Patient Admission

Post-procedural recovery following sub-cutaneous ICD (S-ICD) implantation is feared to be more painful and to require more prolonged hospital admission. The purpose of this study was to compare peri-procedural and short clinical outcomes of the S-ICD vs. the Transvenous ICD (TV-ICD). We conducted a single-center cross-sectional study including all consecutive patients who underwent S-ICD implantation by the same operator since January 2016 and a gender and age-matched control group with all single chamber TV-ICD implanted patients over a contemporary time period. Thirty-one patients (sex ratio 1/5; mean age 58.7±13.2years) with S-ICD were compared to 31 matched TV-ICD patients. Duration of the implant procedure was significantly longer for the S-ICD (58.0±24.4min vs 41.7±20.8min TV-ICD, p<0.01). Mean fluoroscopy time for the TV-ICD was 3.5±3.6min vs 0.1±0.01min for all S-ICD patients (p<0.01). Requirement of on-demand analgesia administration, and duration of hospitalization (...

Background: Cutting and piercing injuries are among the leading causes of unintentional injury morbidity in developed countries. In New Zealand, cutting and piercing are second only to falls as the most frequent cause of unintentional home injuries resulting in admissions to hospital among people aged 20 to 64 years. Alcohol intake is known to be associated with many other types of injury. We used a case-crossover study to investigate the role of acute alcohol use (i.e., drinking during the previous 6 h) in unintentional cutting or piercing injuries at home. Methods: A population-based case-crossover study was conducted. We identified all people aged 20 to 64 years, resident in one of three regions of the country (Greater Auckland, Waikato and Otago), who were admitted to public hospital within 48 h of an unintentional non-occupational cutting or piercing injury sustained at home (theirs or another's) from August 2008 to December 2009. The main exposure of interest was use of alcohol in the 6-hour period before the injury occurred and the corresponding time intervals 24 h before, and 1 week before, the injury. Other information was collected on known and potential confounders. Information was obtained during face-to-face interviews with cases, and through review of their medical charts. Results: Of the 356 participants, 71% were male, and a third sustained injuries from contact with glass. After adjustment for other paired exposures, the odds ratio for injury after consuming 1 to 3 standard drinks of alcohol during the 6-hour period before the injury (compared to the day before), compared to none, was 1.77 (95% confidence interval 0.84 to 3.74), and for four or more drinks was 8.68 (95% confidence interval 3.11 to 24.3). Smokers had higher alcohol-related risks than non-smokers. Conclusions: Alcohol consumption increases the odds of unintentional cutting or piercing injury occurring at home and this risk increases with higher levels of drinking.

Introduction: Many patients with intentional drug overdose (IDO) are admitted to a medium (MC) or intensive care unit (IC) without ever requiring MC/IC related interventions. The objective of this study was to develop a decision tool, using parameters readily available in the emergency room (ER) for patients with an IDO, to identify patients requiring admission to a monitoring unit. Methods: Retrospective cohort study among cases of IDO with drugs having potentially acute effects on neurological, circulatory or ventilatory function, admitted to the MC/IC unit between 2007 and 2013. A decision tool was developed, using 6 criteria, representing intubation, breathing, oxygenation, cardiac conduction, blood pressure, and consciousness. Cases were labeled as 'high acuity' if one or more criteria were present. Results: Among 255 cases of IDO that met the inclusion criteria, 197 were identified as "high acuity". Only 70 of 255 cases underwent one or more MC/IC related interventions, of which 67 were identified as 'high acuity by the decision tool (sensitivity 95.7%). In a population of patients with intentional drug overdose with agents having potentially acute effect on vital functions, 95.7% of MC/IC interventions could be predicted by clinical assessment, supplemented with electrocardiogram and blood gas analysis, in the ER.

Atrial fibrillation and heart failure often coexist, causing substantial cardiovascular morbidity and mortality. β blockers are indicated in patients with symptomatic heart failure with reduced ejection fraction; however, the efficacy of these drugs in patients with concomitant atrial fibrillation is uncertain. We therefore meta-analysed individual-patient data to assess the efficacy of β blockers in patients with heart failure and sinus rhythm compared with atrial fibrillation. We extracted individual-patient data from ten randomised controlled trials of the comparison of β blockers versus placebo in heart failure. The presence of sinus rhythm or atrial fibrillation was ascertained from the baseline electrocardiograph. The primary outcome was all-cause mortality. Analysis was by intention to treat. Outcome data were meta-analysed with an adjusted Cox proportional hazards regression. The study is registered with Clinicaltrials.gov, number NCT0083244, and PROSPERO, number CRD42014010...

Objetivo: Determinar a mortalidade e identificar fatores de riscos associados em pacientes em uma UTI de cirurgia torácica. Métodos: Foram avaliados retrospectivamente 141 pacientes admitidos na UTI de cirurgia torácica do Hospital Estadual de Denizli, localizado na cidade de Denizli, Turquia, entre janeiro de 2006 e agosto de 2008. Foram coletados dados sobre gênero, idade, causa de admissão, intervenções invasivas e operações, status de ventilação mecânica invasiva, infecções e tempo de permanência na UTI. Resultados: Dos 141 pacientes, 103 (73,0%) eram do sexo masculino e 38 (23,0%) do sexo feminino. A média de idade foi de 52,1 anos (variação: 12-92 anos), e a taxa de mortalidade foi de 16,3%. A causa de admissão mais frequente foi trauma. A mortalidade correlacionou-se com idade avançada (p < 0,05), uso de ventilação mecânica invasiva (OR = 42,375; p < 0,05), longa permanência na UTI (p < 0,05) e causas de admissão específicas -trauma, injúria por arma de fogo, injúria por arma branca e malignidade (p < 0,05 para todos). Conclusões: Os pacientes em uma UTI de cirurgia torácica têm alta morbidade e mortalidade. Um conhecimento maior dos fatores de risco de mortalidade pode melhorar a eficiência do tratamento, resultando em diminuição da morbidade e mortalidade, o que gerará economia de tempo e reduzirá os custos financeiros. Descritores: Unidades de terapia intensiva; Cirurgia torácica/mortalidade; Mortalidade hospitalar; Fatores de risco.

