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1.
Enferm. foco (Brasília) ; 11(1,n.esp): 199-204, ago. 2020.
Article in Portuguese | LILACS (Americas), BDENF | ID: biblio-1116670

ABSTRACT

Objetivo: relatar a experiência vivenciada de um serviço de emergência hospitalar do Sistema Único de Saúde (SUS) sobre os fluxos de atendimento a pacientes suspeitos ou confirmados por COVID-19. Método: trata-se de um estudo qualitativo com caráter descritivo, do tipo relato de experiência, visando a reflexão e discussão crítica acerca da experiência vivenciada por profissionais da enfermagem em um hospital de referência da região sul do Brasil no enfrentamento à pandemia. Resultados: para atendimento dos pacientes suspeitos ou confirmados de infecção por coronavírus, foram organizados planos de contingência e fluxos de atendimento nos setores de emergência em conexão com as demais áreas do hospital. Criou-se o Centro de Triagem e a sala vermelha COVID-19. Conclusão: constatou-se a importância da participação multidisciplinar para organização logística, de recursos humanos e materiais para o estabelecimento das novas rotinas assistenciais em curto prazo. (AU)


Objective: to report the experience of a hospital emergency service of the Sistema Único de Saúde (SUS) on the flows of care to patients suspected or confirmed by COVID-19. Method: it is a qualitative study with a descriptive character, of the experience report type, aiming at reflection and critical discussion about the experience lived by nursing professionals in a reference hospital in the southern region of Brazil in facing the pandemic. Results: for the care of patients suspected or confirmed of coronavirus infection, contingency plans and care flows were organized in the emergency departments in connection with the other areas of the hospital. The Triage Center and the COVID-19 red room were created. Conclusion: the importance of multidisciplinary participation for logistical, human and material resources was found to establish new care routines in the short term. (AU)


Objetivo: informar la experiencia de un servicio de emergencia hospitalario del Sistema Único de Saúde (SUS) sobre los flujos de atención a pacientes sospechosos o confirmados por COVID-19. Método: es un estudio cualitativo con carácter descriptivo, del tipo de informe de experiencia, con el objetivo de reflexionar y debatir críticamente sobre la experiencia vivida por profesionales de enfermería en un hospital de referencia en la región sur de Brasil frente a la pandemia. Resultados: para la atención de pacientes sospechosos o confirmados de infección por coronavirus, se organizaron planes de contingencia y flujos de atención en los departamentos de emergencia en conexión con las otras áreas del hospital. Se crearon el Centro de detección y la sala roja COVID-19. Conclusión: se encontró la importancia de la participación multidisciplinaria para los recursos logísticos, humanos y materiales para establecer nuevas rutinas de atención a corto plazo. (AU)


Subject(s)
Pandemics , Risk Management , Nursing , Coronavirus , Emergency Service, Hospital
2.
Neumol. pediátr. (En línea) ; 15(2): 317-323, mayo 2020. tab
Article in Spanish | LILACS (Americas) | ID: biblio-1099528

ABSTRACT

The emergence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has posed great challenges for both public health and medical clinical practice since the first cases reported in Wuhan, China. Coronavirus disease (CoVID-19) is a zoonotic disease caused by an RNA virus. SARS-CoV-2 is transmitted through respiratory droplets and fomites, and it has a lethality estimated at 4%. In the pediatric population it mainly produces mild cases, but it also can cause severe cases with hypoxemia, respiratory distress, and multiple organ failure. Children have been recognized as an important disease vector than can spread disease to higher risk groups. It is fundamental to rearrange emergency department functioning, in order to achieve an adequate patient flow that reduces the risk of disease transmission. In the following, we lay out the recommendations for patient care in the emergency room.


La emergencia mundial del virus SARS-CoV-2 (CoV2) ha producido grandes desafíos para la salud pública y para la atención clínica, desde la aparición de los primeros casos en Wuhan, China. La enfermedad, CoVID-19, es una infección zoonótica producida por un virus RNA (1). Se transmite a través de gotitas y fómites con una letalidad estimada en 4%. En pediatría, provoca cuadros respiratorios en su mayoría leves, pero también cuadros severos con hipoxemia y distrés respiratorio (2). Se ha reconocido al niño como un vector importante que aumenta los contagios en personas que tendrán probablemente cuadros de gravedad. La organización adecuada de los servicios de urgencias es fundamental para lograr un flujo y áreas especiales para los pacientes sospechosos de CoVID-19 y así evitar nuevos contagios. A continuación, se detallan las principales recomendaciones para la atención de estos pacientes en un servicio de urgencias.


