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Pesquisa : N04.761.559.590.399.250 [Categoria DeCS]
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  1 / 19 MEDLINE  
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[PMID]:28973065
[Au] Autor:Guidet B; Leblanc G; Simon T; Woimant M; Quenot JP; Ganansia O; Maignan M; Yordanov Y; Delerme S; Doumenc B; Fartoukh M; Charestan P; Trognon P; Galichon B; Javaud N; Patzak A; Garrouste-Orgeas M; Thomas C; Azerad S; Pateron D; Boumendil A; ICE-CUB 2 Study Network
[Ad] Endereço:Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de Réanimation Médicale, Paris, France.
[Ti] Título:Effect of Systematic Intensive Care Unit Triage on Long-term Mortality Among Critically Ill Elderly Patients in France: A Randomized Clinical Trial.
[So] Source:JAMA;318(15):1450-1459, 2017 10 17.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: The high mortality rate in critically ill elderly patients has led to questioning of the beneficial effect of intensive care unit (ICU) admission and to a variable ICU use among this population. Objective: To determine whether a recommendation for systematic ICU admission in critically ill elderly patients reduces 6-month mortality compared with usual practice. Design, Setting, and Participants: Multicenter, cluster-randomized clinical trial of 3037 critically ill patients aged 75 years or older, free of cancer, with preserved functional status (Index of Independence in Activities of Daily Living ≥4) and nutritional status (absence of cachexia) who arrived at the emergency department of one of 24 hospitals in France between January 2012 and April 2015 and were followed up until November 2015. Interventions: Centers were randomly assigned either to use a program to promote systematic ICU admission of patients (n=1519 participants) or to follow standard practice (n=1518 participants). Main Outcomes and Measures: The primary outcome was death at 6 months. Secondary outcomes included ICU admission rate, in-hospital death, functional status, and quality of life (12-Item Short Form Health Survey, ranging from 0 to 100, with higher score representing better self-reported health) at 6 months. Results: One patient withdrew consent, leaving 3036 patients included in the trial (median age, 85 [interquartile range, 81-89] years; 1361 [45%] men). Patients in the systematic strategy group had an increased risk of death at 6 months (45% vs 39%; relative risk [RR], 1.16; 95% CI, 1.07-1.26) despite an increased ICU admission rate (61% vs 34%; RR, 1.80; 95% CI, 1.66-1.95). After adjustments for baseline characteristics, patients in the systematic strategy group were more likely to be admitted to an ICU (RR, 1.68; 95% CI, 1.54-1.82) and had a higher risk of in-hospital death (RR, 1.18; 95% CI, 1.03-1.33) but had no significant increase in risk of death at 6 months (RR, 1.05; 95% CI, 0.96-1.14). Functional status and physical quality of life at 6 months were not significantly different between groups. Conclusions and Relevance: Among critically ill elderly patients in France, a program to promote systematic ICU admission increased ICU use but did not reduce 6-month mortality. Additional research is needed to understand the decision to admit elderly patients to the ICU. Trial Registration: clinicaltrials.gov Identifier: NCT01508819.
[Mh] Termos MeSH primário: Resultados de Cuidados Críticos
Estado Terminal/mortalidade
Unidades de Terapia Intensiva/estatística & dados numéricos
Admissão do Paciente/estatística & dados numéricos
Triagem
[Mh] Termos MeSH secundário: Atividades Cotidianas
Idoso
Idoso de 80 Anos ou mais
Cuidados Críticos/normas
Feminino
França/epidemiologia
Nível de Saúde
Mortalidade Hospitalar
Seres Humanos
Masculino
Avaliação de Resultados (Cuidados de Saúde)
Avaliação de Programas e Projetos de Saúde
Qualidade de Vida
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171020
[Lr] Data última revisão:
171020
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171004
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.13889


  2 / 19 MEDLINE  
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[PMID]:28867256
[Au] Autor:Bauer PR; Kumbamu A; Wilson ME; Pannu JK; Egginton JS; Kashyap R; Gajic O
[Ad] Endereço:Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN. Electronic address: Bauer.Philippe@mayo.edu.
