Hospital readmission within 30 days of older adults hospitalized in a public hospital

Older adults have difficulty monitoring their drug therapy in the first thirty days following hospital discharge. This transition care period may trigger hospital readmissions. The study aims to identify the factors associated with the readmission of older adults 30 days after discharge from the perspective of drug therapy. This is a cross-sectional study and hospital admission within 30 days was defined as readmission to any hospital 30 days after discharge. The complexity of the drug therapy was established by the Medication Regimen Complexity Index (MRCI).. Readmission risks were predicted by the "Readmission Risk Score - RRS". The multivariate logistic regression was used to identify factors associated with readmission within 30 days after discharge. Two hundred fifty-five older adults were included in the study, of which 32 (12.5%) had non-elective hospital readmission. A higher number of readmissions was observed with increased RRS value, suggesting a linear gradient effect. The variables included in the final logistic regression model were the diagnosis of cancer (OR=2.9, p=0.031), pneumonia (OR=2.3, p=0.055), and High MRCI (> 16.5) following discharge (OR=1.9, p=0.119). The cancer diagnosis is positively associated with hospital readmissions of older adults within 30 days

Desordens no comportamento alimentar antes e após a cirurgia de bypass gástrico em um hospital público / Disorders in eating behavior before and after gastric bypass surgery in a public hospital

A cohort study with 25 patients was carried out in a public hospital unit aiming to identify the prevalence of eating disorders before bariatric surgery; verify their persistence at 6 months postoperatively; and analyze how such disorders influenced the ponderal weight loss in bariatric patients. Through anthropometric comparative analysis and the applica-tion of questionnaires regarding eating behavior, patients were classified as ?presenting? or ?free from? eating disorders before and 6 months after surgery. Significant reduction was observed in the prevalence of nocturnal eating and binge eating among patients at 6 months postoperatively. Lower loss of excess weight was verified among patients classified as ?presenting? eating disorders in the preoperative phase. Patients affected by eating disorders require monitoring by expert staff, which contributes to achieve satisfactory results.

Con el objetivo de determinar la prevalencia de trastornos alimentarios antes de la cirugía bariátrica, de comprobar si éstos persistieron 6 meses después de la intervención y de analizar cómo tales trastornos influyeron en la pérdida de peso de los pacientes bariátricos, se realizó un estudio de cohorte con 25 pacientes en unidad de hospital público, con medición antropométrica y aplicación de un cuestionario relacionado con el comportamiento alimentario, siendo clasificados, los pacientes, como portadores o libres de trastornos alimentarios, antes de la cirugía y 6 meses después. Se encontró una reducción significativa en la prevalencia de comedores compulsivos y nocturnos entre aquellos pacientes evaluados 6 meses después de la intervención. Se evidenció una menor pérdida del exceso de peso entre los pacientes clasificados como portadores de trastornos alimentarios en la fase preoperatoria. Pacientes que sufren de trastornos alimentarios requieren un seguimiento con personal especializado, contribuyendo, así, al logro de resultados satisfactorios.

Objetivando identificar a prevalência de desordens alimentares antes da cirurgia bariátrica, verificar se persistiram aos 6 meses do pós-operatório e analisar como tais desordens influenciaram na perda ponderal de pacientes bariátricos, realizou-se um estudo de coorte com 25 pacientes em unidade pública hospitalar, com aferição antropométrica e aplicação de questionário referente ao comportamento alimentar, sendo classificados como portadores ou livres de desordens alimentares antes e 6 meses após a realização da cirurgia. Foi verificada uma redução significativa na prevalência de comedores compulsivos e comedores noturnos entre os pacientes aos 6 meses do pós-operatório. Foi evidenciada menor perda do excesso de peso entre os pacientes classificados como portadores de desordens alimentares na fase pré-operatória. Pacientes acometidos por desordens alimentares necessitam de acompanhamento com equipe especializada, contribuindo para o alcance de resultados satisfatórios.