Subject(s)
Humans , Child , Pneumonia, Viral/therapy , Intensive Care Units, Pediatric/organization & administration , Coronavirus Infections/therapy , Betacoronavirus , Emergency Service, Hospital/organization & administration , Pandemics
4.
Article in English | WPRIM (Western Pacific) | ID: wprim-782271

ABSTRACT

OBJECTIVES: The aim of this study was to develop machine learning (ML) and initial nursing assessment (INA)-based emergency department (ED) triage to predict adverse clinical outcome.METHODS: The retrospective study included ED visits between January 2016 and December 2017 that resulted in either intensive care unit admission or emergency room death. We trained four classifiers using logistic regression and a deep learning model on INA and low dimensional (LD) INA, logistic regression on the Korea Triage and acuity scale (KTAS) and Sequential Related Organ Failure Assessment (SOFA). We varied the outcome ratio for external validation. Finally, variables of importance were identified using the random forest model's information gain. The four most influential variables were used for LD modeling for efficiency.RESULTS: A total of 86,304 patient visits were included, with an overall outcome rate of 3.5%. The area under the curve (AUC) values for the KTAS model were 76.8 (74.9–78.6) with logistic regression and 74.0 (72.1–75.9) for the SOFA model, while the AUC values of the INA model were 87.2 (85.9–88.6) and 87.6 (86.3–88.9) with logistic regression and deep learning, suggesting that the ML and INA-based triage system result more accurately predicted the outcomes. The AUC values for the LD model were 81.2 (79.4–82.9) and 80.7 (78.9–82.5) for logistic regression and deep learning, respectively.CONCLUSIONS: We developed an ML and INA-based triage system for EDs. The novel system was able to predict clinical outcomes more accurately than existing triage systems, KTAS and SOFA.


Subject(s)
Area Under Curve , Emergencies , Emergency Service, Hospital , Forests , Humans , Intensive Care Units , Korea , Learning , Logistic Models , Machine Learning , Nursing Assessment , Nursing , Retrospective Studies , Triage
5.
Article in English | WPRIM (Western Pacific) | ID: wprim-782269

ABSTRACT

OBJECTIVES: Foreign patients are more likely to receive inappropriate health service in the emergency room. This study aimed to investigate whether there is health inequality between foreigners and natives who visited emergency rooms with injuries and to examine its causes.METHODS: We analyzed clinical data from the National Emergency Department Information System database associated with patients of all age groups visiting the emergency room from 2013 to 2015. We analyzed data regarding mortality, intensive care unit admission, emergency operation, severity, area, and transfer ratio.RESULTS: A total of 4,464,603 cases of injured patients were included, of whom 67,683 were foreign. Injury cases per 100,000 population per year were 2,960.5 for native patients and 1,659.8 for foreign patients. Foreigners were more likely to have no insurance (3.1% vs. 32.0%, p < 0.001). Serious outcomes (intensive care unit admission, emergency operation, or death) were more frequent among foreigners. In rural areas, the difference between serious outcomes for foreigners compared to natives was greater (3.7% for natives vs. 5.0% for foreigners, p < 0.001). The adjusted odds ratio for serious outcomes for foreign nationals was 1.412 (95% confidence interval [CI], 1.336–1.492), and that for lack of insurance was 1.354 (95% CI, 1.314–1.394).CONCLUSIONS: Injured foreigners might more frequently suffer serious outcomes, and health inequality was greater in rural areas than in urban areas. Foreign nationality itself and lack of insurance could adversely affect medical outcomes.


Subject(s)
Emergencies , Emergency Service, Hospital , Emigrants and Immigrants , Ethnic Groups , Health Services , Healthcare Disparities , Humans , Information Systems , Insurance , Intensive Care Units , Mortality , Odds Ratio , Population Groups , Socioeconomic Factors , Wounds and Injuries
6.
Article in English | WPRIM (Western Pacific) | ID: wprim-782219

ABSTRACT

BACKGROUND: Use of appropriate antibiotics for the treatment of pneumonia is integral in patients admitted to intensive care units (ICUs). Although it is recommended that empirical treatment regimens should be based on the local distribution of pathogens in patients with suspected hospital-acquired pneumonia, few studies observe patients admitted to ICUs with nursing home–acquired pneumonia (NHAP). We found factors associated with the use of inappropriate antibiotics in patients with pneumonia admitted to the ICU via the emergency room (ER).METHODS: We performed a retrospective cohort study of 83 pneumonia patients with confirmed causative bacteria admitted to ICUs via ER March 2015–May 2017. We compared clinical parameters, between patients who received appropriate or inappropriate antibiotics using the Mann-Whitney U, Pearson's chi-square, and Fisher's exact tests. We investigated independent factors associated with inappropriate antibiotic use in patients using multivariate logistic regression.RESULTS: Among 83 patients, 30 patients (36.1%) received inappropriate antibiotics. NHAP patients were more frequently treated with inappropriate antibiotics than with appropriate antibiotics (47.2% vs. 96.7%, p<0.001). Methicillin-resistant Staphylococcus aureus was more frequently isolated from individuals in the inappropriate antibiotics–treated group than in the appropriate antibiotics–treated group (7.5% vs. 70.0%, p<0.001). In multivariate analysis, NHAP was independently associated with the use of inappropriate antibiotics in patients with pneumonia admitted to the ICU via ER.CONCLUSION: NHAP is a risk factor associated with the use of inappropriate antibiotics in patients with pneumonia admitted to the ICU via the ER.