[Ti] Título:Timing of Intubation in Acute Respiratory Failure Associated With Sepsis: A Mixed Methods Study.
[So] Source:Mayo Clin Proc;92(10):1502-1510, 2017 Oct.
[Is] ISSN:1942-5546
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To analyze bedside clinicians' perspectives regarding the decision process to optimize timing of intubation in sepsis-associated acute respiratory failure. PARTICIPANTS AND METHODS: This mixed methods study was conducted from March 1, 2015, through June 30, 2016. Using qualitative research methods, factors that influenced variability in the decision to intubate were organized into categories and used to build a theoretical explanatory model grounded in current practice variance. All coding schemes were independently reviewed for accuracy and consistency. Themes and findings were then refined with member checking by feedback from individuals and from an anonymous questionnaire until saturation was achieved. RESULTS: The practice of intubation varied according to 3 domains: (1) patient factors included the nature of the acute illness, comorbidities, clinical presentation, severity, trajectory, and values and preferences; (2) clinician factors included background, training, experience, and practice style; and (3) system factors included workload, policies and protocols, hierarchy, communications, culture, and team dynamics. In different contexts, intubation was considered early (elective), just in time (urgent), or late (rescue). The initial assessment, initial decision, and reassessment mattered. CONCLUSION: Recognizing that the variability in both the decision to intubate and its timing depends on many factors, and not on clinical criteria alone, should render the clinician more attentive to the eventual progression of the acute respiratory failure.
[Mh] Termos MeSH primário: Tomada de Decisão Clínica/métodos
Síndrome do Desconforto Respiratório do Adulto
Sepse/complicações
Tempo para o Tratamento/normas
[Mh] Termos MeSH secundário: Adulto
Idoso
Atitude do Pessoal de Saúde
Resultados de Cuidados Críticos
Feminino
Pessoal de Saúde/classificação
Pessoal de Saúde/psicologia
Pessoal de Saúde/normas
Seres Humanos
Masculino
Meia-Idade
Pesquisa Qualitativa
Melhoria de Qualidade
Síndrome do Desconforto Respiratório do Adulto/diagnóstico
Síndrome do Desconforto Respiratório do Adulto/etiologia
Síndrome do Desconforto Respiratório do Adulto/terapia
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171024
[Lr] Data última revisão:
171024
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170905
[St] Status:MEDLINE


  3 / 19 MEDLINE  
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[PMID]:27874920
[Au] Autor:Nyberg H; Samuelsson C; Frigyesi A
[Ad] Endereço:Skånes universitetssjukhus - intensiv och perioperativ vård Lund, Sweden Lunds universitet - IKV, avd. för anestesi och intensivvård Lund, Sweden.
[Ti] Título:[Better intensive care outcomes for men than women especially in septic shock and after cardiac arrest].
[Ti] Título:Män har bättre intensivvårds­överlevnad än kvinnor - Gäller främst diagnoser som hjärtstopp och septisk chock..
[So] Source:Lakartidningen;113, 2016 11 15.
[Is] ISSN:1652-7518
[Cp] País de publicação:Sweden
[La] Idioma:swe
[Ab] Resumo:Better intensive care outcomes for men than women especially in septic shock and after cardiac arrest In this study 11 764 intensive care admissions to Skåne University Hospital in Sweden between 2008 and 2015 were studied for any gender differences in outcome for different diagnoses. As known from previous studies, men had more intensive care admissions and had a higher morbidity necessitating the use of risk adjusted mortality measures. Through a simple but new application of VLAD we found this risk-adjusted mortality measure to be more sensitive in detecting differences in mortality between groups than the more commonly used SMR. The main finding was somewhat surprisingly that intensive care outcomes are better for males than females. This difference was most marked in septic shock and post cardiac arrest and did not seem to be caused by unequal distribution of care. Our findings were also confirmed using a bootstrap technique on EMR-matched cohorts.
