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[PMID]:29351557
[Au] Autor:Mizuno S; Kunisawa S; Sasaki N; Fushimi K; Imanaka Y
[Ad] Endereço:Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Sakyo-ku, Japan.
[Ti] Título:Effects of night-time and weekend admissions on in-hospital mortality in acute myocardial infarction patients in Japan.
[So] Source:PLoS One;13(1):e0191460, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Patients admitted to hospital during off-hours may experience poorer quality of care and clinical outcomes. However, few studies have examined the variations in clinical processes and outcomes across admission times and days of the week in acute myocardial infarction (AMI) patients. This study aimed to comparatively analyze the effect of weekend and weekday admissions stratified by admission time on in-hospital mortality in AMI patients. METHODS AND RESULTS: Using a large nationwide administrative database, we analyzed 103,908 AMI patients admitted to 639 Japanese acute care hospitals between April 2011 and March 2015. We divided patients into the following 4 groups: weekday daytime admissions, weekday night-time admissions, weekend daytime admissions, and weekend night-time admissions. A hierarchical logistic regression model was used to comparatively examine in-hospital mortality among the groups after adjusting for age, sex, ambulance use, Killip class, comorbidities, and the number of cardiologists in the admitting hospital. In addition, we also calculated and compared the adjusted odds ratios of various AMI therapies among the groups. The in-hospital mortality rate of weekend daytime admissions was higher than those admitted during other times (weekday daytime: 6.8%; weekday night-time; 6.5%, weekend daytime; 7.6%; weekend night-time: 6.6%; P < 0.001), even after adjusting for the covariates (adjusted odds ratio for weekend daytime admissions: 1.10; 95% confidence interval: 1.03-1.19). The prescription rates of guideline-based medications provided on the first day of admission were higher in night-time admissions than in daytime admissions. CONCLUSIONS: In-hospital mortality rates were higher in AMI patients admitted during weekend daytime hours when compared with patients admitted during other times. Furthermore, patients admitted during daytime hours had lower prescription rates of guideline-based medications. Our findings indicate that weekend daytime admissions may be a potential target for improvement in the Japanese healthcare system.
[Mh] Termos MeSH primário: Infarto do Miocárdio/mortalidade
[Mh] Termos MeSH secundário: Plantão Médico
Idoso
Feminino
Mortalidade Hospitalar
Seres Humanos
Japão/epidemiologia
Modelos Logísticos
Masculino
Meia-Idade
Admissão do Paciente
Fatores de Risco
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180120
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0191460


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[PMID]:29181931
[Au] Autor:Raknes G; Morken T; Hunskår S
[Ti] Título:Local emergency medical communication centres - staffing and populations.
[Ti] Título:Legevaktsentralar ­ bemanning og folketal..
[So] Source:Tidsskr Nor Laegeforen;137(22), 2017 11 28.
[Is] ISSN:0807-7096
[Cp] País de publicação:Norway
[La] Idioma:eng; nor
[Ab] Resumo:BACKGROUND: There are several examples of inadequate staffing at local emergency medical communication centres (LEMCs) resulting in limited availability and long waits on the telephone. There are no guidelines for population size or the staffing of a LEMC. In the following, we present models of catchment areas and staffing. MATERIAL AND METHOD: Traffic intensity on Saturdays and Sundays was based on data on figures for patient contacts at seven LEMCs in 2014 and 2015. We defined the minimum optimal population base as at least 50 % probability of ≥ 10 contacts in the course of a night duty. The Erlang-C formula was used to estimate service level and hence staffing requirements on the basis of population and response-time requirements. We have surveyed the combined staffing requirements of all the LEMCs in Norway. RESULT: The minimum optimal population base was 29 134. In 2016, 48 of 103 LEMCs were smaller than this. In order to be able to satisfy the response-time requirements in the Norwegian Emergency Medicine Regulations, 112 LEMC night operators and 158 day operators would be necessary for the whole of Norway. A reduction of the response-time requirement from 120 to ten seconds would require 9.8 % more operators at night and 17 % more operators during the day. INTERPRETATION: The models we have presented provide a basis for planning the population base and staffing of LEMCs. Significantly stricter response-time requirements will result in limited need for more personnel.