Subject(s)
Anti-Bacterial Agents , Bacteria , Cohort Studies , Critical Care , Emergency Service, Hospital , Hospitals, Teaching , Humans , Intensive Care Units , Logistic Models , Methicillin-Resistant Staphylococcus aureus , Multivariate Analysis , Nursing , Pneumonia , Retrospective Studies , Risk Factors
8.
Yonsei Medical Journal ; : 48-55, 2020.
Article in English | WPRIM (Western Pacific) | ID: wprim-782124

ABSTRACT

PURPOSE: Data on the comparative effectiveness of infliximab (IFX) or adalimumab (ADA) in patients with ulcerative colitis (UC) are extremely limited, especially in the Asian population. We compared clinically important outcomes [colectomy, UC-related emergency room (ER) visits, UC-related hospitalizations, and need for corticosteroids] for these two biologics in biologic-naïve Korean patients with UC.MATERIALS AND METHODS: Using National Health Insurance claims, we collected data on patients who were diagnosed with UC and exposed to IFX or ADA between 2010 and 2016.RESULTS: A total of 862 new users of biologics were included, of whom 630 were treated with IFX and 232 were treated with ADA. Over a median follow-up of 1.8 years after starting biologic therapy, there were no significant differences in the risk of colectomy [adjusted hazard ratio (aHR), 1.87; 95% confidence interval (CI), 0.30–11.63], ER visits (aHR, 1.58; 95% CI, 0.79–3.16), hospitalizations (aHR, 0.83; 95% CI, 0.59–1.17), and corticosteroid use (aHR, 1.16; 95% CI, 0.76–1.78) between IFX and ADA users. These results were stable even when only patients who used biologics for ≥6 months were analyzed. Additionally, these results were unchanged in patients treated with biologic monotherapy or combination therapy with immunomodulators.CONCLUSION: In this nationwide population-based study, there was no significant difference in the risk of colectomy, ER visits, hospitalizations, and corticosteroid use between IFX and ADA users. Our findings indicate that IFX and ADA have comparable effectiveness in biologic-naïve Korean patients with UC.


Subject(s)
Adalimumab , Asian Continental Ancestry Group , Biological Products , Biological Therapy , Colectomy , Colitis, Ulcerative , Emergency Service, Hospital , Follow-Up Studies , Hospitalization , Humans , Immunologic Factors , Infliximab , National Health Programs , Ulcer
9.
Article in English | WPRIM (Western Pacific) | ID: wprim-782071

ABSTRACT

BACKGROUND AND PURPOSE: The pathophysiologic mechanisms underlying benign convulsions with mild gastroenteritis (CwG) in children remain unclear. We investigated the incidence of ketosis in CwG and whether this is related to seizures.METHODS: This retrospective study included children aged from 6 months to 6 years who visited our emergency department and were diagnosed as CwG between June 2015 and December 2018. The clinical and laboratory data were analyzed for these cases. Ketosis and severe ketosis were defined as blood β-hydroxybutyrate levels of ≥0.6 and ≥4.5 mmol/L, respectively.RESULTS: We enrolled 42 pediatric CwG patients aged 21.0±11.5 months (mean±SD) whose blood β-hydroxybutyrate level was 3.65±1.51 mmol/L. Ketosis was observed in 95.2% of these children, while 35.7% had severe ketosis. Compared to the non-severe-ketosis group (n=27), the severe-ketosis group (n=15) demonstrated significantly lower blood glucose levels (68.8 vs. 82.6 mg/dL, p=0.020) and sodium levels (134.2 vs. 135.6 mEq/L, p=0.018), and included a larger proportion of low-body-weight children (defined as adjusted weight < 50th percentile for age and sex) (53.3% vs. 18.5%, p=0.019). However, the incidence of repetitive seizures (two or more during an illness period) did not differ between these groups. Moreover, severe ketosis was not associated with the risk of seizure recurrence in the emergency department.CONCLUSIONS: Children with CwG are in a state of considerable ketosis. Severe ketosis in CwG may be associated with low blood glucose and sodium levels but does not reduce seizure recurrence.


Subject(s)
Blood Glucose , Child , Emergency Service, Hospital , Gastroenteritis , Humans , Incidence , Ketosis , Recurrence , Retrospective Studies , Seizures , Sodium
10.
Article in English | WPRIM (Western Pacific) | ID: wprim-782050

ABSTRACT

BACKGROUND: Long-term oxygen therapy provides various benefits, including prolonged survival for severely hypoxic chronic obstructive pulmonary disease (COPD) patients. However, adequate management strategies for home oxygen therapy are not well established in Korea. This study aimed to explore the current situation of home oxygen therapy to provide basic data for developing a strategy for COPD patients on home oxygen therapy.METHODS: In this cross-sectional study, we enrolled COPD patients using home oxygen therapy for at least 1 month. Face-to-face interviews were conducted, guided by a structured questionnaire about home oxygen therapy.RESULTS: A total of 195 patients were enrolled. The mean age was 72.6 ± 9.7 years, and 76.4% of patients were men. The mean modified Medical Research Council, COPD Assessment Test, and EuroQol-5D index scores were 3.4 ± 0.8, 29.7 ± 6.8, and 0.35 ± 0.44, respectively. At rest, patients were prescribed oxygen for 12.5 ± 7.3 hr/day and used 12.9 ± 8.5 hr/day on average. During exercise, the mean duration of prescribed oxygen was 6.6 ± 4.3 hr/day, and the actual use was 1.1 ± 2.9 hr/day. A total of 25.6% of patients used ambulatory oxygen; with financial burden the main reason for nonuse. The mean number of hospitalizations and emergency room visits were 2.5 and 2.6, respectively.CONCLUSION: This study revealed low adherence to home oxygen therapy, poor health-related quality of life, frequent hospitalizations, and a high financial burden among COPD patients using home oxygen therapy. The study highlights the need for adequate strategies to improve the quality of home oxygen therapy.


