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[PMID]:29179830
[Au] Autor:Brunero S; Buus N; West S
[Ad] Endereço:University of Sydney, Australia. Electronic address: scott.brunero@health.nsw.gov.au.
[Ti] Título:Categorising Patients Mental Illness by Medical Surgical Nurses in the General Hospital Ward: A Focus Group Study.
[So] Source:Arch Psychiatr Nurs;31(6):614-623, 2017 12.
[Is] ISSN:1532-8228
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:AIM: To gain insight into medical surgical nurses' process(es) of categorising mental illness in general hospitals. BACKGROUND: Categorising patients is a daily social practice that helps medical surgical nurses understand their work and actions. Medical surgical nurses' categorising of mentally ill patients in general hospitals is a means in which they articulate their understanding of mental illness and perform their clinical practice. How medical surgical nurses categorise, and the impact that categorising can have on their work practices is poorly understood. DESIGN: A focus group study. METHOD: Focus group discussions (n=2) of medical surgical nurses' understanding and experience of delivering care to patients with mental illness in a general tertiary referral hospital were conducted in November 2014. Discourse analysis was used to analyse the transcribed data to uncover how participants made discursive evaluations and how this related to their daily clinical practice. RESULTS: The analysis uncovered participant's use of four categories of mentally ill patients: the managed, the unpredictable, the emotional and the dangerous. For participants these categories explained and justified their clinical practice as linked to the challenges and barriers they experienced in providing effective care within the larger healthcare organisation. CONCLUSION: The language used by medical/surgical reflects the wider discourse of managerialism in healthcare organisations. The recognition of these categories can be used by educators, liaison mental health services and policy makers to reconsider service design and learning opportunities for medical surgical nurses to reduce stigmatisation of patients with mental illness.
[Mh] Termos MeSH primário: Grupos Focais/métodos
Hospitais Gerais
Transtornos Mentais/enfermagem
Pessoas Mentalmente Doentes/classificação
Recursos Humanos de Enfermagem no Hospital/psicologia
[Mh] Termos MeSH secundário: Adulto
Atitude do Pessoal de Saúde
Feminino
Seres Humanos
Estudos Longitudinais
Estereotipagem
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180306
[Lr] Data última revisão:
180306
[Sb] Subgrupo de revista:IM; N
[Da] Data de entrada para processamento:171129
[St] Status:MEDLINE


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[PMID]:29308840
[Au] Autor:Korableva AA; Yudina EV; Ziganshina LE
[Ti] Título:Efficacy of Management for Rational Use of Antibiotics in Surgical Departments at a Multi-Disciplinary Hospital: Results of a 7-year Pharmacoepidemiological Research.
[So] Source:Vestn Ross Akad Med Nauk;72(1):26-32, 2017.
