Virus spectrum of inpatients with acute respiratory infection in Pudong New Area , Shanghai / 公共卫生与预防医学

Objective To understand the viral spectrum of inpatients with acute respiratory infection in Pudong New Area, and to explore the composition of pathogens in hospitalized children and adults. Methods Samples of acute respiratory infection cases from 10 medical institutions were collected from 2011 to 2020 and tested for human influenza virus, human adenovirus, rhinovirus, human parainfluenza virus, respiratory syncytial virus, human coronavirus, human metapneumovirus and human boca virus. Results A total of 3 145 inpatients were monitored, with a median age of 61 years. The positive rate of any virus was 32.43% (1 020/3 145), and the single virus infection accounted for 85.98% (877/1 020). In single virus infection, the positive rate of human influenza virus was the highest (9.67%, 304/3 145), with influenza A (80.26%, 244/304) as the main virus. The second was rhinovirus (3.97%, 125/3 145). The positive rate of any virus in different age groups was statistically significant (χ2=103.38，P2=123.06，P2=90.37，P<0.001). Conclusion The positive rate of virus in hospitalized patients with acute respiratory infection is relatively high in Pudong New Area, Shanghai, with human influenza virus being the main virus. The virus spectrum of hospitalized children and adults is inconsistent. In the future, in-depth research should be strengthened, focusing on the distribution of pathogens in different populations and seasonal prevention and treatment.

Higiene das mãos dos profissionais de saúde: perspectivas do estudante de enfermagem no papel de paciente/familiar / Higiene de manos de los profesionales de la salud: perspectiva de estudiantes de enfermería en el papel de paciente/familiar / Healthcare professionals' hand hygiene: perspectives of nursing student's in patients/relatives role

Resumo Objetivo Investigar as opiniões e atitudes dos estudantes de enfermagem no papel de pacientes ou familiares de pacientes, a respeito do comportamento de higiene das mãos dos profissionais de saúde e da participação dos pacientes na campanha de higiene das mãos. Métodos Estudo transversal prospectivo realizado entre 2021-2022 no Nursing Department, Faculty of Health Sciences, de duas universidades turcas. A amostra do estudo foi composta por 330 alunos. Os dados foram coletados por meio de questionário autoaplicável. A taxa de resposta do questionário foi de 89,43%. O teste qui-quadrado foi utilizado na análise dos dados. Resultados A média de idade dos estudantes foi de 19,80±1,30 anos, 76,1% eram do sexo feminino, 50,9% afirmaram ter recebido instrução sobre Infecções Associadas aos Cuidados de Saúde (IACS). Enquanto 30,1% dos estudantes relataram realizar a higiene das mãos "9 a 11 vezes" em sua vida diária, 54,6% relataram "12 a 15 vezes" no hospital, e 96,4% dos estudantes se perguntaram se os profissionais de saúde realizavam a higiene das mãos antes de fornecer cuidados durante as internações. De acordo com 30,5% dos estudantes, lembretes dos pacientes e seus familiares sobre a realização da higiene das mãos antes do contato com os pacientes os deixariam satisfeitos. Houve diferença estatisticamente significativa entre a instrução anterior dos estudantes sobre IACS e a higiene das mãos como cuidado importante a pacientes hospitalizados (p<0,05). Conclusão Os estudantes de enfermagem apresentaram conhecimento suficiente sobre a higiene das mãos e uma atitude positiva frente aos comportamentos de higiene das mãos dos profissionais de saúde. Estudantes de enfermagem como pacientes e familiares dos pacientes podem ser incluídos nas campanhas de higiene das mãos dos profissionais de saúde, desde que as etapas do programa sejam bem planejadas.

Resumen Objetivo Investigar las opiniones y actitudes de los estudiantes de enfermería en el papel de pacientes o familiares de pacientes respecto al comportamiento de higiene de manos de los profesionales de la salud y de la participación de los pacientes en la campaña de higiene de manos. Métodos Estudio transversal prospectivo realizado entre 2021 y 2022 en el Nursing Department, Faculty of Health Sciences, de dos universidades turcas. La muestra del estudio estuvo compuesta por 330 alumnos. Los datos se recopilaron mediante cuestionario autoaplicado. El índice de respuesta del cuestionario fue de 89,43 %. Se utilizó la prueba ji cuadrado en el análisis de los datos. Resultados El promedio de edad de los estudiantes fue de 19,80±1,30 años, el 76,1 % era de sexo femenino, el 50,9 % afirmó haber recibido instrucción sobre infecciones asociadas a los cuidados de la salud (IACS). Mientras el 30,1 % de los estudiantes relató realizar la higiene de manos "9 a 11 veces" en su vida diaria, el 54,6 % relató "12 a 15 veces" en el hospital, el 96,4 % de los estudiantes se preguntó si los profesionales de la salud realizaban la higiene de manos antes de brindar cuidados durante las internaciones. El 30,5 % de los estudiantes estuvo satisfecho con los recordatorios de los pacientes y sus familiares sobre la realización de la higiene de manos antes del contacto con los pacientes. Hubo diferencia estadísticamente significativa entre la instrucción anterior de los estudiantes sobre IACS y la higiene de manos como cuidado importante en pacientes hospitalizados (p<0,05). Conclusión Los estudiantes de enfermería presentaron conocimientos suficientes sobre la higiene de manos y una actitud positiva frente a los comportamientos de higiene de manos de los profesionales de la salud. Puede incluirse a los estudiantes de enfermería como pacientes y familiares de los pacientes en las campañas de higiene de manos de los profesionales de la salud, siempre que las etapas del programa estén bien planificadas.

Abstract Objective To investigate the views and attitudes of nursing students, as patients or relatives, on healthcare professionals' hand hygiene behavior and patient participation hand hygiene campaign. Methods This prospective cross-sectional study was conducted in the nursing departments of the health and science faculties at two Turkish universities between 2021-2022. The study sample comprised 330 students. Data were collected using a self-administered questionnaire. The response rate of the questionnaire was 89.43%. Chi-square test was used in data analysis. Results The mean age of students was 19.80±1.30 years, 76.1% were female, 50.9% stated they had received education regarding healthcare-associated infections (HAI). While 30.1% of students reported they performed hand hygiene "9-11 times" in their daily lives, 54.6% reported performing "12-15 times" in the hospital, and 96.4% of students expressed wondering if healthcare professionals performed hand hygiene before offering care during hospitalizations. Among students, 30.5% stated that reminders from patients and their relatives about performing hand hygiene before contact with patients would make them happy. There was a statistically significant difference between students' previous training in HAIs and hand hygiene as an important inpatient care (p<0.05). Conclusion Nursing students had sufficient knowledge of hand hygiene and a positive attitude towards hand hygiene behaviors of healthcare professionals. Nursing students, such as patients and their relatives, can be included in hand hygiene campaigns for healthcare professionals, provided that the program steps are well planned.

