RESUMEN
A Patient Blood Management programme was established at the University Hospital of Zurich, along with a monitoring and feedback programme, at the beginning of 2014 with a first analysis reported in 2015. Our study aimed to investigate the further impact of this Patient Blood Management monitoring and feedback programme on transfusion requirements and related costs. We included adult patients discharged between 2012 and 2017. A total of 213,882 patients underwent analysis: 66,659 patients in the baseline period (2012-2013); 35,309 patients in the year after the introduction of the Patient Blood Management monitoring and feedback programme (2014) and 111,914 patients in the continued sustainability period (2015-2017). The introduction of the Patient Blood Management monitoring and feedback programme reduced allogeneic blood product transfusions by 35%, from 825 units per 1000 hospital discharges in 2012 to 536 units in 2017. The most sustained effect was an approximately 40% reduction in red blood cell transfusions, from 535 per 1000 discharges to 319 units. Fewer patients were transfused in the periods after the introduction of the Patient Blood Management monitoring and feedback programme (6251 (9.4%) vs. 2932 (8.3%) vs. 8196 (7.3%); p < 0.001). Compared with 2012, the yearly OR for being exposed to any blood transfusion declined steadily after the introduction of the Patient Blood Management monitoring and feedback programme to 0.64 (95%CI 0.61-0.68; p < 0.001) in 2017. For patients requiring extracorporeal membrane oxygenation, transfusion requirements were also sustainably reduced. This reduction in allogeneic blood transfusions led to savings of 12,713,754 Swiss francs (£ 9,497,000 sterling; EUR 11,100,000; US$ 12,440,000) in blood product acquisition costs over 4 years. In-hospital mortality was not affected by the programme. The Patient Blood Management monitoring and feedback programme sustainably reduced transfusion requirements and related costs, without affecting in-hospital mortality.
Asunto(s)
Transfusión Sanguínea/economía , Monitoreo Fisiológico/economía , Monitoreo Fisiológico/métodos , Adulto , Ahorro de Costo , Transfusión de Eritrocitos/economía , Oxigenación por Membrana Extracorpórea , Retroalimentación , Femenino , Adhesión a Directriz , Mortalidad Hospitalaria , Humanos , MasculinoRESUMEN
We present a 68-year-old female who suffered extensive complications after severe myocardial infarction (MI) in the circumflex (CX) territory. At 24 hours after the initial event, the patient presented with a covered right ventricular free wall rupture (FWR) which was followed by a rupture of the left posterior wall ten days later. We report here on a rare case of delayed two-step biventricular FWR after severe MI in the CX territory.
Asunto(s)
Rotura Cardíaca Posinfarto/etiología , Ventrículos Cardíacos , Infarto del Miocardio/complicaciones , Anciano , Procedimientos Quirúrgicos Cardíacos , Resultado Fatal , Femenino , Rotura Cardíaca Posinfarto/diagnóstico , Rotura Cardíaca Posinfarto/terapia , Ventrículos Cardíacos/patología , Ventrículos Cardíacos/cirugía , Humanos , Contrapulsador Intraaórtico , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/terapia , Derrame Pericárdico/etiología , Pericardiocentesis , Índice de Severidad de la Enfermedad , Factores de TiempoRESUMEN
OBJECTIVES: Titanium plate osteosynthesis (Synthes) is an alternative option for sternal closure. The indications and time point of application are still debated. This study investigated the application and feasibility of this technique after median sternotomy. METHODS: Forty-one patients (29 M/12F, mean age 63 ± 17 years) received the plate system for complicated sternal conditions. Indications, intraoperative course and postoperative follow-up were assessed. RESULTS: Sternal deformity was present in 5 % (2/41), sternal fractures in 17 % (7/41), bone defect in 12 % (5/41), wire loosening in 39 % (16/41) and pseudoarthrosis in 27 % (11/41). 54 % (22/41) of patients showed concomitant sternal infection. Two intraoperative complications were noted: mammary artery injury (1 patient), pleural injury (1 patient). At discharge the patients reported no pain (90 %, 37/41) or only occasional discomfort (10 %, 4/41). Postoperative complications were subcutaneous hematoma in 12 % (5/41), seroma in 12 % (5/41) and sternal reinfection in 7 % (3/41). 12 % (5/41) showed occasional discomfort and 7 % (3/41) had persistent pain leading to plate removal. CONCLUSION: The Titanium Sternal Fixation System is comfortable and easy to use. It can be used to treat a wide spectrum of indications, especially for pseudoarthrosis, an entity which has not yet received sufficient attention.
