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[PMID]:28459900
[Au] Autor:Gundareddy VP; Maruthur NM; Chibungu A; Bollampally P; Landis R; Eid SM
[Ad] Endereço:Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
[Ti] Título:Association Between Radiologic Incidental Findings and Resource Utilization in Patients Admitted With Chest Pain in an Urban Medical Center.
[So] Source:J Hosp Med;12(5):323-328, 2017 May.
[Is] ISSN:1553-5606
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Increasing use of testing among hospitalized patients has resulted in an increase in radiologic incidental findings (IFs), which challenge the provision of high-value care in the hospital setting. OBJECTIVE: To understand impact of radiologic incidental findings on resource utilization in patients hospitalized with chest pain. DESIGN: Retrospective observational cross sectional study. SETTING: Academic medical center. PARTICIPANTS: Adult patients hospitalized with principal diagnosis of chest pain. MEASUREMENTS: Demographic, imaging, and length of stay (LOS) data were abstracted from the medical charts. We used multiple logistic regression to evaluate factors associated with radiologic IFs and negative binomial regression to evaluate the association between radiologic IFs and LOS. RESULTS: 1811 consecutive admissions with chest pain were analyzed retrospectively over a period of 24 months; 376 patients were included in the study after exclusion criteria were applied and readmissions removed. Of these, 197 patients (52%) had 364 new radiologic IFs on imaging; most IFs were of minor (50%) or moderate clinical significance (42%), with only 7% of major significance. Odds of finding radiologic IFs increased with age (adjusted odds ratio, 1.04; 95% confidence interval [CI], 1.01-1.06) and was associated with a 26% increase in LOS (adjusted incidence rate ratio, 1.26; 95% CI, 1.07-1.49). CONCLUSION: Radiologic IFs were very common among patients hospitalized with chest pain of suspected cardiac origin and independently associated with an increase in the LOS. Interventions to address radiologic IFs may reduce LOS and, thereby, support high-value care. Journal of Hospital Medicine 2017;12:323-328.
[Mh] Termos MeSH primário: Dor no Peito/diagnóstico por imagem
Recursos em Saúde/utilização
Hospitais Urbanos/utilização
Achados Incidentais
Admissão do Paciente
Serviço Hospitalar de Radiologia/utilização
[Mh] Termos MeSH secundário: Adulto
Dor no Peito/terapia
Estudos Transversais
Feminino
Recursos em Saúde/tendências
Hospitais Urbanos/tendências
Seres Humanos
Masculino
Meia-Idade
Admissão do Paciente/tendências
Serviço Hospitalar de Radiologia/tendências
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[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:170502
[St] Status:MEDLINE
[do] DOI:10.12788/jhm.2722


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[PMID]:28453720
[Au] Autor:Chavehpour Y; Rashidian A; Raghfar H; Emamgholipour Sefiddashti S; Maroofi A
[Ad] Endereço:Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
[Ti] Título:'Seeking affluent neighbourhoods?' a time-trend analysis of geographical distribution of hospitals in the Megacity of Tehran.
[So] Source:Health Policy Plan;32(5):669-675, 2017 Jun 01.
[Is] ISSN:1460-2237
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Objective: Access to hospitals in megacities in low and middle income countries might be hampered by travel barriers and distance. We assessed the 'inverse care law' hypothesis: whether hospitals tended to be built in the relatively better-off areas through the time. Methods: A longitudinal time-series study (1966 to 2011) in Tehran to measure inequality in the distribution of hospital beds. We assessed correlations between the district socioeconomic status and availability of hospital beds via regression analyses, estimated correlation, Gini and concentration indices, and used GIS models to map hospital distributions through time. Finding: We found a clear relationship between socioeconomic status and number of hospital beds per capita ( P -values <0.05). Gini coefficients were about 0.6 and 0.8 for public and private beds, respectively. A third of the variations in hospital bed distribution was explained by the welfare status of the district. For every extra residential room per capita, 130 to 280 extra beds were observed per ten thousand population at the district level. In 2011, out of 162 hospitals, 110 were located in six districts around the centre and northern part of the city. During the time period only two private hospitals were built in relatively disadvantaged districts. Conclusion: Over a period of about fifty years new hospitals had been established in the relatively affluent areas of the city and the relationship between socioeconomic status of district with total, private and public beds were direct and intensive. Results indicate the problem of inequality may remain over time and be resistant to policy initiatives and major political changes.