[Is] ISSN:0869-6047
[Cp] País de publicação:Russia (Federation)
[La] Idioma:eng
[Ab] Resumo:Background: Irrational medicine use including excessive use and abuse of antibiotics remains a crucial problem for the healthcare systems. In this regard, studies examining approaches to improving the clinical use of medicines are highly important. Aim: to assess the efficacy rate of management for the rational use of antibiotics in surgical departments of a multi-disciplinary hospital. Material and Methods: The intervention complex combined the research, educational, and methodological activities: local protocols for perioperative antibiotic prophylaxis (PABP) for various surgical departments were developed; local PABP protocols were discussed with the physicians of specialized surgical departments; official order on implementation of PABP was issued; the list of drug prescriptions for registration of the first pre-operative antibiotic dose was changed; audit and feedback processes were introduced as well as consultations of a clinical pharmacologist were implemented. We assessed the efficacy rate of the interventions basing on the changes in consumption of antibiotics (both quantitatively and qualitatively) at surgical departments of a hospital using ATC/DDD methodology. Comparison of the studied outcomes was performed before and after the intervention implementation and between the departments (vascular and abdominal surgery). The consumption of antibacterial agents (ATCJ01) was measured as a number of defined daily doses (DDD) per 100 bed-days (DDD/100 bed-days, indicator recommended by the World Health Organization, WHO) and DDD per 100 treated patients (DDD/100 treated patients). Results: From 2006 to 2012, a decrease in antibacterial consumption in surgical departments by 188 DDD/100 treated patients was observed. We obtained the opposite results when using an indicator of DDD/100 bed-days (increase by 2.5 DDD/100 bed-days) which could be explained by the dependence on indices of overall hospital work and its changes during the examined period. Observed changes in antibacterial consumption varied in different surgical departments. The most pronounced positive changes were noted in the department of vascular surgery: decrease in total antibacterial consumption by 298 DDD/100 treated patients, decrease in the use of cephalosporins of the III generation from 141 to 38 DDD/100 treated patients. These positive changes were accompanied by the same (low) level of consumption/use of reserve antibiotics. In the department of abdominal surgery, there was no decrease in total antibiotic consumption, as well as in consumption of broad-spectrum cephalosporins of the III generation and fluoroquinolones, and we observed an increase in the use of reserve antibiotics (carbapenems) during the study period. Positive changes in antibiotic consumption were associated with the positive attitude of the manager/head of the department towards interventions: we observed the most pronounced decrease in antibiotic consumption straight after the publication of the administrative order on perioperative antibacterial prophylaxis. Conclusion: The combination of scientific, educational, and methodological interventions is effective for improving antibiotic application. The study results provide the rationale for analyzing the drug consumption using the DDD/100 treated patients measure in addition to the WHO-recommended indicator of DDD/100 bed-days which depends on overall hospital performance.
[Mh] Termos MeSH primário: Antibacterianos
Revisão de Uso de Medicamentos
Hospitais Gerais
[Mh] Termos MeSH secundário: Revisão de Uso de Medicamentos/métodos
Revisão de Uso de Medicamentos/estatística & dados numéricos
Hospitais Gerais/métodos
Hospitais Gerais/organização & administração
Hospitais Gerais/normas
Seres Humanos
Melhoria de Qualidade
Federação Russa
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Bacterial Agents)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180220
[Lr] Data última revisão:
180220
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180109
[St] Status:MEDLINE
[do] DOI:10.15690/vramn704


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[PMID]:28747225
[Au] Autor:Reynish EL; Hapca SM; De Souza N; Cvoro V; Donnan PT; Guthrie B
[Ad] Endereço:Dementia and Ageing Research Group, Faculty of Social Science, University of Stirling, Stirling, FK9 4LA, UK. emma.reynish@stir.ac.uk.
[Ti] Título:Epidemiology and outcomes of people with dementia, delirium, and unspecified cognitive impairment in the general hospital: prospective cohort study of 10,014 admissions.
[So] Source:BMC Med;15(1):140, 2017 07 27.
[Is] ISSN:1741-7015
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Cognitive impairment of various kinds is common in older people admitted to hospital, but previous research has usually focused on single conditions in highly-selected groups and has rarely examined associations with outcomes. This study examined prevalence and outcomes of cognitive impairment in a large unselected cohort of people aged 65+ with an emergency medical admission. METHODS: Between January 1, 2012, and June 30, 2013, admissions to a single general hospital acute medical unit aged 65+ underwent a structured specialist nurse assessment (n = 10,014). We defined 'cognitive spectrum disorder' (CSD) as any combination of delirium, known dementia, or Abbreviated Mental Test (AMT) score < 8/10. Routine data for length of stay (LOS), mortality, and readmission were linked to examine associations with outcomes. RESULTS: A CSD was present in 38.5% of all patients admitted aged over 65, and in more than half of those aged over 85. Overall, 16.7% of older people admitted had delirium alone, 7.9% delirium superimposed on known dementia, 9.4% known dementia alone, and 4.5% unspecified cognitive impairment (AMT score < 8/10, no delirium, no known dementia). Of those with known dementia, 45.8% had delirium superimposed. Outcomes were worse in those with CSD compared to those without - LOS 25.0 vs. 11.8 days, 30-day mortality 13.6% vs. 9.0%, 1-year mortality 40.0% vs. 26.0%, 1-year death or readmission 62.4% vs. 51.5% (all P < 0.01). There was relatively little difference by CSD type, although people with delirium superimposed on dementia had the longest LOS, and people with dementia the worst mortality at 1 year. CONCLUSIONS: CSD is common in older inpatients and associated with considerably worse outcomes, with little variation between different types of CSD. Healthcare systems should systematically identify and develop care pathways for older people with CSD admitted as medical emergencies, and avoid only focusing on condition-specific pathways such as those for dementia or delirium alone.