The brief behavioral activation treatment for depression is a simple, cost-effective method for treating depression. Based on basic behavioral theory and recent evidence that the behavioral component may be the active mechanism of change in cognitive-behavioral treatments of clinical depression, the authors designed a treatment to systematically increase exposure to positive activities, and thereby improve affect and corresponding cognitions. This article describes the rationale for the treatment and provides the treatment in manual form to be utilized by patients in therapy.

Notices late 1970s and is now rising. After allowing for the proportion of births to mothers over 35 years, the trend with year remains significant at the 5% level, OR=0-9996, (95%CI: 0 9995, 0 9997). Over the period there has also been a steady increase in the proportion of single mothers. As single mothers are more likely to have boys,4 it is likely that the decline in the sex ratio of children born to other women is even greater. This decline in the sex ratio remains unexplained. Possibilities are a general fall in the frequency of intercourse, perhaps due to the increasing stress of society or changes in male or female hormone levels. The latter could be consequence of air pollution which was shown by Williams et a15 to be associated with a lower sex ratio.

Notices late 1970s and is now rising. After allowing for the proportion of births to mothers over 35 years, the trend with year remains significant at the 5% level, OR=0-9996, (95%CI: 0 9995, 0 9997). Over the period there has also been a steady increase in the proportion of single mothers. As single mothers are more likely to have boys,4 it is likely that the decline in the sex ratio of children born to other women is even greater. This decline in the sex ratio remains unexplained. Possibilities are a general fall in the frequency of intercourse, perhaps due to the increasing stress of society or changes in male or female hormone levels. The latter could be consequence of air pollution which was shown by Williams et a15 to be associated with a lower sex ratio.

Background: Inconsistency in social status and its impact on health have been a focus of research 30-40 years ago. Yet, there is little recent information on it's association with ischaemic heart disease (IHD) morbidity and IHD is still defined as one of the major health problems in socioeconomically developed societies. Methods: A secondary analysis of prospective historical data from 68 805 male and female members of a statutory German health insurance company aged 25-65 years was conducted. Data included information on sociodemographic variables, social status indicators (education, occupational grade and income) and hospital admissions because of IHD. Results: Findings from Cox regression analysis showed an increased risk for IHD in the group with the highest educational level, whereas the lowest occupational and income groups had the highest hazard ratio (HR). Further analysis revealed that after adjustment for income status inconsistency (defined by the combination of higher educational level with lower occupational status) accounts for increased risk of IHD (HR for men, 3.14 and for women, 3.63). An association of similar strength was observed regarding high education/low income in women (HR 3.53). The combination of low education with high income reduced the risk among men (HR 0.29). No respective findings were observed concerning occupational group and income. Conclusions: Status inconsistency is associated with the risk of IHD as well as single traditional indicators of socioeconomic position. Information on status inconsistency should be measured in addition to single indicators of socioeconomic status to achieve a more appropriate estimation of the risk of IHD.

Background: Nigeria, the most populous country in Africa and the 8th most populous in the world with a population of over 154 million, does not have current data on substance abuse treatment demand and treatment facilities; however, the country has the highest one-year prevalence rate of Cannabis use (14.3%) in Africa and ranks third in Africa with respect to the one-year prevalence rate of cocaine (0.7%) and Opioids (0.7%) use. This study aimed to determine the types, spread and characteristics of the substance abuse treatment centers in Nigeria. Methods: The study was a cross sectional survey of substance abuse treatment centers in Nigeria. Thirty-one units were invited and participated in filling an online questionnaire, adapted from the European Treatment Unit/Program Form (June 1997 version). Results: All the units completed the online questionnaire. A large proportion (48%) was located in the South-West geopolitical zone of the country. Most (58%) were run by Non-Governmental Organizations. Half of them performed internal or external evaluation of treatment process or outcome. There were a total of 1043 for all categories of paid and volunteer staff, with an average of 33 staff per unit. Most of the funding came from charitable donations (30%). No unit provided drug substitution/maintenance therapy. The units had a total residential capacity of 566 beds. New client admissions in the past one year totalled 765 (mean = 48, median = 26.5, min = 0, max = 147) and 2478 clients received services in the non-residential units in the past year. No unit provided syringe exchange services. Conclusions: The study revealed a dearth of substance abuse treatment units (and of funds for the available ones) in a country with a large population size and one of the highest prevalence rates of substance abuse in Africa. The available units were not networked and lacked a directory or an evaluation framework. To provide an environment for effective monitoring, funding and continuous quality improvement, the units need to be organized into a sustainable network.

Background -The prevalence of micro- organisms causing community-acquired pneumonia in patients who required ad- mission to hospital was investigated and the percentage of cases whose aetiology remained unknown due to the study design and logistical problems estimated. Methods -Between January 1991 and April 1993 all patients with community-acquired pneumonia admitted to six hospitals were included in the study. Aetiological diag- nosis, categorised as definite, probable and possible, was based on the results of routine microbiological and serological tests. Results -Three hundred and thirty four patients with a median age of 65 (range 17-92) years were enrolled in the study. The diagnosis of community-acquired pneumonia was definite in 108 cases, and probable or possible in 73 and 27 cases, respectively, including dual infections. Streptococcus pneumoniae was the pre- dominant pathogen (27%) followed by vir- uses and Haemophilus influenzae (both about 8%) and Mycoplasma pneumoniae (6%). Chlamydia spp (3%) and Legionella pneumophila (2%) were less frequently de- tected. No diagnosis was made in 45% of the cases. With adjustment for anti- microbial therapy before admission and for other logistical considerations, it is es- timated that the aetiology could have been ascertained in 65% of the cases. Conclusions -Streptococcus pneumoniae is the most frequently detected cause of community-acquired pneumonia. The in- ability to detect a micro-organism results mainly from the use of routine diagnostic tests and, to a lesser extent, from logistical problems or the use of antibiotics before admission.

