Base de dados : MEDLINE
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[PMID]:29386448
[Au] Autor:Sawaguchi T; Kamo T
[Ad] Endereço:Showa University School of Medicine.
[Ti] Título:[Some Attentional Points in the Clinical Aspects of Trauma Care].
[So] Source:Nihon Eiseigaku Zasshi;73(1):57-61, 2018.
[Is] ISSN:1882-6482
[Cp] País de publicação:Japan
[La] Idioma:jpn
[Ab] Resumo:Almost all patients requiring care for a combination of sexual, physiological, and psychological trauma, suffer from psychological or mental illness. Mental symptoms are well known to be associated with the violence very well and assailants have a violence dependency but it is not a well known mental disease. Changing of roles between being an assailant and being a victim is observed in half of the patients. In patients with trauma, hyperarousal and apathy appears simultaneously, and avoidance symptoms, intrusion symptoms, and crashed sleep, dissociation are also recognized. In addition, symptoms of orality are observed in patients requiring trauma care. However, hyperarousal, disturbance of sleep, and suicidal ideation improve quickly and the symptoms of a pair of a mother-child pair are well correlated. In organic non-temporary hyper psychogenic diseases (physiological diseases and surgery, and so on), non-organic psychogenic diseases (psychiatric diseases), and diseases on the border line between organic and non-organic diseases (psychosomatic diseases and may be unknown to non-medical professionals knowledge of such characteristic symptoms) is important information for health and medical care in the regional comprehensive care setting.
[Mh] Termos MeSH primário: Transtornos de Estresse Pós-Traumáticos/terapia
[Mh] Termos MeSH secundário: Assistência Integral à Saúde
Seres Humanos
Equipe de Assistência ao Paciente
Psicoterapia de Grupo
Apoio Social
Transtornos de Estresse Pós-Traumáticos/diagnóstico
Transtornos de Estresse Pós-Traumáticos/etiologia
Transtornos de Estresse Pós-Traumáticos/psicologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[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:180202
[St] Status:MEDLINE
[do] DOI:10.1265/jjh.73.57


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[PMID]:27770800
[Au] Autor:Hongisto MT; Nuotio M; Luukkaala T; Väistö O; Pihlajamäki HK
[Ad] Endereço:Department of Orthopedics and Traumatology, Seinäjoki Central Hospital, Hanneksenrinne 7, Seinäjoki, 60220, Finland. markus.hongisto@uta.fi.
[Ti] Título:Does cognitive/physical screening in an outpatient setting predict institutionalization after hip fracture?
[So] Source:BMC Musculoskelet Disord;17(1):444, 2016 10 22.
[Is] ISSN:1471-2474
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Institutionalization after hip fracture is a socio-economical burden. We examined the predictive value of Instrumental Activities of Daily Living (IADL) and Mini Mental State Examination (MMSE) for institutionalization after hip fracture to identify patients at risk for institutionalization. METHODS: Fragility hip fracture patients ≥65 years of age (n = 584) were comprehensively examined at a geriatric outpatient clinic 4 to 6 months after surgery and followed 1 year postoperatively. A telephone interview with a structured inquiry was performed at 1, 4, and 12 months after hip fracture. RESULTS: Age-adjusted univariate logistic regression analysis revealed that IADL and MMSE scores measured at the outpatient clinic were significantly associated with living arrangements 1 year after hip fracture. Multivariate logistic regression analysis established that institutionalization 1 year after hip fracture was significantly predicted by institutionalization at 4 months (odds ratio [OR] 16.26, 95 % confidence interval [CI] 7.37-35.86), IADL <5 (OR 12.96, 95 % CI 1.62-103.9), and MMSE <20 (OR 4.19, 95 % CI 1.82-9.66). A cut-off value of 5 was established for IADL with 100 % (95 % CI 96 %-100 %) sensitivity and 38 % (95 % CI 33 %-43 %) specificity and for MMSE, a cut-off value of 20 had 83 % (95 % CI 74 %-91 %) sensitivity and 65 % (95 % CI 60 %-70 %) specificity for institutionalization. During the time period from 4 to 12 months, 66 (11 %) patients changed living arrangements, and 36 (55 %) of these patients required more supportive accommodations. CONCLUSION: IADL and MMSE scores obtained 4 to 6 months after hospital discharge may be applicable for predicting institutionalization among fragility hip fracture patients ≥65 years of age at 1 year after hip fracture. An IADL score of ≥5 predicted the ability to remain in the community. Changes in living arrangements also often occur after 4 months.