Factores de riesgo asociados al agravamiento clínico de los pacientes ingresados con enfermedad de Alzhéimer

Introducción: La principal causa de demencia degenerativa es la enfermedad de Alzhéimer. En la población cubana, una de cada cuatro personas de 65 años y más fallece por esta enfermedad u otra forma de demencia. Objetivo : Identificar los factores de riesgo asociados al agravamiento clínico de los pacientes ingresados con enfermedad de Alzhéimer en el Hospital Psiquiátrico Universitario Rene Vallejo Ortiz entre enero de 2013 y diciembre de 2022. Métodos: Se realizó un estudio observacional, descriptivo y transversal. El universo estuvo integrado por todos los pacientes ingresados en la mencionada institución asistencial y docente. La muestra no probabilística y a criterio de los autores la integraron 77 pacientes adultos con el diagnóstico de la enfermedad en el periodo de estudio señalado. Las historias clínicas fueron la fuente secundaria de información. Se utilizó estadística descriptiva e inferencial. La información se resumió en tablas y gráficos. Resultados: El 90,6 % presentaban más de 60 años y más de la mitad eran del sexo masculino (54,5 %). La mayoría de los pacientes presentaron diversos síntomas asociados. Lo trastornos de personalidad y orientación se constataron en el 75,3 % mientras que los de memoria en el 72,7 %. Conclusiones: El agravamiento clínico luego del ingreso hospitalario se acentuó en aquellos pacientes sin escolaridad, solteros, desocupados, con enfermedades cerebro vasculares y presencia de familias disfuncionales presentaron. Los pacientes anémicos o con signos de irritación cortical focal en región frontoparietal con generalización secundaria presentaron mayoritariamente un empeoramiento clínico.

Introduction: The main cause of degenerative dementia is Alzheimer's disease. In the Cuban population, one in four people aged 65 and over dies from this disease or another form of dementia. Objective: To identify the risk factors associated with the clinical worsening of patients admitted with Alzheimer's disease at the Rene Vallejo Ortiz University Psychiatric Hospital. Methods: An observational, descriptive and cross-sectional study was carried out. The universe was made up of all patients admitted to the aforementioned healthcare and teaching institution. The non-probabilistic sample and at the discretion of the authors was made up of 77 adult patients with the diagnosis of the disease in the indicated study period between January 2013 and December 2022. Medical records were the secondary source of information. Descriptive and inferential statistics were used. The information was summarized in tables and graphics. Results: 90.6% were over 60 years old and more than half were male (54.5%). Most patients presented various associated symptoms. Personality and orientation disorders were found in 75.3%, while memory disorders were found in 72.7%. Conclusions: The clinical worsening after hospital admission was accentuated in those patients without schooling, single, unemployed, with cerebrovascular diseases and presence of dysfunctional families. Anemic patients or patients with signs of focal cortical irritation in the frontoparietal region with secondary generalization mostly presented clinical worsening.

Relação entre benefício e risco em interações medicamentosas nas prescrições médicas de um hospital universitário no estado de São Paulo / Benefit-risk relationship in drug interactions in prescriptions from a university hospital in the state of São Paulo / Relación beneficio-riesgo en interacciones medicamentosas en prescripciones de un hospital universitario del estado de São Paulo

Objetivo: Avaliar interações medicamentosas (IM), em que os riscos se so- brepõem aos benefícios (nível I) ou os benefícios se sobrepõem aos riscos (nível II); a partir da análise retrospectiva de prescrições médicas em um Hospital Universitário no estado de São Paulo, Brasil. Métodos: Foram analisadas 19762 prescrições médicas des- tinadas à farmácia do hospital, de janeiro a setembro de 2009; com o auxílio de programas sobre IM, para categorizar IM de nível I e II. Resultados: Na análise 26,53% apresentaram IM, em que 23,64% foram classificadas em nível I e 76,35% em nível II. Dentre as IM com maior frequência no nível I, estavam: ácido acetilsalicílico (AAS) e clopidogrel, AAS e heparina, captopril e espironolactona, digoxina e hidroclorotiazida. Houve uma redução em percentual de IM de nível I, comparando janeiro representado por 26,5% e setembro representado por 18,4%. Já nas IM de nível II, tem-se as seguintes associações com maior frequência: AAS e propranolol, AAS e insulina regular humana, AAS e ate- nolol, AAS e enalapril, AAS e carvedilol. Conclusão: A atuação dos farmacêuticos cola- borou à redução de IM de nível I, devido à intervenção por meio de comunicação estabe- lecida com os prescritores; sinalizando a importância da equipe interprofissional em saúde.

Objective: To evaluate drug interactions (MI), in which risks outweigh the benefits (level I) or benefits outweigh the risks (level II); from the retrospective analysis of medical prescriptions in a University Hospital in the state of São Paulo, Brazil. Methods: 19,762 prescriptions destined to the hospital pharmacy were analyzed, from January to September 2009; with the help of programs on MI, to categorize level I and II MI. Results: In the analysis 26.53% presented MI, in which 23.64% were classified in level I and 76.35% in level II. Among the most frequent level I MI were: acetylsalicylic acid (ASA) and clopidogrel, ASA and heparin, captopril and spironolactone, digoxin and hydrochlorothiazide. There was a reduction in the percentage of level I MI, comparing January, which accounted for 26.5%, and September, which accounted for 18.4%. As for level II MI, the following associations were more frequent: ASA and propranolol, ASA and regular human insulin, ASA and atenolol, ASA and enalapril, ASA and carvedilol. Conclusion: The role of pharmacists collaborated to the reduction of level I MI, due to the intervention by means of communication established with the prescribers; signaling the importance of the interprofessional health team.