The aim of this study was to determine the concentrations of thyroid axis hormones in psychotic patients on hospital admission and to search for the associations between the concentrations of these hormones and prior drug use as well as mental symptoms. Material and Methods. Psychiatric diagnoses, psychotropic drug use, and the severity of psychoses were evaluated using the standard methods on admission. Venous blood from patients and healthy controls was drawn for the analysis of free thyroxin (FT4), free triiodothyronine (FT3), thyroid-stimulating hormone (TSH), and sex hormone-binding globulin (SHBG) concentrations. Results. Eighty-one psychotic patients, free of a thyroid disorder, were enrolled into the study. Compared with the controls, they displayed the higher FT4 concentrations in the general group (P=0.003) and the higher SHBG concentrations only in men (P=0.013). The FT4 concentration was higher in the patients who were not taking an antipsychotic drug on admission (P=0.0...

background: We have compared the incidence of acute myocardial infarction (AMI) before and after Hurricane Katrina along with contributing factors. methods: This is a single-center, retrospective study conducted at Tulane University Health Sciences Center involving patients admitted for AMI in the two years before Hurricane Katrina and in the seven years afterward. Using pre-specified demographic and clinical data, we compared the pre-Katrina and post-Katrina cohorts. results: In the 7-year post-Katrina period, there were 1378 admissions for AMI out of a total census of 61633 patients (2.24%) compared to 150 admissions out of a census of 21,079 (0.7%) in the 2-year pre-Katrina group (p<0.0001). The post-Katrina group had a higher prevalence of known coronary artery disease (48.7% vs. 30.7%, p<0.005), prior coronary artery bypass grafts (15.9% vs 9.3%%, p<0.05), hyperlipidemia (55.0% vs. 45.4%, p<0.05), smoking (50.9% vs. 39.3% p<0.05), substance abuse (14.5% vs. 6.7%, p<0.05) and psychiatric comorbidities (12.3% vs. 6.7%, p<0.05). The post-Katrina group was also more likely to have had been prescribed aspirin (47.9% vs. 31.3%, p<0.005), beta blockers (46.9% vs. 34.0%, p<0.05), ACE inhibitors or angiotensin receptor blockers (50.3% vs. 36.0%, p<0.05) and statins (48.0% vs. 28.0%, p<0.001), was more likely to be unemployed (18.1% vs. 2.0%, p<0.0001), uninsured (12.3% vs. 6.0%, p<0.05) and to be residents of New Orleans (88.3% vs. 70.0%, p<0.0001). No significant differences between the two groups were noticed in terms of age, sex, ethnicity or hypertension. Hurricane Katrina placed a tremendous impact on the physical, emotional and psychological wellbeing of New Orleans residents. The three fold increase in incidence of AMI in the community has persisted despite improved adherence to standard of care and guidelines. These findings highlight the importance of devising strategies to improve long term cardiovascular health of a community after a natural disaster, particularly in view of the recent spate of global natural disasters.

T. A. Carmo foi responsável pela coleta de dados e pela redação da versão preliminar do artigo. Também foi responsável pelo delineamento da pesquisa, análise de dados, revisão crítica e aprovação da versão final do artigo. S. M. Andrade e A. Cerci Neto participaram do delineamento da pesquisa, análise de dados, revisão crítica e aprovação da versão final do artigo. Ao professor Darli Antonio Soares (in memoriam) pela orientação segura e competente dada durante o desenvolvimento deste trabalho.

Objective Physician participation in Continuing Medical Education programs may be influenced by a number of factors. To evaluate the factors associated with compliance with the Continuing Medical Education requirements at a private hospital, we investigated whether physicians’ activity, measured by volumes of admissions and procedures, was associated with obtaining 40 Continuing Medical Education credits (40 hours of activities) in a 12-month cycle. Methods In an exclusive and non-mandatory Continuing Medical Education program, we collected physicians’ numbers of hospital admissions and numbers of surgical procedures performed. We also analyzed data on physicians’ time since graduation, age, and gender. Results A total of 3,809 credentialed, free-standing, private practice physicians were evaluated. Univariate analysis showed that the Continuing Medical Education requirements were more likely to be achieved by male physicians (odds ratio 1.251; p=0.009) and who had a higher number o...

Recent observational studies have pointed out many problems regarding the pre-hospital and in-hospital management of patients with acute coronary syndrome (ACS). The present study analyses the epidemiology of ACS in Campania Region. It has enrolled the 92.3% of coronary care units (CCU) of the Campania. The results indicate that 77% of patients admitted in CCU have ACS and the time of admission in CCU is still too long. Moreover the vast majority of patients arrive at the hospital without emergency ambulance and 48% of patients admitted in CCU for ACS with elevated ST segment do not receive any reperfusion therapy; compared with the 35.1% of patients included in the BLITZ study. The challenge of the SSN in the next future is to improve the &quot;decision making&quot; in the management of patients with ACS. This goal could be reached by an optimal organization of the hospital and out-of-hospital emergency services creating an integrated network of cardiological assistance.

Recent observational studies have pointed out many problems regarding the pre-hospital and in-hospital management of patients with acute coronary syndrome (ACS). The present study analyses the epidemiology of ACS in Campania Region. It has enrolled the 92.3% of coronary care units (CCU) of the Campania. The results indicate that 77% of patients admitted in CCU have ACS and the time of admission in CCU is still too long. Moreover the vast majority of patients arrive at the hospital without emergency ambulance and 48% of patients admitted in CCU for ACS with elevated ST segment do not receive any reperfusion therapy; compared with the 35.1% of patients included in the BLITZ study. The challenge of the SSN in the next future is to improve the "decision making" in the management of patients with ACS. This goal could be reached by an optimal organization of the hospital and out-of-hospital emergency services creating an integrated network of cardiological assistance.