[Mh] Termos MeSH primário: Assistência Integral à Saúde/métodos
Avaliação Geriátrica/métodos
Serviços de Saúde para Idosos
Fraturas do Quadril/terapia
Institucionalização
Testes Neuropsicológicos
Exame Físico
[Mh] Termos MeSH secundário: Acidentes por Quedas
Atividades Cotidianas
Fatores Etários
Idoso
Idoso de 80 Anos ou mais
Assistência Ambulatorial/métodos
Cognição
Feminino
Fraturas do Quadril/economia
Instituição de Longa Permanência para Idosos
Seres Humanos
Masculino
Estudos Prospectivos
Fatores de Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171209
[Lr] Data última revisão:
171209
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE


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[PMID]:29065149
[Au] Autor:Shamu T; Chimbetete C; Shawarira-Bote S; Mudzviti T; Luthy R
[Ad] Endereço:Newlands Clinic, Highlands, Harare, Zimbabwe.
[Ti] Título:Outcomes of an HIV cohort after a decade of comprehensive care at Newlands Clinic in Harare, Zimbabwe: TENART cohort.
[So] Source:PLoS One;12(10):e0186726, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Data on long-term outcomes of patients receiving antiretroviral therapy (ART) in sub-Saharan Africa are few. We describe outcomes of patients commenced on ART at Newlands Clinic between 2004 and 2006 after ≥10 years of comprehensive care including, psychosocial, adherence and food support. METHODS: In this retrospective cohort study, patient data from an electronic medical record collected during routine care were analysed. We describe baseline characteristics, virological and clinical outcomes, attrition rates, and treatment adverse effects until November 2016. We defined virological suppression as viral load <50 copies/ml and virological failure as >1000 copies/ml after ≥6 months of ART. RESULTS: We analysed data for 605 patients (67% female) who commenced ART, and were followed-up for 5819 person-years (median: 10.7 years, IQR: 10.1-11.4). Median age at ART initiation was 34 years (IQR: 17-42). Pre-ART, 129 (21.3%) patients had history of pulmonary tuberculosis (PTB). In care, 66 (11%) developed PTB, and 24 (4%) developed extrapulmonary tuberculosis. 385 (63.6%) patients experienced ≥1 adverse event, the most frequent being stavudine-induced peripheral neuropathy (n = 252, 41.7%). At database closure on 14 November 2016, 474 (78.3%) patients were still in care, 428 (90.3%) being virologically suppressed, and 21 (4.4%) failing. While 483 (79.8%) remained on first line, 122 (20.2%) were switched to second line ART. Fifty-nine patients (9.8%) were transferred to other ART facilities, 45 (7.4%) were lost to follow-up, 25 (4.1%) died, and two stopped ART. CONCLUSION: Comprehensive HIV care can result in low mortality, high retention in care and virologic suppression rates in resource limited settings.
[Mh] Termos MeSH primário: Instituições de Assistência Ambulatorial
Fármacos Anti-HIV/uso terapêutico
Assistência Integral à Saúde
Infecções por HIV/tratamento farmacológico
[Mh] Termos MeSH secundário: Adolescente
Adulto
Estudos de Coortes
Feminino
Infecções por HIV/imunologia
Infecções por HIV/virologia
Seres Humanos
Perda de Seguimento
Masculino
Adulto Jovem
Zimbábue
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-HIV Agents)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171113
[Lr] Data última revisão:
171113
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171025
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0186726


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[PMID]:28820896
[Au] Autor:Pinazo MJ; Pinto J; Ortiz L; Sánchez J; García W; Saravia R; Cortez MR; Moriana S; Grau E; Lozano D; Gascon J; Torrico F
[Ad] Endereço:International Health Department, ISGlobal, Barcelona Center for International Health Research, (CRESIB), Hospital Clínic-Universitat de Barcelona, Spain.
[Ti] Título:A strategy for scaling up access to comprehensive care in adults with Chagas disease in endemic countries: The Bolivian Chagas Platform.