Asunto(s)
Infecciones Bacterianas/cirugía , Placas Óseas , Hilos Ortopédicos , Procedimientos de Cirugía Plástica/instrumentación , Esternotomía , Dehiscencia de la Herida Operatoria/cirugía , Infección de la Herida Quirúrgica/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Infecciones Bacterianas/complicaciones , Niño , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Fracturas Óseas/etiología , Hematoma/etiología , Humanos , Masculino , Arterias Mamarias/lesiones , Persona de Mediana Edad , Pleura/lesiones , Seudoartrosis/etiología , Procedimientos de Cirugía Plástica/métodos , Factores de Riesgo , Seroma/etiología , Esternotomía/efectos adversos , Dehiscencia de la Herida Operatoria/etiología , Infección de la Herida Quirúrgica/microbiología , Técnicas de Sutura , Titanio , Resultado del TratamientoRESUMEN
OBJECTIVE: Children of mentally ill parents are known as a high-risk population for the development of psychological disturbances. In this study, the psychiatric diagnoses, the severity and chronicity and the comorbidity of a parental mental illness as well as the non-specific parameters were examined in terms of their influence on the children's mental health. METHODS: n = 62 children of psychiatric inpatients were examined regarding their psychic symptomatology, assessed with the CBCL-Parent Report Form. The psychiatric ICD-10 diagnoses and comorbidities as well as the severity (CGI) of the mentally ill parents were collected from psychiatric assessment forms. RESULTS: Children of parents with personality disorders (PD) are evaluated as highly affected by their parents, regardless of whether the PD is the primary or the comorbid diagnosis. Children of parents suffering from addictive disorders are seen as the least affected by their parents. Overall, children of parents with multiple diagnoses tend to be rated as more affected. Severity of illness and chronicity do not have a considerable impact on the children's development of mental health problems. Strikingly, children with a high length of exposure to a parental illness are psychologically less affected than children with shorter times of exposure. Thus, children possibly acquire effective coping mechanisms with increasing time of exposure. CONCLUSIONS: The results reveal the necessity of preventive programmes, especially in case of personality disorders. In addition the necessity for external assessment of the children becomes clear, especially in those cases where the parents exhibit a poor acceptance of their disease.
Asunto(s)
Hijo de Padres Discapacitados/psicología , Trastornos Mentales/psicología , Padres/psicología , Adaptación Psicológica , Adolescente , Adulto , Niño , Enfermedad Crónica , Comorbilidad , Familia , Femenino , Humanos , Clasificación Internacional de Enfermedades , Masculino , Trastornos Mentales/epidemiología , Persona de Mediana Edad , Satisfacción Personal , Trastornos de la Personalidad/psicología , Adulto JovenRESUMEN
In a 70-year-old patient with severe aortic valve stenosis, preoperative standard imaging (transthoracic echocardiography and angiography) detected an unclear subannular cavity structure. Initially interpreted as an aneurysm of Valsalva, the structure was identified intraoperatively as a huge chronic abscess cavity and exclusion was carried out by pericardial patch plasty. This case draws attention to the importance of a differential diagnosis of an abscess due to infective endocarditis in cases of unclear subannular structures rashly diagnosed as aneurysm of Valsalva.
Asunto(s)
Absceso/diagnóstico , Aneurisma de la Aorta/diagnóstico , Estenosis de la Válvula Aórtica/diagnóstico , Endocarditis/diagnóstico , Seno Aórtico/patología , Absceso/microbiología , Absceso/cirugía , Anciano , Estenosis de la Válvula Aórtica/microbiología , Estenosis de la Válvula Aórtica/cirugía , Enfermedad Crónica , Angiografía Coronaria , Diagnóstico Diferencial , Ecocardiografía Transesofágica , Endocarditis/complicaciones , Endocarditis/microbiología , Implantación de Prótesis de Válvulas Cardíacas , Humanos , Masculino , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
OBJECTIVE: The COBRA therapy (combination therapy in early rheumatoid arthritis) has proven to be an effective treatment for early RA, but is rarely prescribed. A survey showed reluctance of Dutch reumatologists to apply COBRA therapy in early RA. The present qualitative study was carried out to further explore the reservation of Dutch rheumatologists towards prescribing COBRA therapy and include patients' view on (components of) COBRA therapy. METHODS: Two focus group discussions were undertaken for rheumatologists (n(1) = 8, n(2) = 7) and two for patients (n(1) = 4, n(2) = 8). In addition, in-depth interviews were conducted with 11 rheumatologists and 1 patient. These were taped and transcribed. Two independent researchers identified themes and these were discussed with three other researchers. RESULTS: Rheumatologists were positive concerning effectiveness of COBRA therapy, but highly concerned about their patients' possible negative reaction to the large amount of pills to be prescribed. In addition, rheumatologists perceived lack of time explaining and prescribing COBRA therapy and felt uncomfortable prescribing high doses of prednisolone. Patients were positive about an aggressive combination therapy such as COBRA, and they had no qualms taking many pills if this could improve their prognosis. Patients associated prednisolone with negative side-effects, but were also aware of the benefits and the need of prednisolone in rough times. A decrease in the amount of pills after intensive treatment was highly appreciated. CONCLUSION: Rheumatologists and patients differed in opinion about the use of COBRA therapy. Rheumatologists were particularly concerned about their patients' reaction towards them prescribing such an aggressive and complex therapy, whereas patients, while aware of the side-effects, were most interested in suppressing illness symptoms and reducing future damage regardless of the amount of pills.