[Mh] Termos MeSH primário: Resultados de Cuidados Críticos
Cuidados Críticos/estatística & dados numéricos
Mortalidade Hospitalar
Unidades de Terapia Intensiva/estatística & dados numéricos
Fatores Sexuais
[Mh] Termos MeSH secundário: Idoso
Estudos de Coortes
Feminino
Parada Cardíaca/mortalidade
Seres Humanos
Masculino
Meia-Idade
Choque Séptico/mortalidade
Suécia/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1705
[Cu] Atualização por classe:171011
[Lr] Data última revisão:
171011
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161123
[St] Status:MEDLINE


  4 / 19 MEDLINE  
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[PMID]:27727179
[Au] Autor:Gaballa A; Sundin M; Stikvoort A; Abumaree M; Uzunel M; Sairafi D; Uhlin M
[Ad] Endereço:Department of Oncology and Pathology, Karolinska Institutet, SE-141 86 Stockholm, Sweden. Ahmed.Gaballa@ki.se.
[Ti] Título:T Cell Receptor Excision Circle (TREC) Monitoring after Allogeneic Stem Cell Transplantation; a Predictive Marker for Complications and Clinical Outcome.
[So] Source:Int J Mol Sci;17(10), 2016 Oct 11.
[Is] ISSN:1422-0067
[Cp] País de publicação:Switzerland
[La] Idioma:eng
[Ab] Resumo:Allogeneic hematopoietic stem cell transplantation (HSCT) is a well-established treatment modality for a variety of malignant diseases as well as for inborn errors of the metabolism or immune system. Regardless of disease origin, good clinical effects are dependent on proper immune reconstitution. T cells are responsible for both the beneficial graft-versus-leukemia (GVL) effect against malignant cells and protection against infections. The immune recovery of T cells relies initially on peripheral expansion of mature cells from the graft and later on the differentiation and maturation from donor-derived hematopoietic stem cells. The formation of new T cells occurs in the thymus and as a byproduct, T cell receptor excision circles (TRECs) are released upon rearrangement of the T cell receptor. Detection of TRECs by PCR is a reliable method for estimating the amount of newly formed T cells in the circulation and, indirectly, for estimating thymic function. Here, we discuss the role of TREC analysis in the prediction of clinical outcome after allogeneic HSCT. Due to the pivotal role of T cell reconstitution we propose that TREC analysis should be included as a key indicator in the post-HSCT follow-up.
[Mh] Termos MeSH primário: Receptores de Antígenos de Linfócitos T
Transplante de Células-Tronco
[Mh] Termos MeSH secundário: Aloenxertos
Biomarcadores/sangue
Resultados de Cuidados Críticos
Doença Enxerto-Hospedeiro/diagnóstico
Seres Humanos
Receptores de Antígenos de Linfócitos T/sangue
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Biomarkers); 0 (Receptors, Antigen, T-Cell)
[Em] Mês de entrada:1705
[Cu] Atualização por classe:170512
[Lr] Data última revisão:
170512
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161012
[St] Status:MEDLINE


  5 / 19 MEDLINE  
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[PMID]:27575796
[Au] Autor:Coen J; Curry K
[Ad] Endereço:Clinical Nurse Specialist Program, University of Pittsburgh School of Nursing, Baccalaureate Nursing Program, University of Pittsburgh, and Cardiac Intensive Care Unit, Allegheny General Hospital, Pittsburgh, Pennsylvania (Mrs Coen); and Cardiovascular Institute Allegheny Health Network, Allegheny General Hospital, and Clinical Nurse Specialist Program, University of Pittsburgh, Pittsburgh, Pennsylvania (Mrs Curry).
[Ti] Título:Improving Heart Failure Outcomes: The Role of the Clinical Nurse Specialist.