[So] Source:PLoS Negl Trop Dis;11(8):e0005770, 2017 Aug.
[Is] ISSN:1935-2735
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Bolivia has the highest prevalence of Chagas disease (CD) in the world (6.1%), with more than 607,186 people with Trypanosoma cruzi infection, most of them adults. In Bolivia CD has been declared a national priority. In 2009, the Chagas National Program (ChNP) had neither a protocol nor a clear directive for diagnosis and treatment of adults. Although programs had been implemented for congenital transmission and for acute cases, adults remained uncovered. Moreover, health professionals were not aware of treatment recommendations aimed at this population, and research on CD was limited; it was difficult to increase awareness of the disease, understand the challenges it presented, and adapt strategies to cope with it. Simultaneously, migratory flows that led Bolivian patients with CD to Spain and other European countries forced medical staff to look for solutions to an emerging problem. INTERVENTION: In this context, thanks to a Spanish international cooperation collaboration, the Bolivian platform for the comprehensive care of adults with CD was created in 2009. Based on the establishment of a vertical care system under the umbrella of ChNP general guidelines, six centres specialized in CD management were established in different epidemiological contexts. A common database, standardized clinical forms, a and a protocolized attention to adults patients, together with training activities for health professionals were essential for the model success. With the collaboration and knowledge transfer activities between endemic and non-endemic countries, the platform aims to provide care, train health professionals, and create the basis for a future expansion to the National Health System of a proven model of care for adults with CD. RESULTS: From 2010 to 2015, a total of 26,227 patients were attended by the Platform, 69% (18,316) were diagnosed with T. cruzi, 8,567 initiated anti-parasitic treatment, more than 1,616 health professionals were trained, and more than ten research projects developed. The project helped to increase the number of adults with CD diagnosed and treated, produce evidence-based clinical practice guidelines, and bring about changes in policy that will increase access to comprehensive care among adults with CD. The ChNP is now studying the Platform's health care model to adapt and implement it nationwide. CONCLUSIONS: This strategy provides a solution to unmet demands in the care of patients with CD, improving access to diagnosis and treatment. Further scaling up of diagnosis and treatment will be based on the expansion of the model of care to the NHS structures. Its sustainability will be ensured as it will build on existing local resources in Bolivia. Still human trained resources are scarce and the high staff turnover in Bolivia is a limitation of the model. Nevertheless, in a preliminary two-years-experience of scaling up this model, this limitations have been locally solved together with the health local authorities.
[Mh] Termos MeSH primário: Doença de Chagas/epidemiologia
Assistência Integral à Saúde/normas
Pessoal de Saúde/educação
Programas de Rastreamento/normas
[Mh] Termos MeSH secundário: Adulto
Antiparasitários/uso terapêutico
Bolívia/epidemiologia
Doença de Chagas/tratamento farmacológico
Seres Humanos
Incidência
Cooperação Internacional
Programas Nacionais de Saúde/organização & administração
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antiparasitic Agents)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170917
[Lr] Data última revisão:
170917
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170819
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pntd.0005770


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[PMID]:28783772
[Au] Autor:Craner JR; Skillings JL; Barnes CR
[Ad] Endereço:Division of Psychiatry and Behavioral Medicine, Spectrum Health System, Grand Rapids, MI, USA.
[Ti] Título:Obsessive-compulsive disorder: Under-recognized and responsive to treatment.
[So] Source:J Fam Pract;66(8):503-506, 2017 Aug.
[Is] ISSN:1533-7294
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Mood or anxiety concerns, when explored, may reveal associated OCD symptoms. Pharmacotherapy and cognitive behavioral therapy have proven effective.
[Mh] Termos MeSH primário: Antipsicóticos/uso terapêutico
Medicina de Família e Comunidade
Transtorno Obsessivo-Compulsivo/diagnóstico
Transtorno Obsessivo-Compulsivo/tratamento farmacológico
[Mh] Termos MeSH secundário: Adulto
Transtorno Bipolar/diagnóstico
Assistência Integral à Saúde
Feminino
Seres Humanos
Inibidores da Captação de Serotonina/uso terapêutico
[Pt] Tipo de publicação:CASE REPORTS
[Nm] Nome de substância:
0 (Antipsychotic Agents); 0 (Serotonin Uptake Inhibitors)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170904
[Lr] Data última revisão:
170904
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170808
[St] Status:MEDLINE


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[PMID]:28577690
[Au] Autor:Moreno GA; Wang A; Sánchez González Y; Díaz Espinosa O; Vania DK; Edlin BR; Brookmeyer R
[Ad] Endereço:Precision Health Economics, Los Angeles, CA, USA.
