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[PMID]:28749017
[Au] Autor:Ong WL; Foroudi F; Evans S; Millar J
[Ad] Endereço:Department of Radiation Oncology, Olivia Newton-John Cancer and Wellness Centre, Austin Health, Heidelberg, Vic., Australia.
[Ti] Título:Large institutional variations in use of androgen deprivation therapy with definitive radiotherapy in a population-based cohort of men with intermediate- and high-risk prostate cancer.
[So] Source:BJU Int;120 Suppl 3:35-42, 2017 11.
[Is] ISSN:1464-410X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To evaluate the pattern of use of androgen deprivation therapy (ADT) with definitive radiotherapy (RT) in men with prostate cancer (PCa) in a population-based study in Australia. PATIENTS AND METHODS: This is a prospective cohort of men with intermediate- and high-risk PCa, captured in the population-based Prostate Cancer Outcome Registry Victoria, who were treated with definitive prostate RT between January 2010 and December 2015. The primary outcome of interest was ADT utilization. Chi-squared test for trend was used to evaluate the temporal trend in the use of ADT over the study period. Multivariate logistic regressions were used to evaluate the effects of patient-, tumour- and treatment-related factors, and treatment institutions (public/ private and metropolitan/ regional) on the likelihood of ADT utilization. RESULTS: A total of 1806 men were included in the study, 199 of whom (11%) had favourable National Comprehensive Cancer Network (NCCN) intermediate-risk disease (i.e. only one intermediate-risk feature, primary Gleason grade 3, and <50% biopsy core involved), 687 (38%) had unfavourable NCCN intermediate-risk disease, and 920 (51%) had high-risk disease. Of the 1806 men, 1155 (64%) received ADT with RT. Men with NCCN high-risk PCa (84%) were more likely to have ADT than men with favourable NCCN intermediate-risk (32%) and unfavourable NCCN intermediate-risk (46%) PCa (P < 0.001). Men treated in public institutions (66%, vs 47% in private institutions; P < 0.001) and regional centres (78%, vs 59% in metropolitan institutions; P < 0.001) were more likely to receive ADT. There was a trend towards an increase in ADT utilization from 50% in 2010 to 64% in 2015 (P < 0.001). In multivariate analyses (adjusting for age, tumour-related factors, year of treatment and use of brachytherapy boost), treatment institution (public and regional) remained independently associated with increased likelihood of ADT utilization. Men with intermediate-risk PCa treated in regional and public institutions were 2.7 times (95% confidence interval [CI] 1.9-3.9; P < 0.001) and 2.8 times (95% CI 1.4-5.3; P = 0.002), more likely to receive ADT with RT, respectively, while men with high-risk PCa treated in regional and public institutions were 3.1 times (95% CI 1.7-5.7; P < 0.001) and 3.0 times (95% CI 1.7-5.4; P < 0.001), more likely to receive ADT with RT, respectively. CONCLUSION: This is the largest Australasian contemporary series reporting on the pattern of use of ADT with definitive prostate RT. While there was an increasing trend towards use of ADT over time, ADT still appeared to be underutilized in certain groups of patients who may benefit from ADT, with approximately one in five men with high-risk and one in two with unfavourable intermediate-risk PCa not receiving ADT with RT. There was notable variation in the use of ADT between public vs private and metropolitan vs regional institutions.
[Mh] Termos MeSH primário: Antagonistas de Androgênios/uso terapêutico
Hospitais Privados/estatística & dados numéricos
Hospitais Públicos/estatística & dados numéricos
Neoplasias da Próstata
[Mh] Termos MeSH secundário: Idoso
Seres Humanos
Masculino
Meia-Idade
Estudos Prospectivos
Neoplasias da Próstata/tratamento farmacológico
Neoplasias da Próstata/epidemiologia
Neoplasias da Próstata/radioterapia
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Androgen Antagonists)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170728
[St] Status:MEDLINE
[do] DOI:10.1111/bju.13969


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[PMID]:29241381
[Au] Autor:Barrois B; Colin D; Allaert FA
[Ad] Endereço:a Département Qualité , Centre Hospitalier de Gonesse , Gonesse , France.
[Ti] Título:Prevalence, characteristics and risk factors of pressure ulcers in public and private hospitals care units and nursing homes in France.
[So] Source:Hosp Pract (1995);46(1):30-36, 2018 Feb.
