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[PMID]:29360306
[Au] Autor:Lee A; Berry MD; Thomson Reuters Accelus.
[Ti] Título:Long-Term Care: Facility Quality and Safety.
[So] Source:Issue Brief Health Policy Track Serv;2017:1-44, 2017 Dec 26.
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Assistência de Longa Duração/organização & administração
Casas de Saúde/organização & administração
Segurança do Paciente
Instituições de Cuidados Especializados de Enfermagem/organização & administração
[Mh] Termos MeSH secundário: Antipsicóticos/uso terapêutico
Planejamento em Desastres
Sistemas de Combate a Incêndio
Fraude
Seres Humanos
Controle de Infecções
Medicaid
Medicare
Abuso Físico
Lesão por Pressão
Qualidade da Assistência à Saúde
Delitos Sexuais
Mídias Sociais
Governo Estadual
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antipsychotic Agents)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180219
[Lr] Data última revisão:
180219
[Sb] Subgrupo de revista:T
[Da] Data de entrada para processamento:180124
[St] Status:MEDLINE


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[PMID]:29319943
[Au] Autor:Office of the Secretary, Department of Defense (DoD).
[Ti] Título:TRICARE; Reimbursement of Long Term Care Hospitals and Inpatient Rehabilitation Facilities. Final rule.
[So] Source:Fed Regist;82(249):61678-94, 2017 Dec 29.
[Is] ISSN:0097-6326
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:This final rule establishes reimbursement rates for Long Term Care Hospitals (LTCHs) and Inpatient Rehabilitation Facilities (IRFs) in accordance with the statutory requirement that TRICARE inpatient care "payments shall be determined to the extent practicable in accordance with the same reimbursement rules as apply to payments to providers of services of the same type under Medicare." This final rule adopts Medicare's reimbursement methodologies for inpatient services provided by LTCHs and IRFs. Each reimbursement methodology will be phased in over a 3-year period. This final rule also removes the definitions for "hospital, long-term (tuberculosis, chronic care, or rehabilitation)" and "long-term hospital care," and creates separate definitions for "Long Term Care Hospital" and "Inpatient Rehabilitation Facility" adopting Centers for Medicare & Medicaid Services (CMS) classification criteria. This final rule also includes authority for a year-end, discretionary General Temporary Military Contingency Payment Adjustment (GTMCPA) for inpatient services in TRICARE network IRFs when deemed essential to meet military contingency requirements.
[Mh] Termos MeSH primário: Planos de Assistência de Saúde para Empregados/economia
Reembolso de Seguro de Saúde/economia
Assistência de Longa Duração/economia
Centros de Reabilitação/economia
Mecanismo de Reembolso/economia
Instituições de Cuidados Especializados de Enfermagem/economia
[Mh] Termos MeSH secundário: Economia Hospitalar
Seres Humanos
Militares
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180122
[Lr] Data última revisão:
180122
[Sb] Subgrupo de revista:T
[Da] Data de entrada para processamento:180111
[St] Status:MEDLINE


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[PMID]:29229128
[Au] Autor:Fernandes-Taylor S; Berg S; Gunter R; Bennett K; Smith MA; Rathouz PJ; Greenberg CC; Kent KC
[Ad] Endereço:Department of Surgery, Wisconsin Surgical Outcomes Research Program, University of Wisconsin-Madison, Madison, Wisconsin. Electronic address: fernandes-taylor@surgery.wisc.edu.
[Ti] Título:Thirty-day readmission and mortality among Medicare beneficiaries discharged to skilled nursing facilities after vascular surgery.
[So] Source:J Surg Res;221:196-203, 2018 Jan.