[Ti] Título:Value of Comprehensive HCV Treatment among Vulnerable, High-Risk Populations.
[So] Source:Value Health;20(6):736-744, 2017 Jun.
[Is] ISSN:1524-4733
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: The objective of this study was to explore the trade-offs society and payers make when expanding treatment access to patients with chronic hepatitis C virus (HCV) infection in early stages of disease as well as to vulnerable, high-risk populations, such as people who inject drugs (PWID) and HIV-infected men who have sex with men (MSM-HIV). METHODS: A discrete time Markov model simulated HCV progression and treatment over 20 years. Population cohorts were defined by behaviors that influence the risk of HCV exposure: PWID, MSM-HIV, an overlap cohort of individuals who are both PWID and MSM-HIV, and all other adults. Six different treatment scenarios were modeled, with varying degrees of access to treatment at different fibrosis stages and to different risk cohorts. Benefits were measured as quality-adjusted life-years and a $150,000/quality-adjusted life-year valuation was used to assess social benefits. RESULTS: Compared with limiting treatment to METAVIR fibrosis stages F3 or F4 and excluding PWID, expanding treatment to patients in all fibrosis stages and including PWID reduces cumulative new infections by 55% over a 20-year horizon and reduces the prevalence of HCV by 93%. We find that treating all HCV-infected individuals is cost saving and net social benefits are over $500 billion greater compared with limiting treatment. Including PWID in treatment access saves 12,900 to 41,200 lives. CONCLUSIONS: Increased access to treatment brings substantial value to society and over the long-term reduces costs for payers, as the benefits accrued from long-term reduction in prevalent and incident cases, mortality, and medical costs outweigh the cost of treatment.
[Mh] Termos MeSH primário: Assistência Integral à Saúde/economia
Custos de Cuidados de Saúde/estatística & dados numéricos
Acesso aos Serviços de Saúde/economia
Hepatite C Crônica/terapia
Cirrose Hepática/terapia
[Mh] Termos MeSH secundário: Adulto
Redução de Custos
Progressão da Doença
Usuários de Drogas
Infecções por HIV/complicações
Hepatite C Crônica/economia
Hepatite C Crônica/patologia
Homossexualidade Masculina
Seres Humanos
Cirrose Hepática/economia
Cirrose Hepática/virologia
Masculino
Cadeias de Markov
Prevalência
Anos de Vida Ajustados por Qualidade de Vida
Fatores de Risco
Abuso de Substâncias por Via Intravenosa/epidemiologia
Fatores de Tempo
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1706
[Cu] Atualização por classe:171024
[Lr] Data última revisão:
171024
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170605
[St] Status:MEDLINE


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[PMID]:28246476
[Au] Autor:Seo JY; Lee C; Jin EH; Yun MH; Lim JH; Kang HY; Yang JI; Chung SJ; Yang SY; Kim JS
[Ad] Endereço:Ji Yeon Seo, Changhyun Lee, Eun Hyo Jin, Joo Hyun Lim, Hae Yeon Kang, Jong In Yang, Su Jin Chung, Sun Young Yang, Joo Sung Kim, Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul 06236, South Korea.
[Ti] Título:Is a split-dose regimen of 2 L polyethylene glycol plus ascorbic acid tolerable for colonoscopy in an early morning visit to a comprehensive medical check-up?
[So] Source:World J Gastroenterol;23(6):1030-1037, 2017 Feb 14.