Objetivo: Evaluar las interacciones medicamentosas (IM), en las que los riesgos superan a los beneficios (nivel I) o los beneficios superan a los riesgos (nivel II); a partir del análisis retrospectivo de las prescripciones médicas en un Hospital Universitario del estado de São Paulo, Brasil. Métodos: Se analizaron 19.762 prescripciones destinadas a la farmacia del hospital, de enero a septiembre de 2009; con la ayuda de programas sobre IM, para categorizar los IM de nivel I y II. Resultados: En el análisis el 26,53% presentaron IM, en el que el 23,64% se clasificaron en nivel I y el 76,35% en nivel II. Entre los IM de nivel I más frecuentes estaban: ácido acetilsalicílico (AAS) y clopidogrel, AAS y heparina, captopril y espironolactona, digoxina e hidroclorotiazida. Hubo una reducción del porcentaje de IM de nivel I, comparando enero, que supuso el 26,5%, y septiembre, que supuso el 18,4%. En cuanto a los IM de nivel II, fueron más frecuentes las siguientes asociaciones: AAS y propranolol, AAS e insulina humana regular, AAS y atenolol, AAS y enalapril, AAS y carvedilol. Conclusiones: El papel de los farmacéuticos colaboró a la reducción de las IM de nivel I, debido a la intervención mediante la comunicación establecida con los prescriptores; señalando la importancia del equipo sanitario interprofesional.

Knowledge, attitude, and practice toward mucormycosis among patients discharged from a COVID-19 care tertiary center in South India: A questionnaire-based survey

Purpose: To study the awareness of mucormycosis among discharged inpatients after receiving treatment for COVID?19 infection at a tertiary COVID care center in south India. Methods: This was a telephone?based survey conducted using a questionnaire consisting of 38 questions in five sections in the month of June–July 2021. COVID?positive inpatients who had been admitted, treated, and discharged from a government medical college were contacted via phones, and their responses were directly entered into the Google Forms platform. Results: A total of 222 participants were included in the study. Among all the participants, a cumulative 66% of participants had some knowledge of mucormycosis and 98/222 (44%) did not have any idea of mucormycosis in spite of being admitted to the hospital. More than 40% of them reported that their prime source of information was through mass communication. Around 81% of the respondents were aware that it can occur after COVID?19 infection. Among them, only 25 knew that systemic steroids were the main risk factor. Sixty?four out of 124 knew that diabetes is a major risk factor. Fifty percent agreed that a vaccine for COVID can prevent mucormycosis. Conclusion: Such knowledge, attitude, and practice (KAP) studies give us an idea of the impact of the measures taken for educating the public. In this study, a cumulative 66% of participants had some knowledge of mucormycosis and 34.7% were diabetics who had better knowledge and practice scores than non?diabetics. Sixty?six point nine percent felt that it was possible to prevent this condition

Valor pronóstico de la hipoglucemia hospitalaria / Prognostic value of hospital hypoglycemia

Resumen Introducción: La hipoglucemia hospitalaria (HH) es un problema importante ya que se vincula a muerte hospitalaria, estadía prolongada y mayores costos, en personas con y sin diabetes, en área crítica y sala general, sobre todo en los casos de hipoglucemia grave. El objetivo de nuestro trabajo fue comparar la mortalidad hospitalaria, pase a área crítica y tiempo de internación en adultos con HH, según la gravedad de la misma. Métodos: Se realizó un estudio de cohorte retrospectiva en pacientes adultos interna dos con hipoglucemia en el Hospital Italiano de Buenos Aires entre 2013 y 2018. Se definieron tres grupos de hipoglucemia: leve (glucemia entre 70 y 54 mg/dl), grave (glucemia < 54 mg/dl ≥ 40 mg/dl) y crítica (glucemia < 40mg/dl). Resultados: Un total de 5994 pacientes tuvieron HH, la mayoría presentó hipoglucemia leve (72%). La hipoglucemia grave y la crítica, comparadas con la hipoglucemia leve se asociaron a una mayor mortalidad: OR 2.6 (IC95% 2.2-3.1) y 4.2 (IC95% 3.5-5.0) respectivamente; y a mayor internación en áreas de cuidados críticos: OR 1.6 (IC95% 1.4-1.9) y 3.2 (IC95% 2.6-4.0) respectivamente. No hubo diferencias en el tiempo de internación. Discusión: Esta información aporta evidencia en nuestro país, sobre el valor pronóstico de la hipo glucemia, cuya mayor gravedad se asocia a mayor internación en áreas críticas y mayor mortalidad hospitalaria.

Abstract Background: Hospital hypoglycemia (HH) is an important problem since it is linked to hospital death, prolonged stay and higher costs, both in people with and without diabetes, in the critical area and general ward, especially in cases of severe hypoglycemia. The objective of our work was to compare hospital mortality, transfer to the critical area and hospitalization periods in adults with HH according to its severity. Methods: We conducted a retrospective cohort of adults hospitalized with hypoglycemia at the Hospital Italiano de Buenos Aires between 2013 and 2018. Three groups of hypoglycemia were defined: mild (glycemia between 70 and 54 mg/dl), severe (glycemia < 54 mg/dl and ≥ 40 mg/dl) and critical (glycemia<40mg/dl). Results: A total of 5994 patients had HH, the majority presented mild hypoglycemia (72%). Severe and critical hypoglycemia, compared with mild hypo glycemia, were associated with higher mortality: OR 2.6 (95%CI 2.2-3.1) and 4.2 (95%CI 3.5-5.0) respectively; and increased hospitalization in critical care areas: OR 1.6 (95%CI 1.4-1.9) and 3.2 (95%CI 2.6-4.0) respectively. There were no differences in length of stay. Discussion: This information provides, in our country, evidence on the prognostic value of hypoglycemia, whose greater severity is associated with increased hospitalization in critical areas and higher hospital mortality.