[Is] ISSN:1095-8673
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Readmission within 30 d of an acute hospital stay is frequent, costly, and increasingly subject to penalties. Early readmission is most common after vascular surgery; these patients are often discharged to skilled nursing facilities (SNFs), making postacute care an essential partner in reducing readmissions. We characterize 30-day readmissions among vascular surgery patients discharged to SNF to provide evidence for this understudied segment of readmission after specialty surgery. METHODS: We utilize the Centers for Medicare & Medicaid Services Chronic Conditions Warehouse, a longitudinal 5% national random sample of Medicare beneficiaries to study 30-day readmission or death after discharge to SNF following abdominal aortic aneurysm repair or lower extremity revascularization from 2005-2009. Descriptive statistics and logistic regression with Least Adaptive Shrinkage and Selection Operator were used for analysis. RESULTS: Two thousand one hundred ninety-seven patients underwent an abdominal aortic aneurysm procedure or lower extremity revascularization at 686 hospitals and discharged to 1714 SNFs. Eight hundred (36%) were readmitted or had died at 30 d. In adjusted analysis, predictors of readmission or death at 30 d included SNF for-profit status (OR [odds ratio] = 1.2; P = 0.032), number of hospitalizations in the previous year (OR = 1.06; P = 0.011), number of comorbidities (OR = 1.06; P = 0.004), emergent procedure (OR = 1.69; P < 0.001), renal complication (OR = 1.38; P = 0.003), respiratory complication (OR = 1.45; P < 0.001), thromboembolic complication (OR = 1.57; P = 0.019), and wound complication (OR = 0.70; P = 0.017). CONCLUSIONS: Patients discharged to SNF following vascular surgery have exceptionally high rates of readmission or death at 30 d. Many factors predicting readmission or death potentially modify decision-making around discharge, making early detection, discharge planning, and matching patient needs to SNF capabilities essential to improving outcomes.
[Mh] Termos MeSH primário: Alta do Paciente
Readmissão do Paciente/estatística & dados numéricos
Instituições de Cuidados Especializados de Enfermagem
Procedimentos Cirúrgicos Vasculares/mortalidade
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Feminino
Seres Humanos
Masculino
Estados Unidos/epidemiologia
[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:171213
[St] Status:MEDLINE


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[PMID]:28830975
[Au] Autor:Xian Y; Thomas L; Liang L; Federspiel JJ; Webb LE; Bushnell CD; Duncan PW; Schwamm LH; Stein J; Fonarow GC; Hoenig H; Montalvo C; George MG; Lutz BJ; Peterson ED; Bettger JP
[Ad] Endereço:From the Duke Clinical Research Institute, Durham, NC (Y.X., L.T., L.L., J.J.F., L.E.W., E.D.P., J.P.B.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD (J.J.F.); Department of Neurology, Wake
[Ti] Título:Unexplained Variation for Hospitals' Use of Inpatient Rehabilitation and Skilled Nursing Facilities After an Acute Ischemic Stroke.
[So] Source:Stroke;48(10):2836-2842, 2017 Oct.
[Is] ISSN:1524-4628
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND PURPOSE: Rehabilitation is recommended after a stroke to enhance recovery and improve outcomes, but hospital's use of inpatient rehabilitation facilities (IRFs) or skilled nursing facility (SNF) and the factors associated with referral are unknown. METHODS: We analyzed clinical registry and claims data for 31 775 Medicare beneficiaries presenting with acute ischemic stroke from 918 Get With The Guidelines-Stroke hospitals who were discharged to either IRF or SNF between 2006 and 2008. Using a multilevel logistic regression model, we evaluated patient and hospital characteristics, as well as geographic availability, in relation to discharge to either IRF or SNF. After accounting for observed factors, the median odds ratio was reported to quantify hospital-level variation in the use of IRF versus SNF. RESULTS: Of 31 775 patients, 17 662 (55.6%) were discharged to IRF and 14 113 (44.4%) were discharged to SNF. Compared with SNF patients, IRF patients were younger, more were men, had less health-service use 6 months prestroke, and had fewer comorbid conditions and in-hospital complications. Use of IRF or SNF varied significantly across hospitals (median IRF use, 55.8%; interquartile range, 34.8%-75.0%; unadjusted median odds ratio, 2.59; 95% confidence interval, 2.44-2.77). Hospital-level variation in discharge rates to IRF or SNF persisted after adjustment for patient, clinical, and geographic variables (adjusted median odds ratio, 2.87; 95% confidence interval, 2.68-3.11). CONCLUSIONS: There is marked unexplained variation among hospitals in their use of IRF versus SNF poststroke even after accounting for clinical characteristics and geographic availability. CLINICAL TRIAL REGISTRATION: URL: https://clinicaltrials.gov. Unique identifier: NCT02284165.