[So] Source:Crit Care Nurs Q;39(4):335-44, 2016 Oct-Dec.
[Is] ISSN:1550-5111
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:This article identifies and explains barriers to optimal outcomes of heart failure and the role of the clinical nurse specialist in overcoming these obstacles, improving patient outcomes and quality of life. In recent years, advances in heart failure management have increased survival rates, and as a result, the number of patients requiring services to manage disease progression and the complex array of symptoms associated with end-stage heart disease. Management of the heart failure patient is dependent on the severity of the disease and wide range of available treatment regimens. Disease progression can be unpredictable and treatment regimens increasingly complex. The authors present a typical case of a patient with heart failure, identify the barriers to optimal outcomes in managing heart failure, as well as describe the roles of the clinical nurse specialist in overcoming these barriers within 3 spheres of clinical nurse specialist influence: patient, health care provider, and health care systems. The clinical nurse specialist role is ideally suited to positively affect heart failure outcomes. These positive effects are drawn from the dynamic and unique nature of the clinical nurse specialist role and are perpetrated through the 3 spheres of clinical nurse specialist practice: patient, health care provider, and heath care system.
[Mh] Termos MeSH primário: Resultados de Cuidados Críticos
Insuficiência Cardíaca/terapia
Enfermeiras Clínicas
Papel do Profissional de Enfermagem
[Mh] Termos MeSH secundário: Protocolos Clínicos
Gerenciamento Clínico
Insuficiência Cardíaca/enfermagem
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170417
[Lr] Data última revisão:
170417
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:160831
[St] Status:MEDLINE
[do] DOI:10.1097/CNQ.0000000000000127


  6 / 19 MEDLINE  
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[PMID]:27404021
[Au] Autor:Mehta AB; Douglas IS; Walkey AJ
[Ad] Endereço:1 The Pulmonary Center, Division of Pulmonary and Critical Care Medicine, and.
[Ti] Título:Hospital Noninvasive Ventilation Case Volume and Outcomes of Acute Exacerbations of Chronic Obstructive Pulmonary Disease.
[So] Source:Ann Am Thorac Soc;13(10):1752-1759, 2016 Oct.
[Is] ISSN:2325-6621
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Higher hospital case volume may produce local expertise ("practice makes perfect"), resulting in better patient outcomes. Associations between hospital noninvasive ventilation (NIV) case volume and outcomes for patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) are unclear. OBJECTIVES: To determine associations between total hospital NIV case volume for all indications and NIV failure and hospital mortality among patients with acute exacerbations of COPD. METHODS: Using the 2011 California State Inpatient Database and multivariable hierarchical logistic regression, we calculated hospital-level risk-adjusted rates for NIV failure (progression from NIV to invasive mechanical ventilation) and hospital mortality among patients with acute exacerbations of COPD. MEASUREMENTS AND MAIN RESULTS: We identified 37,516 hospitalizations for acute exacerbations of COPD in 252 California hospitals in 2011. Total hospital NIV use for all indications ranged from 2 to 565 cases (median, 64; interquartile range, 96). Hospital NIV failure rates for acute exacerbations of COPD ranged from 3.7 to 31.3% (median, 8.5%; interquartile range, 4.2). At the hospital level, higher total hospital NIV case volume was weakly associated with higher hospital NIV failure rates for acute exacerbations of COPD (r = 0.13; P = 0.03). Higher hospital NIV failure rates were weakly associated with higher hospital mortality rates for acute exacerbations of COPD (r = 0.15; P = 0.02), but higher total hospital NIV case volume was not associated with hospital mortality for exacerbations of COPD (r = -0.11; P = 0.08). At the patient level, patients admitted to high-NIV versus low-NIV case-volume hospitals had greater odds of NIV failure (quartile 4 vs. quartile 1 adjusted odds ratio [aOR], 1.95; 95% confidence interval [CI], 1.12-3.40). Compared with initial treatment with invasive mechanical ventilation, NIV failure was associated with higher odds of death (aOR, 1.81; 95% CI, 1.35-2.44). However, admission to high-NIV versus low-NIV case-volume hospitals was not significantly associated with patient in-hospital mortality (quartile 4 vs. quartile 1 aOR, 0.76; 95% CI, 0.57-1.02). CONCLUSIONS: Despite strong evidence for use of NIV in the management of acute exacerbations of COPD, we observed no significant mortality benefit and higher rates of NIV failure in high-NIV case-volume hospitals. Further investigation of patient selection and hospital factors associated with NIV failure is needed to maximize favorable patient outcomes associated with use of NIV for acute exacerbations of COPD.