A segurança do paciente e a avaliação do risco de quedas / Patient safety and fall-risk assessment / Seguridad del paciente y evaluación de riesgo de caída

Objetivo: Avaliar os pacientes hospitalizados quanto ao risco de quedas. Métodos: Estudo transversal, realizado por meio da aplicação da escala de Morse e registros de prontuários. Realizou-se estatísticas descritivas e Teste Qui-quadrado de Pearson, adotando-se o nível de 5%. Resultados: Dos 244 participantes, 139 (57%) eram do sexo masculino, 86 (47,5%) idosos, 116 (47,5%) com companheiro, 112 (45,9%) pardos e 173 (70,9%) com baixa escolaridade. O risco de quedas foi associado ao histórico de quedas (p=0,000), diagnóstico secundário (p<0,001), deambulação (p=0,002), marcha (p<0,001) e estado mental (p<0,000). A maioria dos entrevistados 194 (79,5%) estão sob um risco moderado a alto de sofrer quedas da própria altura 37 (15,2%), ocorridas no quarto ou na enfermaria 38 (15,6%). Conclusão: Observou-se um risco moderado a alto para quedas nos pacientes hospitalizados, o que aponta para a necessidade de implementação de políticas de segurança do paciente para garantir a qualidade da assistência. (AU)

Objective: Assess hospitalized patients for the risk of falls. Methods: Cross-sectional study, carried out through the application of the Morse scale and medical records. Descriptive statistics and Pearson's Chi-square test were performed, adopting the 5% level. Results: Of the 244 participants, 139 (57%) were male, 86 (47.5%) elderly, 116 (47.5%) with a partner, 112 (45.9%) brown and 173 (70.9%) with low education level. The risk of falls was associated with a history of falls (p = 0.000), secondary diagnosis (p <0.001), walking (p = 0.002), gait (p <0.001) and mental status (p <0.000). Most respondents 194 (79.5%) are at moderate to high risk of suffering falls from their own height 37 (15.2%), in their bedroom or in the ward 38 (15.6%). Conclusion: There was a moderate to high risk for falls in hospitalized patients, which points to the need of implementing patient safety policies in order to guarantee quality of care. (AU)

Objetivo: Evaluar a los pacientes hospitalizados por el riesgo de caídas. Métodos: Estudio transversal, realizado a través de la aplicación de la escala Morse y registros médicos. Se realizaron estadísticas descriptivas y la prueba de Chi-cuadrado de Pearson, adoptando el nivel del 5%. Resultados: De los 244 participantes, 139 (57%) eran hombres, 86 (47.5%) ancianos, 116 (47.5%) con una pareja, 112 (45.9%) marrones y 173 (70.9%) con baja educacion. El riesgo de caídas se asoció con antecedentes de caídas (p = 0.000), diagnóstico secundario (p <0.001), caminar (p = 0.002), marcha (p <0.001) y estado mental (p <0.000). La mayoría de los encuestados 194 (79.5%) tienen un riesgo moderado a alto de sufrir caídas desde su propia altura 37 (15.2%), ocurriendo en el dormitorio o en la sala 38 (15.6%). Conclusión: Hubo un riesgo moderado a alto de caídas en pacientes hospitalizados, lo que apunta a la necesidad de implementar políticas de seguridad del paciente para garantizar la calidad de la atención. (AU)

Contenido de sodio en antimicrobianos parenterales: Una fuente extra de sodio a considerarse en pacientes hospitalizados

Los antimicrobianos parenterales son esenciales en el tratamiento de infecciones intrahospitalarias, sin embargo, es importante considerar la carga de sodio y volumen que pueden aportar, especialmente, en pacientes con restricción sódica. En el presente estudio se identificaron los antimicrobianos parenterales usados en uno de los hospitales más grandes del Perú. Se revisó la cantidad de sodio intrínseco y se calculó la cantidad de sodio total por día de tratamiento según el régimen frecuentemente usado en adultos. Como resultado, se encontró que 22% de las terapias antimicrobianas superaban el requerimiento de sodio diario, lo que podría ser perjudicial para pacientes con insuficiencia cardiaca, enfermedad renal crónica, con cirrosis hepática, entre otros.

Parenteral antibiotics are essential in the treatment of nosocomial infections; however, their sodium load and volume should be considered as an extra source, especially, in patients with sodium restriction. In this study, we identified the parental antibiotics used in one of the largest hospitals in Peru. We reviewed the amount of intrinsic sodium and we calculated the sodium load per day of treatment according to the commonly used regimen in adults. As a result, we found that 22% of the antibiotic treatment regimens exceed the daily sodium requirement, which could be harmful for patients with heart failure, chronic kidney disease, liver cirrhosis, among others.

Quedas entre pacientes internados em um hospital público e de ensino: uma análise das notificações / Falls of patients admitted to a public and teaching hospital: an analysis of notifications / Caídas en pacientes ingresados en un hospital público y docente: análisis de las no-tificaciones

Objetivo: descrever o perfil das quedas notificadas de pacientes internados em um hospital público e de ensino. Método: estudo descritivo e retrospectivo, com análise estatística descritiva, inferencial e de correspondência múltipla dos dados de notificações do aplicativo Vigilância em Saúde e Gestão de Riscos Assistenciais Hospitalares sobre quedas de pacientes internados entre 2017 e 2019. Resultados: predominaram, dentre 153 notificações de quedas no período, as ocorridas no quarto, em unidades de atendimento cirúrgico, emergencial e clínico, sofridas por pacientes do sexo masculino, na faixa etária entre 20 e 59 anos. Nesta, destacaram-se os idosos. A abrasão foi o dano mais relatado. A análise de correspondência múltipla não apresentou significância. Conclusão: a análise dos eventos notificados contribuiu para o planejamento e a implantação do Programa Fall Tailoring Interventions for Patient Safety Brasil para aprimoramento da gestão dos riscos relacionados.(AU)

Objective: to describe the profile of reported falls of patients admitted to a public and teaching hospital. Method: descriptive and retrospective study, with descriptive, inferential, and multiple correspondence statistical analysis of notification data from the Health Surveillance and Hospital Care Risk Management app on falls of hospitalized patients between 2017 and 2019. Results: predominated, among 153 notifications of falls in the period, those occurring in the ward, in surgical, emergency, and clinical care units, suffered by male patients, aged between 20 and 59 years. In this, the elderly stood out. Abrasion was the most reported harm. Multiple correspondence analysis did not show significance. Conclusion: the analysis of reported events contributed to the planning and implementation of the Fall Tailoring Interventions for Patient Safety Program in Brazil to improve the management of related risks.(AU)