[Mh] Termos MeSH primário: Isquemia Encefálica/terapia
Hospitalização
Instituições de Cuidados Especializados de Enfermagem/utilização
Reabilitação do Acidente Vascular Cerebral/utilização
Acidente Vascular Cerebral/terapia
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Isquemia Encefálica/diagnóstico
Isquemia Encefálica/epidemiologia
Feminino
Hospitalização/tendências
Seres Humanos
Masculino
Sistema de Registros
Instituições de Cuidados Especializados de Enfermagem/normas
Acidente Vascular Cerebral/diagnóstico
Acidente Vascular Cerebral/epidemiologia
Reabilitação do Acidente Vascular Cerebral/normas
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171009
[Lr] Data última revisão:
171009
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170824
[St] Status:MEDLINE
[do] DOI:10.1161/STROKEAHA.117.016904


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[PMID]:28821351
[Au] Autor:Wiesel J; Salomone TJ
[Ad] Endereço:NYU Langone Medical Center, New York, NY. Electronic address: josephw634@aol.com.
[Ti] Título:Screening for Atrial Fibrillation in Patients ≥65 Years Using an Automatic Blood Pressure Monitor in a Skilled Nursing Facility.
[So] Source:Am J Cardiol;120(8):1322-1324, 2017 Oct 15.
[Is] ISSN:1879-1913
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Early detection of asymptomatic atrial fibrillation (AF) provides an opportunity to treat patients to reduce their risk of stroke. Long-term residents of skilled nursing facilities frequently have multiple risk factors for strokes due to AF and may benefit from screening for AF. Patients in a skilled nursing facility 65 years and older, without a history of AF and without a pacemaker or defibrillator, were evaluated using a Microlife WatchBP Home A automatic blood pressure monitor that can detect AF when set to a triple reading mode. Those with readings positive for AF were evaluated with a standard 12-lead electrocardiogram (ECG) or a 30-second single-channel ECG to confirm the presence of AF. A total of 101 patients were screened with an average age of 78 years, and 48 (48%) were female. Nine automatic blood pressure monitor readings were positive for possible AF. Of those, 7 (6.9%, 95% confidence intervals 3.0% to 14.2%) had AF confirmed with ECG. Only 2 (2%, 95% confidence interval 0.3% to 7.7%) were false-positive readings. One-time screening for AF using an automatic blood pressure monitor in a skilled nursing facility resulted in a high number of patients with newly diagnosed AF.
[Mh] Termos MeSH primário: Fibrilação Atrial/diagnóstico
Monitores de Pressão Arterial
Pressão Sanguínea/fisiologia
Diagnóstico Precoce
Instituições de Cuidados Especializados de Enfermagem
Acidente Vascular Cerebral/prevenção & controle
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Fibrilação Atrial/epidemiologia
Fibrilação Atrial/fisiopatologia
Desenho de Equipamento
Feminino
Seres Humanos
Incidência
Masculino
Projetos Piloto
Fatores de Risco
Acidente Vascular Cerebral/epidemiologia
Acidente Vascular Cerebral/etiologia
Estados Unidos/epidemiologia
[Pt] Tipo de publicação:CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171003
[Lr] Data última revisão:
171003
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170820
[St] Status:MEDLINE


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[PMID]:28815552
[Au] Autor:Toles M; Colón-Emeric C; Naylor MD; Asafu-Adjei J; Hanson LC
[Ad] Endereço:University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
[Ti] Título:Connect-Home: Transitional Care of Skilled Nursing Facility Patients and their Caregivers.
[So] Source:J Am Geriatr Soc;65(10):2322-2328, 2017 Oct.