[Mh] Termos MeSH primário: Plantão Médico
[Mh] Termos MeSH secundário: Plantão Médico/organização & administração
Plantão Médico/normas
Plantão Médico/utilização
Serviços Médicos de Emergência/recursos humanos
Serviços Médicos de Emergência/organização & administração
Serviços Médicos de Emergência/normas
Serviços Médicos de Emergência/utilização
Acesso aos Serviços de Saúde
Seres Humanos
Noruega
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171129
[St] Status:MEDLINE
[do] DOI:10.4045/tidsskr.17.0176


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[PMID]:29284008
[Au] Autor:Wang B; Zhang Y; Wang X; Hu T; Li J; Geng J
[Ad] Endereço:Department of Cardiology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu, China.
[Ti] Título:Off-hours presentation is associated with short-term mortality but not with long-term mortality in patients with ST-segment elevation myocardial infarction: A meta-analysis.
[So] Source:PLoS One;12(12):e0189572, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The association between off-hours presentation and mortality in patients with ST-segment elevation myocardial infarction (STEMI) remains unclear. We performed a meta-analysis to assess the impact of off-hours presentation on short- and long-term mortality among STEMI patients. METHODS: We searched PubMed, EMBASE, and the Cochrane Library from their inception to 10 July 2016. Studies were eligible if they evaluated the relationship of off-hours (weekend and/or night) presentation with short- and/or long-term mortality. RESULTS: A total of 30 studies with 33 cohorts involving 192,658 STEMI patients were included. Off-hours presentation was associated with short-term mortality (odds ratio [OR] 1.07, 95% confidence interval [CI] 1.02-1.12, P = 0.004) but not with long-term mortality (OR 1.00, 95% CI 0.94-1.07, P = 0.979). No significant heterogeneity was observed. The outcomes remained the same after sensitivity analyses and trim and fill analyses. Subgroup analyses showed that STEMI patients undergoing primary percutaneous coronary intervention do not have a higher risk of short-term mortality (OR 1.061, 95% CI 0.993-1.151). In addition, higher mortality was observed only during hospitalization (OR 1.072, 95% CI 1.022-1.125), not at the 30-day, 1-year or long-term follow-ups. CONCLUSIONS: Off-hours presentation was associated with an increase in short-term mortality, but not long-term mortality, among STEMI patients. Clinical approaches to decrease short-term mortality regardless of the time of presentation should be evaluated in future studies.
[Mh] Termos MeSH primário: Plantão Médico
Eletrocardiografia/métodos
Infarto do Miocárdio/mortalidade
[Mh] Termos MeSH secundário: Seres Humanos
Infarto do Miocárdio/fisiopatologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180129
[Lr] Data última revisão:
180129
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171229
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0189572


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[PMID]:29251460
[Au] Autor:Keast K
[Ti] Título:NURSE PRACTITIONERS TAKING URGENT CARE OF PERTH.
[So] Source:Aust Nurs Midwifery J;24(5):22, 2016 11.
[Is] ISSN:2202-7114
[Cp] País de publicação:Australia
[La] Idioma:eng
[Ab] Resumo:From chronic disease management to emergency care, Nurse Practitioners (NPs) have been redefining the face of health care in Australia since 2000. While the role continues to remain a largely untapped health solution, two endorsed nurse practitioners are treading their own career path with an innovative venture.
[Mh] Termos MeSH primário: Plantão Médico/organização & administração
Instituições de Assistência Ambulatorial/recursos humanos
Mobilidade Ocupacional
Profissionais de Enfermagem
Papel do Profissional de Enfermagem
[Mh] Termos MeSH secundário: Seres Humanos
Austrália Ocidental
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180118
[Lr] Data última revisão:
180118
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:171219
[St] Status:MEDLINE


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[PMID]:29199794
[Au] Autor:Hälinen M; Mattila K; Janhunen H
[Ti] Título:Emergency medicine residents in the implementation of thrombolysis for acute ischemic stroke.