Red cell distribution width (RDW), traditionally employed as a parameter for classifying anemia, has undergone a remarkable transformation in clinical medicine to emerge as a powerful prognostic biomarker across an extensive spectrum of pathological conditions. This comprehensive review meticulously examines RDW's extraordinary evolution from its conventional role in hematology to its current standing as a versatile clinical indicator with broad applicability. A significant advantage of RDW is its automatic calculation by modern automated hematology analyzers as part of routine complete blood counts, rendering it exceptionally accessible and cost-effective as a biomarker in clinical settings worldwide. The complex pathophysiological mechanisms linking elevated RDW to various disease states involve sophisticated interactions between inflammatory cascades, oxidative stress pathways, nutritional deficiencies, bone marrow dysfunction, and metabolic dysregulations. The growing body of evidence supporting RDW's clinical utility extends across multiple medical specialties, including cardiovascular medicine, hepatology, gastroenterology, endocrinology, pulmonology, infectious diseases, rheumatology, neurology, nephrology, and oncology. Despite its demonstrated broad applicability, significant challenges in standardization and interpretation persist, necessitating further research. Future investigative directions are focused on establishing disease-specific thresholds, integrating RDW into existing risk prediction models, and elucidating the molecular mechanisms that connect RDW elevation to pathological processes. As our understanding continues to deepen, RDW demonstrates exceptional promise for developing personalized approaches to disease monitoring and prognostication, firmly establishing its position as an invaluable tool in contemporary clinical practice.
Keywords: Red cell distribution width (RDW), Biomarker, Prognostic indicator, Cardiovascular disease, Hematological parameters, Mortality prediction

institutionalisation following acute hospital admission is common and yet poorly described, with policy documents advising against this transition. to characterise the individuals admitted to a care home on discharge from an acute hospital admission and to describe their assessment. a retrospective cohort study of people admitted to a single large Scottish teaching hospital. 100 individuals admitted to the acute hospital from home and discharged to a care home. a single researcher extracted data from ward-based case notes. people discharged to care homes were predominantly female (62%), widowed (52%) older adults (mean 83.6 years) who lived alone (67%). About 95% had a diagnosed cognitive disorder or evidence of cognitive impairment. One-third of cases of delirium were unrecognised. Hospital stays were long (median 78.5 days; range 14-231 days) and transfers between settings were common. Family request, dementia, mobility, falls risk and behavioural concerns were the commonest reaso...

The Lancet Commission on Global Surgery established the Three Delays framework, categorising delays in accessing timely surgical care into delays in seeking care (First Delay), reaching care (Second Delay), and receiving care (Third Delay). Globally, knowledge gaps regarding delays for fracture care, and the lack of large prospective studies informed the rationale for our international observational study. We investigated delays in hospital admission as a surrogate for accessing timely fracture care and explored factors associated with delayed hospital admission. In this prospective observational substudy of the ongoing International Orthopaedic Multicenter Study in Fracture Care (INORMUS), we enrolled patients with fracture across 49 hospitals in 18 low-income and middle-income countries, categorised into the regions of China, Africa, India, south and east Asia, and Latin America. Eligible patients were aged 18 years or older and had been admitted to a hospital within 3 months of sustaining an orthopaedic trauma. We collected demographic injury data and time to hospital admission. Our primary outcome was the number of patients with open and closed fractures who were delayed in their admission to a treating hospital. Delays for patients with open fractures were defined as being more than 2 h from the time of injury (in accordance with the Lancet Commission on Global Surgery) and for those with closed fractures as being a delay of more than 24 h. Secondary outcomes were reasons for delay for all patients with either open or closed fractures who were delayed for more than 24 h. We did logistic regression analyses to identify risk factors of delays of more than 2 h in patients with open fractures and delays of more than 24 h in patients with closed fractures. Logistic regressions were adjusted for region, age, employment, urban living, health insurance, interfacility referral, method of transportation, number of fractures, mechanism of injury, and fracture location. We further calculated adjusted relative risk (RR) from adjusted odds ratios, adjusted for the same variables. This study was registered with ClinicalTrials.gov, NCT02150980, and is ongoing. Findings Between April 3, 2014, and May 10, 2019, we enrolled 31 255 patients with fractures, with a median age of 45 years (IQR 31-62), of whom 19 937 (63•8%) were men, and 14 524 (46•5%) had lower limb fractures, making them the most common fractures. Of 5256 patients with open fractures, 3778 (71•9%) were not admitted to hospital within 2 h. Of 25 999 patients with closed fractures, 7141 (27•5%) were delayed by more than 24 h. Of all regions, Latin America had the greatest proportions of patients with delays (173 [88•7%] of 195 patients with open fractures; 426 [44•7%] of 952 with closed fractures). Among patients delayed by more than 24 h, the most common reason for delays were interfacility referrals (3755 [47•7%] of 7875) and Third Delays (cumulatively interfacility referral and delay in emergency department: 3974 [50•5%]), while Second Delays (delays in reaching care) were the least common (423 [5•4%]). Compared with other methods of transportation (eg, walking, rickshaw), ambulances led to delay in transporting patients with open fractures to a treating hospital (adjusted RR 0•66, 99% CI 0•46-0•93). Compared with patients with closed lower limb fractures, patients with closed spine (adjusted RR 2•47, 99% CI 2•17-2•81) and pelvic (1•35, 1•10-1•66) fractures were most likely to have delays of more than 24 h before admission to hospital. Interpretation In low-income and middle-income countries, timely hospital admission remains largely inaccessible, especially among patients with open fractures. Reducing hospital-based delays in receiving care, and, in particular, improving interfacility referral systems are the most substantial tools for reducing delays in admissions to hospital.