[Is] ISSN:1532-5415
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Older adults that transfer from skilled nursing facilities (SNF) to home have significant risk for poor outcomes. Transitional care of SNF patients (i.e., time-limited services to ensure coordination and continuity of care) is poorly understood. OBJECTIVE: To determine the feasibility and relevance of the Connect-Home transitional care intervention, and to compare preparedness for discharge between comparison and intervention dyads. DESIGN: A non-randomized, historically controlled design-enrolling dyads of SNF patients and their family caregivers. SETTING: Three SNFs in the Southeastern United States. PARTICIPANTS: Intervention dyads received Connect-Home; comparison dyads received usual discharge planning. Of 173 recruited dyads, 145 transferred to home, and 133 completed surveys within 3 days of discharge. INTERVENTION: The Connect-Home intervention consisted of tools and training for existing SNF staff to deliver transitional care of patient and caregiver dyads. MEASUREMENTS: Feasibility was assessed with a chart review. Relevance was assessed with a survey of staff experiences using the intervention. Preparedness for discharge, the primary outcome, was assessed with Care-Transitions Measure-15 (CTM-15). RESULTS: The intervention was feasible and relevant to SNF staff (i.e., 96.9% of staff recommended intervention use in the future). Intervention dyads, compared to comparison dyads, were more prepared for discharge (CTM-15 score 74.7 vs 65.3, mean ratio 1.16, 95% CI: 1.08, 1.24). CONCLUSION: Connect-Home is a promising transitional care intervention for older patients discharged from SNF care. The next step will be to test the intervention using a cluster randomized trial, with patient outcomes including re-hospitalization.
[Mh] Termos MeSH primário: Cuidadores
Serviços de Assistência Domiciliar
Alta do Paciente
Instituições de Cuidados Especializados de Enfermagem
Cuidado Transicional
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Estudos de Viabilidade
Feminino
Seres Humanos
Masculino
Sudeste dos Estados Unidos
[Pt] Tipo de publicação:CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171103
[Lr] Data última revisão:
171103
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170818
[St] Status:MEDLINE
[do] DOI:10.1111/jgs.15015


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[PMID]:28805359
[Au] Autor:Centers for Medicare & Medicaid Services (CMS), HHS
[Ti] Título:Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2018, SNF Value-Based Purchasing Program, SNF Quality Reporting Program, Survey Team Composition, and Correction of the Performance Period for the NHSN HCP Influenza Vaccination Immunization Reporting Measure in the ESRD QIP for PY 2020. Final rule.
[So] Source:Fed Regist;82(149):36530-634, 2017 Aug 04.
[Is] ISSN:0097-6326
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:This final rule updates the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for fiscal year (FY) 2018. It also revises and rebases the market basket index by updating the base year from 2010 to 2014, and by adding a new cost category for Installation, Maintenance, and Repair Services. The rule also finalizes revisions to the SNF Quality Reporting Program (QRP), including measure and standardized resident assessment data policies and policies related to public display. In addition, it finalizes policies for the Skilled Nursing Facility Value-Based Purchasing Program that will affect Medicare payment to SNFs beginning in FY 2019. The final rule also clarifies the regulatory requirements for team composition for surveys conducted for investigating a complaint and aligns regulatory provisions for investigation of complaints with the statutory requirements. The final rule also finalizes the performance period for the National Healthcare Safety Network (NHSN) Healthcare Personnel (HCP) Influenza Vaccination Reporting Measure included in the End-Stage Renal Disease (ESRD) Quality Incentive Program (QIP) for Payment Year 2020.
[Mh] Termos MeSH primário: Medicare/economia
Medicare/legislação & jurisprudência
Sistema de Pagamento Prospectivo/economia
Sistema de Pagamento Prospectivo/legislação & jurisprudência
Instituições de Cuidados Especializados de Enfermagem/economia
Instituições de Cuidados Especializados de Enfermagem/legislação & jurisprudência
Aquisição Baseada em Valor/economia
Aquisição Baseada em Valor/legislação & jurisprudência
[Mh] Termos MeSH secundário: Seres Humanos
Vacinas contra Influenza
Garantia da Qualidade dos Cuidados de Saúde/economia
Garantia da Qualidade dos Cuidados de Saúde/legislação & jurisprudência
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Influenza Vaccines)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170906
[Lr] Data última revisão:
170906
[Sb] Subgrupo de revista:T
[Da] Data de entrada para processamento:170815
[St] Status:MEDLINE


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[PMID]:28724043
[Au] Autor:Gorzoni ML; Aguado MRV; Pires SL; Faria LFC
[Ad] Endereço:Adjunct Professor, Department of Internal Medicine, Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brazil.