[Mh] Termos MeSH primário: Acesso aos Serviços de Saúde
Número de Leitos em Hospital/estatística & dados numéricos
Hospitais Urbanos/estatística & dados numéricos
Fatores Socioeconômicos
[Mh] Termos MeSH secundário: Geografia
Irã (Geográfico)
[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/czw172


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[PMID]:28458492
[Au] Autor:Belete T; Medfu G; Yemiyamrew E
[Ad] Endereço:Psychiatry Unit, School of Nursing, College of Health Sciences, Mekelle University, Ethiopia.
[Ti] Título:Prevalence of HIV Associated Neurocognitive Deficit among HIV Positive People in Ethiopia: A Cross Sectional Study at Ayder Referral Hospital.
[So] Source:Ethiop J Health Sci;27(1):67-76, 2017 Jan.
[Is] ISSN:2413-7170
[Cp] País de publicação:Ethiopia
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: HIV associated neurocognitive deficit impairs motor activity, neuropsychiatric functioning, daily activity and work activity usually due to the immune suppression effect of the virus. Sub-Saharan region including Ethiopia is the region with the highest burden of HIV. However, a few studies are found on this aspect nationally. This study was aimed at determining the prevalence and the factors associated with cognitive impairment among HIV positive people in Ethiopia who attended Ayder Comprehensive Specialized Hospital. METHOD: A hospital based cross sectional study was employed on 234 participants selected using systematic random sampling technique. Data was collected thrpugh face-to-face interview, observation and document review. International HIV dementia scale, activity of daily living scale and Hospital Anxiety and Depression scale were used to assess neuro cognitive deficit, activity of daily living, anxiety and depression respectively. The data was analyzed by using SPSS window 20. RESULTS: About 88% of the subjects were receiving highly active antiretroviral therapy. The magnitude of Neuro cognitive deficit was 33.3% (95% CI; 27.7% - 40.6%). Impairment in the activity of daily living was observed on 9.8% of the participants. Besides, 55.6% and 67.1% had anxiety and depressive disorders respectively. Late clinical stage of the illness (AOR= 4.2 (95% CI; 1.19, 14.44)) and impairment in the activity of daily living were significantly associated with neurocognitive deficit (AOR= 7.19 (95% CI; 1.73, 21.83). CONCLUSION: A higher prevalence of neurocognitive deficit was observed that was related to impaired activity of daily living and being in late stages of the illness. Hence, this should be a strong alarm for early detection of the problem and consistent review of the treatment regimen.
[Mh] Termos MeSH primário: Infecções por HIV/epidemiologia
Transtornos Neurocognitivos/epidemiologia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Comorbidade
Estudos Transversais
Etiópia/epidemiologia
Feminino
Hospitais Urbanos
Seres Humanos
Masculino
Meia-Idade
Prevalência
Encaminhamento e Consulta
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180228
[Lr] Data última revisão:
180228
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE


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[PMID]:28470687
[Au] Autor:Li Y; Zhang M; Liu X; Cui W; Rampersad S; Li F; Lin Z; Yang P; Li H; Sheng C; Cheng X; Qu S
[Ad] Endereço:Department of Endocrinology & Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
[Ti] Título:Correlates and prevalence of hypogonadism in patients with early- and late-onset type 2 diabetes.
[So] Source:Andrology;5(4):739-743, 2017 07.
[Is] ISSN:2047-2927
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:This study aims to compare the prevalence of hypogonadism between male patients with early-onset type 2 diabetes mellitus (T2DM) and late-onset type 2 diabetes. A total of 122 male patients with early-onset T2DM (diagnosis age ≤40 years) and 100 male patients with late-onset T2DM (diagnosis age >40 years) were recruited from our in-patient department between 1 January 2013 and 28 December 2015. Serum FSH, LH, testosterone, lipid profile, uric acid, HbA1c, and beta-cell function were determined in blood samples. The diagnosis of hypogonadism was based on the levels of LH, FSH, and total testosterone. The mean onset age was 29.86 ± 6.31 and 54.47 ± 9.97 years old in the early-onset group and late-onset group, respectively. Compared with late-onset T2DM, those with early-onset T2DM had a higher proportion of new-onset diabetes, were more likely to be obese, and had worse glycemic control, lipid control, and lower sex hormone-binding globulin (SHBG). The prevalence of hypogonadism was much higher in the early-onset group than in the late-onset group (48.0% vs. 26.7%, p < 0.05). The rate of secondary hypogonadism in the early-onset group and late-onset group were 44.3% and 25.0%, respectively (p < 0.05). Obesity, waist circumference, and SHBG were significantly associated with serum total testosterone level in all, early-onset, and late-onset T2DM. Both all and early-onset T2DM groups had positive correlations between total testosterone and fasting C-peptide, total cholesterol, triglycerides, and uric acid. Our results indicate that in a population of admission to a large urban hospital in China, the prevalence of hypogonadism was higher in the patients with early-onset T2DM than that of late-onset T2DM. This prevalence might be attributable to greater obesity, worse lipid control, and lower SHBG levels in those patients.