Background: Hospital readmission is a significant health burden. More than 20% of heart failure (HF) patients are readmitted within 30 days of discharge leading to billions of dollars in health care expenditures. However, the role of prior hospital admissions to predict 30-day readmission for HF patients is not fully understood. Methods: We retrospectively analyzed HF hospitalization data for 4 years at a single medical center. Association between prior admission and 30-day readmission after HF hospitalization was assessed using a multivariate logistic regression model. Results: A total of 1,999 patients with index HF hospitalizations were identified, and 366 of them (18%) were readmitted within 30 days. The rate of readmission was 14%, 20%, and 33% in patients with 0, 1, ≥ 2 prior admissions. Patients with one prior admission had a 50% higher risk (confidence interval [CI] 1.10-2.05, p = 0.011) for readmission, while those with ≥ 2 prior admissions had a more than 3-fold increase in readmission p < 0.001), after adjustments for relevant clinical covariates. Prior hospital admission provided incremental value in predicting readmissions, shown by the significant improvement in the readmission predictive model (C-statistics increased from 0.57 to 0.63). However, neither the length of stay nor recency of prior admission was a significant factor in predicting readmissions. Conclusions: Hospital admission prior to an index HF hospitalization is associated with a significantly increased risk for 30-day hospital readmission and could be used to identify patients at high-risk for readmission and potentially target interventions to reduce the risk of readmission for these patients.

Pattern of admissions in a general surgical unit was studied from January 1980 to July 1981. Of 1021 cases admitted 697 were non-emergency and 324 were emergency admissions. Trauma and Appendicitis were the most common surgical emergencies, whereas Hernias, Anorectal conditions and diseases of the Gall bladder were the most frequent non-emergency admissions. The length of hospital stay in relation with Hernia and Anorectal conditions is critically studied (JPMA 32:187, 1982).

The Emergency, Triage, Assessment and Treatment plus Admission care (ETAT+) course, a comprehensive advanced pediatric life support course, was introduced in Rwanda in 2010 to facilitate the achievement of the fourth Millennium Development Goal. The impact of the course on improving healthcare workers (HCWs) knowledge and practical skills related to providing emergency care to severely ill newborns and children in Rwanda has not been studied. To evaluate the impact of the ETAT+ course on HCWs knowledge and practical skills, and to identify factors associated with greater improvement in knowledge and skills. We used a one group, pre-post test study using data collected during ETAT+ course implementation from 2010 to 2013. The paired t-test was used to assess the effect of ETAT+ course on knowledge improvement in participating HCWs. Mixed effects linear and logistic regression models were fitted to explore factors associated with HCWs performance in ETAT+ course knowledge and practical skills assessments, while accounting for clustering of HCWs in hospitals. 374 HCWs were included in the analysis. On average, knowledge scores improved by 22.8/ 100 (95% confidence interval (CI) 20.5, 25.1). In adjusted models, bilingual (French &

Older Adults are a rapidly growing population in the United States and in the state of Minnesota (Passel & Cohn, 2008, Minnesota Department of Human Services, 2018). African Americans as well as other minority groups experience race, socioeconomic status, and health disparity issues found to be “large, pervasive, and persistent over time” (Williams, Mohammed, Leavell & Collings, 2010, p. 93). This study asks three questions to learn about the lived experiences of African American Older Adults residing in a large Minneapolis nursing facility: How they experience life in the nursing facility; what elements of racial disparities exist in the facility as they experience them, and how staff/administrator perceive such racial disparities. In-depth interviews, participant observations and research of facility were sources of data. Answers revealed that: Seven out of the ten interviewees moved North to avoid segregation and seek a better life for themselves and their families. Each African ...

Older Adults are a rapidly growing population in the United States and in the state of Minnesota (Passel & Cohn, 2008, Minnesota Department of Human Services, 2018). African Americans as well as other minority groups experience race, socioeconomic status, and health disparity issues found to be “large, pervasive, and persistent over time” (Williams, Mohammed, Leavell & Collings, 2010, p. 93). This study asks three questions to learn about the lived experiences of African American Older Adults residing in a large Minneapolis nursing facility: How they experience life in the nursing facility; what elements of racial disparities exist in the facility as they experience them, and how staff/administrator perceive such racial disparities. In-depth interviews, participant observations and research of facility were sources of data. Answers revealed that: Seven out of the ten interviewees moved North to avoid segregation and seek a better life for themselves and their families. Each African ...

Background: Our aim was to determine if hyponatremia, defined as serum sodium level < 135 mmol/L, is a predictor of worse outcome in a cohort of real-world patients with heart failure (HF). Methods: We used data of the National registry of HF (RICA) from Spain, an ongoing multicenter, prospective cohort study. The patients were assigned to two groups regarding sodium levels. Primary end-point was first all-cause readmission, or death by any cause. Secondary end-points were the number of days hospitalized, and the presence of complications. Results: We identified 973 patients, 147 (15.11%) with hyponatremia. The median age of patients enrolled was 77.25 ± 8.79 years-old, the global comorbidity measured by Charlson comorbidity index (CCI) was upper 3 points and preserved ejection fraction was present in 67.1% of them. Clinical complications during admission were significantly higher in the patients with hyponatremia (35.41%, p < 0.001) and this remained as significant predictor after logistic regression adjustment (OR 1.08, p < 0.01). Also mortality and readmissions were more frequent in patients with hyponatremia (20.69% and 22.41%, respectively) but after Cox regression adjustment hyponatremia in our cohort was not associated with increase in 90-day all-cause mortality and readmissions, and only CCI remained significant for primary end-point (HR 1.08, p < 0.001). Conclusions: Hyponatremia is an independent predictor of complications during hospitalization in our real-world cohort, but was not associated with 90 days mortality or readmissions. Global comorbidity, however, played an important role, and could influence the mortality and readmissions of our patients.