[Is] ISSN:2219-2840
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:AIM: To evaluate the effectiveness and tolerability of a split-dose 2 L polyethylene glycol (PEG)/ascorbic acid (AA) regimen for healthy examinees who visited for comprehensive medical check-up in the early morning. METHODS: From February 2015 to March 2015, examinees of average risk who were scheduled for a colonoscopy in the morning were retrospectively enrolled. RESULTS: The 189 examinees were divided into split-dose and non-split-dose groups. The adequacy of bowel preparation for the split-dose group the non-split-dose group was 96.8% 85.2%, respectively, < 0.001, and the compliance of the last meal restriction was 74.6% 58.2%, respectively, < 0.001. The sleep disturbance ( < 0.001) was more prevalent in the split-dose group, however the willingness to repeat the same preparation method ( = 0.243) was not different in both groups. The split-dose regimen was the most important factor influencing adequate bowel preparation in multivariate analysis (HR = 10.89, 95%CI: 6.53-18.17, < 0.001). CONCLUSION: A split-dose regimen of 2 L PEG/AA for an early morning colonoscopy was more effective and showed better compliance for diet restriction without any difference in satisfaction and discomfort. Introducing a split-dose regimen of 2 L PEG/AA to morning colonoscopy examinees is effective and tolerable in a comprehensive medical check-up setting.
[Mh] Termos MeSH primário: Ácido Ascórbico/administração & dosagem
Catárticos/administração & dosagem
Colonoscopia/métodos
Polietilenoglicóis/administração & dosagem
[Mh] Termos MeSH secundário: Adulto
Ácido Ascórbico/efeitos adversos
Catárticos/efeitos adversos
Assistência Integral à Saúde
Esquema de Medicação
Feminino
Seres Humanos
Masculino
Meia-Idade
Cooperação do Paciente
Satisfação do Paciente
Exame Físico
Polietilenoglicóis/efeitos adversos
Guias de Prática Clínica como Assunto
Estudos Prospectivos
Estudos Retrospectivos
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Cathartics); 30IQX730WE (Polyethylene Glycols); PQ6CK8PD0R (Ascorbic Acid)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170811
[Lr] Data última revisão:
170811
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170302
[St] Status:MEDLINE
[do] DOI:10.3748/wjg.v23.i6.1030


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[PMID]:28241908
[Au] Autor:Fort MP; Namba LM; Dutcher S; Copeland T; Bermingham N; Fellenz C; Lantz D; Reusch JJ; Bayliss EA
[Ad] Endereço:Research Assistant Professor in the Department of Health Systems, Management and Policy and the Centers for American Indian and Alaska Native Health at the University of Colorado Denver in Aurora. meredith.fort@ucdenver.edu.
[Ti] Título:Implementation and Evaluation of the Safety Net Specialty Care Program in the Denver Metropolitan Area.
[So] Source:Perm J;21, 2017.
[Is] ISSN:1552-5775
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: In response to limited access to specialty care in safety-net settings, an integrated delivery system and three safety-net organizations in the Denver, CO, metropolitan area launched a unique program in 2013. The program offers safety-net providers the option to electronically consult with specialists. Uninsured patients may be seen by specialists in office visits for a defined set of services. This article describes the program, identifies aspects that have worked well and areas that need improvement, and offers lessons learned. METHODS: We quantified electronic consultations (e-consults) between safety-net clinicians and specialists, and face-to-face specialist visits between May 2013 and December 2014. We reviewed and categorized all e-consults from November and December 2014. In 2015, we interviewed 21 safety-net clinicians and staff, 12 specialists, and 10 patients, and conducted a thematic analysis to determine factors facilitating and limiting optimal program use. RESULTS: In the first 20 months of the program, safety-net clinicians at 23 clinics made 602 e-consults to specialists, and 81 patients received face-to-face specialist visits. Of 204 primary care clinicians, 103 made e-consults; 65 specialists participated in the program. Aspects facilitating program use were referral case managers' involvement and the use of clear, concise questions in e-consults. Key recommendations for process improvement were to promote an understanding of the different health care contexts, support provider-to-provider communication, facilitate hand-offs between settings, and clarify program scope. CONCLUSION: Participants perceived the program as responsive to their needs, yet opportunities exist for continued uptake and expansion. Communitywide efforts to assess and address needs remain important.