Subject(s)
Cross-Sectional Studies , Emergency Service, Hospital , Hospitalization , Humans , Korea , Male , Morinda , Oxygen , Patient Acceptance of Health Care , Pulmonary Disease, Chronic Obstructive , Quality of Life
12.
Article in English | WPRIM (Western Pacific) | ID: wprim-810968

ABSTRACT

BACKGROUND: This study described and analysed the features of powered mobility device (PMD)-related injuries and compared elderly and younger adult injuries.METHODS: Data from Korea Emergency Department-based Injury In-depth Surveillance (EDIIS) database involving eight emergency departments in 2011–2016 were analysed. The inclusion criteria were injuries sustained during the use of PMDs. The variables were compared between adults aged ≥ 65 years and younger adults. Primary and secondary outcomes were severe trauma and poor clinical course accordingly. The logistic regression analysis was used to identify risk factors for study outcomes.RESULTS: A total of 231 adults were enrolled, of whom 150 were ≥ 65 years of age. The total number of PMD-related injuries and the proportion of elderly injured patients increased annually, and most injuries occurred on the roadway and did not involve crash opponents. By multivariate analysis, patients aged ≥ 65 years had a higher injury severity score (adjusted odds ratio [AOR], 2.78; 95% confidence interval [CI], 1.50–5.40) and had a higher incidence of intensive care unit admissions, surgery, and death (AOR, 2.42; 95% CI, 1.16–5.28).CONCLUSION: Given the higher number and severity of injuries sustained among elderly adults ≥ 65 years of age shown in this study, we recommend that safety educations, such as the use of protective equipment and the safe driving on the roadway, are considered for PMD users ≥ 65 years of age.


Subject(s)
Adult , Aged , Emergencies , Emergency Service, Hospital , Epidemiology , Humans , Incidence , Injury Severity Score , Intensive Care Units , Korea , Logistic Models , Multivariate Analysis , Odds Ratio , Risk Factors , Wheelchairs
13.
Rev. latinoam. enferm. (Online) ; 28: e3273, 2020. tab
Article in English | LILACS (Americas), BDENF | ID: biblio-1101725

ABSTRACT

Objective: to verify the relationship between the socio-demographic and work profile of the nursing professionals and the patient safety climate in a public emergency hospital. Method: a cross-sectional study carried out with 177 nursing professionals from a public emergency hospital. For data collection, the Safety Attitudes Questionnaire - Short Form 2006 was used, validated and cross-culturally adapted to the Portuguese language. To check the factors related to the instrument's domains, bivariate and multivariate analyses were performed. Results: working in the medical and surgical clinic or emergency room, on a night shift, and having the intention to leave nursing, reduced the general safety climate in the multiple regression analysis. The younger professionals, with less than four years in the institution, and those who worked in the night shift had a lower safety climate related to the perception of the management. On the other hand, having a work contract with a hired worker improved the general safety climate and workplace satisfaction. Conclusion: identifying predictors on patient safety scores is an important management tool that allows diagnosing, planning and executing activities from the domains that need to be improved.


Objetivo: verificar a relação entre o perfil sociodemográfico e laboral dos profissionais de enfermagem e o clima de segurança do paciente de um hospital público de urgências. Método: estudo transversal realizado com 177 profissionais de enfermagem de um hospital público de urgências. Para a coleta de dados, foi utilizado o Safety Attitudes Questionnaire - Short Form 2006, validado e adaptado transculturalmente para a língua portuguesa. Para verificar os fatores relacionados aos domínios do instrumento, foram realizadas análises bivariadas e multivariáveis. Resultados: atuar na clínica médica e cirúrgica ou pronto-socorro, em turno noturno e possuir intenção de sair da enfermagem diminuiu o clima de segurança geral, em análise de regressão múltipla. Os profissionais mais novos, com menos de quatro anos na instituição e os que atuavam no turno noturno apresentaram menor clima de segurança relacionado à percepção da gerência. Em contrapartida, ter vínculo de trabalho celetista melhorou o clima de segurança geral e a satisfação no trabalho. Conclusão: identificar preditores sobre os escores de segurança do paciente é uma importante ferramenta gerencial que permite diagnosticar, planejar e executar atividades a partir dos domínios que precisam ser aprimorados.


Objetivo: verificar la relación entre el perfil sociodemográfico y laboral de los profesionales de enfermería y el clima de seguridad del paciente en un hospital público de urgencias. Método: estudio transversal realizado con 177 profesionales de enfermería de un hospital público de urgencias. Para la recopilación de datos, se utilizó el Safety Attitudes Questionnaire - Short Form 2006, validado y adaptado transculturalmente al idioma portugués. Para verificar los factores relacionados con los dominios del instrumento se realizaron análisis bivariados y multivariados. Resultados: actuar en la clínica médica y quirúrgica o en la sala de emergencias, en un turno nocturno, y tener la intención de abandonar la enfermería, redujo el clima de seguridad general en el análisis de regresión múltiple. Los profesionales más jóvenes, con menos de cuatro años en la institución, y aquellos que trabajaban en el turno nocturno tuvieron un clima menor de seguridad relacionado con la percepción de la gerencia. Por otro lado, tener un contrato de trabajo con un trabajador contratado mejoró el clima general de seguridad y la satisfacción laboral. Conclusión: identificar los predictores en las puntuaciones de seguridad del paciente es una herramienta de gestión importante que permite diagnosticar, planificar y ejecutar actividades desde los dominios que deben mejorarse.