[Ti] Título:Compulsory notification at skilled nursing facilities.
[So] Source:Rev Assoc Med Bras (1992);63(5):447-451, 2017 May.
[Is] ISSN:1806-9282
[Cp] País de publicação:Brazil
[La] Idioma:eng
[Ab] Resumo:Introduction:: Notifiable diseases (NDs) encompass conditions of high clinical severity and/or contagious. Being closed communities, long-term care facilities (LTCF) are places that deserve attention on their own, but one might be left wondering: what is the reality of NDs at Brazilian LTCFs? Objective:: To determine the prevalence and type of NDs at large LTCF. Method:: Active search for NDs conducted by the Hospital Infection Control Committee (HICC) in 459 beds. Due to the low turnover of patients, the monthly list kept by the HICC on NDs was analyzed. Data were grouped into males and females, and into elderly (age ≥ 60 years) and non-elderly (age ≤ 59 years). Results:: 31 diseases in 29 patients (6.9% of all inpatients - 19 males and 10 females): 23 cases of hepatitis C, five of hepatitis B, two of human immunodeficiency virus (HIV), and one case of renal tuberculosis. One patient with hepatitis B and another HIV-positive also had hepatitis C. There was no statistical significance in the comparison of the two groups with the total number of other institutionalized patients - by age and gender - for total number of NDs and cases of hepatitis C (p>0.05). Conclusion: : Chronic NDs and those requiring chronic treatment observed in this study suggest that Brazil needs more studies to define the dynamics of these diseases at LTCFs.
[Mh] Termos MeSH primário: Notificação de Doenças/estatística & dados numéricos
Instituição de Longa Permanência para Idosos/estatística & dados numéricos
Instituições de Cuidados Especializados de Enfermagem/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adulto
Distribuição por Idade
Idoso
Idoso de 80 Anos ou mais
Brasil/epidemiologia
Infecção Hospitalar/prevenção & controle
Feminino
Infecções por HIV/epidemiologia
Hepatite B/epidemiologia
Hepatite C/epidemiologia
Seres Humanos
Masculino
Meia-Idade
Prevalência
Fatores de Risco
Distribuição por Sexo
Tuberculose Renal/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170929
[Lr] Data última revisão:
170929
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170721
[St] Status:MEDLINE


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[PMID]:28688653
[Au] Autor:Budnick HC; Tyroch AH; Milan SA
[Ad] Endereço:Department of Surgery, Texas Tech University Health Sciences Center, El Paso, Texas. Electronic address: hailey.budnick@ttuhsc.edu.
[Ti] Título:Ethnic disparities in traumatic brain injury care referral in a Hispanic-majority population.
[So] Source:J Surg Res;215:231-238, 2017 Jul.
[Is] ISSN:1095-8673
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Functional outcomes after traumatic brain injury (TBI) can be significantly improved by discharge to posthospitalization care facilities. Many variables influence the discharge disposition of the TBI patient, including insurance status, patient condition, and patient prognosis. The literature has demonstrated an ethnic disparity in posthospitalization care referral, with Hispanics being discharged to rehabilitation and nursing facilities less often than non-Hispanics. However, this relationship has not been studied in a Hispanic-majority population, and thus, this study seeks to determine if differences in neurorehabilitation referrals exist among ethnic groups in a predominately Hispanic region. METHODS: This study is a retrospective cohort that includes 1128 TBI patients who presented to University Medical Center El Paso, Texas, between the years 2005 and 2015. The patients' age, sex, race, residence, admission Glasgow Coma Scale (GCS), GCS motor, Injury Severity Score (ISS), hospital and intensive care unit length of stay (LOS), mechanism of injury, and discharge disposition were analyzed in univariate and multivariate models. RESULTS: Our study population had an insurance rate of 55.5%. Insurance status and markers of injury severity (hospital LOS, intensive care unit LOS, ISS, GCS, and GCS motor) were predictive of discharge disposition to rehabilitation facilities. The study population was 70% Hispanic, yet Hispanics were discharged to rehabilitation facilities (relative risk: 0.56, P: 0.001) and to long-term acute care/nursing facilities (relative risk: 0.35, P < 0.0001) less than non-Hispanics even after LOS, ISS, ethnicity, insurance status, and residence were adjusted for in multivariate analysis. CONCLUSIONS: This study suggests that patients of different ethnicities but comparable traumatic severity and insurance status receive different discharge dispositions post-TBI even in regions in which Hispanics are the demographic majority.