[So] Source:Duodecim;132(24):2342-48, 2016.
[Is] ISSN:0012-7183
[Cp] País de publicação:Finland
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Traditionally, neurologists have been in charge of thrombolytic treatment of ischemic stroke. In 2013, emergency medicine residents started working in the frontline at the Central Hospital of Central Finland (CHCF). They were trained to evaluate and give thrombolytic treatment to acute ischemic stroke patients out of hours, with the possibility of consulting a neurologist. MATHERIALS AND METHODS: Retrospective study of acute stroke patients in CHCF, who received thrombolytic therapy during 2012 and 2014. In 2012 thrombolytic treatment was initiated by neurologists only, In 2014 emergency medicine registrars initiated thrombolytic therapy out of hours. RESULTS: The annual number of tissue plasminogen activator treatment (tPA) increased and door-to needle time significantly decreased from 2012 to 2014. There were no significant differences in complications and overall functional capacity at 3 months. CONCLUSIONS: This study indicated that training of emergency medicine physicians to give thrombolytic treatment to acute ischemic stroke is feasible and may shorten in-hospital delays.
[Mh] Termos MeSH primário: Isquemia Encefálica/tratamento farmacológico
Medicina de Emergência/educação
Internato e Residência
Acidente Vascular Cerebral/tratamento farmacológico
Terapia Trombolítica/métodos
Ativador de Plasminogênio Tecidual/administração & dosagem
[Mh] Termos MeSH secundário: Plantão Médico
Educação de Pós-Graduação em Medicina
Feminino
Finlândia
Seres Humanos
Tempo de Internação/estatística & dados numéricos
Masculino
Encaminhamento e Consulta
Estudos Retrospectivos
Tempo para o Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
EC 3.4.21.68 (Tissue Plasminogen Activator)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180108
[Lr] Data última revisão:
180108
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171205
[St] Status:MEDLINE


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[PMID]:29224662
[Au] Autor:Mitchell JW; O Connell WG; Gilliland CA; Best IM
[Ad] Endereço:Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image Guided Medicine, Emory University Hospital, Atlanta, GA. Electronic address: jason.mitchell@emory.edu.
[Ti] Título:Managing Venous Thromboembolic Disease On-Call.
[So] Source:Tech Vasc Interv Radiol;20(4):281-287, 2017 Dec.
[Is] ISSN:1557-9808
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Managing venous thromboembolic disease on-call requires the interventional radiologist consider not only potential risk and benefit to the patient but also available resources in the IR suite as well as throughout the hospital, such as intensive care monitoring during treatment. We demonstrate how our practice manages these on-call cases ranging from deep venous thrombosis to acute pulmonary embolism and decide which patients need emergent treatment and which can undergo delayed intervention during working hours. In all cases, an adequate preprocedural clinical assessment is crucial.
[Mh] Termos MeSH primário: Plantão Médico
Procedimentos Endovasculares/métodos
Embolia Pulmonar/terapia
Radiografia Intervencionista
Terapia Trombolítica/métodos
Tromboembolia Venosa/terapia
Trombose Venosa/terapia
[Mh] Termos MeSH secundário: Angiografia por Tomografia Computadorizada
Procedimentos Endovasculares/efeitos adversos
Procedimentos Endovasculares/instrumentação
Seres Humanos
Masculino
Meia-Idade
Flebografia
Valor Preditivo dos Testes
Embolia Pulmonar/diagnóstico por imagem
Embolia Pulmonar/fisiopatologia
Fatores de Risco
Terapia Trombolítica/efeitos adversos
Fatores de Tempo
Resultado do Tratamento
Tromboembolia Venosa/diagnóstico por imagem
Tromboembolia Venosa/fisiopatologia
Trombose Venosa/diagnóstico por imagem
Trombose Venosa/fisiopatologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180105
[Lr] Data última revisão:
180105
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171212
[St] Status:MEDLINE


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[PMID]:29088237
[Au] Autor:Haines TP; Bowles KA; Mitchell D; O'Brien L; Markham D; Plumb S; May K; Philip K; Haas R; Sarkies MN; Ghaly M; Shackell M; Chiu T; McPhail S; McDermott F; Skinner EH
[Ad] Endereço:Department of Physiotherapy, Monash University, Frankston, Victoria, Australia.