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Antirreumáticos/uso terapéutico , Artritis Reumatoide/tratamiento farmacológico , Actitud del Personal de Salud , Actitud Frente a la Salud , Antirreumáticos/efectos adversos , Quimioterapia Combinada , Femenino , Grupos Focales , Humanos , Masculino , Metotrexato/efectos adversos , Metotrexato/uso terapéutico , Países Bajos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Prednisolona/efectos adversos , Prednisolona/uso terapéutico , Sulfasalazina/efectos adversos , Sulfasalazina/uso terapéuticoRESUMEN
OBJECTIVE: To investigate the performance of low-dose, dual-source computed tomography (DSCT) coronary angiography in the step-and-shoot (SAS) mode for the diagnosis of significant coronary artery stenoses in comparison with conventional coronary angiography (CCA). DESIGN, SETTING AND PATIENTS: Prospective, single-centre study conducted in a referral centre enrolling 120 patients (71 men, mean (SD) age 68 (9) years, mean (SD) body mass index 26.2 (3.2) kg/m2). All study participants underwent DSCT in the SAS mode and CCA within 14 days. Twenty-seven patients were given intravenous beta blockers for heart rate reduction before CT. Patients were excluded if a target heart rate
Asunto(s)
Angiografía Coronaria/métodos , Estenosis Coronaria/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Adulto , Anciano , Anciano de 80 o más Años , Distribución de Chi-Cuadrado , Medios de Contraste , Femenino , Frecuencia Cardíaca , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Dosis de Radiación , Interpretación de Imagen Radiográfica Asistida por Computador , Sensibilidad y Especificidad , Estadísticas no ParamétricasRESUMEN
OBJECTIVE: To prospectively investigate the diagnostic accuracy of dual-source 64-slice computed tomography coronary angiography (CTCA), calcium scoring (CS) and both methods combined for assessing significant coronary artery stenoses relative to conventional coronary angiography (CCA). DESIGN, SETTING AND PATIENTS: Prospective, single-centre study conducted in a referral centre enrolling 74 consecutive patients (24 women; mean age 62 (SD 12) years) from August-October 2006. All study participants underwent CS, CTCA and CCA. Diagnostic accuracy was calculated for CS, CTCA and both methods combined relative to CCA. Not-evaluative segments at computed tomography were considered false positive. RESULTS: CCA identified 139 stenoses in 36 patients. Average heart rate during CTCA was 68 (13) bpm (range 35-102 bpm), and 2% of segments (21/1001) in 11% of patients (8/74) were not evaluative. Considering these as false positives, per-patient sensitivity and specificity was 98% and 87%. When using CS cut-off values of 0 to exclude and >or=400 to predict stenosis, sensitivity and specificity of CS was 100% and 70%, respectively. Combining CS and CTCA in all patients correctly reclassified five patients, while six were falsely classified as stenotic, all of them correctly classified with CTCA alone. Using CS only in patients with not-evaluative segments correctly reclassified five patients while avoiding misclassifications (sensitivity 98%, specificity 100%). CONCLUSION: Dual-source CTCA allows the diagnosis of significant stenoses with a high diagnostic accuracy. Selectively combining CS with CTCA in patients with not-evaluative coronary segments improves specificity from 87% to 100% without decreasing the high sensitivity of 98%.
Asunto(s)
Calcinosis/diagnóstico , Angiografía Coronaria/métodos , Enfermedad de la Arteria Coronaria/diagnóstico , Tomografía Computarizada por Rayos X/métodos , Anciano , Calcinosis/complicaciones , Enfermedad de la Arteria Coronaria/complicaciones , Vasos Coronarios/patología , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Curva ROC , Sensibilidad y EspecificidadRESUMEN
In total, 132 cancer patients in four oncology outpatient clinics in Hamburg completed a questionnaire consisting of a newly designed instrument for measuring psychosocial support. In this questionnaire, patients were asked about their knowledge of institutions offering support, their previous participation in psychosocial support, the reasons for participation and their experience with and attitude towards it. A second section consisted of standardized instruments: the EORTC QLQ-C30 questionnaire (Aaronson), the Brief Symptom Inventory (Derogatis and Melisaratos), the List of Physical Complaints (von Zerssen and Koller) and the Impact of Event Scale (Horowitz). Descriptive and variance-analytical methods were used for the analysis of results. Most respondents were women (88%). The largest group (72%) had a history of breast cancer. A total of 28% of the patients in the sample had participated in psychosocial support, about 4% of these in self-help groups. Participants in psychosocial support did not differ from non-participants in gender, but they were significantly younger. They showed considerably higher scores in emotional and physical distress than non-participants, their attitude towards psychosocial support was more positive, and they had more knowledge about institutions offering support than non-participants. The main reasons listed for their participation in psychosocial support were mental distress, a desire to obtain help, and the wish to cope with the illness. The main reason for not participating was sufficient support from the family, friends or doctors.