[Mh] Termos MeSH primário: Disfunção Cognitiva/epidemiologia
Delírio/epidemiologia
Demência/epidemiologia
Hospitais Gerais
[Mh] Termos MeSH secundário: Idoso
Disfunção Cognitiva/terapia
Estudos de Coortes
Delírio/complicações
Delírio/terapia
Demência/terapia
Feminino
Hospitalização
Seres Humanos
Pacientes Internados
Tempo de Internação
Masculino
Prevalência
Estudos Prospectivos
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1711
[Cu] Atualização por classe:180127
[Lr] Data última revisão:
180127
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170728
[St] Status:MEDLINE
[do] DOI:10.1186/s12916-017-0899-0


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[PMID]:28452817
[Au] Autor:Manji F; McCarty K; Kurzweil V; Mark E; Rathmell JP; Agarwala AV
[Ad] Endereço:From the *Department of Anesthesia, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; †Department of Medicine, Boston Medical Center, Boston, Massachusetts; ‡Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts; §Center for Quality and Safety, Massachusetts General Hospital, Boston, Massachusetts; ‖Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts; and ¶Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts.
[Ti] Título:Measuring and Improving the Quality of Preprocedural Assessments.
[So] Source:Anesth Analg;124(6):1846-1854, 2017 06.
[Is] ISSN:1526-7598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Preprocedural assessments are used by anesthesia providers to optimize perioperative care for patients undergoing invasive procedures. When these assessments are performed in advance by providers who are not caring for the patient during the procedure, there is an additional layer of complexity in ensuring that the workup meets the needs of the primary anesthesia care team. In this study, anesthesia providers were asked to rate the quality of preprocedural assessments prepared by other providers to evaluate anesthesia care team satisfaction. METHODS: Quality ratings for preprocedural assessments were collected from anesthesia providers on the day of surgery using an electronic quality assurance tool from January 9, 2014 to October 21, 2014. Users could rate assessments as "exemplary," "satisfactory," or "unsatisfactory." Free text comments could be entered for any of the quality ratings chosen. A reviewer trained in clinical anesthesia categorized all comments as "positive," "constructive," or "neutral" and conducted in-depth chart reviews triggered by 67 "constructive" comments submitted during the first 3 months of data collection to further subcategorize perceived deficiencies in the preprocedural assessments. In May 2014, providers were asked to participate in a midpoint survey and provide general feedback about the preprocedural process and evaluations. RESULTS: 37,611 procedures requiring anesthesia were analyzed. Of the 17,522 (46.6%) cases with a rated preprocedural assessment, anesthesia providers rated 3828 (21.8%) as "exemplary," 13,454 (76.8%) as "satisfactory," and 240 (1.4%) as "unsatisfactory." The monthly proportion of "unsatisfactory" ratings ranged from 3.1% to 0% over the study period, whereas the midpoint survey showed that anesthesia providers estimated that the number of unsatisfactory evaluations was 11.5%. Preprocedural evaluations performed on inpatients received significantly better ratings than evaluations performed on outpatients by the preadmission testing clinic or phone program (P < .0001). The most common reason given for "unsatisfactory" ratings was a perception of "missing information" (49.2%). Chart reviews revealed that inadequate documentation was in reality the most common deficiency in preprocedural evaluations (35 of 67 reviews, 52.2%). CONCLUSIONS: The overwhelming majority of preprocedural assessments performed at our institution were considered satisfactory or exemplary by day-of-surgery anesthesia providers. This was demonstrated by both the case-by-case ratings and midpoint survey. However, the perceived frequency of "unsatisfactory" evaluations was worse when providers were asked to reflect on the quality of preprocedural evaluations generally versus rate them individually. Analysis of comments left by providers allowed us to identify specific and actionable areas for improvement. This method can be used by other institutions to identify systemic deficiencies in the preprocedural evaluation process.