Subject(s)
Humans , Male , Female , Socioeconomic Factors , Attitude of Health Personnel , Safety Management , Emergency Service, Hospital/standards , Patient Safety , Job Satisfaction , Nursing Staff, Hospital
14.
Rev Rene (Online) ; 21: e43218, 2020. tab, graf
Article in Portuguese | LILACS (Americas), BDENF | ID: biblio-1101374

ABSTRACT

RESUMO Objetivo avaliar a relação entre a gravidade clínica de pacientes e as horas de cuidados dos profissionais de enfermagem em um pronto socorro. Métodos estudo correlacional, que se utilizou dos instrumentos Nursing Activities Score e Acute Physiology and Chronic Health Evaluation I. Resultados incluíram-se 338 pacientes. As médias mais altas foram identificadas no grupo óbitos sendo (22,0%) para Acute Physiology and Chronic Health Evaluation II e (56,8%) para Nursing Activities Score, (p=0,000). Obteve-se relação moderada entre esses escores. Ademais, os dois instrumentos utilizados se mostraram capazes de predizer o óbito. Conclusão as avaliações do agravamento dos pacientes e da demanda por cuidados, podem contribuir com a adequação do número de pessoal, a redução do tempo de permanência nas salas de emergência e o planejamento assistencial de qualidade elevada.


ABSTRACT Objective to evaluate the relationship between the clinical severity of the patients and the hours of care of nursing professionals in an emergency room. Methods correlational study, which used the Nursing Activities Score and Acute Physiology and Chronic Health Evaluation I instruments. Results we included 338 patients. The highest averages were identified in the group related to deaths, with (22.0%) for Acute Physiology and Chronic Health Evaluation II and (56.8%) for Nursing Activities Score, (p=0.000). We obtained a moderate relationship between these scores. Moreover, the two instruments used proved to be capable of predicting deaths. Conclusion evaluations of the worsening of patients and the demand for care can contribute to the adequacy of the number of personnel, the reduction of the length of stay in the emergency rooms and the high-quality care planning.


Subject(s)
Severity of Illness Index , Workload , Critical Care , Emergency Service, Hospital , Nursing Care
15.
Article in English | WPRIM (Western Pacific) | ID: wprim-762461

ABSTRACT

BACKGROUND: Rapid and accurate diagnosis of acute myocardial infarction (AMI) is critical for initiating effective treatment and achieving better prognosis. We investigated the performance of copeptin for early diagnosis of AMI, in comparison with creatine kinase myocardial band (CK-MB) and troponin I (TnI). METHODS: We prospectively enrolled 271 patients presenting with chest pain (within six hours of onset), suggestive of acute coronary syndrome, at an emergency department (ED). Serum CK-MB, TnI, and copeptin levels were measured. The diagnostic performance of CK-MB, TnI, and copeptin, alone and in combination, for AMI was assessed by ROC curve analysis by comparing the area under the curve (AUC). Sensitivity, specificity, negative predictive value, and positive predictive value of each marker were obtained, and the characteristics of each marker were analyzed. RESULTS: The patients were diagnosed as having ST elevation myocardial infarction (STEMI; N=43), non-ST elevation myocardial infarction (NSTEMI; N=25), unstable angina (N=78), or other diseases (N=125). AUC comparisons showed copeptin had significantly better diagnostic performance than TnI in patients with chest pain within two hours of onset (AMI: P=0.022, ≤1 hour; STEMI: P=0.017, ≤1 hour and P=0.010, ≤2 hours). In addition, TnI and copeptin in combination exhibited significantly better diagnostic performance than CK-MB plus TnI in AMI and STEMI patients. CONCLUSIONS: The combination of TnI and copeptin improves AMI diagnostic performance in patients with early-onset chest pain in an ED setting.


Subject(s)
Acute Coronary Syndrome , Angina, Unstable , Area Under Curve , Chest Pain , Creatine Kinase , Diagnosis , Early Diagnosis , Emergencies , Emergency Service, Hospital , Humans , Myocardial Infarction , Prognosis , Prospective Studies , ROC Curve , Sensitivity and Specificity , Troponin I
16.
Asia Pacific Allergy ; (4): 1-2020.
Article in English | WPRIM (Western Pacific) | ID: wprim-785464