[Mh] Termos MeSH primário: Diabetes Mellitus Tipo 2/epidemiologia
Hipogonadismo/epidemiologia
[Mh] Termos MeSH secundário: Adulto
Idade de Início
Idoso
Biomarcadores/sangue
Glicemia/análise
China/epidemiologia
Estudos Transversais
Diabetes Mellitus Tipo 2/sangue
Diabetes Mellitus Tipo 2/diagnóstico
Hormônio Foliculoestimulante Humano/sangue
Hemoglobina A Glicada/análise
Hospitais Urbanos
Seres Humanos
Hipogonadismo/sangue
Hipogonadismo/diagnóstico
Insulina/sangue
Lipídeos/sangue
Hormônio Luteinizante/sangue
Masculino
Meia-Idade
Admissão do Paciente
Prevalência
Fatores de Risco
Globulina de Ligação a Hormônio Sexual/análise
Testosterona/sangue
Ácido Úrico/sangue
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Biomarkers); 0 (Blood Glucose); 0 (Follicle Stimulating Hormone, Human); 0 (Glycated Hemoglobin A); 0 (Insulin); 0 (Lipids); 0 (Sex Hormone-Binding Globulin); 0 (hemoglobin A1c protein, human); 268B43MJ25 (Uric Acid); 3XMK78S47O (Testosterone); 9002-67-9 (Luteinizing Hormone)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180227
[Lr] Data última revisão:
180227
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170505
[St] Status:MEDLINE
[do] DOI:10.1111/andr.12360


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[PMID]:29385173
[Au] Autor:Fleet R; Bussières S; Tounkara FK; Turcotte S; Légaré F; Plant J; Poitras J; Archambault PM; Dupuis G
[Ad] Endereço:Department of Family Medicine and Emergency Medicine, Université Laval, Québec, QC, Canada.
[Ti] Título:Rural versus urban academic hospital mortality following stroke in Canada.
[So] Source:PLoS One;13(1):e0191151, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Stroke is one of the leading causes of death in Canada. While stroke care has improved dramatically over the last decade, outcomes following stroke among patients treated in rural hospitals have not yet been reported in Canada. OBJECTIVES: To describe variation in 30-day post-stroke in-hospital mortality rates between rural and urban academic hospitals in Canada. We also examined 24/7 in-hospital access to CT scanners and selected services in rural hospitals. MATERIALS AND METHODS: We included Canadian Institute for Health Information (CIHI) data on adjusted 30-day in-hospital mortality following stroke from 2007 to 2011 for all acute care hospitals in Canada excluding Quebec and the Territories. We categorized rural hospitals as those located in rural small towns providing 24/7 emergency physician coverage with inpatient beds. Urban hospitals were academic centres designated as Level 1 or 2 trauma centres. We computed descriptive data on local access to a CT scanner and other services and compared mean 30-day adjusted post-stroke mortality rates for rural and urban hospitals to the overall Canadian rate. RESULTS: A total of 286 rural hospitals (3.4 million emergency department (ED) visits/year) and 24 urban hospitals (1.5 million ED visits/year) met inclusion criteria. From 2007 to 2011, 30-day in-hospital mortality rates following stroke were significantly higher in rural than in urban hospitals and higher than the Canadian average for every year except 2008 (rural average range = 18.26 to 21.04 and urban average range = 14.11 to 16.78). Only 11% of rural hospitals had a CT-scanner, 1% had MRI, 21% had in-hospital ICU, 94% had laboratory and 92% had basic x-ray facilities. CONCLUSION: Rural hospitals in Canada had higher 30-day in-hospital mortality rates following stroke than urban academic hospitals and the Canadian average. Rural hospitals also have very limited local access to CT scanners and ICUs. These rural/urban discrepancies are cause for concern in the context of Canada's universal health care system.