[Mh] Termos MeSH primário: Anestesiologistas/normas
Equipe de Assistência ao Paciente/normas
Cuidados Pré-Operatórios/normas
Melhoria de Qualidade/normas
Indicadores de Qualidade em Assistência à Saúde/normas
[Mh] Termos MeSH secundário: Serviço Hospitalar de Anestesia
Anestesiologistas/psicologia
Atitude do Pessoal de Saúde
Boston
Competência Clínica
Conhecimentos, Atitudes e Prática em Saúde
Hospitais Gerais
Seres Humanos
Pacientes Internados
Ambulatório Hospitalar
Pacientes Ambulatoriais
Avaliação de Programas e Projetos de Saúde
Análise e Desempenho de Tarefas
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:180109
[Lr] Data última revisão:
180109
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1213/ANE.0000000000001834


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[PMID]:29255546
[Au] Autor:Rasaholiarison NF; Randrianasolo RO; Rajaonarison LA; Rakotomanana JL; Razafimahefa J; Tehindrazanarivelo AD
[Ad] Endereço:Service de Neurologie, Hôpital Befelatanana, Antananarivo, Madagascar.
[Ti] Título:[Frequency and characteristics of strokes involving the perforating arteries in the Department of Neurology at the Befelatanana General Hospital, Antananarivo].
[Ti] Título:Fréquence et caractéristiques des AVC impliquant les artères perforantes dans le Service de Neurologie de l'Hopital Bafelatanana, Antananarivo..
[So] Source:Pan Afr Med J;28:76, 2017.
[Is] ISSN:1937-8688
[Cp] País de publicação:Uganda
[La] Idioma:fre
[Ab] Resumo:Introduction: Strokes of the perforating arteries are mainly arteriolopathies. They result in dementia and stroke recurrence. This study aimed to evaluate the frequency and characteristics of these strokes to better prevent these complications. Methods: We conducted a descriptive, retrospective study in the department of neurology at the Befelatanana general hospital, Antananarivo over the period 01 March-25 September 2015. All patients with abrupt neurological deficit and deep brain involvement on brain scanner were included in the study. The features of strokes involving the perforating arteries were collected. Data were processed with SPSS 20 software. Results: Out of 172 patients with a stroke, 83(48.25%) had stroke involving the perforating arteries. Stroke involving the perforating arteries affected young people (65.06%) aged less than 65 years and preferentially the male population (61.44%). Haemorrhagic forms accounted for 67.46%. Thirty-one patients (37.34%) had stroke recurrences and, among them, almost a quarter had 2 recurrences (38.70%) in less than a year. All patients with recurrence had dysexecutive disorder (p < 0.0001) and poor antihypertensive medication adherence. Mortality accounted for only 6.02% in patients with onset of these strokes during hospitalization. Conclusion: Specific neurologic follow-up is necessary after a first stroke involving perforating arteries in order to make an early diagnosis of dementia and to prevent recurrences.