ABSTRACT

BACKGROUND: In the Emergency Department (ED), diagnosis and management of anaphylaxis are challenging with at least 50% of anaphylaxis episodes misdiagnosed when the diagnostic criteria of current guidelines are not used.OBJECTIVE: Objective of our study was to assess anaphylaxis diagnosis and management in patients presenting to the ED.METHODS: Retrospective chart review conducted on patients presenting to The Medical City Hospital ED, the Philippines from 2013–2015 was done. Cases were identified based on International Statistical Classification of Diseases, 10th revision coding for either anaphylaxis or other allergic related diagnosis. Cases fitting the definition of anaphylaxis as identified by the National Institute of Allergy and Infectious Disease and the Food Allergy and Anaphylaxis Network (NIAID/FAAN) were included. Data collected included demographics, signs and symptoms, triggers and management.RESULTS: A total of 105 cases were evaluated. Incidence of anaphylaxis for the 3-year study period was 0.03%. Of the 105 cases, 35 (33%) were diagnosed as “urticaria” or “hypersensitivity reaction” despite fulfilling the NIAID/FAAN anaphylaxis criteria. There was a significant difference in epinephrine administration between those given the diagnosis of anaphylaxis versus misdiagnosed cases (61 [87%] vs. 12 [34%], χ² = 30.77, p < 0.01); and a significant difference in time interval from arrival at the ED to epinephrine administration, with those diagnosed as anaphylaxis (48%) receiving epinephrine within 10 minutes, versus ≥ 60 minutes for most of the misdiagnosed group (χ² = 52.97, p < 0.01).CONCLUSION: Despite current guidelines, anaphylaxis is still misdiagnosed in the ED. Having an ED diagnosis of anaphylaxis significantly increases the likelihood of epinephrine administration, and at a shorter time interval.


Subject(s)
Anaphylaxis , Classification , Clinical Coding , Communicable Diseases , Demography , Diagnosis , Emergencies , Emergency Service, Hospital , Epinephrine , Food Hypersensitivity , Hospitals, Urban , Humans , Hypersensitivity , Incidence , Philippines , Retrospective Studies , Tertiary Care Centers
17.
Arch. argent. pediatr ; 117(6): 368-374, dic. 2019. tab
Article in English, Spanish | LILACS (Americas), BINACIS | ID: biblio-1046244

ABSTRACT

Introducción: La contaminación y el clima tienen impacto en la patología respiratoria en niños; pocos estudios lo evaluaron en la Ciudad de Buenos Aires.Objetivo: Evaluar el impacto de la interacción entre contaminantes atmosféricos y clima en las consultas por infección respiratoria aguda baja (IRAB) en un hospital pediátrico.Métodos: Estudio ecológico, de series temporales con modelos aditivos generalizados, que incluyó todas las consultas y consultas por IRAB (urgencias) entre 2012 y 2016. Para controlar sesgos, se conformó una serie con promedios móviles de 7 días para consultas por IRAB. Los predictores fueron niveles diarios de contaminantes atmosféricos (monóxido de carbono, dióxido nitroso, material particulado < 10 µ) y variables meteorológicas (temperatura, humedad). Los contaminantes fueron medidos en 3 estaciones de monitoreo. Se controló por variables temporales (día de la semana, semestre cálido/frío).Resultados: Las consultas totales fueron 455 256 y por IRAB 17 298. Solo consultas totales correlacionaron con día de la semana (lunes y sábados, más consultas y jueves, menos). El semestre cálido registró menos consultas por IRAB que el frío (riesgo relativo = 0,23; intervalo de confianza 95 %: 0,29-0,18; p < 0,001).Una estación de monitoreo no presentó ninguna correlación; las otras mostraron correlación débil entre monóxido de carbono y material particulado < 10 µ y consultas por IRAB.Conclusión: La época del año explica con precisión el incremento del número de consultas totales y por IRAB. Aunque el nivel de algunos contaminantes muestra correlación con el número de consultas, su impacto es irrelevante.Palabras clave: contaminación del aire, clima, infecciones del sistema respiratorio, niño.


Introduction: Pollution and climate have an impact on pediatric respiratory diseases; few studies have assessed this in the Autonomous City of Buenos Aires.Objective: To assess the impact of the interaction between air pollutants and climate on the Emergency Department visits for acute lower respiratory tract infection (ALRTI) in a children's hospital.Methods: Ecological, time-series study with generalized additive models that included total visits and visits for ALRTI to the Emergency Department between 2012 and 2016. A series with 7-day moving averages for ALRTI visits was founded as a bias control measure. Predictors were daily levels of air pollutants (carbon monoxide, nitrous dioxide, particulate matter < 10 µ) and meteorological variables (temperature, humidity). Pollutants were measured at three monitoring stations. Temporal variables (day of the week, warm/cold semester) were controlled.Results: There were 455 256 total visits; 17 298 accounted for visits for ALRTI. A correlation was established only between total visits and day of the week (Mondays and Saturdays, more visits; Thursdays, less visits). Less visits for ALRTI were recorded in the warm semester compared to the cold semester (relative risk = 0.23; 95 % confidence interval: 0.29-0.18; p < 0.001). One monitoring station did not show any correlation; the other two stations showed a weak correlation between carbon monoxide and particulate matter < 10 µ and visits for ALRTI. Conclusion: The season accurately accounts for the increased number of total visits and visits for ALRTI. Although there was a correlation between the level of certain pollutants and the number of visits, its impact was irrelevant.