during a 1-year period (October 2014 -September 2015) as a part of the implementation of Safe Clinical Practice, Medication Reconciliation of the European Network for Patient Safety and Quality of Care Joint Action (PASQ JA) project. Patients older than 18 years taking at least one regular prescription medication were eligible for inclusion. Discrepancies between pharmacists' Best Possible Medication History (BPMH) and physicians' admission orders were detected and communicated directly to the physicians to clarify whether the observed changes in therapy were intentional or unintentional. All discrepancies were discussed by an expert panel and classified according to their potential to cause harm. In 411 patients included in the study, 1200 medication discrepancies were identified, with 202 (16.8%) being unintentional. One or more unintentional medication discrepancy was found in 148 (35%) patients. The most frequent type of unintentional medication discrepancy was drug omission (63.9%) followed by an incorrect dose (24.2%). More than half (59.9%) of the identified unintentional medication discrepancies had the potential to cause moderate to severe discomfort or clinical deterioration in the patient. Around 60% of medication errors were assessed as having the potential to threaten the patient safety. Clinical pharmacist-led medication reconciliation was shown to be an important tool in detecting medication discrepancies and preventing adverse patient outcomes. This standardized medication reconciliation process may be widely applicable to other health care organizations and clinical settings.

The authors are deeply indebted to Yogi Bhajan, PhD, a master of Kundalini Yoga, who originally taught the techniques employed in this study and originally inspired the 3HO Foundation SuperHealth program on addictions. The authors acknowledge the invaluable collaboration of Dr. B.L. Goyal of the Dr. Vidya Sagar Mental Hospital who provided the clinical residential facility for the program. The authors are also grateful to Sat Sat Nam Kaur Khalsa who provided consultation on the study design and to the therapists and yoga instructors

pela disponibilidade para a gestão, monitorização de todo o trabalho envolvido na elaboração desta publicação. Agradeço também à Exmª Dra. Sílvia Reis Monteiro e ao Exmº Dr. Rui Baptista a disponibilidade e acessibilidade para o esclarecimento de dúvidas e acesso aos dados necessários para executar este trabalho. Os resultados deste estudo são semelhantes aos resultados de estudos anteriores. O tabagismo não é factor de bom prognóstico a curto prazo após SCA. As taxas superiores de mortalidade e morbilidade verificadas em não fumadores reflectem um grupo que apresenta idade superior e maior número de co-morbilidades. A cessação tabágica deve ser incentivada no âmbito da redução do risco associado a doença coronária.

Background: Influenza A (H1N1) infection usually has a self-limiting course (5–7 days), but some patients may progress to severe pneumonia or complications, resulting in a significantly prolonged course of the disease. This case reports a special case of protracted H1N1 infection lasting more than one month. The patient presented with persistent chest pain (>1 month) as the initial symptom. The preliminary diagnosis was “encapsulated empyema.” The results of multiple PCR tests on respiratory samples (swabs from the throat and sputum) in the early stage of fever were negative, masking the existence of the disease, and secondary bacterial mixed infections occurred. Through targeted next-generation sequencing (tNGS) of bronchoalveolar lavage fluid (BALF), it was finally confirmed as H1N1 virus infection. This highlights the crucial diagnostic value of lower respiratory tract sample testing in overcoming false negatives in upper respiratory tract testing. Further analysis revealed that the patient’s weakened immunity might be a new risk factor for protracted influenza, providing clinical implications for the delayed initiation of antiviral treatment and the management of encapsulated empyema.
Case Presentation: This article reports a 49-year-old male patient who had a history of gastric perforation surgery and appendicitis surgery. He was admitted to the hospital with chest pain for more than 1 month and fever for 2 days. The final diagnosis was influenza A (H1N1) combined with purulent pleural effusion caused by Fusobacterium nucleatum and Klebsiella pneumoniae infection. The patient initially presented with a large amount of encapsulated pleural effusion on the right side. Empirical use of “ceftriaxone” for 5 days of anti-infection treatment was ineffective. The pleural fluid tNGS indicated “Fusobacterium nucleatum sequence number 9, relative abundance 49.9%.” Subsequently, the treatment was adjusted to “piperacillin-tazobactam” for 3 days. The patient no longer had fever, but on the 18th day of treatment, the patient had a fever again. The re-examination of nasopharyngeal swabs for influenza A and B antigens was all “negative.” The treatment continued with “piperacillin-tazobactam.” On the 21st day, the patient still had a fever. Bronchoalveolar lavage fluid tNGS indicated “influenza A virus H1N1 sequence number 1344, relative abundance 76.2%, Klebsiella pneumoniae sequence number 50, relative abundance 0.3%.” On the 22nd day, oseltamivir was added for antiviral treatment for 1 day. The fever was controlled, and the patient’s condition improved and was discharged. On the 29th day of follow-up after discharge, the patient’s pulmonary infection and pleural effusion had significantly absorbed.
Conclusion: This case suggests that for patients with refractory pleural effusion and repeated fever, the possibility of mixed viral and bacterial infection should be considered. When traditional respiratory tract tests are negative, molecular techniques such as BALF tNGS should be actively adopted to clarify the etiological diagnosis and guide precise treatment.