Objetivo: describir el perfil de las caídas de pacientes internados reportadas en un hospital público y de enseñanza. Método: estudio descriptivo y retrospectivo, con análisis estadístico descriptivo, inferencial y análisis de correspondencias múltiples de datos de notificación de la aplicación Vigilancia en Salud y Gestión de Riesgos de Atención Hospitalaria sobre caídas de pacientes hospitalizados entre 2017 y 2019. Resultados: predominó, entre 153 notificaciones de caídas en el período, las ocurridas en el dormitorio, en unidades quirúrgicas, de emergencia y de atención clínica, sufridos por pacientes del sexo masculino, con edades entre 20 y 59 años. En este último, se destacaron los adultos mayores. La abrasión fue el daño más reportado. El análisis de correspondencia múltiple no mostró significación. Conclusión: el análisis de los eventos notificados contribuyó para la planificación e implementación del Programa Fall Tailoring Interventions for Patient Safety en Brasil para mejorar la gestión de sus riesgos re-lacionados.(AU

Alterações de linguagem em pacientes pós lesão encefálica adquirida na fase aguda / Language changes in patients after brain injury acquired in the acute phase

Caracterizar as alterações de linguagem encontradas em pacientes com lesão encefálica adquirida em fase aguda Métodos: Trata-se de uma pesquisa observacional, descritiva do tipo transversal. A avaliação foi realizada nas enfermarias de um hospital de urgências, com pacientes de idade superior a 18 anos, diagnóstico de lesão encefálica adquirida e tempo de internação de até 60 dias. O protocolo utilizado incluiu avaliação das praxias orais, expressão, compreensão da linguagem oral e leitura. Ao final, foi possível apresentar as hipóteses diagnósticas de afasias fluentes e não fluentes, disartria e sem alteração de linguagem. A análise dos dados foi realizada por meio de estatística descritiva através da distribuição de frequência absoluta e frequência relativa Resultados: A amostra foi composta por 24 pacientes sendo a maioria do gênero masculino, com média de idade de 51 anos. O diagnóstico de maior frequência foi Acidente Vascular Cerebral. Dos pacientes avaliados, 79% tiveram alterações de fala/linguagem. As hipóteses diagnósticas fonoaudiológicas encontradas foram: afasia global, afasia de broca, afasia transcortical mista, afasia de condução, afasia transcortical motora, afasia transcortical sensorial e disartria. Conclusão: A afasia global foi o transtorno de linguagem de maior ocorrência entre os indivíduos, bem como o gênero masculino e o acidente vascular cerebral. A avaliação da linguagem de pacientes com lesões encefálicas adquiridas na fase aguda é pertinente, pois promove o levantamento de alterações desde as perceptíveis até as mais discretas

To characterize the language disorders found in patients with brain injury acquired in the acute phase Methods: This is an observational, descriptive cross-sectional study. The evaluation was carried out in the wards of an emergency hospital, with patients aged over 18 years, diagnosed with acquired brain injury and hospitalization time of up to 60 days. The protocol used included assessment of oral praxis, expression, comprehension of oral language and reading. In the end, it was possible to present the diagnostic hypotheses of fluent and non-fluent aphasias, dysarthria and without language alteration. Data analysis was performed using descriptive statistics through the distribution of absolute frequency and relative frequency. Results: The sample consisted of 24 patients, most of whom were male, with a mean age of 51 years. The most frequent diagnosis was Cerebral Vascular Accident. Of the evaluated patients, 79% had speech/language disorders. The speech-language diagnostic hypotheses found were: global aphasia, drill aphasia, mixed transcortical aphasia, conduction aphasia, motor transcortical aphasia, sensory transcortical aphasia and dysarthria. Conclusion: Global aphasia was the most frequent language disorder among individuals, as well as males and stroke. The evaluation of the language of patients with brain injuries acquired in the acute phase is relevant, as it promotes the survey of changes from the perceptible to the most discreet

Establishment and verification of a diagnostic prediction model for non-suicidal self-injury behaviors in adolescents with depressive disorder / 四川精神卫生

ObjectiveTo establish a diagnostic prediction model for non-suicidal self-injury （NSSI） behaviors in adolescents with depressive disorder， in order to provide references for early identification of NSSI behaviors in them. MethodsRetrospective analysis was performed on the clinical data of adolescents with depressive disorder （n=366） who were admitted to the Pediatric Department of Shenzhen Kangning Hospital from January 1 to December 31， 2021. According to the Diagnostic criteria of Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5） diagnostic criteria for NSSI， the patients were divided into comorbid NSSI group （n=289） and non-NSSI group （n=77）. The selected adolescents were randomly divided into a training set （n=258） and a verification set （n=108） in a 7∶3 ratio. Logistic regression analysis was used to screen the independent risk factors for NSSI behaviors in adolescents with depressive disorder， which served as the basis for prediction model. Finally， the receiver operating characteristic （ROC） curve was established and the area under curve （AUC） was calculated to evaluate the discrimination in the training set and validation set. Calibration curve was applied to evaluate the calibration degree of the model. The Homser-Lemeshow （HL） test was conducted to evaluate the goodness of fit of the model. And decision curve analysis （DCA） was performed to evaluate the clinical benefit of the model. ResultsGender （β=1.734， OR=5.561， 95% CI： 2.678~11.964）， education level （β=0.864， OR=2.737， 95% CI： 1.174~4.795）， history of suicide attempts （β=0.932， OR=2.539， 95% CI： 1.253~5.144）， being an only child （β=0.745， OR=2.106， 95% CI： 1.029~4.311） and depression severity （β=0.056， OR=1.058， 95% CI： 1.025~1.092） were independent risk factors related to NSSI behaviors in adolescents with depressive disorder （P<0.05 or 0.01）. The AUC was 0.808 （95% CI： 0.746~0.870） in the training set， and was 0.722 （95% CI： 0.581~0.864） in the validation set. The prediction model showed good calibration with the HL test （P=0.561）. ConclusionGender， education level， suicide attempt history， being an only child and depression severity are independent risk factors for NSSI behaviors in adolescents with depressive disorder， furthermore， the diagnostic clinical prediction model constructed using above factors for NSSI behaviors in adolescents with depressive disorder has displayed good sensitivity and specificity.