[Ti] Título:Impact of disinvestment from weekend allied health services across acute medical and surgical wards: 2 stepped-wedge cluster randomised controlled trials.
[So] Source:PLoS Med;14(10):e1002412, 2017 Oct.
[Is] ISSN:1549-1676
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Disinvestment (removal, reduction, or reallocation) of routinely provided health services can be difficult when there is little published evidence examining whether the services are effective or not. Evidence is required to understand if removing these services produces outcomes that are inferior to keeping such services in place. However, organisational imperatives, such as budget cuts, may force healthcare providers to disinvest from these services before the required evidence becomes available. There are presently no experimental studies examining the effectiveness of allied health services (e.g., physical therapy, occupational therapy, and social work) provided on weekends across acute medical and surgical hospital wards, despite these services being routinely provided internationally. The aim of this study was to understand the impact of removing weekend allied health services from acute medical and surgical wards using a disinvestment-specific non-inferiority research design. METHODS AND FINDINGS: We conducted 2 stepped-wedge cluster randomised controlled trials between 1 February 2014 and 30 April 2015 among patients on 12 acute medical or surgical hospital wards spread across 2 hospitals. The hospitals involved were 2 metropolitan teaching hospitals in Melbourne, Australia. Data from n = 14,834 patients were collected for inclusion in Trial 1, and n = 12,674 in Trial 2. Trial 1 was a disinvestment-specific non-inferiority stepped-wedge trial where the 'current' weekend allied health service was incrementally removed from participating wards each calendar month, in a random order, while Trial 2 used a conventional non-inferiority stepped-wedge design, where a 'newly developed' service was incrementally reinstated on the same wards as in Trial 1. Primary outcome measures were patient length of stay (proportion staying longer than expected and mean length of stay), the proportion of patients experiencing any adverse event, and the proportion with an unplanned readmission within 28 days of discharge. The 'no weekend allied health service' condition was considered to be not inferior if the 95% CIs of the differences between this condition and the condition with weekend allied health service delivery were below a 2% increase in the proportion of patients who stayed in hospital longer than expected, a 2% increase in the proportion who had an unplanned readmission within 28 days, a 2% increase in the proportion who had any adverse event, and a 1-day increase in the mean length of stay. The current weekend allied health service included physical therapy, occupational therapy, speech therapy, dietetics, social work, and allied health assistant services in line with usual care at the participating sites. The newly developed weekend allied health service allowed managers at each site to reprioritise tasks being performed and the balance of hours provided by each professional group and on which days they were provided. Analyses conducted on an intention-to-treat basis demonstrated that there was no estimated effect size difference between groups in the proportion of patients staying longer than expected (weekend versus no weekend; estimated effect size difference [95% CI], p-value) in Trial 1 (0.40 versus 0.38; estimated effect size difference 0.01 [-0.01 to 0.04], p = 0.31, CI was both above and below non-inferiority margin), but the proportion staying longer than expected was greater with the newly developed service compared to its no weekend service control condition (0.39 versus 0.40; estimated effect size difference 0.02 [0.01 to 0.04], p = 0.04, CI was completely below non-inferiority margin) in Trial 2. Trial 1 and 2 findings were discordant for the mean length of stay outcome (Trial 1: 5.5 versus 6.3 days; estimated effect size difference 1.3 days [0.9 to 1.8], p < 0.001, CI was both above and below non-inferiority margin; Trial 2: 5.9 versus 5.0 days; estimated effect size difference -1.6 days [-2.0 to -1.1], p < 0.001, CI was completely below non-inferiority margin). There was no difference between conditions for the proportion who had an unplanned readmission within 28 days in either trial (Trial 1: 0.01 [-0.01 to 0.03], p = 0.18, CI was both above and below non-inferiority margin; Trial 2: -0.01 [-0.02 to 0.01], p = 0.62, CI completely below non-inferiority margin). There was no difference between conditions in the proportion of patients who experienced