[Mh] Termos MeSH primário: Lesões Encefálicas Traumáticas/reabilitação
Disparidades em Assistência à Saúde/etnologia
Hispano-Americanos
Alta do Paciente/estatística & dados numéricos
Encaminhamento e Consulta/estatística & dados numéricos
Centros de Reabilitação/utilização
Instituições de Cuidados Especializados de Enfermagem/utilização
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Lesões Encefálicas Traumáticas/etnologia
Feminino
Seres Humanos
Modelos Logísticos
Masculino
Meia-Idade
Estudos Retrospectivos
Instituições de Cuidados Especializados de Enfermagem/estatística & dados numéricos
Texas
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171003
[Lr] Data última revisão:
171003
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170710
[St] Status:MEDLINE


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[PMID]:28682855
[Au] Autor:Famorca M; Beauchaine D; Angulo N
[Ad] Endereço:Mary Famorca, MAN, RN, WCC, COCN, Mayo Clinic Arizona, Phoenix, Arizona. Debra Beauchaine, MN, RN, AGPCNP, CWOCN-AP, Mayo Clinic Arizona, Phoenix, Arizona. Nancy Angulo, BS, RN, CWOCN, Cancer Treatment Center of America, Goodyear, Arizona.
[Ti] Título:Management of a Complex Peristomal Calciphylaxis: A Case Study.
[So] Source:J Wound Ostomy Continence Nurs;44(4):380-383, 2017 Jul/Aug.
[Is] ISSN:1528-3976
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Calciphylaxis, also referred to as calcific uremic arteriolopathy, is a rare and serious syndrome of small blood vessels with a high mortality rate. Calciphylaxis lesions require intensive wound management with medical interventions for the patient to survive the sequelae of sepsis and present unique challenges when found in the peristomal skin. CASE: A 33-year-old man presented with multiple malodorous stage 4 pressure injuries of his sacrococcygeal and gluteal area. His medical history included chronic kidney disease requiring hemodialysis since 2007, diabetes mellitus, and incomplete paraplegia. He underwent diverting colostomy to enhance wound healing. His hospital stay was complicated by the development of a peristomal calciphylaxis lesion (PCL) that made ostomy pouching especially challenging for the nursing staff. His care needs were also aggravated by nonadherence to diet restriction, pressure injury prevention efforts, and a continued need for high doses of analgesic medication. Collectively, these issues presented a challenge for the health care team during his hospital course and during safe discharge planning. CONCLUSIONS: The peristomal calciphylaxis lesion decreased in surface area and improved in appearance with the use of various wound care products as his medical condition improved. Skilled nursing management in the context of ongoing interdisciplinary collaboration assisted in managing the patient's peristomal calciphylaxis, ultimately leading to safe discharge from hospital.
[Mh] Termos MeSH primário: Calciofilaxia/terapia
Colostomia/efeitos adversos
Cicatrização
[Mh] Termos MeSH secundário: Adulto
Calciofilaxia/mortalidade
Violeta de Genciana/farmacologia
Violeta de Genciana/uso terapêutico
Seres Humanos
Masculino
Azul de Metileno/farmacologia
Azul de Metileno/uso terapêutico
Paraplegia/complicações
Lesão por Pressão/terapia
Diálise Renal
Insuficiência Renal Crônica/complicações
Insuficiência Renal Crônica/terapia
Instituições de Cuidados Especializados de Enfermagem/organização & administração
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
J4Z741D6O5 (Gentian Violet); T42P99266K (Methylene Blue)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
171102
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:170707
[St] Status:MEDLINE
[do] DOI:10.1097/WON.0000000000000343



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