[Is] ISSN:2154-8331
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: The aim of this study conducted in 2014 was to describe the prevalence of pressure ulcers in different types of French hospital unit at the national level to compare them with data from the 1994 and 2004 study. METHODS: This cross-sectional study was conducted over a single day. All care units were invited to participate by drawing lots stratified by region in successive waves until 1,200 agreements were obtained. Lots were drawn for towns with more than 10,000 inhabitants. All public- and private-sector hospital facilities in each town drawn by lot were invited to participate in the survey. RESULTS: 776 hospital services throughout France took part and accommodated 21,538 patients: 12,752 women (59.2%) and 8,786 men (40.8%). Of these patients, 1,753 (8.1%; IC95% = 7.7; 8.5) had pressure ulcers. The pressure-ulcer rate was 7.8% (IC95% = [7.3; 8.3] (n = 997)) for hospitalized women and 8.6% (IC95% = [8.0; 9.2] (n = 756)) for men (p = 0.0381). The 8.1% level reported in 2014 therefore points to a reduction in pressure-ulcer prevalence; 8.6% in 1994 and 8.9% in 2004. CONCLUSIONS: The actions performed daily by healthcare professionals to prevent pressure ulcers, supported by research and training programs, including those by PERSE, are having a real impact over time.
[Mh] Termos MeSH primário: Instituição de Longa Permanência para Idosos/estatística & dados numéricos
Hospitais Privados/estatística & dados numéricos
Hospitais Públicos/estatística & dados numéricos
Casas de Saúde/estatística & dados numéricos
Lesão por Pressão/epidemiologia
Lesão por Pressão/prevenção & controle
[Mh] Termos MeSH secundário: Distribuição por Idade
Idoso
Idoso de 80 Anos ou mais
Estudos Transversais
Feminino
França
Seres Humanos
Masculino
Desnutrição/epidemiologia
Meia-Idade
Limitação da Mobilidade
Prevalência
Medição de Risco
Fatores de Risco
Índice de Gravidade de Doença
Distribuição por Sexo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180205
[Lr] Data última revisão:
180205
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171216
[St] Status:MEDLINE
[do] DOI:10.1080/21548331.2018.1418139


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[PMID]:27779329
[Au] Autor:Aranda-Neri JC; Suárez-López L; DeMaria LM; Walker D
[Ad] Endereço:Education and Research in Health, Area General Hospital Number 5 Zacatepec Morelos, Mexican Social Security Institute Delegation Morelos, Mexico.
[Ti] Título:Indications for Cesarean Delivery in Mexico: Evaluation of Appropriate Use and Justification.
[So] Source:Birth;44(1):78-85, 2017 Mar.
[Is] ISSN:1523-536X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Cesarean delivery is one of the most widely used surgical interventions in Latin America and in many cases it is performed with no clear medical indication. Our objective was to analyze the relationship between reported indications for a cesarean and support for that indication in the clinical record in four Mexican hospitals, during the 2006-2007 period. METHODS: The data are from 604 (37.1%) women from a total of 1,625 who were admitted to the hospital in labor, and who gave birth through cesarean. Multivariate logistical regression analysis was used to explore the association between indications for clinically justified or unjustified surgery and other clinical and sociodemographic variables. RESULTS: Supporting clinical information for indications of cesarean delivery were found in only 45 percent of the cases considered. The adjusted statistical analysis showed that the variables associated with an unjustified indication for cesarean were: not having had a prior birth (OR 1.84 [95% CI 1.16-2.89]), having a maximum cervical dilation of 4 centimeters or less at time of cesarean (OR 2.44 [95% CI 1.53-3.87]), and having received care in a private hospital (OR 6.11 [95% CI 1.90-19.57]). DISCUSSION: The indications for cesarean related to labor dynamics were those least supported. Not having had a prior birth poses the greatest risk of having a poorly supported indication for a cesarean delivery. It would be prudent to institute audits, and greater requirements for and surveillance of documentation for cesarean delivery indications.