any adverse event in Trial 1 (0.01 [-0.01 to 0.03], p = 0.33, CI was both above and below non-inferiority margin), but a lower proportion of patients had an adverse event in Trial 2 when exposed to the no weekend allied health condition (-0.03 [-0.05 to -0.004], p = 0.02, CI completely below non-inferiority margin). Limitations of this research were that 1 of the trial wards was closed by the healthcare provider after Trial 1 and could not be included in Trial 2, and that both withdrawing the current weekend allied health service model and installing a new one may have led to an accommodation period for staff to adapt to the new service settings. Stepped-wedge trials are potentially susceptible to bias from naturally occurring change over time at the service level; however, this was adjusted for in our analyses. CONCLUSIONS: In Trial 1, criteria to say that the no weekend allied health condition was non-inferior to current weekend allied health condition were not met, while neither the no weekend nor current weekend allied health condition demonstrated superiority. In Trial 2, the no weekend allied health condition was non-inferior to the newly developed weekend allied health condition across all primary outcomes, and superior for the outcomes proportion of patients staying longer than expected, proportion experiencing any adverse event, and mean length of stay. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12613001231730 and ACTRN12613001361796.
[Mh] Termos MeSH primário: Plantão Médico/organização & administração
Dietética/organização & administração
Serviços de Saúde
Unidades Hospitalares
Terapia Ocupacional/organização & administração
Fisioterapia/organização & administração
Serviço Social/organização & administração
[Mh] Termos MeSH secundário: Plantão Médico/economia
Pessoal Técnico de Saúde
Austrália
Dietética/economia
Hospitalização
Seres Humanos
Tempo de Internação/estatística & dados numéricos
Modelos Lineares
Análise Multinível
Terapia Ocupacional/economia
Readmissão do Paciente/estatística & dados numéricos
Fisioterapia/economia
Serviço Social/economia
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171110
[Lr] Data última revisão:
171110
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171101
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pmed.1002412


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[PMID]:28767908
[Au] Autor:Azevedo WF; Mathias LADST
[Ad] Endereço:Universidade Federal da Paraíba, João Pessoa, PB, Brazil.
[Ti] Título:Work addiction and quality of life: a study with physicians.
[So] Source:Einstein (Sao Paulo);15(2):130-135, 2017 Apr-Jun.
[Is] ISSN:2317-6385
[Cp] País de publicação:Brazil
[La] Idioma:eng; por
[Ab] Resumo:Objective: To evaluate the quality of life of physicians and investigate to what extent it is affected by work addiction. Methods: This is an exploratory, descriptive and cross-sectional study, conducted with 1,110 physicians. For data collection, we used a questionnaire with sociodemographic information, the World Health Organization Quality of Life BREF, and the Work Addiction Scale. Results: Most physicians presented high quality of life. Female participants presented lower quality of life in the domains psychologic, environment and general (p<0.05). Quality of life was negatively correlated with the number of shifts (p<0.005). The higher the addiction to work, the lower the quality of life. Conclusion: The research allowed understanding the implications of work addiction in the quality of life. Further studies are required to support the development of strategies that improve health conditions and quality of life of medical professionals. Objetivo: Avaliar a qualidade de vida de médicos e investigar em que medida a adição ao trabalho a afeta. Métodos: Trata-se de um estudo exploratório, descritivo e transversal, realizado com 1.110 médicos. Para coleta de dados, optou-se por utilizar um questionário contendo informações sociodemográficas, bem como aplicar o instrumento World Health Organization Quality of Life-BREF e a Escala de Adição ao Trabalho. Resultados: Os médicos, em sua maioria, apresentaram alta qualidade de vida. Os participantes do sexo feminino tiveram menor qualidade de vida em relação aos homens nos domínios psicológico, meio ambiente e geral (p<0,05). A qualidade de vida correlacionou-se negativamente com o número de plantões (p<0,005), e quanto maior a adição ao trabalho, menor a qualidade de vida. Conclusão: A pesquisa permitiu o conhecimento das implicações da adição ao trabalho sobre a qualidade de vida. Novos estudos são necessários para subsidiar a elaboração de estratégias que melhorem a saúde e a qualidade de vida do profissional médico.