[Mh] Termos MeSH primário: Anti-Hipertensivos/administração & dosagem
Artérias Cerebrais/patologia
Demência/etiologia
Acidente Vascular Cerebral/epidemiologia
[Mh] Termos MeSH secundário: Fatores Etários
Idoso
Demência/diagnóstico
Feminino
Hospitalização
Hospitais Gerais
Seres Humanos
Estudos Longitudinais
Madagáscar/epidemiologia
Masculino
Adesão à Medicação
Meia-Idade
Recidiva
Estudos Retrospectivos
Fatores de Risco
Fatores Sexuais
Acidente Vascular Cerebral/mortalidade
Acidente Vascular Cerebral/fisiopatologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antihypertensive Agents)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171222
[Lr] Data última revisão:
171222
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171220
[St] Status:MEDLINE
[do] DOI:10.11604/pamj.2017.28.76.13593


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[PMID]:29230259
[Au] Autor:Lukuke HM; Kasamba E; Mahuridi A; Nlandu RN; Narufumi S; Mukengeshayi AN; Malou V; Makoutode M; Kaj FM
[Ad] Endereço:Ecole de Santé Publique, Université de Lubumbashi, République Démocratique du Congo.
[Ti] Título:[Nosocomial urinary tract and surgical site infection rates in the Maternity Ward at the General Referral Hospital in Katuba, Lubumbashi, Democratic Republic of the Congo].
[Ti] Título:L'incidence des infections nosocomiales urinaires et des sites opératoires dans la maternité de l'Hôpital Général de Référence de Katuba à Lubumbashi en République Démocratique du Congo..
[So] Source:Pan Afr Med J;28:57, 2017.
[Is] ISSN:1937-8688
[Cp] País de publicação:Uganda
[La] Idioma:fre
[Ab] Resumo:Introduction: In Intertropical Africa hospitalized patients are exposed to a risk of nosocomial infections. The dearth of published data on this subject limits the descriptive analysis of the situation. This study aimed to determine the incidence, the germs responsible for these infections and the risk factors of nosocomial infections in the Maternity Ward at the General Referral Hospital in Katuba, Lubumbashi, Democratic Republic of the Congo. Methods: We conducted a descriptive, longitudinal study from 1 October 2014 to 1 January 2015. Our study population consisted of 207 women who had been hospitalized in the Maternity Ward at the General Referral Hospital in Katuba. We carried out a comprehensive data collection. Results: Nosocomial infection rate accounted for 15.5%. Parturient women who had been hospitalized for more than three days were three times more likely to develop a nosocomial infection (p=0.003), while those who had had a complicated delivery were four times more likely to be at risk of developing nosocomial infection (p = 0.000). Escherichia coli was the most isolated causative agent (38.1%), followed by Citrobacter freundi (23.8%), Acinobacter baumani (.18, 2%), Staphylococcus aureus (18.2%), Enterococcus aureus (14.3%) and Pseudomonas aeroginosa (9.1%). Ampicillin was the most prescribed antibiotic, to which isolated microbes were resistant. Conclusion: It is necessary to improve hospital hygiene and to conduct further study to examine the similarity between germs strains in the environment and those in biological fluids.
[Mh] Termos MeSH primário: Bactérias/isolamento & purificação
Infecção Hospitalar/epidemiologia
Infecção da Ferida Cirúrgica/epidemiologia
Infecções Urinárias/epidemiologia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Antibacterianos/uso terapêutico
Infecção Hospitalar/tratamento farmacológico
Infecção Hospitalar/microbiologia
República Democrática do Congo
Farmacorresistência Bacteriana
Feminino
Hospitais Gerais
Seres Humanos
Incidência
Estudos Longitudinais
Meia-Idade
Gravidez
Fatores de Risco
Infecção da Ferida Cirúrgica/tratamento farmacológico
Infecção da Ferida Cirúrgica/microbiologia
Infecções Urinárias/tratamento farmacológico
Infecções Urinárias/microbiologia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Bacterial Agents)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171222
[Lr] Data última revisão:
171222
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171213
[St] Status:MEDLINE
[do] DOI:10.11604/pamj.2017.28.57.9866


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[PMID]:29187916
[Au] Autor:Choua O; Rimtebaye K; Yamingue N; Moussa K; Kaboro M
[Ad] Endereço:Département de Chirurgie, Faculté des Sciences de la Santé Humaine BP 1117 N'Djaména, Tchad.