[Mh] Termos MeSH primário: Cesárea/estatística & dados numéricos
Assistência à Saúde/normas
Obstetrícia/normas
[Mh] Termos MeSH secundário: Adulto
Bases de Dados Factuais
Técnicas e Procedimentos Diagnósticos
Feminino
Hospitais Privados/estatística & dados numéricos
Hospitais Públicos/estatística & dados numéricos
Seres Humanos
Modelos Logísticos
México/epidemiologia
Análise Multivariada
Gravidez
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; OBSERVATIONAL STUDY
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180201
[Lr] Data última revisão:
180201
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161026
[St] Status:MEDLINE
[do] DOI:10.1111/birt.12259


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[PMID]:29205825
[Au] Autor:Watters DA; Richardson M
[Ad] Endereço:Department of Surgery, Deakin University, Geelong, Victoria, Australia.
[Ti] Título:Let's make the most of the underutilized capacity of the private hospital system for educating our future surgical workforce.
[So] Source:ANZ J Surg;87(12):962-963, 2017 12.
[Is] ISSN:1445-2197
[Cp] País de publicação:Australia
[La] Idioma:eng
[Mh] Termos MeSH primário: Hospitais Privados
[Pt] Tipo de publicação:EDITORIAL; COMMENT
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180131
[Lr] Data última revisão:
180131
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171206
[St] Status:MEDLINE
[do] DOI:10.1111/ans.14178


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[PMID]:29230261
[Au] Autor:Onakpoya UU; Adenle AD; Adenekan AT
[Ad] Endereço:Department of Surgery, Obafemi Awolowo University, Ile-Ife, Nigeria.
[Ti] Título:Early experience with open heart surgery in a pioneer private hospital in West Africa: the Biket medical centre experience.
[So] Source:Pan Afr Med J;28:59, 2017.
[Is] ISSN:1937-8688
[Cp] País de publicação:Uganda
[La] Idioma:eng
[Ab] Resumo:Introduction: More than forty years after the first open heart surgery in Nigeria, all open heart surgeries were carried out in government-owned hospitals before the introduction of such surgeries in 2013 at Biket Medical Centre, a privately owned hospital in Osogbo, South-western Nigeria. The aim of this paper is to review our initial experience with open heart surgery in this private hospital. Methods: All patients who underwent open heart surgery between August 2013 and January 2014 were included in this prospective study. The medical records of the patients were examined and data on age, sex, diagnosis, type of surgery, cardiopulmonary bypass details, complications and length of hospital stay were extracted and the data was analysed using SPSS version 16. Results: Eighteen patients comprising of 12 males and 6 females with ages ranging between 8 months and 52 years (mean= of 15.7 +/- 15 years) were studied. Pericardial patch closure of isolated ventricular septal defect was done in 7 patients (38.9%) while total correction of isolated tetralogy of Fallot was carried out in 5 patients (27.8%). Two patients had mitral valve repair for rheumatic mitral regurgitation. Sixty day mortality was 0%. Conclusion: Safe conduct of open heart surgery in the private hospital setting is feasible in Nigeria. It may be our only guarantee of hitch free and sustainable cardiac surgery.
[Mh] Termos MeSH primário: Procedimentos Cirúrgicos Cardíacos/métodos
Ponte Cardiopulmonar/métodos
Cardiopatias/cirurgia
Complicações Pós-Operatórias/epidemiologia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Criança
Pré-Escolar
Feminino
Cardiopatias/fisiopatologia
Hospitais Privados
Seres Humanos
Lactente
Tempo de Internação
Masculino
Meia-Idade
Nigéria
Estudos Prospectivos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[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.2017.28.59.13188


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[PMID]:29229155
[Au] Autor:Castellanos SA; Buentello G; Gutierrez-Meza D; Forgues A; Haubert L; Artinyan A; Macdonald CL; Suliburk JW
[Ad] Endereço:Baylor College of Medicine, Michael E. Debakey Department of Surgery, Houston, Texas.
[Ti] Título:Use of Game Theory to model patient engagement after surgery: a qualitative analysis.
[So] Source:J Surg Res;221:69-76, 2018 Jan.