[Mh] Termos MeSH primário: Comportamento Aditivo/psicologia
Médicos/psicologia
Médicos/estatística & dados numéricos
Qualidade de Vida/psicologia
Inquéritos e Questionários
Equilíbrio Trabalho-Vida/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adulto
Plantão Médico/estatística & dados numéricos
Estudos Transversais
Feminino
Seres Humanos
Masculino
Médicas/psicologia
Médicas/estatística & dados numéricos
Fatores de Risco
Fatores Socioeconômicos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170928
[Lr] Data última revisão:
170928
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170803
[St] Status:MEDLINE


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[PMID]:28693381
[Au] Autor:Takagi H; Ando T; Umemoto T; ALICE (All-Literature Investigation of Cardiovascular Evidence) group
[Ad] Endereço:1 Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan.
[Ti] Título:A meta-analysis of weekend admission and surgery for aortic rupture and dissection.
[So] Source:Vasc Med;22(5):398-405, 2017 Oct.
[Is] ISSN:1477-0377
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:We performed a meta-analysis to determine whether weekend admission and surgery for ruptured abdominal/thoracic aortic aneurysm (RAAA/RTAA) and acute aortic dissection (AAD) is associated with increased mortality. MEDLINE and EMBASE were searched from January 1946 to December 2016 using PubMed and OVID. Eligible studies were prospective or retrospective, comparative or cohort studies enrolling patients admitting or undergoing surgery for RAAA/RTAA/AAD and reporting mortality after weekend (including holiday) versus weekday admission/surgery. Our search identified 11 studies including a total of 166,195 patients. A pooled analysis of 13 adjusted odds ratios (ORs), one adjusted hazard ratio, and one unadjusted OR from all 11 studies demonstrated a statistically significant 32% increase in mortality with weekend admission/surgery (OR, 1.32; 95% confidence interval (CI), 1.20 to 1.45; p < 0.00001). Despite possible publication bias disadvantageous to weekend admission/surgery based on funnel plot asymmetry, adjustment for the asymmetry using the trim-and-fill method did not alter the significant association of weekend admission/surgery with increased mortality (OR, 1.21; 95% CI, 1.09 to 1.34; p = 0.0006). In conclusion, weekend admission/surgery for ruptured abdominal/thoracic aortic aneurysm and acute aortic dissection (AAD) may be associated with increased mortality.
[Mh] Termos MeSH primário: Plantão Médico
Aneurisma Dissecante/cirurgia
Aneurisma Aórtico/cirurgia
Ruptura Aórtica/cirurgia
Admissão do Paciente
Procedimentos Cirúrgicos Vasculares
[Mh] Termos MeSH secundário: Aneurisma Dissecante/diagnóstico por imagem
Aneurisma Dissecante/mortalidade
Aneurisma Aórtico/diagnóstico por imagem
Aneurisma Aórtico/mortalidade
Ruptura Aórtica/diagnóstico por imagem
Ruptura Aórtica/mortalidade
Distribuição de Qui-Quadrado
Seres Humanos
Razão de Chances
Medição de Risco
Fatores de Risco
Fatores de Tempo
Resultado do Tratamento
Procedimentos Cirúrgicos Vasculares/efeitos adversos
Procedimentos Cirúrgicos Vasculares/mortalidade
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171030
[Lr] Data última revisão:
171030
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170712
[St] Status:MEDLINE
[do] DOI:10.1177/1358863X17718259


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[PMID]:28639916
[Au] Autor:Regus S; Lang W; Heinz M; Uder M; Schmid A
[Ad] Endereço:1 Department of Vascular Surgery, University Hospital, Erlangen, Germany.