Perfil dos pacientes portadores de síndrome coronariana aguda submetidos à intervenção coronariana percutânea / Profile of patients with acute coronary syndrome undergoing percutaneous coronary intervention

Mais de 12 milhões de pessoas têm doença arterial coronariana e maisde 1 milhão apresenta um infarto do miocárdio a cada ano nos EstadosUnidos, resultando em cerca de 466.000 mortes atribuídas à doença arterialcoronariana. No Brasil, o infarto agudo do miocárdio representa a maiorcausa de morte e incapacidade. O atendimento rápido a estes pacientes,bem como a realização de angioplastia transluminal coronariana, podemdiminuir o risco de morbimortalidade destes pacientes. Objetivo: Descrevero perfil dos pacientes portadores de síndrome coronariana aguda submetidosà intervenção coronariana percutânea. Métodos: Trata-se de um estudoseccional, exploratório, descritivo, retrospectivo, com abordagemquantitativa. A amostra foi composta por 39 pacientes, internados naUTI Hemodinâmica de um hospital escola, na cidade de Recife - PE, noperíodo de julho de 2010 a julho de 2011. Foi realizada análise de banco dedados COREHEMO do serviço de cardiologia intervencionista da referidainstituição no período de fevereiro a março de 2012. Resultados: Dos 39pacientes estudados, 56,4% são do sexo masculino, a faixa etária maisacometida foi a de 50-79 anos, com 76,9% dos casos. A hipertensão arterialsistêmica aparece em 97,4% dos casos. A apresentação clínica da doença é,em sua maioria, angina estável, representando 82% da amostra. 87,2% dospacientes fazia uso de antiagregantes plaquetários. Conclusão: A maioriados resultados mostra-se semelhante aos dados nacionais, porém, deve-sedar mais atenção ao correto preenchimento dos formulários dos pacientes,bem como à importância do acompanhamento de exames laboratoriais quesão preconizados por diretrizes vigentes...

More than 12 million people have coronary artery disease and more than1 million has a myocardial infarction each year in the United States,resulting in about 466,000 deaths attributed to coronary artery disease.In Brazil, acute myocardial infarction is the major cause of death anddisability. The quick service to these patients, as well as the performanceof percutaneous transluminal coronary angioplasty may decrease the riskof morbidity and mortality of these patients. Objective: To describe theprofile of patients with acute coronary syndrome undergoing percutaneouscoronary intervention. Methods: This is a cross-sectional study,exploratory, descriptive, retrospective, with a quantitative approach.The sample consisted of 39 patients admitted to the ICU Hemodynamicsof a teaching hospital, in Recife - PE, in the period July 2010 to July2011. Analysis was performed database COREHEMO interventionalcardiology service of that institution in the period February to March2012. Results: Of 39 patients 56.4% were males, the age group mostaffected was between 50-79 years, with 76.9% of cases. Systemic arterialhypertension appears in 97.4% of cases. The clinical presentation ofdisease is mostly stable angina, representing 82% of the sample. 87.2%of patients used antiplatelet. Conclusion: Most of the results were similarto national data, however, more attention should be given to the correctcompletion of patient forms, as well as the importance of monitoringlaboratory tests that are recommended by current guidelines...

High genetic diversity among Pseudomonas aeruginosa and Acinetobacter spp. isolated in a public hospital in Brazil

In Brazil and other regions of the world, Pseudomonas aeruginosa and Acinetobacter spp. have emerged as important agents of nosocomial infection and are commonly involved in outbreaks. The main objective of the present study was to evaluate the genetic relationship among P. aeruginosa and Acinetobacter spp. isolated from patients in a public university hospital in northwestern Paraná, Brazil, and report their antimicrobial resistance profile. A total of 75 P. aeruginosa and 94 Acinetobacter spp. isolates were phenotypically identified and tested for antibiotic susceptibility using automated methodology. Polymyxin B was tested by disk diffusion for P. aeruginosa. Metallo-β-lactamase (MBL) was detected using a disk approximation test. Genotyping was performed using enterobacterial repetitive intergenic consensus polymerase chain reaction (ERIC-PCR). Approximately 55% of the P. aeruginosa isolates and 92% of the Acinetobacter spp. isolates were multiresistant, but none were MBL-producers. ERIC-PCR revealed the presence of small clusters of carbapenem-resistant Acinetobacter spp., most likely OXA-type carbapenemase producers. Furthermore, high genetic diversity in P. aeruginosa and Acinetobacter spp. clinical isolates was observed, suggesting that cross-transmission is not very frequent in the studied hospital.