Background: Takotsubo cardiomyopathy (TTC) is increasingly well-recognized as a cause of chest-pain syndromes, especially in aging females. The most common complications of TTC occur in the first 24 hours post onset of symptoms and include shock and/or arrhythmias. Hypothesis: We tested the hypothesis that the severity of early hypotension in TTC reflects the extent of myocardial involvement and dysfunction. Methods: In 80 consecutive TTC patients, correlates of blood pressure on the day of admission were sought via univariate followed by multivariate analysis. Results: Mean systolic blood pressure (SBP) on day 1 was 120 ± 24 (SD) mm Hg. During the first 3 days of admission, 39% of patients had SBP <90 mm Hg, and 9% died and/or required intra-aortic balloon pump insertion. The extent of release of N-terminal pro-brain natriuretic peptide, with its potential correlate of associated vasodilator activity, varied inversely with pulmonary-artery saturation, a measure of cardiac output. However, there was no significant relationship between normetanephrine release and SBP. On multivariate analyses there was no significant relationship between SBP and (1) wall-motion score index (as an index of left-ventricular systolic dysfunction) or (2) T 2 enhancement on cardiac magnetic resonance imaging and peak N-terminal pro-brain natriuretic peptide (as indices of myocardial inflammation). Conclusions: Although severe hypotension and shock occur commonly during acute stages of TTC, these complications are multifactorial in origin, probably representing a combination of impaired inotropic state and vasodilatation. Importantly, initial hypotension does not imply severe left ventricular inflammation or systolic dysfunction.

to identify the factors associated with the occurrence of adverse events in critical elderly patients admitted to intensive care unit according to demographic and clinical characteristics. a retrospective cohort study was conducted in nine units of a teaching hospital. Data were collected from medical records and from monitoring of nursing shift change. We used the t-test/Mann-Whitney, chi-square and logistic regression to test associations. Significance level of 5% was used. out of the 315 elderly, 94 experienced events. Those who experienced events were men (60.6%) with mean age of 70.7 years, length of hospital stay of 10.6 days and survivors (61.7%). Most of the 183 events were clinical processes and procedures (37.1%). There was an association between adverse event and length of hospital stay in the unit (p=0.000; OR=1.10, 95% CI [1.06, 1.14]). the identification of associated events and factors in the elderly subsidize the prevention of these occurrences before the vulnerabili...

To evaluate the accuracy of red cell distribution width (RDW) to platelet ratio (RPR) to predict in-hospital mortality in acute pancreatitis (AP). Between January 2010 and June 2012, 102 patients with AP were recruited to the study. In this retrospective cohort study, for all subjects, demographic data on hospital admission, AP etiology, co-morbid diseases, organ failure assessment, laboratory parameters and length of hospital stay were examined. Additionally, we used a non-invasive prediction method in addition to the RPR to evaluate the disease severity. Multivariate logistic regression analyses were used to evaluate the impact of RPR on hospital admission to predict mortality. The male-female ratio (59/43) was 1.37 with a median age of 56.5 years (17-89 years). In both univariate and multivariate analyses, RDW and RPR were presented as independent and significant variables on admission to predict mortality. The RPR obtained on hospital admission was persistently higher among non-...

The consumption of mad honey has been traditionally associated with various health benefits, including antioxidant properties and potential therapeutic effects. However, it can also pose significant health risks, particularly when contaminated with toxins or certain compounds. Wild honey can contain toxic substances such as grayanotoxanes, which are derived from the nectar of certain plants, including those in the Rhododendron family. This case emphasizes the importance of recognizing grayanotoxane toxicity from mad honey ingestion in patients with altered mental status and syncope. Early supportive care, close monitoring and a thorough differential diagnosis are critical for a favorable outcome. In conclusion, while wild honey can be a beneficial dietary component, it also presents risks that should not be overlooked. Clinicians must maintain a high index of suspicion for toxicity in patients with unexplained neurological symptoms after honey consumption. This case underscores the need for further research into the effects of wild honey and the development of guidelines for its safe consumption.

Background. We tested the hypothesis that cognitive impairment upon admission (CIA) and cognitive decline (CD) during hospitalization are associated with an increased risk for functional decline (FD) in older inpatients. Methods. The Italian Group of Pharmacoepidemiology in the Elderly (Gruppo Italiano di Farmacoepidemiologia nell'Anziano, GIFA) project was a multicenter survey of 9061 older patients admitted to Italian hospitals between 1991 and 1997. CIA was defined as a Hodkinson Abbreviated Mental Test score ,7 on admission. The percentage of participants who developed FD, defined as loss of the ability to perform without help one or more activities of daily living between admission and discharge, was compared in patients who did and did not have CIA, and between those who lost at least one point in Hodkinson Abbreviated Mental Test score (CD) and those who did not. Results. Mean age was 77.4 years, and women represented 52.3% of the sample. CIA was present in 21.0% of the patients. During hospitalization, 176 patients (1.9%) experienced FD (4% of those with CIA vs 1.3% of those without CIA). In multivariate analysis, CIA was an important risk factor for FD (odds ratio 2.4; 95% confidence interval, 1.7-3.5; p , .001), independent of age, gender, comorbidity, polypharmacy, and disability on admission. CD occurred in 3.7% of the sample and was strongly associated with an increased risk for FD (odds ratio 16.0; 95% confidence interval, 10.8-23.6; p , .001). Conclusions. Elderly patients with CIA have a higher risk for FD. New strategies should be implemented to prevent FD in patients with cognitive impairment, who account for a high percentage of older persons who are admitted to hospitals.

Assisted living and similar residential care communities provide services to individuals who cannot live independently but generally do not require the skilled level of care provided by nursing homes. In 2014, there were 30,200 residential care communities nationwide (1). This report presents the most current national estimates of residential care community operating characteristics and compares these characteristics by community bed size. State-level estimates for the characteristics presented in this report are available from http://www.cdc.gov/nchs/nsltcp/nsltcp_products.htm.