Epidemiological characteristics of carbapenem-resistant Klebsiella pneumoniae infection in adult inpatients / 公共卫生与预防医学

Objective To analyze the epidemiological characteristics of carbapenem-resistant Klebsiella pneumoniae (CRKP) in adult inpatients, and to provide a theoretical basis for the diagnosis and treatment of CRKP. Methods A total of 753 hospitalized patients with Klebsiella pneumoniae (KPN) infection in our hospital from 2017 to 2021 were selected as the investigation subjects. According to the sensitivity to carbapenem drugs, the patients were divided into carbapenem sensitive Klebsiella pneumoniae (CSKP) group (n=638) and CRKP group (n=115). The age, gender, department distribution, underlying diseases, length of hospital stay, use of antibiotics and other clinical data of all subjects were analyzed by self-made survey scale of our hospital. Univariate analysis and logistic regression analysis were used to analyze the risk factors of CRKP nosocomial infection in adult inpatients. Results Among of 753 KPN patients, 115 cases (15.27%) were detected with CRKP, including 87 males and 28 females. The detection rate of CRKP in different age groups was significantly different (P60 years was significantly higher than that in the age group of 41-60 years, 21-40 years, and 16-20 years (P2 value =0.725, P>0.05). CRKP strains were mainly isolated from oral and maxillofacial surgery (19.13%), infection department (15.65%), geriatric department (15.65%), and ICU (14.78%). The detection rate of CRKP in different pathogenic bacteria samples was different, including sputum (19.40%), urine (15.43%) and blood (12.58%), with statistically significant difference (P<0.05) The respiratory tract sputum specimens were all expectoration. There were significant differences in age, gender, use of carbapenems ≥7 days, invasive procedures, use of antibiotics ≥2 kinds, use of antibiotics ≥14 days, and use of enzyme inhibitors ≥7 days between the CSKP group and the CRKP group (P<0.05). Antimicrobial application time ≥14 days (OR=5.412), invasive operation (OR=6.431), and carbapenem use ≥7 days (OR=5.417) were the risk factors for CRKP nosocomial infection in adult inpatients (P<0.05). Conclusion Nosocomial infection of CRKP occurs mostly in elderly ICU patients. Intervention measures should be given to adult inpatients who have used antibiotics for ≥14 days, invasive procedures, and carbapenem antibiotics for ≥7 days, which can reduce the risk of CRKP infection in inpatients.

Risk assessment and prevention management of venous thromboembolism in hospitalized patients in plateau area / 中华健康管理学杂志

Objective:To explore the risk assessment and prevention management of hospital-associated venous thromboembolism (HA-VTE) in plateau area.Methods:This was a prospective observational study. A total of 200 patients hospitalized for acute medical diseases or surgery in the People′s Hospital of Tibet Autonomous Region from May to June 2022 were consecutively enrolled. Padua score or Caprini risk assessment model was used for dynamic risk assessment and stratification of VTE in all patients. At the same time, bleeding risk was assessed according to age, complications, trauma history, drug therapy, invasive procedures and other factors. The implementation of mechanical and/or drug prophylaxis was dynamically recorded during hospitalization. The change of VTE risk and prevention during hospitalization were the primary outcome, and the occurrence of HA-VTE events and bleeding events during hospitalization or within 90 days after enrollment were the secondary outcome.Results:A total of 196 patients were enrolled in the study, including 130 (66.3%) in internal medicine and 66 (33.7%) in surgery. There were 64 (49.2 %) and 27 (40.9%) patients with high risk of VTE within 1 day after admission among medical and surgical patients, respectively. During hospitalization, 58 (44.6%) and 49 (74.2%) patients with high risk of VTE were re-evaluated among medical and surgical patients, respectively. There were 39 (30.0%) medical patients and 54 (81.8%) surgical patients who had an increased risk of VTE due to changes in their conditions. In terms of VTE prevention, 32 patients (16.3%) received VTE prophylaxis, only 17 medical patients (8.7%) with high risk of VTE received drug prophylaxis, and 2 patients (1.0%) with high risk of VTE developed HA-VTE events after drug prophylaxis. A total of 8 (4.1%) surgical patients received drug prophylaxis, of which 1 (0.5%) received mechanical prophylaxis at the same time, and no surgical patients experienced HA-VTE events after prophylaxis. HA-VTE events occurred in 11 patients (5.6%) during hospitalization or within 90 days after enrollment.Conclusion:Considering the complex and changeable risk factors of VTE, insufficient VTE prevention and high incidence of HA-VTE in hospitalized patients in plateau areas, Padua score and Caprini risk assessment model are recommended for early, dynamic and full VTE risk assessment of patients, so as to standardize the VTE prevention and improve the quality of health management of hospitalized patients in plateau areas.

The association of frailty status with nutritional risk and the effect on outcomes in elderly surgical inpatients / 中华临床营养杂志

Objective:To study the association of frailty status with nutritional risk and the effect on clinical outcomes among elderly surgical inpatients.Methods:Elderly inpatients from the surgery department of Beijing Hospital were enrolled from January to June 2021. Frail scale and nutritional risk screening 2002 (NRS 2002) were used for frailty evaluation and nutrition risk screening. The influence of frailty and associated nutrition risk in elderly surgical inpatients was analyzed.Results:487 elderly surgical patients were included, of whom 131 cases were in the non-frailty group, 279 cases were in the pre-frailty group and 77 cases were in the frailty group, according to the Frail scale score. 146 cases were at nutritional risk, of whom 8 (6.1% of 131) were in the non-frailty group, 87 (31.2% of 279) in the pre-frailty group and 51 (66.2% of 77) were in the frailty group. According to univariate/multivariate logistic regression analysis of frailty in elderly surgical patients, a higher NRS 2002 score, older age, and the presence of multiple concurrent diseases (≥ 5) were significantly associated with frailty ( P < 0.001). The Frail scale score was positively correlated with NRS 2002 score ( r = 0.448, P < 0.01). Multiple comparisons showed that frailty had statistically significant effects on hospital stay and medical costs in elderly surgical patients ( P < 0.05). Conclusions:The prevalence of frailty is higher in elderly surgical patients, and the prevalence of nutritional risk increases with the progression of frailty. Frailty can lead to prolonged hospital stays and increased hospital costs in elderly surgical patients.