[Mh] Termos MeSH primário: Mortalidade Hospitalar
Hospitais Rurais/estatística & dados numéricos
Hospitais Urbanos/estatística & dados numéricos
Acidente Vascular Cerebral/mortalidade
[Mh] Termos MeSH secundário: Canadá/epidemiologia
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180223
[Lr] Data última revisão:
180223
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180201
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0191151


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[PMID]:29390516
[Au] Autor:Ding JM; Zhang XZ; Hu XJ; Chen HL; Yu M
[Ad] Endereço:Department of Health Services, The Fourth Military Medical University, Xi'an, Shaanxi.
[Ti] Título:Analysis of hospitalization expenditures and influencing factors for inpatients with coronary heart disease in a tier-3 hospital in Xi'an, China: A retrospective study.
[So] Source:Medicine (Baltimore);96(51):e9341, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The medical costs for inpatients with coronary heart disease (CHD) have risen to unprecedented levels, putting tremendous financial pressure on their families and the entire society. The objective of this study was to examine the actual direct medical costs of inpatients with CHD and to analyze the influencing factors of those costs, to provide advice on the prevention and control of high medical costs of patients with CHD. METHODS: A retrospective descriptive analysis of hospitalization expenditures data examined 10,301 inpatients with coronary heart disease of a tier-3 hospital in Xi'an from January 1, 2015 to December 31, 2015. The data included demographic information, the average length of stay, and different types of expenses incurred during the hospitalization period. The difference between different groups was analyzed using a univariate analysis, and the influencing factors of hospitalization expenditures were explored by the multiple linear stepwise regression analysis. RESULTS: The average age of these patients was 60.0 years old, the average length of stay was 4.0 days, and the majority were males (7172, 69.6%). The average hospitalization expenses were $6791.38 (3294.16-9, 732.59), and the top 3 expenses were medical consumables, operation fees, and drugs. The influencing factors of hospitalization expenditures included the length of stay, the number of times of admission, the type of medical insurance schemes, whether have a surgery or not, the gender, the age, and the marriage status. CONCLUSION: The inpatients with CHD in this tier-3 hospital were mostly over 45 years old. The average medical cost of males was much higher than that of females. Our findings suggest that the solution for tremendous hospitalization expenditures should be that more attention is paid to controlling the high expense of medical consumables and that the traditional method of reducing medical expenses by shortening the length of stay is still important in nowadays. Furthermore, the type of medical insurance schemes has different impacts on medical expenses. Reducing or controlling high hospitalization expenditures is a complicated process that needs multifaceted cooperation.
[Mh] Termos MeSH primário: Doença das Coronárias/economia
Custos Hospitalares
Hospitalização/economia
Tempo de Internação/economia
[Mh] Termos MeSH secundário: Adulto
Fatores Etários
Idoso
Análise de Variância
China
Estudos de Coortes
Doença das Coronárias/diagnóstico
Doença das Coronárias/terapia
Feminino
Gastos em Saúde
Hospitalização/estatística & dados numéricos
Hospitais Urbanos
Seres Humanos
Pacientes Internados/estatística & dados numéricos
Masculino
Meia-Idade
Estudos Retrospectivos
Fatores de Risco
Fatores Sexuais
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180219
[Lr] Data última revisão:
180219
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180203
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009341


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[PMID]:29351178
[Au] Autor:Welton JM; Kleiner C; Valdez C; Richardson S; Boyle K; Lucas E
[Ad] Endereço:Author Affiliations: Professor and Senior Scientist (Dr Welton), Health Systems Research, University of Colorado College of Nursing, Aurora; Research Scientist, Nursing Outcomes, Research, and EBP (Dr Kleiner), Biostatistician, Department of Patient Safety and Quality (Ms Valdez), Professional Development Specialist, Nursing Education, Research, and AHA (Ms Richardson), and Chief Nursing Officer (Dr Boyle), Denver Health, Colorado; Research Assistant and Graduate Student (Mr Lucas), MPH Program, University of Colorado School of Public Health, Aurora.
[Ti] Título:Using Time-Referenced Data to Assess Medication Administration Performance and Quality.
[So] Source:J Nurs Adm;48(2):100-106, 2018 Feb.