No Brasil, bem como em outras regiões do mundo, Pseudomonas aeruginosa e Acinetobacter spp. surgiram como importantes agentes de infecção nosocomial e são comumente envolvidos em surtos. O objetivo principal deste estudo foi descrever a relação genética de P. aeruginosa e Acinetobacter spp. isoladas de pacientes internados em hospital universitário público do noroeste do Paraná - Brasil e reportar o perfil de resistência dessas bactérias. Um total de 75 P. aeruginosa e 94 Acinetobacter spp. isolados foi fenotipicamente identificado e testado para a suscetibilidade aos antibióticos por metodologia automatizada. A polimixina B foi testada por difusão em disco para P. aeruginosa. Metalo-β-lactamase (MBL) foi detectada por disco-aproximação. Análise genotípica foi realizada por enterobacterial repetitive intergenic consensus polymerase chain reaction (ERIC-PCR). Aproximadamente 55% dos isolados de P. aeruginosa e 92% de Acinetobacter spp. isolados foram multirresistentes, mas nenhum foi produtor de MBL. Os resultados de ERIC-PCR revelaram pequenos grupamentos de Acinetobacter spp. resistentes aos carbapenêmicos, provavelmente pela produção de carbapenemases do tipo OXA. Além disso, alta diversidade genética entre os isolados de P. aeruginosa e Acinetobacter spp. foi observada, sugerindo que a transmissão cruzada destas espécies bacterianas não é muito frequente em nosso hospital.

Strategic alliances: an analysis of Catalan hospitals / Alianzas estratégicas: un análisis de los hospitales catalanes

OBJECTIVE: To analyze the strategic alliances that Catalan hospitals form with other health care entities and other types of institutions to foster technological and organizational innovation. METHODS: Qualitative case studies were conducted at a sample of 16 public hospitals in Catalonia, Spain. The sample was limited to three (Level 1-3) of Catalonia's four levels of hospitals (classified according to the complexity of the diagnoses and treatments they provide), but Level 4 hospitals were considered as part of the network in the analysis of the alliances. At each hospital, interviews were conducted with the manager, the medical director, and the service director, using a questionnaire that gathered information on strategic alliances with a focus on telemedicine. Qualitative data processing was applied to identify patterns of alliances between hospitals and other institutions. RESULTS: Catalan hospitals interact with other health care agents through three main types of associations: alliances with other hospitals (the most frequent type); alliances with primary care centers (reported mostly by Level 2 hospitals); and alliances with other institutions (e.g., local government, medical companies, and universities). Human resource-sharing (staff mobility) and training were reported most frequently as reasons for creating the alliances. CONCLUSIONS: Strategic alliances are formed between hospitals and other health care agents to help improve performance, competitiveness, and services provided to users. These results may help health care system managers promote strategic alliances as a means of optimizing system efficiency without reducing user satisfaction-a key challenge within the context of the current economic situation.

OBJETIVO: Analizar las alianzas estratégicas que los hospitales catalanes forjan con otras entidades de atención de la salud y otros tipos de instituciones para fomentar la innovación tecnológica y de las organizaciones. MÉTODOS: Se condujeron estudios cualitativos de casos en una muestra de 16 hospitales públicos de Cataluña, España. La muestra se limitó a tres (Niveles 1 a 3) de los cuatro niveles de los hospitales catalanes (clasificados según la complejidad de los diagnósticos y los tratamientos que proporcionan), pero los hospitales de Nivel 4 se consideraron parte de la red en el análisis de las alianzas. En cada hospital se efectuaron entrevistas con el gerente, el director médico y el director de servicio, mediante un cuestionario que recopilaba información sobre las alianzas estratégicas con hincapié en la telemedicina. Se aplicó el procesamiento cualitativo de datos para identificar los modelos de alianzas entre los hospitales y otras instituciones. RESULTADOS: Los hospitales catalanes interactúan con otros agentes de atención de la salud a través de tres tipos principales de asociaciones: alianzas con otros hospitales (el tipo más frecuente); alianzas con centros de atención primaria (según lo informado principalmente por los hospitales de Nivel 2); y alianzas con otras instituciones (por ejemplo, el gobierno local, las empresas médicas y las universidades). El intercambio de recursos humanos (movilidad del personal) y la capacitación fueron mencionados como los motivos más frecuentes para crear las alianzas. CONCLUSIONES: Se forman alianzas estratégicas entre los hospitales y otros agentes de atención de la salud con el objeto de mejorar el desempeño, la competitividad y los servicios prestados a los usuarios. Estos resultados pueden ayudar a los gerentes de los sistemas de atención de la salud a promover alianzas estratégicas como medio para optimizar la eficiencia del sistema sin reducir la satisfacción de los usuarios -un reto clave en el contexto de la situación económica actual.