Operational recommendations on nutrition management for elderly inpatients with COVID-19 / 中华临床营养杂志

Elderly inpatients with coronavirus disease 2019 (COVID-19) are often at nutritional risk and at higher risk of critical disease. The standardized nutrition treatment could effectively improve the nutritional status, quality of life, and clinical outcomes of COVID-19 patients, and is an important component of the comprehensive management of COVID-19. The individualized nutrition diagnosis, treatment and monitoring should be conducted in compliance to standard procedures of medical nutrition therapy, with consideration of the clinical characteristics of elderly COVID-19 inpatients. The Department of Clinical Nutrition at Peking Union Medical College Hospital has integrated the latest clinical nutrition guidelines and clinical practice of nutrition support of COVID-19, with the aim to provide evidence-based, concise and practical recommendations on nutritional management for elderly inpatients with COVID-19. The recommendations here are to inform effective and standardized nutrition support practice.

Predictive analysis of the number of hospitalized patients with acute pancreatitis based on time series model / 中华胰腺病杂志

Objective:To predict and analyze the number of acute pancreatitis (AP) inpatients based on time series model, and to explore the predictive efficiency of the model.Methods:Clinical data of AP inpatients in the Affiliated Hospital of Southwest Medical University from January 2014 to December 2019 were collected. R software was used to collect the time series of AP inpatients, and the trend and seasonal characteristics of AP inpatients from 2014 to 2018 were analyzed. Furthermore, the autoregressive moving average (ARIMA) model was established through stationarity test, model ordering and model testing steps, and the best selected model was used to predict the monthly number of inpatients in 2019 to verify its prediction efficiency.Results:A total of 3 939 AP patients were included in the study. The most common etiology for AP was cholestrogenic (48.2%), followed by hyperacylglyceremia (36.3%). The peak age of hospitalization was from 40 to 60 years old. Time series analysis showed that the number of AP inpatients increased year by year. The highest peak of the disease was from February to March, followed by September to November; and there was seasonal variation and the incidence was relatively small in summer. The established original training set sequence did not pass the stationarity test ( P=0.061), so the ARIMA model was established after it was transformed into a stationarity sequence by first-order difference. According to the criterion of minimum AIC value, ARIMA(2, 1, 1)(1, 1, 1) 12 was selected as the best model. The model was used to predict the number of AP inpatients in 2019, showing that it could better fit the trend of onset time and had good short-term prediction effect. The mean root error and absolute error were 6.8790 and 4.7783, respectively. Conclusions:The number of AP inpatients increases year by year with seasonal changes. ARIMA model is effective in predicting the number of AP inpatients and can be used for short-term prediction.

Analysis of SARS-CoV-2 Infection Among Inpatients in a Tertiary Hospital in Guangzhou During the Covid-19 Pandemic / 中山大学学报(医学科学版)

ObjectiveAt the end of November 2022， Guangzhou implemented the latest Covid-19 epidemic prevention policy and began to gradually lift the lockdown. However， under the new epidemic prevention situation， the situation of SARS-CoV-2 infection in hospitalized patients in China is still unclear. Accordingly， this paper aims to study the SARS-CoV-2 infection of hospitalized patients in Guangzhou under the new epidemic prevention and control situation. MethodsThe results of SARS-CoV-2 nucleic acid tests in our hospital from the end of November 2022 to the beginning of February 2023 were retrospectively analyzed. The positive rate of SARS-CoV-2 nucleic acid tests in outpatients and inpatients under the new epidemic prevention situation， and the nosocomial infection of SARS-CoV-2 in inpatients were statistically analyzed. ResultsThis study retrospectively analyzed the SARS-CoV-2 nucleic acid test results of 13 959 patients， including 6 966 outpatients and 6 993 inpatients. On November 30， 2022， the SARS-CoV-2 nucleic acid test results of outpatients began to be positive， indicating that the outbreak of the SARS-CoV-2 infection had begun. On December 7， one case of SARS-CoV-2 nucleic acid test results of hospitalized patients was positive， and nosocomial infections began to break out. On December 15， the positive rate of SARS-CoV-2 nucleic acid test among patients exceeded 40 %， and the epidemic entered its peak period. After the end of December， the test positive rate gradually decreased， but the positive rate of inpatients was always higher than that of outpatients. Compared with December 2022， the positive rate of SARS-CoV-2 nucleic acid test of patients in many departments in January 2023 decreased， but the positive rate of SARS-CoV-2 nucleic acid test of inpatients in the oncology department increased significantly （P < 0.001）. Further analysis found that the nosocomial infection rate of SARS-CoV-2 in inpatients was 86.57 % （329/380）. However， the nosocomial infection rate in lymphoma patients ［58.33 % （14/24）］ was significantly lower than that of the hospitalized patients with other disease types （P < 0.001）. ConclusionThe positive rate of SARS-CoV-2 nucleic acid testing among patients reached its peak in mid-December 2022. In January 2023， the positive rate of SARS-CoV-2 nucleic acid testing gradually decreased， while the number or positive rate of SARS-CoV-2 nucleic acid testing positive patients in some departments increased. The nosocomial infection rate among hospitalized patients is as high as 90 %. There are differences in the nosocomial infection rate of SARS-CoV-2 among inpatients with different disease types. In summary， this study provides preliminary data on the epidemiological characteristics of SARS-CoV-2 infection among hospitalized patients in Guangzhou， as well as the protection against infection among hospitalized patients and cross-infection between medical staffs and patients.