[Mh] Termos MeSH primário: Mortalidade Hospitalar
Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos
Ventilação não Invasiva/estatística & dados numéricos
Doença Pulmonar Obstrutiva Crônica/mortalidade
Doença Pulmonar Obstrutiva Crônica/terapia
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
California/epidemiologia
Resultados de Cuidados Críticos
Bases de Dados Factuais
Progressão da Doença
Feminino
Seres Humanos
Pacientes Internados
Modelos Logísticos
Masculino
Meia-Idade
Análise Multivariada
Razão de Chances
Estudos Retrospectivos
Falha de Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[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:160713
[St] Status:MEDLINE


  7 / 19 MEDLINE  
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[PMID]:27177785
[Au] Autor:Horváth B
[Ti] Título:[Tribute to Kálmán Széll MD on his 90th birthday].
[Ti] Título:A kilencvenéves Széll Kálmán dr. köszöntése..
[So] Source:Orv Hetil;157(21):803-4, 2016 May 22.
[Is] ISSN:0030-6002
[Cp] País de publicação:Hungary
[La] Idioma:hun
[Mh] Termos MeSH primário: Cuidados Críticos/história
Cirurgia Geral/história
Unidades de Terapia Intensiva/história
[Mh] Termos MeSH secundário: Distinções e Prêmios
Cristianismo
Cuidados Críticos/organização & administração
Resultados de Cuidados Críticos
História do Século XX
História do Século XXI
Seres Humanos
Hungria
Unidades de Terapia Intensiva/organização & administração
Liderança
Política
[Pt] Tipo de publicação:HISTORICAL ARTICLE; JOURNAL ARTICLE
[Ps] Nome de pessoa como assunto:Széll K
[Em] Mês de entrada:1608
[Cu] Atualização por classe:160514
[Lr] Data última revisão:
160514
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160515
[St] Status:MEDLINE
[do] DOI:10.1556/650.2016.HO2547


  8 / 19 MEDLINE  
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[PMID]:27038535
[Au] Autor:Tuppin P; Samson S; Fagot-Campagna A; Woimant F
[Ad] Endereço:CNAMTS, Direction de la stratégie des études et des statistiques, 26-50, avenue du Professeur-André-Lemierre, 75986 Paris cedex 20, France. Electronic address: philippe.tuppin@cnamts.fr.
[Ti] Título:Care pathways and healthcare use of stroke survivors six months after admission to an acute-care hospital in France in 2012.
[So] Source:Rev Neurol (Paris);172(4-5):295-306, 2016 Apr-May.