Este trabalho levanta diagnósticos de enfermagem mais freqüentes, a partir do histórico de enfermagem e procedimento médico, com o objetivo de subsidiar a assistência no Serviço de Enfermagem em Oncologia do Centro de Atenção Integral à Saúde da Mulher (CAISM). Os cinco diagnósticos mais freqüentes foram: potencial para infecção, potencial para temperatura corporal alterada, potencial para aspiração e constipação colônica do padrão trocar, e potencial para intolerância à atividade do padrão mover. O histórico estava direcionado para estes padrões, dificultando a interpretação dos dados que envolviam predominantemente aspectos psicossocioculturais e espirituais, que foram registrados de forma pouco clara ou omitidos. UNITERMOS: diagnóstico de enfermagem, enfermagem oncológica INTRODUÇÃO O diagnóstico de enfermagem foi introduzido no Brasil em 1967, por Horta, que se baseou na teoria da motivação humana de Maslow. HORTA 6 propôs uma assistência de enfermagem sistematizada em seis fases, sendo o diagnóstico uma destas fases. Segundo MARIA & ARCURI

S chizophreniform dis or der (SFD) has an un clear di ag nos - tic and prog nos tic sta tus within the schizo phrenic spectrum; a dearth of re search and in con sis tent re sults limit the generalizability of the re search re sults so far (1). Some research ers sug gest a link with the af fec tive dis or ders, whereas oth ers main tain that, re gard ing prog no sis, SFD lies be tween schizo phre nia and the af fec tive dis or ders. The SFD en tity has ad di tional in her ent prob lems. Di ag no sis based on ill ness length is prob lem atic be cause it in volves var i ous sociocultural fac tors. It could be that SFD pa tients are in fact schizo phre nia suf fer ers with good prog nos tic fac tors (GPF) who seek treat ment early. Set ting the di ag no sis be fore re mission (pro vi sional SFD) is also prob lem atic. Sev eral SFD fol low-up stud ies have been per formed: Beiser and oth ers fol lowed 29 pa tients with SFD and re ported that 8 pa tients re cov ered com pletely (true SFD), while 18 pa tients de vel oped schizo phre nia, and 3 were rediagnosed as suf fer ing from bi po lar dis or der af ter a 9-month fol low-up (2). Opjordsmoen re ported sim i lar re sults, with 56% of pa tients stud ied de vel op ing schizo phre nia, and 27% dis play ing true SFD (that is, re cov ered) over sev eral de cades of fol low-up (3). In a 4-year fol low-up of SFD pa tients (n = 42), Moreno and oth ers re ported that 80.9% were rediagnosed dur ing the follow-up as suf fer ing from schizo phre nia (4). In a 6-year follow-up study of SFD with good prog no sis (n = 20), Benazzi found that 35% of the pa tients de vel oped a ma jor af fec tive 58

Introduction: There is a paucity of data about the clinical characteristics that help identify patients at high risk of influenza infection upon ICU admission. We aimed to identify predictors of influenza infection in patients admitted to ICUs during the 2007/2008 and 2008/2009 influenza seasons and the second wave of the 2009 H1N1 influenza pandemic as well as to identify populations with increased likelihood of seasonal and pandemic 2009 influenza (pH1N1) infection. Methods: Six Toronto acute care hospitals participated in active surveillance for laboratory-confirmed influenza requiring ICU admission during periods of influenza activity from 2007 to 2009. Nasopharyngeal swabs were obtained from patients who presented to our hospitals with acute respiratory or cardiac illness or febrile illness without a clear nonrespiratory aetiology. Predictors of influenza were assessed by multivariable logistic regression analysis and the likelihood of influenza in different populations was calculated. Results: In 5,482 patients, 126 (2.3%) were found to have influenza. Admission temperature ≥38°C (odds ratio (OR) 4.7 for pH1N1, 2.3 for seasonal influenza) and admission diagnosis of pneumonia or respiratory infection (OR 7.3 for pH1N1, 4.2 for seasonal influenza) were independent predictors for influenza. During the peak weeks of influenza seasons, 17% of afebrile patients and 27% of febrile patients with pneumonia or respiratory infection had influenza. During the second wave of the 2009 pandemic, 26% of afebrile patients and 70% of febrile patients with pneumonia or respiratory infection had influenza. The findings of our study may assist clinicians in decision making regarding optimal management of adult patients admitted to ICUs during future influenza seasons. Influenza testing, empiric antiviral therapy and empiric infection control precautions should be considered in those patients who are admitted during influenza season with a diagnosis of pneumonia or respiratory infection and are either febrile or admitted during weeks of peak influenza activity.

Background: The emergency department (ED) is the point of entry for nearly two-thirds of patients admitted to the average US hospital. Due to unacceptable waits, 3% of patients will leave the ED without being seen by a physician. Objectives: To study intake processes and identify new strategies for improving patient intake. Methods: A year-long learning collaborative was created to study innovations involving the intake of ED patients. The collaborative focused on the collection of successful innovations for ED intake for an ''improvement competition.'' Using a qualitative scoring system, finalists were selected and their innovations were presented to the members of the collaborative at an Association for Health Research Quality-funded conference. Results: Thirty-five departments/organizations submitted abstracts for consideration involving intake innovations, and 15 were selected for presentation at the conference. The innovations were presented to ED leaders, researchers, and policymakers. Innovations were organized into three groups: physical plant changes, technological innovations, and process/flow changes. Conclusion: The results of the work of a learning collaborative focused on ED intake are summarized here as a qualitative review of new intake strategies. Early iterations of these new and unpublished innovations, occurring mostly in nonacademic settings, are presented.

Abdominal trauma refers to harm inflicted on the abdominal region. Indications of such injuries encompass discomfort, sensitivity, rigidity, and discoloration of the abdominal exterior. Potential complications could include hemorrhage and infections. Methods for diagnosis may involve imaging techniques such as ultrasound, computed tomography scans, and peritoneal lavage, while surgical intervention could be necessary for treatment. Injuries are classified into two categories: blunt and penetrating, which may result in harm to abdominal organs. Damage to the lower thorax could lead to injury to the spleen or liver. Both blunt and penetrating wounds can affect abdominal organs and their associated blood vessels. Blunt force trauma may cause blood to accumulate within a solid organ's structure or in the wall of a hollow organ. When a hollow organ suffers an injury, its contents may spill into the abdominal cavity, leading to irritation and inflammation.