[Is] ISSN:1095-8673
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Patient engagement is challenging to define and operationalize. Qualitative analysis allows us to explore patient perspectives on this topic and establish themes. A game theoretic signaling model also provides a framework through which to further explore engagement. METHODS: Over a 6-mo period, thirty-eight interviews were conducted within 6 wk of discharge in patients undergoing thyroid, parathyroid, or colorectal surgery. Interviews were transcribed, anonymized, and analyzed using the NVivo 11 platform. A signaling model was then developed depicting the doctor-patient interaction surrounding the patient's choice to reach out to their physician with postoperative concerns based upon the patient's perspective of the doctor's availability. This was defined as "engagement". We applied the model to the qualitative data to determine possible causations for a patient's engagement or lack thereof. A private hospital's and a safety net hospital's populations were contrasted. RESULTS: The private patient population was more likely to engage than their safety-net counterparts. Using our model in conjunction with patient data, we determined possible etiologies for this engagement to be due to the private patient's perceived probability of dealing with an available doctor and apparent signals from the doctor indicating so. For the safety-net population, decreased access to care caused them to be less willing to engage with a doctor perceived as possibly unavailable. CONCLUSIONS: A physician who understands these Game Theory concepts may be able to alter their interactions with their patients, tailoring responses and demeanor to fit the patient's circumstances and possible barriers to engagement.
[Mh] Termos MeSH primário: Teoria do Jogo
Modelos Teóricos
Participação do Paciente
Cuidados Pós-Operatórios/psicologia
Período Pós-Operatório
[Mh] Termos MeSH secundário: Adulto
Idoso
Feminino
Hospitais Privados
Seres Humanos
Masculino
Meia-Idade
Provedores de Redes de Segurança
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171220
[Lr] Data última revisão:
171220
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171213
[St] Status:MEDLINE


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[PMID]:28469117
[Au] Autor:Shobowale EO; Solarin AU; Elikwu CJ; Onyedibe KI; Akinola IJ; Faniran AA
[Ad] Endereço:Department of Medical Microbiology and Parasitology, Ben Carson School of Medicine, Babcock University, Ilishan-Remo, Ogun State, Nigeria.
[Ti] Título:Neonatal sepsis in a Nigerian private tertiary hospital: Bacterial isolates, risk factors, and antibiotic susceptibility patterns.
[So] Source:Ann Afr Med;16(2):52-58, 2017 Apr-Jun.
[Is] ISSN:0975-5764
[Cp] País de publicação:India
[La] Idioma:eng
[Ab] Resumo:BACKGROUND/OBJECTIVES: Neonatal sepsis is an important cause of morbidity and mortality in the pediatric age group in spite of several attempts at mitigating its effects. This article determines the prevalence of neonatal sepsis and the pathogens responsible for sepsis as well as risk factors and outcome at the Babcock University Teaching Hospital. METHODS: A retrospective analysis of laboratory records of consecutive babies delivered within and outside our hospital suspected of having sepsis over a 1-year period. RESULTS: The isolation rate was 34% from 100 neonates with the predominant pathogens being coagulase-negative staphylococci (CONS), Staphylococcus aureus, and Klebsiella pneumoniae. The risk factors for sepsis were age <3 days (P = 0.03) and prematurity (P < 0.001). The mortality rate was 12% with risk factors for mortality being birth weight <2500 g (P = 0.005), prematurity (P = 0.036), premature rupture of membranes (P = 0.007), and delivery outside a tertiary hospital (P = 0.007). Meropenem, ciprofloxacin, and amikacin showed the highest rates of in vitro efficacy. CONCLUSION: We highlight the prevalent pathogens in our local facility to be a combination of CONS, S. aureus, and K. pneumoniae with susceptibility patterns showing meropenem, ciprofloxacin, and amikacin to be our most effective antimicrobials in vitro.
[Mh] Termos MeSH primário: Antibacterianos/farmacologia
Farmacorresistência Bacteriana
Klebsiella pneumoniae/efeitos dos fármacos
Triagem Neonatal/métodos
Sepse Neonatal/epidemiologia
Staphylococcus aureus/efeitos dos fármacos
[Mh] Termos MeSH secundário: Antibacterianos/uso terapêutico
Estudos Transversais
Feminino
Hospitais Privados
Seres Humanos
Recém-Nascido
Infecções por Klebsiella/tratamento farmacológico
Infecções por Klebsiella/epidemiologia
Infecções por Klebsiella/microbiologia
Klebsiella pneumoniae/isolamento & purificação
Masculino
Testes de Sensibilidade Microbiana
Sepse Neonatal/tratamento farmacológico
Sepse Neonatal/microbiologia
Prevalência
Estudos Retrospectivos
Fatores de Risco
Infecções Estafilocócicas/tratamento farmacológico
Infecções Estafilocócicas/epidemiologia
Infecções Estafilocócicas/microbiologia
Staphylococcus aureus/isolamento & purificação
Centros de Atenção Terciária
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Bacterial Agents)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171211
[Lr] Data última revisão:
171211
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170505
[St] Status:MEDLINE
[do] DOI:10.4103/aam.aam_34_16


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[PMID]:28818864
[Au] Autor:Singh T; Peters SR; Tirschwell DL; Creutzfeldt CJ
[Ad] Endereço:From the Department of Neurology, Harborview Medical Center, University of Washington, Seattle. nanites@uw.edu.