[Mh] Termos MeSH primário: Acesso aos Serviços de Saúde
Serviços de Saúde
Pessoas sem Cobertura de Seguro de Saúde
Encaminhamento e Consulta
Provedores de Redes de Segurança
Especialização
Telemedicina
[Mh] Termos MeSH secundário: Adulto
Atitude do Pessoal de Saúde
Administração de Caso
Colorado
Comunicação
Assistência Integral à Saúde
Eletrônica
Feminino
Seres Humanos
Masculino
Meia-Idade
Visita a Consultório Médico
Satisfação do Paciente
Médicos
Avaliação de Programas e Projetos de Saúde
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170901
[Lr] Data última revisão:
170901
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170301
[St] Status:MEDLINE


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[PMID]:28126830
[Au] Autor:Mayor S
[Ad] Endereço:London.
[Ti] Título:Hospitals struggle to integrate physical and mental healthcare, inquiry finds.
[So] Source:BMJ;356:j411, 2017 Jan 25.
[Is] ISSN:1756-1833
[Cp] País de publicação:England
[La] Idioma:eng
[Mh] Termos MeSH primário: Assistência Integral à Saúde/organização & administração
Continuidade da Assistência ao Paciente/organização & administração
Administração Hospitalar
Serviços de Saúde Mental/organização & administração
[Mh] Termos MeSH secundário: Seres Humanos
Reino Unido
[Pt] Tipo de publicação:NEWS
[Em] Mês de entrada:1703
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170128
[St] Status:MEDLINE
[do] DOI:10.1136/bmj.j411


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[PMID]:28118530
[Au] Autor:Kumar A; Karmarkar A; Downer B; Vashist A; Adhikari D; Al Snih S; Ottenbacher K
[Ad] Endereço:Center for Gerontology and Health Care Research, School of Public Health, Brown University, Providence, Rhode Island.
[Ti] Título:Current Risk Adjustment and Comorbidity Index Underperformance in Predicting Post-Acute Utilization and Hospital Readmissions After Joint Replacements: Implications for Comprehensive Care for Joint Replacement Model.
[So] Source:Arthritis Care Res (Hoboken);69(11):1668-1675, 2017 Nov.
[Is] ISSN:2151-4658
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To compare the performances of 3 comorbidity indices, the Charlson Comorbidity Index, the Elixhauser Comorbidity Index, and the Centers for Medicare & Medicaid Services (CMS) risk adjustment model, Hierarchical Condition Category (HCC), in predicting post-acute discharge settings and hospital readmission for patients after joint replacement. METHODS: A retrospective study of Medicare beneficiaries with total knee replacement (TKR) or total hip replacement (THR) discharged from hospitals in 2009-2011 (n = 607,349) was performed. Study outcomes were post-acute discharge setting and unplanned 30-, 60-, and 90-day hospital readmissions. Logistic regression models were built to compare the performance of the 3 comorbidity indices using C statistics. The base model included patient demographics and hospital use. Subsequent models included 1 of the 3 comorbidity indices. Additional multivariable logistic regression models were built to identify individual comorbid conditions associated with high risk of hospital readmissions. RESULTS: The 30-, 60-, and 90-day unplanned hospital readmission rates were 5.3%, 7.2%, and 8.5%, respectively. Patients were most frequently discharged to home health (46.3%), followed by skilled nursing facility (40.9%) and inpatient rehabilitation facility (12.7%). The C statistics for the base model in predicting post-acute discharge setting and 30-, 60-, and 90-day readmission in TKR and THR were between 0.63 and 0.67. Adding the Charlson Comorbidity Index, the Elixhauser Comorbidity Index, or HCC increased the C statistic minimally from the base model for predicting both discharge settings and hospital readmission. The health conditions most frequently associated with hospital readmission were diabetes mellitus, pulmonary disease, arrhythmias, and heart disease. CONCLUSION: The comorbidity indices and CMS-HCC demonstrated weak discriminatory ability to predict post-acute discharge settings and hospital readmission following joint replacement.
[Mh] Termos MeSH primário: Artroplastia de Substituição/tendências
Assistência Integral à Saúde/tendências
Medicare/tendências
Aceitação pelo Paciente de Cuidados de Saúde
Readmissão do Paciente/tendências
Risco Ajustado/tendências
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Artroplastia de Substituição/efeitos adversos
Comorbidade
Feminino
Previsões
Seres Humanos
Modelos Logísticos
Masculino
Medicare/utilização
Estudos Retrospectivos
Risco Ajustado/métodos
Estados Unidos/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
171102
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170125
[St] Status:MEDLINE
[do] DOI:10.1002/acr.23195



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