[Ti] Título:[Epidemiological, clinical and therapeutic aspects of blunt abdominal trauma in patients undergoing surgery at the General Hospital of National Reference of N'Djamena, Chad: about 49 cases].
[Ti] Título:Aspects des traumatismes fermés de l'abdomen opérés à l'Hôpital Général de Référence Nationale de N'Djaména (HGRN), Tchad: à propos de 49 cas..
[So] Source:Pan Afr Med J;26:50, 2017.
[Is] ISSN:1937-8688
[Cp] País de publicação:Uganda
[La] Idioma:fre
[Ab] Resumo:Introduction: Blunt abdominal traumas are common. Methods: We retrospectively reviewed the medical records of 49 patients with blunt abdominal trauma who underwent surgery at the General Hospital of National Reference of N'Djamena, Chad over a period of 5 years. Epidemiological, clinical and therapeutic parameters of patients were studied. Results: The study included 42 men and 7 women, mean age 21.3 years. The causes of blunt abdominal traumas were: road traffic accidents in 61.2% of cases; wall collapses (14.3%); assaults (8.2%). Blunt abdominal traumas were more frequent in August (14.28%) and October (16.32%). The waiting time for admission in hospital was 6-12h in 43% of cases. At discharge, wounded patients used private car in 85.7% of cases. Clinically, patients were often hemodynamically stable (55.1%). Medical imaging was dominated by direct radiography of the abdomen (57.1%). The most observed lesions were those located only in the small intestine (16.32%) or related to that of the bladder (8.16%) and spleen (2.04%). Laparotomy was negative in 6.12% of cases. Morbidity (12.2%) was dominated by abdominal wall abscess. Mortality rate was 6.1%. Conclusion: Road traffic accidents are the leading cause of blunt abdominal traumas. It is important to minimize delays in diagnosis, and treatment. Road safety measures should be implemented to prevent accidents.
[Mh] Termos MeSH primário: Traumatismos Abdominais/cirurgia
Acidentes de Trânsito/estatística & dados numéricos
Laparotomia
Ferimentos não Penetrantes/cirurgia
[Mh] Termos MeSH secundário: Traumatismos Abdominais/diagnóstico
Traumatismos Abdominais/epidemiologia
Parede Abdominal/patologia
Abscesso/diagnóstico
Abscesso/epidemiologia
Adulto
Chade/epidemiologia
Feminino
Hospitais Gerais
Seres Humanos
Masculino
Estudos Retrospectivos
Fatores de Tempo
Violência/estatística & dados numéricos
Ferimentos não Penetrantes/diagnóstico
Ferimentos não Penetrantes/enzimologia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[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.2017.26.50.8327


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[PMID]:29068923
[Au] Autor:Seth AK; Lin AM; Austen WG; Gilman RH; Gallico GG; Colwell AS
[Ad] Endereço:Boston, Mass. From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School.
[Ti] Título:Impact of Patient Subtype and Surgical Variables on Abdominoplasty Outcomes: A 12-Year Massachusetts General Hospital Experience.
[So] Source:Plast Reconstr Surg;140(5):899-908, 2017 Nov.