Effect of Diurnal Temperature Range on the Number of Residents Hospitalized Due to Stroke in Lanzhou / 中国医学科学院学报

Objective To analyze the relationship between diurnal temperature range (DTR) and the hospitalization of stroke in Lanzhou,so as to provide a scientific basis for probing into the mechanism of temperature changes in inducing stroke and formulating comprehensive prevention and control measures for stroke by relevant departments.Methods The information of the patients hospitalized due to stroke in Lanzhou during January 2014 to December 2019 and the air pollutants (PM10,SO2,and NO2) and meteorological data in the same period were collected for statistical analysis.Spearman rank correlation analysis was performed to analyze the correlations between air pollutants and meteorological factors.The distributed lag nonlinear model was adopted to fit the relationship between DTR and the number of stroke inpatients,and three-dimensional diagrams and the correlation diagrams of DTR against stroke risk were established.The stratified analysis was performed according to gender and age (< 65 years and ≥65 years).Results From 2014 to 2019,a total of 92 812 stroke patients were hospitalized in Lanzhou,with a male-to-female ratio of 1.35:1.There was a nonlinear relationship between DTR and the number of stroke inpatients in Lanzhou,which presented a lag effect.The low DTR at 4.5 ℃ had the largest RR value of 1.25 (95%CI=1.16-1.35) for stroke inpatients at a cumulative lag of 18 d.The effect of high DTR (18.5 ℃) on the hospitalization of stroke patients peaked at a cumulative lag of 21 d,with an RR value of 1.09 (95%CI=1.01-1.18).The stratified analysis results suggested that low levels of DTR had greater effects on the hospitalization of male stroke patients and stroke patients <65 years.Conclusions Short-term exposure to different levels of DTR had an impact on the number of stroke inpatients,and low levels of DTR had a slightly greater impact on stroke inpatients than high levels of DTR.Importance should be attached to the protection of males and people aged <65 years at low levels of DTR.

Early mobilisation following fragility hip fracture surgery: current trends and association with discharge outcomes in a local tertiary hospital

INTRODUCTION@#Postoperative day 1 (POD 1) mobilisation is a key clinical indicator for the fragility hip fracture surgery population. This study aimed to evaluate the current trends of POD 1 mobilisation at our institution and to review the relationships between early mobilisation and outcomes of early functional recovery, length of stay (LOS) and discharge destination.@*METHODS@#In this preliminary observational study, data pertaining to demographics, premorbid function, health status, injury and surgical factors, POD 1 mobilisation status and clinical outcomes of interest were retrieved from eligible patients. Patients who attained POD 1 ambulation formed the early ambulation (EA) group, while the remaining patients formed the delayed ambulation (DA) group. Data were analysed for any significant difference between the groups.@*RESULTS@#One hundred and fifteen patients were included in the analysis. The rate of patients achieving at least sitting out of bed on POD 1 was 80.0% (n=92), which was comparable to the data available from international hip fracture audit databases. There were 55 (47.8%) patients in the EA group and 60 (52.5%) patients in the DA group. The EA group was approximately nine times more likely to achieve independence in ambulation at discharge compared to the DA group (adjusted odds ratio 9.20, 95% confidence interval 1.50-56.45; P = 0.016). There were observed trends of shorter LOS and more proportion of home discharge in the EA group compared to the DA group (P > 0.05).@*CONCLUSION@#This is the first local study to offer benchmark of the POD 1 mobilisation status for this population. Patients who attained POD 1 ambulation had better early functional recovery.

Riesgo cardiovascular en pacientes ingresados en un Centro de Atención al diabético

Introducción: La diabetes mellitus constituye un importante problema de salud a nivel mundial. El riesgo cardiovascular en pacientes diabéticos es similar al que se observa en no diabéticos que han sufrido infarto del miocardio. Objetivo: Evaluar el riesgo cardiovascular en pacientes ingresados en el Centro de Atención al Diabético de Pinar del Río. Métodos: Se realizó un estudio observacional descriptivo de corte transversal en pacientes ingresados en el Centro de Atención al Diabético perteneciente al Hospital General Docente Abel Santamaría Cuadrado de la provincia Pinar del Río, en el período comprendido desde el 1ro enero de 2019 hasta el 31 diciembre de 2020. El universo de estudio quedó constituido por 689 pacientes con diagnóstico de diabetes mellitus y la muestra por 527, seleccionados a través de un muestreo probabilístico aleatorio simple, con una frecuencia esperada del 50 %, límite de confianza 5 % y nivel de confianza 95 %. Para el análisis de la información se utilizó el sistema estadístico, Statistical Package for Social Sciences, se aplicó análisis univariado de carácter descriptivo, se utilizaron estadígrafos descriptivos como la distribución de frecuencias absoluta y relativa. Se utilizó la prueba no paramétrica Chi cuadrado para datos cualitativos con un nivel de significación del 95 % (p<0,05). Resultados: En la serie predominó el sexo femenino (53,89 %), grupo etario de 60 a 69 años de edad (31,31 %) y afectados de piel blanca (75,9 %). Se observó preponderancia del sobrepeso/obesidad (74,75 %), seguido de la hipertensión arterial (73,62 %). Prevaleció el riesgo cardiovascular bajo (44,97 %). Conclusiones: La diabetes mellitus es una enfermedad crónica asociada a complicaciones cardiovasculares que produce aumento de riesgo cardiovascular y deterioro de la calidad de vida. Resulta fundamental instaurar estrategias de prevención primaria para detectar riesgos en forma temprana.

Introduction: Diabetes mellitus is a major health problem worldwide. The cardiovascular risk in diabetic patients is similar to that observed in non-diabetics who have suffered myocardial infarction. Objective: To evaluate the cardiovascular risk in patients admitted to the Diabetic Care Center of Pinar del Río. Methods: A cross-sectional descriptive observational study was carried out in patients admitted to the Diabetic Care Center belonging to the Abel Santamaría Cuadrado General Teaching Hospital in Pinar del Río province, in the period from January 1st, 2019 to December 31st, 2020. The universe of study was made up of 689 patients diagnosed with diabetes mellitus and the sample was 527, selected through simple random probabilistic sampling, with an expected frequency of 50 %, confidence limit 5 % and confidence level 95 %. For the analysis of the information, the statistical system, Statistical Package for Social Sciences, was applied, univariate analysis of a descriptive nature was applied, and descriptive statistics were used, such as the distribution of absolute and relative frequencies. The non-parametric Chi square test was used for qualitative data with a significance level of 95 % (p<0.05). Results : The female sex (53.89 %), age group 60 to 69 years of age (31.31 %) and white-skinned patients (75.9 %) predominated in the series. There was a preponderance of overweight/obesity (74.75 %), followed by arterial hypertension (73.62 %). Low cardiovascular risk prevailed (44.97 %). Conclusions: Diabetes Mellitus is a chronic disease associated with cardiovascular complications that causes increased cardiovascular risk and impaired quality of life. It is essential to establish primary prevention strategies to detect risks early.