[Is] ISSN:0035-3787
[Cp] País de publicação:France
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Care pathways and healthcare management are not well described for patients hospitalized for stroke. METHODS: Among the 51 million beneficiaries of the French national health insurance general scheme (77% of the French population), patients hospitalized for a first stroke in 2012 and still alive six months after discharge were included using data from the national health insurance information system (Sniiram). Patient characteristics were described by discharge destination-home or rehabilitation center (for < 3 months)-and were followed during their first three months back home. RESULTS: A total of 61,055 patients had a first admission to a public or private hospital for stroke (mean age; 72 years, 52% female), 13% died during their stay and 37% were admitted to a stroke management unit. Overall, 40,981 patients were still alive at six months: 33% of them were admitted to a rehabilitation center (mean age: 73 years) and 54% were discharged directly to their home (mean age 67 years). For each group, 45 and 62% had been previously admitted to a stroke unit. Patients discharged to rehabilitation centers had more often comorbidities, 39% were highly physically dependent and 44% were managed in specialized neurology centers. For patients with a cerebral infarction who were directly discharged to their home 76% received at least one antihypertensive drug, 96% an antithrombotic drug and 76% a lipid-lowering drug during the following month. For those with a cerebral hemorrhage, these frequencies were respectively 46, 33 and 28%. For those admitted to a rehabilitation center, more than half had at least one visit with a physiotherapist or a nurse, 15% a speech therapist, 10% a neurologist or a cardiologist and 15% a psychiatrist during the following three months back home (average numbers of visits for those with at least one visit: 23 for physiotherapists and 100 for nurses). Patients who returned directly back home had fewer physiotherapist (30%) or nurse (47%) visits but more medical consultations. The 3-month re-hospitalization rate for patients who were discharged directly to their home was 23% for those who had been admitted to a stroke unit and 25% for the others. In rehabilitation centers, this rate was 10% for patients who stayed < 3 months. CONCLUSIONS: These results illustrate the value of administrative databases to study stroke management, care pathways and ambulatory care. These data should be used to improve care pathways, organization, discharge planning and treatments.
[Mh] Termos MeSH primário: Resultados de Cuidados Críticos
Procedimentos Clínicos
Recursos em Saúde/estatística & dados numéricos
Reabilitação do Acidente Vascular Cerebral
Acidente Vascular Cerebral/terapia
Sobreviventes
[Mh] Termos MeSH secundário: Idoso
Procedimentos Clínicos/organização & administração
Procedimentos Clínicos/normas
Procedimentos Clínicos/estatística & dados numéricos
Feminino
França/epidemiologia
Seres Humanos
Tempo de Internação/estatística & dados numéricos
Masculino
Meia-Idade
Admissão do Paciente
Alta do Paciente/normas
Alta do Paciente/estatística & dados numéricos
Centros de Reabilitação/normas
Centros de Reabilitação/estatística & dados numéricos
Acidente Vascular Cerebral/mortalidade
Reabilitação do Acidente Vascular Cerebral/métodos
Reabilitação do Acidente Vascular Cerebral/estatística & dados numéricos
Sobreviventes/estatística & dados numéricos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170421
[Lr] Data última revisão:
170421
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160404
[St] Status:MEDLINE


  9 / 19 MEDLINE  
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[PMID]:26801901
[Au] Autor:de Oliveira Manoel AL; Goffi A; Marotta TR; Schweizer TA; Abrahamson S; Macdonald RL
[Ad] Endereço:St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1 W8, Canada. airtonleo.manoel@gmail.com.
[Ti] Título:The critical care management of poor-grade subarachnoid haemorrhage.
[So] Source:Crit Care;20:21, 2016 Jan 23.
[Is] ISSN:1466-609X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Aneurysmal subarachnoid haemorrhage is a neurological syndrome with complex systemic complications. The rupture of an intracranial aneurysm leads to the acute extravasation of arterial blood under high pressure into the subarachnoid space and often into the brain parenchyma and ventricles. The haemorrhage triggers a cascade of complex events, which ultimately can result in early brain injury, delayed cerebral ischaemia, and systemic complications. Although patients with poor-grade subarachnoid haemorrhage (World Federation of Neurosurgical Societies 4 and 5) are at higher risk of early brain injury, delayed cerebral ischaemia, and systemic complications, the early and aggressive treatment of this patient population has decreased overall mortality from more than 50% to 35% in the last four decades. These management strategies include (1) transfer to a high-volume centre, (2) neurological and systemic support in a dedicated neurological intensive care unit, (3) early aneurysm repair, (4) use of multimodal neuromonitoring, (5) control of intracranial pressure and the optimisation of cerebral oxygen delivery, (6) prevention and treatment of medical complications, and (7) prevention, monitoring, and aggressive treatment of delayed cerebral ischaemia. The aim of this article is to provide a summary of critical care management strategies applied to the subarachnoid haemorrhage population, especially for patients in poor neurological condition, on the basis of the modern concepts of early brain injury and delayed cerebral ischaemia.