[Is] ISSN:1539-0721
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: This study tests the feasibility of using a large (big) clinical data set to test the ability to extract time-referenced data related to medication administration to identify late doses and as-needed (PRN) administration patterns by RNs in an inpatient setting. METHODS: The study is a secondary analysis of a set of data using bar-code medication administration time stamps (n = 3043812) for 50883 patients admitted to a single, urban, 525-bed hospital in 11 inpatient units by 714 nurses between April 1, 2013, and March 31, 2015. RESULTS: The large majority of scheduled medications (43.3%) were administered between 9 to 10 AM and 9 to 10 PM accounting for the most amount of delayed doses. On average, patients received 8.9 medications per day, and nurses administered 19.7 medications per shift. The average full-time nurse administered 3414 medications per year. CONCLUSIONS: The findings support use of time-referenced data to identify clinical processes and performance in administering scheduled and PRN medications.
[Mh] Termos MeSH primário: Esquema de Medicação
Pacientes Internados/estatística & dados numéricos
Erros de Medicação/estatística & dados numéricos
Sistemas de Medicação no Hospital/estatística & dados numéricos
Enfermeiras e Enfermeiros/estatística & dados numéricos
Medicamentos sob Prescrição/administração & dosagem
[Mh] Termos MeSH secundário: Adulto
Feminino
Hospitais Urbanos/estatística & dados numéricos
Seres Humanos
Masculino
Meia-Idade
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Prescription Drugs)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180205
[Lr] Data última revisão:
180205
[Sb] Subgrupo de revista:AIM; IM; N
[Da] Data de entrada para processamento:180120
[St] Status:MEDLINE
[do] DOI:10.1097/NNA.0000000000000580


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[PMID]:29226438
[Au] Autor:Gostin LO
[Ti] Título:The "Great" Generation and a Not-So-Great Health System.
[So] Source:Milbank Q;95(4):698-701, 2017 Dec.
[Is] ISSN:1468-0009
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Cuidados Paliativos
Relações Profissional-Família
[Mh] Termos MeSH secundário: Idoso de 80 Anos ou mais
Hospitais Urbanos
Seres Humanos
Masculino
Cidade de Nova Iorque
Cuidados Paliativos/normas
[Pt] Tipo de publicação:JOURNAL ARTICLE; PERSONAL NARRATIVES
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180202
[Lr] Data última revisão:
180202
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171212
[St] Status:MEDLINE
[do] DOI:10.1111/1468-0009.12292


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[PMID]:28458120
[Au] Autor:Kempf E; Tournigand C; Rochigneux P; Aubry R; Morin L
[Ad] Endereço:AP-HP, Henri Mondor University Hospital, Medical Oncology Department, 51 avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France.
[Ti] Título:Discrepancies in the use of chemotherapy and artificial nutrition near the end of life for hospitalised patients with metastatic gastric or oesophageal cancer. A countrywide, register-based study.
[So] Source:Eur J Cancer;79:31-40, 2017 07.
[Is] ISSN:1879-0852
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:AIM: To evaluate the frequency and the factors associated with the use of chemotherapy and artificial nutrition near the end of life in hospitalised patients with metastatic oesophageal or gastric cancer. METHODS: Nationwide, register-based study, including all hospitalised adults (≥20 years) who died with metastatic oesophageal or gastric cancer between 2010 and 2013, in France. Chemotherapy and artificial nutrition during the final weeks of life were considered as primary outcomes. RESULTS: A total of 4031 patients with oesophageal cancer and 10,423 patients with gastric cancer were included. While the proportion of patients receiving chemotherapy decreased from 35.9% during the 3rd month before death to 7.9% in the final week (p < 0.001 for trend), the use of artificial nutrition rose from 9.6% to 16.0% of patients. During the last week before death, patients with stomach cancer were more likely to receive chemotherapy (adjusted odds ratio (aOR) = 1.35, 95% CI = 1.17-1.56) but less likely to receive artificial nutrition (aOR = 0.80, 95%CI = 0.73-0.88) than patients with cancer of the oesophagus. The adjusted rates of chemotherapy use during the last week of life varied from 1.6% in rural hospitals to 11.2% in comprehensive cancer centres, while the adjusted probability to receive artificial nutrition varied from 12.1% in private for-profit clinics up to 19.9% in rehabilitation care facilities (p < 0.001). CONCLUSIONS: Our study shows that in hospitalised patients with metastatic oesophageal or gastric cancer, the use of chemotherapy decreases while the use of artificial nutrition increases as death approaches. This raises important questions, as clinical guidelines clearly recommend to limit the use of artificial nutrition in contexts of limited life expectancy.