[Is] ISSN:1529-4242
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The traditional abdominoplasty is one of the most common surgical procedures performed. This study evaluates the impact of different surgical techniques and clinical patient factors on abdominoplasty outcomes. METHODS: A retrospective review of consecutive patients undergoing abdominoplasty was performed. RESULTS: Seven hundred seventy-nine patients with a mean age of 43.7 years and a body mass index of 27 kg/m underwent abdominoplasty. The majority were women (92.9 percent), and massive weight loss was present in 34.8 percent. Abdominoplasty techniques included traditional (59.4 percent), belt lipectomy (17.9 percent), fleur-de-lis (16.4 percent), umbilical float (9.2 percent), and mini-abdominoplasty (2.8 percent). Half of the study population [n = 384 (49.3 percent)] had concurrent surgical procedures. Total complications (23.0 percent) consisted primarily of wound- and scar-related complications (15.3 percent). Approximately 60 percent of patients received heparin chemoprophylaxis, with overall thromboembolic and hematoma rates less than 1 percent. Univariate analysis revealed that massive weight loss (p = 0.04), fleur-de-lis (p = 0.03) or belt lipectomy (p = 0.05) techniques, and concurrent medial thigh lift (p < 0.001) all significantly increased complications. Previous scars, amount of weight loss, operative time, liposuction, and other concurrent procedures did not affect total complications. Male sex (OR, 1.96; p = 0.04), fleur-de-lis technique (OR, 1.71; p = 0.04), and medial thigh lift (OR, 3.3; p < 0.001) were independent risk factors for total postoperative complications. CONCLUSION: This study demonstrates that abdominoplasty alone or in combination with liposuction and aesthetic breast surgery can be performed safely, with an acceptable complication profile. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
[Mh] Termos MeSH primário: Abdominoplastia
[Mh] Termos MeSH secundário: Abdominoplastia/métodos
Adulto
Feminino
Seguimentos
Hospitais Gerais
Seres Humanos
Lipectomia
Masculino
Mamoplastia
Massachusetts
Meia-Idade
Avaliação de Resultados (Cuidados de Saúde)
Complicações Pós-Operatórias/epidemiologia
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171109
[Lr] Data última revisão:
171109
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171026
[St] Status:MEDLINE
[do] DOI:10.1097/PRS.0000000000003816


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[PMID]:29016669
[Au] Autor:Li H; Luo X; Ke X; Dai Q; Zheng W; Zhang C; Cassidy RM; Soares JC; Zhang X; Ning Y
[Ad] Endereço:Southern Medical University, Guangzhou, China.
[Ti] Título:Major depressive disorder and suicide risk among adult outpatients at several general hospitals in a Chinese Han population.
[So] Source:PLoS One;12(10):e0186143, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Somatic complaints are often the presenting symptoms of major depressive disorder (MDD) in the outpatient context, because this may go unrecognized. It is well understood that MDD carries an increased risk of suicide. This study aimed to identify the risk factors and association with both MDD and suicidality among Han Chinese outpatients. METHODS: A multicenter study was carried out in 5189 outpatient adults (≥18 years old) in four general hospitals in Guangzhou, China. The 1392 patients who had the Patient Health Questionnaire-9 (PHQ-9) score ≥ 5, indicating depressive symptoms were offered an interview with a psychiatrist by the Mini International Neuropsychiatric Interview (MINI); 819 patients consented and completed the MINI interview. MINI module B was used to assess suicidality. Stepwise binary logistic models were used to estimate the relationship between a significant risk factor and suicide or MDD. According to with or without MDD, the secondary analysis was performed using the logistic regression model for the risk of suicidility. RESULTS: The current prevalence of MDD and the one month prevalence of suicidality were 3.7% and 2.3% respectively. The odds ratio of suicidality in women was more than twice that in men (OR = 2.62; 95% CI 1.45-4.76). Other risk factors which were significantly associated with suicidality were: living alone, higher education, self-reported depression, getting psychiatric diagnoses (MDD, anxiety disorders, and bipolar disorders). Significant risk factors for MDD were also noticed, such as comorbid anxiety disorders, self-reported anxiety, insomnia, suicidal ideation. LIMITATION: It's a cross-sectional study in outpatient clinics using self-report questionnaires. CONCLUSION: This study provides valuable data about the risk factors and association of MDD and suicide risk in adult outpatients in Han Chinese. Those factors allow better the employment of preventative measures.