Subject(s)
Humans , Male , Female , Child , Respiratory Syncytial Viruses , Respiratory Tract Infections , Temperature , Climate Change , Air Pollution , Emergency Service, Hospital , Time Series Studies , Ecological Studies
18.
Enferm. actual Costa Rica (Online) ; (37): 142-154, Jul.-Dez. 2019.
Article in Portuguese | LILACS (Americas), BDENF | ID: biblio-1039761

ABSTRACT

Resumo 23. O processo de trabalho de enfermeiras e enfermeiros nas emergências é gerador de estresse e traz à tona fragilidades do profissional no tocante a sentimentos referentes ao sofrimento e vivência cotidiana com a morte. Isto, em decorrência da interação e o envolvimento necessário à assistência e nas tomadas de decisão em acordo a gravidade do paciente e família. Assim, este estudo objetiva conhecer o enfrentamento da enfermeira no cuidado diante do processo de morte, em emergência. Pesquisa documental, realizada com oito enfermeiras numa emergência de um hospital privado de Florianópolis, Santa Catarina, Brasil, entre maio e junho de 2015. Os dados foram analisados à luz da análise de conteúdo de Bardin e da relação interpessoal de Travelbee. Emergiram duas categorias: A morte vivida por enfermeiras em emergência, O Humano e o técnico no enfrentamento da morte em emergência. Conclui-se que o enfermeiro ao lidar com a morte em meio ao cuidado de restauração da vida mostra-se limitado e necessita de amparo emocional e racional para o cuidado a essa clientela nesse ambiente específico.


Resumen 27. El proceso de trabajo de enfermeras y enfermeros en las emergencias es generador de estrés y trae a la superficie fragilidades del profesional en cuanto a sentimientos referentes al sufrimiento y vivencia cotidiana con la muerte. Esto, como consecuencia de la interacción y la implicación necesaria para la asistencia y las tomas de decisión en concordancia con la gravedad del paciente y la familia. Por lo tanto, este estudio objetiva conocer el enfrentamiento de la enfermera en el cuidado ante el proceso de muerte, en emergencia. Investigación documental, realizada con ocho enfermeras en una emergencia de un hospital privado de Florianópolis, Santa Catarina, Brasil, entre mayo y junio de 2015. Los datos fueron analizados a la luz del análisis de contenido de Bardin y de la relación interpersonal de Travelbee. Emergieron dos categorías: La muerte vivida por enfermeros en emergencia, el Humano y el técnico en el enfrentamiento de la muerte en emergencia. Se concluye que el enfermero al lidiar con la muerte en medio del cuidado de restauración de la vida se muestra limitado y necesita de amparo emocional y racional para el cuidado a esa clientela en ese ambiente específico.


Abstract 31. The work process of nurses in emergencies is a source of stress and brings to the surface the weaknesses of the professional in terms of feelings related to suffering and daily experience with death. This, as a consequence of the interaction and the necessary implication for assistance and decision making by the severity of the patient and the family. Therefore, this study aims to know the confrontation of the nurse in the care before the death process, in an emergency. Documentary research, conducted with eight nurses in an emergency at a private hospital in Florianópolis, Santa Catarina, Brazil, between May and June 2015. The data were analyzed in light of Bardin's content analysis and Travelbee's interpersonal relationship. Two categories emerged: The death experienced by nurses in an emergency, the Human and the technician in the confrontation of death in an emergency. It is concluded that the nurse in dealing with death in the middle of the restoration care of life is limited and needs emotional and rational protection for the care of that clientele in that specific environment.


Subject(s)
Humans , Male , Female , Brazil , Attitude to Death , Mental Health , Emergency Nursing , Death , Emergency Service, Hospital , Nursing Staff, Hospital/psychology
19.
Trends psychiatry psychother. (Impr.) ; 41(3): 237-246, July-Sept. 2019. tab
Article in English | LILACS (Americas) | ID: biblio-1043526

ABSTRACT

Abstract Objective To assess the association between brain-derived neurotrophic factor (BDNF) levels and acute stress disorder (ASD) in patients who have suffered physical trauma. Methods Data were collected at an emergency hospital in Porto Alegre, state of Rio Grande do Sul, southern Brazil. Participants were over 18 years of age, victims of physical trauma, and had been hospitalized for a minimum of 48 hours. A total of 117 hospitalized patients who agreed to participate in the research were grouped according to the shift in which blood was collected (38 subjects from the morning shift and 79 from the afternoon shift), had their BDNF levels measured and responded to other questionnaires. Respondents were further grouped by age into three ranges: 18-30, 31-50 and 51-70 years. Results We found a significant difference in the distribution of BDNF between the two shifts in which blood samples were collected, with the afternoon group having higher BDNF levels (U = 1906.5, p = 0.018). A difference was observed only between the 18-30 group and the 51-70 group in the afternoon shift (Umorning = 1107, pmorning = 0.575; Uafternoon = 7175, pafternoon = 0.028). Conclusions The population whose blood samples were collected in the afternoon showed significantly higher values of BDNF compared to those of the morning shift. This same population presented lower BDNF levels when associated with ASD subtypes A1, A2, and A. We hypothesize that the lower values of BDNF measured in the morning shift were due to a response to the circadian cycle of cortisol, whose action inhibits the expression of serum neurotrophins.


