ke Za Zhi;52(12):805-810, 2017 Dec 25.
[Is] ISSN:0529-567X
[Cp] País de publicação:China
[La] Idioma:chi
[Ab] Resumo:To analyze the incidence and causes of stillbirth in 11 hospitals of Guangdong province, and to explore the appropriate interventions. Clinical data of stillbirth in 11 hospitals of Guangdong province were collected from January 2014 to December 2016. The gestational weeks, causes, maternal conditions and other factors were analyzed. (1) From 2014 to 2016, 103 472 newborns were delivered in the 11 hospitals, and the number of stillbirth was 2 204, with the incidence of 2.13%. Among them, 0.71%(738/103 472) was therapeutic induction, 1.42%(1 066/103 472) was natural stillbirth. At different gestational age (<28 weeks, 28-<37 weeks and ≥37 weeks), the incidence of stillbirth was 55.63% (1 226/2 204), 28.45% (627/2 204) and 15.92% (351/2 204), respectively, with statistically significant difference ( 0.01). (2) For stillbirth<28 weeks, the first reason was therapeutic induction, accounting for 53.34% (654/1 226). For stillbirth during 28-37 weeks, pre-eclampsia was the major cause, accounting for 40.67% (255/627). And for full-term stillbirth, the causes were umbilical cord factors (19.37%, 68/351), abnormal labor (17.09%, 60/351). (3) In all the stillbirth cases, the incidence of fetal growth restriction (FGR) 28 weeks was significantly higher than that during 28-37 weeks [23.49% (288/1 226) vs 18.02% (113/627) , 0.01]. (4) The stillbirth rate during labor was significantly higher in women ≥35 years old than in younger women [63.88% (191/299) vs 36.12% (108/299) ; χ(2)=9.346, 0.000]. For the causes of stillbirth during labor, the incidence of severe maternal obstetrical complications [61.11% (33/54) vs 38.89% (21/54) ; χ(2)=3.323, 0.002], abnormal labor [65.82% (52/79) vs 34.18% (27/79) ; χ(2)=4.067, 0.001] and abnormal fetal position [66.63% (26/39) vs 33.37% (13/39) ; χ(2)=3.002, 0.013] were higher in women ≥35 years old than in younger women. (5) Cesarean section during labor accounted for 33.77% (101/299) of stillbirth, including 76 cases of emergency cesarean section or converted to cesarean section during labor. (1) The incidence of stillbirth in the 11 hospitals is high, and the causes are different at different gestational ages, therefore, different interventions are needed to reduce the incidence in different gestational weeks. Supervision of therapeutic induction should be strengthened <28 gestational weeks; standard management of pregnancy might decrease the occurrence of natural death ≥28 weeks. (2) Attention should be paid to fetal body weight during pregnancy, especially FGR. (3) The stillbirth rate is high in elderly pregnant women, so it is important to strengthen the management of the elderly pregnant women.
[Mh] Termos MeSH primário: Distocia/epidemiologia
Retardo do Crescimento Fetal/epidemiologia
Pré-Eclâmpsia/epidemiologia
Natimorto/epidemiologia
[Mh] Termos MeSH secundário: Adulto
Cesárea
China/epidemiologia
Feminino
Retardo do Crescimento Fetal/etiologia
Idade Gestacional
Hospitais
Seres Humanos
Incidência
Recém-Nascido
Trabalho de Parto
Gravidez
Cuidado Pré-Natal
Natimorto/etnologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180306
[Lr] Data última revisão:
180306
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180112
[St] Status:MEDLINE
[do] DOI:10.3760/cma.j.issn.0529-567x.2017.12.003