[Mh] Termos MeSH primário: Antineoplásicos/uso terapêutico
Neoplasias Esofágicas/terapia
Apoio Nutricional/utilização
Neoplasias Gástricas/terapia
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Institutos de Câncer/estatística & dados numéricos
Feminino
França
Hospitalização/estatística & dados numéricos
Hospitais Urbanos/estatística & dados numéricos
Seres Humanos
Masculino
Meia-Idade
Metástase Neoplásica
Estado Nutricional
Sistema de Registros
Estudos Retrospectivos
Saúde da População Rural/estatística & dados numéricos
Assistência Terminal/métodos
Assistência Terminal/estatística & dados numéricos
Saúde da População Urbana/estatística & dados numéricos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antineoplastic Agents)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:171230
[Lr] Data última revisão:
171230
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE


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[PMID]:28953928
[Au] Autor:Nuzhat S; Ahmed T; Kawser CA; Khan AI; Islam SMR; Shahrin L; Shahunja KM; Shahid ASMSB; Al Imran A; Chisti MJ
[Ad] Endereço:Nutrition and Clinical Services Division (NCSD), International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
[Ti] Título:Age specific fast breathing in under-five diarrheal children in an urban hospital: Acidosis or pneumonia?
[So] Source:PLoS One;12(9):e0185414, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Children with diarrhea often present with fast breathing due to metabolic acidosis from dehydration. On the other hand, age specific fast breathing is the cornerstone for the diagnosis of pneumonia following classification of pneumonia recommended by the World Health Organization (WHO). Correction of metabolic acidosis by rehydrating the diarrheal children requires time, which delays early initiation of appropriate antimicrobials for pneumonia and thereby increases the risk of deaths. We need to further investigate the simple clinical features other than fast breathing which might help us in earliest diagnosis of pneumonia in children with diarrhea Thus, the objective of our study was to identify other contributing clinical features that may independently help for early diagnosis of pneumonia in diarrheal children who present with age specific fast breathing. METHODS: This was an unmatched case-control study. Diarrheal children aged 0-59 months, admitted to Dhaka Hospital of the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b) during January 2014 to December 2014 having age specific fast breathing (<2 month ≥60 breath/min, 2-11 months ≥50 breaths/min, >11-59 months ≥40 breaths/min) were studied. The study children with clinical and radiological pneumonia constituted the cases (n = 276) and those without pneumonia constituted the controls (n = 446). Comparison of clinical features and outcomes between the cases and the controls was made. RESULTS: The distribution of acidosis among the cases and the controls was comparable (35% vs. 41%, p = 0.12). The cases had proportionately higher deaths compared to the controls, however, the difference was not statistically significant (3% vs. 1%; p = 0.23). In logistic regression analysis after adjusting for potential confounders, the cases were independently associated with cough (OR = 62.19, 95% CI = 27.79-139.19; p<0.01) and chest wall indrawing (OR = 31.05, 95%CI = 13.43-71.82; p<0.01) and less often had severe acute malnutrition (OR = 0.33, 95%CI = 0.13-0.79; p<0.01). The sensitivity and specificity of cough were 83% (78-87%) and 93% (91-96%). The sensitivity and specificity for lower chest wall indrawing were 65% (59-71%) and 95% (93-97%). However, the sensitivity and specificity of cough and lower chest wall indrawing combined were 94% (89-97%) and 99% (97-100%). CONCLUSION AND SIGNIFICANCE: Thus, diarrheal children having fast breathing who present with cough and/or lower chest wall indrawing, irrespective of presence or absence of metabolic acidosis, are more likely to have radiological pneumonia. The results underscore the importance of early identification of these simple clinical features that may help to minimize potential delay due to rehydration in initiating prompt treatment of pneumonia in order to reduce fatal consequences in such children.
[Mh] Termos MeSH primário: Acidose/diagnóstico
Diarreia/fisiopatologia
Hospitais Urbanos
Pneumonia/diagnóstico
Respiração
[Mh] Termos MeSH secundário: Acidose/fisiopatologia
Estudos de Casos e Controles
Pré-Escolar
Diagnóstico Diferencial
Feminino
Seres Humanos
Lactente
Masculino
Pneumonia/tratamento farmacológico
Pneumonia/fisiopatologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[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:170928
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0185414



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