[Ti] Título:Palliative Care for Hospitalized Patients With Stroke: Results From the 2010 to 2012 National Inpatient Sample.
[So] Source:Stroke;48(9):2534-2540, 2017 Sep.
[Is] ISSN:1524-4628
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND PURPOSE: Substantial variability exists in the use of life-prolonging treatments for patients with stroke, especially near the end of life. This study explores patterns of palliative care utilization and death in hospitalized patients with stroke across the United States. METHODS: Using the 2010 to 2012 nationwide inpatient sample databases, we included all patients discharged with stroke identified by codes. Strokes were subclassified as ischemic, intracerebral, and subarachnoid hemorrhage. We compared demographics, comorbidities, procedures, and outcomes between patients with and without a palliative care encounter (PCE) as defined by the code V66.7. Pearson χ test was used for categorical variables. Multivariate logistic regression was used to account for hospital, regional, payer, and medical severity factors to predict PCE use and death. RESULTS: Among 395 411 patients with stroke, PCE was used in 6.2% with an increasing trend over time ( <0.05). We found a wide range in PCE use with higher rates in patients with older age, hemorrhagic stroke types, women, and white race (all <0.001). Smaller and for-profit hospitals saw lower rates. Overall, 9.2% of hospitalized patients with stroke died, and PCE was significantly associated with death. Length of stay in decedents was shorter for patients who received PCE. CONCLUSIONS: Palliative care use is increasing nationally for patients with stroke, especially in larger hospitals. Persistent disparities in PCE use and mortality exist in regards to age, sex, race, region, and hospital characteristics. Given the variations in PCE use, especially at the end of life, the use of mortality rates as a hospital quality measure is questioned.
[Mh] Termos MeSH primário: Grupos Étnicos/estatística & dados numéricos
Hospitais/estatística & dados numéricos
Seguro Saúde/estatística & dados numéricos
Cuidados Paliativos/utilização
Qualidade da Assistência à Saúde
Acidente Vascular Cerebral/terapia
[Mh] Termos MeSH secundário: Afroamericanos/estatística & dados numéricos
Idoso
Idoso de 80 Anos ou mais
Americanos Asiáticos/estatística & dados numéricos
Bases de Dados Factuais
Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos
Feminino
Tamanho das Instituições de Saúde/estatística & dados numéricos
Hispano-Americanos/estatística & dados numéricos
Hospitalização
Hospitais Privados/estatística & dados numéricos
Hospitais Públicos/estatística & dados numéricos
Hospitais Filantrópicos/estatística & dados numéricos
Seres Humanos
Índios Norte-Americanos/estatística & dados numéricos
Tempo de Internação/estatística & dados numéricos
Modelos Logísticos
Masculino
Meia-Idade
Análise Multivariada
Indicadores de Qualidade em Assistência à Saúde
Estudos Retrospectivos
Índice de Gravidade de Doença
Acidente Vascular Cerebral/mortalidade
Assistência Terminal
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170927
[Lr] Data última revisão:
170927
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170819
[St] Status:MEDLINE
[do] DOI:10.1161/STROKEAHA.117.016893


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[PMID]:28767585
[Au] Autor:Ferreira PGDS; Galvao TF; Silva MT
[Ad] Endereço:aFederal University of Amazonas, Faculty of Medicine, Post Graduate Program of Surgery, Manaus bState University of Campinas, Faculty of Pharmaceutical Science, Campinas cFederal University of Amazonas, Faculty of Medicine, Manaus, Brazil.
[Ti] Título:Pent-up demand for surgery in the Manaus metropolitan region: A population-based cross-sectional study.