Resumo Objetivo Verificar a associação entre os níveis de fator neurotrófico derivado do cérebro (brain-derived neurotrophic factor [BDNF]) e transtorno de estresse agudo (TEA) em pacientes que sofreram trauma físico. Métodos Os dados foram coletados em um hospital de emergência de Porto Alegre, Rio Grande do Sul, Brasil. Os participantes eram maiores de 18 anos, vítimas de trauma físico e estavam hospitalizados por um período mínimo de 48 horas. Um total de 117 pacientes hospitalizados que concordaram em participar da pesquisa foram agrupados de acordo com o turno de realização da coleta de sangue (38 sujeitos no turno da manhã e 79 sujeitos no turno da tarde), tiveram seus níveis de BDNF medidos e responderam a outros questionários. Os entrevistados também foram agrupados por idade em três faixas etárias: 18-30, 31-50 e 51-70 anos. Resultados Encontramos uma diferença significativa na distribuição de BDNF entre os turnos, sendo que o grupo da tarde apresentou níveis maiores de BDNF (U = 1906,5, p = 0,018). Houve diferença entre o grupo de 18-30 anos e o de 51-70 anos no turno da tarde (Umanhã = 1107, pmanhã = 0,575; Utarde = 7175, ptarde = 0,028). Conclusões A população cuja coleta ocorreu à tarde apresentou valores significativamente maiores de BDNF em relação à coleta do turno da manhã. Esta mesma população apresentou menores níveis dessa neurotrofina quando associada com os subtipos A1, A2 e A de TEA. É possível hipotetizar que os menores valores de BDNF aferidos na coleta do turno da manhã se devam a uma resposta ao ciclo circadiano do cortisol, cuja ação inibe a expressão de neurotrofinas séricas.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Aged , Young Adult , Wounds and Injuries/psychology , Brain-Derived Neurotrophic Factor/metabolism , Brazil , Hydrocortisone/metabolism , Biomarkers/metabolism , Surveys and Questionnaires , Circadian Rhythm , Stress Disorders, Traumatic, Acute/blood , Emergency Service, Hospital , Emergency Treatment/methods , Hospitalization , Middle Aged
20.
Rev. enferm. UFSM ; 9: [19], jul. 15, 2019.
Article in Portuguese | LILACS (Americas), BDENF | ID: biblio-1024667

ABSTRACT

Objetivo: identificar a associação dos aspectos demográficos, clínicos e do manejo terapêutico no desfecho dos pacientes diagnosticados com sepse em uma emergência hospitalar. Método: documental retrospectivo, 312 prontuários de pacientes sépticos, realizado análise descritiva, comparações de dados categóricos utilizaram-se os Testes de Qui quadrado ou Exato de Fisher, com correção de Monte Carlo. Resultados: idade média 65 (±17,66) anos, 51,3% eram mulheres, 52,6% hipertensos, 28,5% diabéticos, 27,2% cardiopatas, 74% diagnosticados com sepse 52,3% foco infeccioso pulmonar. Existe associação entre as variáveis demográficas e os desfechos (p<0,05). Histórico de acidente vascular encefálico, cirrose, cardiopatia e choque séptico associam-se ao óbito (p<0,05). Sinais de alerta e disfunções orgânicas avaliadas associam-se ao desfecho. Foco infeccioso (p=1) e taquicardia (p=0,823) não tem associação com desfecho nem com gravidade da sepse (p=0,120). Conclusão: há associação entre o perfil demográfico do paciente, comorbidades, disfunções orgânicas e manejo terapêutico, com a gravidade da sepse e o desfecho.


Aim: To identify the association of demographic, clinical and therapeutic management aspects with the outcome of patients diagnosed with sepsis in a hospital emergency. Method: retrospective documentary, 312 records of septic patients, descriptive analysis, comparisons of categorical data were used using Chi-square or Fisher's exact tests, with Monte Carlo correction. Results: mean age 65 (± 17.66) years, 51.3% were women, 52.6% hypertensive, 28.5% diabetic, 27.2% heart disease, 74% diagnosed with sepsis 52.3% infectious pulmonary focus. There is an association between demographic variables and outcomes (p <0.05). History of stroke, cirrhosis, heart disease, and septic shock are associated with death (p <0.05). Warning signs and organ dysfunction evaluated are associated with the outcome. Infectious focus (p = 1) and tachycardia (p = 0.823) has no association with outcome or severity of sepsis (p = 0.120). Conclusion: there is an association between patient demographic profile, comorbidities, organ dysfunction and therapeutic management, with sepsis severity and outcome.


Objetivo: identificar la asociación de los aspectos demográficos, clínicos y terapeuticos en el resultado de pacientes diagnosticados con sepsis en una emergencia hospitalar. Método: documental retrospectivo, se utilizaron 312 registros de pacientes sépticos, análisis descriptivo, comparaciones de datos categóricos utilizando Chi-cuadrado o pruebas exactas de Fisher, con corrección de Monte Carlo. Resultados: edad media 65 (± 17.66) años, 51.3% eran mujeres, 52.6% hipertensos, 28.5% diabéticos, 27.2% enfermedades del corazón, 74% diagnosticados con sepsis 52.3% foco pulmonar infeccioso. Existe una asociación entre las variables demográficas y los resultados (p <0.05). Los antecedentes de accidente cerebrovascular, cirrosis, enfermedad cardíaca y shock séptico están asociados con la muerte (p <0.05). Las señales de advertencia y la disfunción orgánica evaluada están asociadas con el resultado. El foco infeccioso (p = 1) y la taquicardia (p = 0.823) no tienen asociación con el resultado o la gravedad de la sepsis (p = 0.120). Conclusión: existe una asociación entre el perfil demográfico del paciente, las comorbilidades, la disfunción orgánica y el tratamiento terapéutico, con la severidad y el resultado de la sepsis.


Subject(s)
Humans , Health Profile , Nursing , Sepsis , Emergency Service, Hospital
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