[Ti] Título:Benefits of Long Versus Short Thrombolysis Times for Acutely Thrombosed Hemodialysis Native Fistulas.
[So] Source:Vasc Endovascular Surg;51(5):233-239, 2017 Jul.
[Is] ISSN:1938-9116
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Local thrombolysis with a time of exposure to recombinant tissue plasminogen activator of 15 to 150 minutes is commonly used to declot acutely thrombosed hemodialysis fistulas. The duration of thrombolysis for the restoration of arteriovenous blood flow remains controversial. The aim of this study was to investigate the outcomes of long thrombolysis treatment (LTT, 3 hours or more) and short thrombolysis treatment (STT, less than 3 hours) in our institution. METHODS: We retrospectively analyzed 86 interventional declotting procedures (28 STT and 58 LTT) applied to 86 acutely thrombosed hemodialysis fistulas. The intervention time (IT) following thrombolysis (from the initial fistulography to the end of the angioplasty maneuvers), the time of day of the intervention (ie, during working hours vs off-hours), and the need for temporary catheter placement (TCP) were assessed. Success was defined as complete access recanalization, and major adverse events were defined as ischemia, bleeding, and access rupture. RESULTS: The ITs were reduced after LTT (63.3 [9.3] minutes) compared to STT (106.7 [24.7], P = .01), but there was no difference in success rate (85.7% STT, 89.7% LTT, P = .722). While all (100%, 58/58) of the angioplasty maneuvers after LTT were performed during regular working hours, 75% (21/28) of those following STT were managed during off-hours ( P < .001). Despite the longer treatment, the need for TCP was not increased after LTT (10.7%) compared to STT (12.1%, P = .515), and the major complication rate was reduced (3.4% after LTT and 28.6% after STT, P = .004). CONCLUSION: Long thrombolysis treatment results in shorter and less complicated percutaneous stenosis treatments during regular working hours. Despite the LTT of up to 25 hours until access for dialysis was achieved, no increase in the risks of TCP or major adverse events were observed following LTT.
[Mh] Termos MeSH primário: Derivação Arteriovenosa Cirúrgica/efeitos adversos
Fibrinolíticos/administração & dosagem
Oclusão de Enxerto Vascular/tratamento farmacológico
Diálise Renal
Terapia Trombolítica/métodos
Trombose/tratamento farmacológico
Ativador de Plasminogênio Tecidual/administração & dosagem
[Mh] Termos MeSH secundário: Doença Aguda
Plantão Médico
Idoso
Idoso de 80 Anos ou mais
Angioplastia
Cateterismo Venoso Central
Feminino
Fibrinolíticos/efeitos adversos
Oclusão de Enxerto Vascular/diagnóstico por imagem
Oclusão de Enxerto Vascular/etiologia
Oclusão de Enxerto Vascular/fisiopatologia
Seres Humanos
Masculino
Meia-Idade
Proteínas Recombinantes/administração & dosagem
Estudos Retrospectivos
Terapia Trombolítica/efeitos adversos
Trombose/diagnóstico por imagem
Trombose/etiologia
Trombose/fisiopatologia
Fatores de Tempo
Ativador de Plasminogênio Tecidual/efeitos adversos
Resultado do Tratamento
Grau de Desobstrução Vascular/efeitos dos fármacos
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Fibrinolytic Agents); 0 (Recombinant Proteins); EC 3.4.21.68 (Tissue Plasminogen Activator)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170906
[Lr] Data última revisão:
170906
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170623
[St] Status:MEDLINE
[do] DOI:10.1177/1538574417715182



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