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[PMID]:29325264
[Au] Autor:Xiong Y; Xia HX; Wang YS; Lin XL; Zhu TT; Zhao Y; Li XT
[Ad] Endereço:Department of Obstetrics, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China.
[Ti] Título:[High risk factors analysis of stillbirth].
[So] Source:Zhonghua Fu Chan Ke Za Zhi;52(12):811-817, 2017 Dec 25.
[Is] ISSN:0529-567X
[Cp] País de publicação:China
[La] Idioma:chi
[Ab] Resumo:To explore the high risk factors of stillbirth. 176 cases of stillbirth were collected in the Obstetrics and Gynecology Hospital of Fudan University from January 1(st), 2010 to December 31(st), 2016. All cases were analyzed retrospectively, including general profile, high risk factors of stillbirth in different years and pregnancy periods. (1) The incidence of stillbirth was 0.178%(176/98 785). Stillbirth occured mostly at 28-28(+6) gestational weeks (10.8%,19/176), and the second peak was 29-29(+6) weeks(10.2%,18/176), while the third common period was 37-37(+6) weeks (9.1%,16/176). After 39 weeks, it maintained at a low level. (2) The top 5 high risk factors of stillbirth were infection (18.2%,32/176), unexplained (13.6%,24/176), hypertention disorders in pregnancy (13.1%, 23/176), umbilical cord torsion (12.5%, 22/176) and fetal malformations (10.2%, 18/176). (3) From 2010 to 2012, the top 3 high risk factors were unexplained, the umbilical cord torsion and infection, while hypertention in pregnancy, infection and fetal malformation became the top 3 high risk factors after 2013. (4) Early stillbirth (20-27(+6) weeks) accounted for 21.6%(38/176); and unexplained (47.4%, 18/38), fetal edema (13.2%, 5/38),infection (13.2%, 5/38), umbilical cord torsion (5.3%, 2/38) were the top 4 high risk factors. Late stillbirth (≥28 weeks) accounted for 78.4%(138/176), with infection (19.6%,27/138), hypertention in pregnancy (15.9%,22/138), umbilical cord torsion (14.5%,20/138) and fetal malformation(12.3%,17/138)being the top 4 high risk factors. More attention should be paid to maternal complications, especially infection and hypertension in pregnancy. Antenatal fetal monitoring, timely termination of pregnancy, standard management of stillbirth and looking for the causes may help reduce the incidence of stillbirth.
[Mh] Termos MeSH primário: Morte Fetal/etiologia
Monitorização Fetal
Hipertensão/epidemiologia
Natimorto/epidemiologia
[Mh] Termos MeSH secundário: Adulto
Feminino
Idade Gestacional
Hospitais
Seres Humanos
Incidência
Gravidez
Estudos Retrospectivos
Fatores de Risco
Natimorto/etnologia
Cordão Umbilical
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180306
[Lr] Data última revisão:
180306
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180112
[St] Status:MEDLINE
[do] DOI:10.3760/cma.j.issn.0529-567x.2017.12.004


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[PMID]:28747463
[Au] Autor:Man S; Schold JD; Uchino K
[Ad] Endereço:From the Clinical Neuroscience Institute, Miami Valley Hospital, Wright State University Boonshoft School of Medicine Dayton, OH (S.M.); Department of Quantitative Health Sciences, Cleveland Clinic, OH (J.D.S.); and Cerebrovascular Center, Neurological Institute, Cleveland Clinic, OH (K.U.).
[Ti] Título:Impact of Stroke Center Certification on Mortality After Ischemic Stroke: The Medicare Cohort From 2009 to 2013.
[So] Source:Stroke;48(9):2527-2533, 2017 09.
[Is] ISSN:1524-4628
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND PURPOSE: An increasing number of hospitals have been certified as primary stroke centers (PSCs). It remains unknown whether the action toward PSC certification has improved the outcome of stroke care. This study aimed to understand whether PSC certification reduced stroke mortality. METHODS: We examined Medicare fee-for-service beneficiaries aged ≥65 years who were hospitalized between 2009 and 2013 for ischemic stroke. Hospitals were classified into 3 groups: new PSCs, the hospitals that received initial PSC certification between 2009 and 2013 (n=634); existing PSCs, the PSCs certified before 2009 (n=785); and non-SCs, the hospitals that have never been certified as PSCs (n=2640). Multivariate logistic regression and Cox proportional hazards model was used to compare the mortality among the 3 groups. RESULTS: Existing PSCs were significantly larger than new PSCs as reflected by total number of beds and annual stroke admission ( <0.0001). Compared with existing PSCs, new PSCs had lower in-hospital (odds ratio, 0.862; 95% confidence interval [CI], 0.817-0.910) and 30-day mortality (hazard ratio [HR], 0.981; 95% CI, 0.968-0.993), after adjusting for patient demographics and comorbidities. Compared with non-SCs, new PSCs had lower adjusted in-hospital (odds ratio, 0.894; 95% CI, 0.848-0.943), 30-day (HR, 0.904; 95% CI, 0.892-0.917), and 1-year mortality (HR, 0.907; 95% CI, 0.898-0.915). Existing PSCs had lower adjusted 30-day (HR, 0.922; 95% CI, 0.911-0.933) and 1-year mortality (HR, 0.900; 95% CI, 0.892-0.907) than non-SCs. CONCLUSIONS: Obtaining stroke certification may reduce stroke mortality and overcome the disadvantage of being smaller hospitals. Further study of other outcome measures will be useful to improve stroke system of care.
[Mh] Termos MeSH primário: Isquemia Encefálica/mortalidade
Certificação/estatística & dados numéricos
Hospitais/estatística & dados numéricos
Acidente Vascular Cerebral/mortalidade
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Planos de Pagamento por Serviço Prestado
Feminino
Seres Humanos
Joint Commission on Accreditation of Healthcare Organizations
Modelos Logísticos
Masculino
Medicare
Análise Multivariada
Prognóstico
Modelos de Riscos Proporcionais
Qualidade da Assistência à Saúde
Estudos Retrospectivos
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1709
[Cu] Atualização por classe:180307
[Lr] Data última revisão:
180307
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170728
[St] Status:MEDLINE
[do] DOI:10.1161/STROKEAHA.116.016473



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