[Mh] Termos MeSH primário: Resultados de Cuidados Críticos
Gerenciamento Clínico
Hemorragia Subaracnóidea/complicações
Hemorragia Subaracnóidea/mortalidade
Hemorragia Subaracnóidea/terapia
[Mh] Termos MeSH secundário: Encéfalo/fisiopatologia
Lesões Encefálicas/complicações
Lesões Encefálicas/prevenção & controle
Isquemia Encefálica/prevenção & controle
Seres Humanos
Aneurisma Intracraniano/complicações
Aneurisma Intracraniano/mortalidade
Aneurisma Intracraniano/terapia
Administração dos Cuidados ao Paciente/métodos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1609
[Cu] Atualização por classe:170220
[Lr] Data última revisão:
170220
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160124
[St] Status:MEDLINE
[do] DOI:10.1186/s13054-016-1193-9


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[PMID]:26492559
[Au] Autor:Morton B; Nagaraja S; Collins A; Pennington SH; Blakey JD
[Ad] Endereço:Department of Clinical Sciences, Respiratory Infection Group, Liverpool School of Tropical Medicine, Liverpoool, United Kingdom; Aintree University Hospitals NHS Foundation Trust, Liverpool, United Kingdom.
[Ti] Título:A Retrospective Evaluation of Critical Care Blood Culture Yield - Do Support Services Contribute to the "Weekend Effect"?
[So] Source:PLoS One;10(10):e0141361, 2015.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The "weekend effect" describes an increase in adverse outcomes for patients admitted at the weekend. Critical care units have moved to higher intensity working patterns to address this with some improved outcomes. However, support services have persisted with traditional working patterns. Blood cultures are an essential diagnostic tool for patients with sepsis but yield is dependent on sampling technique and processing. We therefore used blood culture yield as a surrogate for the quality of support service provision. We hypothesized that blood culture yields would be lower over the weekend as a consequence of reduced support services. METHODS: We performed a retrospective observational study examining 1575 blood culture samples in a university hospital critical care unit over a one-year period. RESULTS: Patients with positive cultures had, on average, higher APACHE II scores (p = 0.015), longer durations of stay (p = 0.03), required more renal replacement therapy (p<0.001) and had higher mortality (p = 0.024). Blood culture yield decreased with repeated sampling with an increased proportion of contaminants. Blood cultures were 26.7% less likely to be positive if taken at the weekend (p = 0.0402). This effect size is the equivalent to the impact of sampling before and after antibiotic administration. CONCLUSIONS: Our study demonstrates that blood culture yield is lower at the weekend. This is likely caused by delays or errors in incubation and processing, reflecting the reduced provision of support services at the weekend. Reorganization of services to address the "weekend effect" should acknowledge the interdependent nature of healthcare service delivery.
[Mh] Termos MeSH primário: Plantão Médico
Infecções Bacterianas/diagnóstico
Sangue/microbiologia
Cuidados Críticos
Erros de Diagnóstico/prevenção & controle
Serviço Hospitalar de Emergência/utilização
[Mh] Termos MeSH secundário: Idoso
Infecções Bacterianas/sangue
Infecções Bacterianas/microbiologia
Resultados de Cuidados Críticos
Feminino
Seguimentos
Seres Humanos
Masculino
Meia-Idade
Estudos Retrospectivos
Manejo de Espécimes
[Pt] Tipo de publicação:CLINICAL TRIAL; JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1606
[Cu] Atualização por classe:151030
[Lr] Data última revisão:
151030
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:151023
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0141361



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