[So] Source:Medicine (Baltimore);96(31):e7660, 2017 Aug.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Waiting lines in healthcare reflect an imbalance between the availability and the demand for medical services. This study aimed to analyze the prevalence and factors associated with the pent-up demand for surgical procedures in the Manaus metropolitan region.We performed a population-based cross-sectional study in 2015. Pent-up demand was based on self-report by the participants; those who reported waiting were contacted by phone to clarify the nature and reasons for the experienced delay.We interviewed 4001 adults in their households. The pent-up demand for surgical procedures in the Manaus metropolitan region was 14% (95% confidence interval: 13-15%). The surgical specialties with the highest demand included orthopedics (18.1%), gynecology (17.0%), ophthalmology (12.4%), neurosurgery (10.8%), and general surgery (10.2%). The main reason for not accessing services was their lack of availability in the public health system, leading some patients to pay for procedures in private facilities. The populations most affected by pent-up demand included elderly individuals, women, and housewives.Pent-up demand for surgical procedures is a common problem in the Manaus metropolitan region and thus requires coordinated actions to optimize access to and capacity of the healthcare system.
[Mh] Termos MeSH primário: Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos
Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adolescente
Adulto
Fatores Etários
Brasil
Estudos Transversais
Feminino
Acesso aos Serviços de Saúde
Hospitais Privados
Seres Humanos
Entrevistas como Assunto
Masculino
Meia-Idade
Programas Nacionais de Saúde
Fatores Sexuais
Inquéritos e Questionários
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:171017
[Lr] Data última revisão:
171017
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170803
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000007660


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[PMID]:28691935
[Au] Autor:Machado FR; Ferreira EM; Sousa JL; Silva C; Schippers P; Pereira A; Cardoso IM; Salomão R; Japiassu A; Akamine N; Mazza BF; Assunção MSC; Fernandes HS; Bossa A; Monteiro MB; Caixeita N; Azevedo LCP; Silva E; Latin American Sepsis Institute Network
[Ti] Título:Quality Improvement Initiatives in Sepsis in an Emerging Country: Does the Institution's Main Source of Income Influence the Results? An Analysis of 21,103 Patients.
[So] Source:Crit Care Med;45(10):1650-1659, 2017 10.
[Is] ISSN:1530-0293
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: We aimed to assess the results of a quality improvement initiative in sepsis in an emerging setting and to analyze it according to the institutions' main source of income (public or private). DESIGN: Retrospective analysis of the Latin American Sepsis Institute database from 2005 to 2014. SETTINGS: Brazilian public and private institutions. PATIENTS: Patients with sepsis admitted in the participant institutions. INTERVENTIONS: The quality improvement initiative was based on a multifaceted intervention. The institutions were instructed to collect data on 6-hour bundle compliance and outcomes in patients with sepsis in all hospital settings. Outcomes and compliance was measured for eight periods of 6 months each, starting at the time of the enrollment in the intervention. The primary outcomes were hospital mortality and compliance with 6-hour bundle. MEASUREMENTS AND MAIN RESULTS: We included 21,103 patients; 9,032 from public institutions and 12,071 from private institutions. Comparing the first period with the eigth period, compliance with the 6-hour bundle increased from 13.5% to 58.2% in the private institutions (p < 0.0001) and from 7.4% to 15.7% in the public institutions (p < 0.0001). Mortality rates significantly decreased throughout the program in private institutions, from 47.6% to 27.2% in the eighth period (adjusted odds ratio, 0.45; 95% CI, 0.32-0.64). However, in the public hospitals, mortality diminished significantly only in the first two periods. CONCLUSION: This quality improvement initiative in sepsis in an emerging country was associated with a reduction in mortality and with improved compliance with quality indicators. However, this reduction was sustained only in private institutions.
[Mh] Termos MeSH primário: Hospitais Privados
Hospitais Públicos
Pacotes de Assistência ao Paciente
Melhoria de Qualidade/organização & administração
Sepse/terapia
[Mh] Termos MeSH secundário: APACHE
Fatores Etários
Idoso
Idoso de 80 Anos ou mais
Brasil/epidemiologia
Diagnóstico Tardio
Países em Desenvolvimento
Feminino
Mortalidade Hospitalar
Seres Humanos
Masculino
Meia-Idade
Escores de Disfunção Orgânica
Estudos Retrospectivos
Sepse/diagnóstico
Sepse/mortalidade
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170925
[Lr] Data última revisão:
170925
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170711
[St] Status:MEDLINE
[do] DOI:10.1097/CCM.0000000000002585



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