[Mh] Termos MeSH primário: Transtorno Depressivo Maior/psicologia
Hospitais Gerais
Ideação Suicida
Suicídio/psicologia
[Mh] Termos MeSH secundário: Adulto
Ansiedade/fisiopatologia
Ansiedade/psicologia
China/epidemiologia
Estudos Transversais
Depressão/fisiopatologia
Depressão/psicologia
Transtorno Depressivo Maior/fisiopatologia
Feminino
Seres Humanos
Modelos Logísticos
Solidão/psicologia
Masculino
Meia-Idade
Razão de Chances
Pacientes Ambulatoriais/psicologia
Prevalência
Escalas de Graduação Psiquiátrica
Fatores de Risco
Autorrelato
Distúrbios do Início e da Manutenção do Sono/fisiopatologia
Distúrbios do Início e da Manutenção do Sono/psicologia
Inquéritos e Questionários
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171031
[Lr] Data última revisão:
171031
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171011
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0186143


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[PMID]:28873473
[Au] Autor:Lee KY; Wan Ahmad WA; Low EV; Liau SY; Anchah L; Hamzah S; Liew HB; Mohd Ali RB; Ismail O; Ong TK; Said MA; Dahlui M
[Ad] Endereço:Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
[Ti] Título:Comparison of the treatment practice and hospitalization cost of percutaneous coronary intervention between a teaching hospital and a general hospital in Malaysia: A cross sectional study.
[So] Source:PLoS One;12(9):e0184410, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: The increasing disease burden of coronary artery disease (CAD) calls for sustainable cardiac service. Teaching hospitals and general hospitals in Malaysia are main providers of percutaneous coronary intervention (PCI), a common treatment for CAD. Few studies have analyzed the contemporary data on local cardiac facilities. Service expansion and budget allocation require cost evidence from various providers. We aim to compare the patient characteristics, procedural outcomes, and cost profile between a teaching hospital (TH) and a general hospital (GH). METHODS: This cross-sectional study was conducted from the healthcare providers' perspective from January 1st to June 30th 2014. TH is a university teaching hospital in the capital city, while GH is a state-level general hospital. Both are government-funded cardiac referral centers. Clinical data was extracted from a national cardiac registry. Cost data was collected using mixed method of top-down and bottom-up approaches. Total hospitalization cost per PCI patient was summed up from the costs of ward admission and cardiac catheterization laboratory utilization. Clinical characteristics were compared with chi-square and independent t-test, while hospitalization length and cost were analyzed using Mann-Whitney test. RESULTS: The mean hospitalization cost was RM 12,117 (USD 3,366) at GH and RM 16,289 (USD 4,525) at TH. The higher cost at TH can be attributed to worse patients' comorbidities and cardiac status. In contrast, GH recorded a lower mean length of stay as more patients had same-day discharge, resulting in 29% reduction in mean cost of admission compared to TH. For both hospitals, PCI consumables accounted for the biggest proportion of total cost. CONCLUSIONS: The high PCI consumables cost highlighted the importance of cost-effective purchasing mechanism. Findings on the heterogeneity of the patients, treatment practice and hospitalization cost between TH and GH are vital for formulation of cost-saving strategies to ensure sustainable and equitable cardiac service in Malaysia.
[Mh] Termos MeSH primário: Custos Hospitalares
Hospitalização/economia
Hospitais Gerais/economia
Hospitais de Ensino/economia
Intervenção Coronária Percutânea/economia
[Mh] Termos MeSH secundário: Estudos Transversais
Feminino
Seres Humanos
Tempo de Internação/economia
Malásia
Masculino
Meia-Idade
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171016
[Lr] Data última revisão:
171016
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170906
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0184410



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