RESUMO
CONTEXT: Inefficiencies in care coordination-specifically, the lack of an effective method of communication among multiple health care professionals-often leads to an unnecessary increase in length of hospital stay. OBJECTIVE: To determine whether daily integrated care conferences (ICCs) would significantly reduce the length of stay for patients with chronic obstructive pulmonary disease (COPD) exacerbation. METHOD: Patients with COPD exacerbation were selected for the study using electronic medical records from 2 osteopathic community hospitals located in northeastern Ohio. One hospital used daily ICCs and the other hospital did not use daily ICCs. The average length of stay for patients at each hospital was retrospectively investigated. RESULTS: A total of 1683 patients with COPD exacerbation were selected. The mean (SD) length of stay in the hospital with daily ICCs was 3.37 (2.89) days compared with 5.55 (3.99) days in the hospital without daily ICCs (P<.0001). At the hospital with daily ICCs, patients aged 40 to 69 years had a 67% shorter hospital stay and patients aged 70 to 99 years or older had a 36% shorter length of stay compared with patients at the hospital without daily ICCs. CONCLUSION: Daily integrated care conferences significantly reduced the length of stay for patients with COPD exacerbation at an osteopathic community-based hospital. Implementing daily ICCs may make current health care services and coordinated care more efficient, resulting in decreased costs and length of stay for patients with COPD exacerbation.
Assuntos
Prestação Integrada de Cuidados de Saúde/métodos , Tempo de Internação/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/terapia , Visitas de Preceptoria/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ohio , Estudos RetrospectivosRESUMO
Penicillin desensitization is indicated in pregnant patients with severe allergies to penicillin with syphilis. The immediate effects of intramuscular epinephrine on the fetus during desensitization remain unreported. We describe a pregnant patient with secondary syphilis and penicillin allergy who developed anaphylaxis during penicillin desensitization. Anaphylaxis resolved after administration of intramuscular epinephrine. Throughout the procedure, continuous electronic fetal monitoring showed a stable fetus without a decrease in variability, tachycardia, decelerations, or signs of fetal distress. This case showed that intramuscular epinephrine is effective in treatment of anaphylaxis in a pregnant patient with little to no immediate effects on the fetus.
Assuntos
Anafilaxia/tratamento farmacológico , Dessensibilização Imunológica/métodos , Epinefrina/administração & dosagem , Feto/efeitos dos fármacos , Penicilinas , Complicações Infecciosas na Gravidez/tratamento farmacológico , Sífilis/tratamento farmacológico , Anafilaxia/imunologia , Dessensibilização Imunológica/efeitos adversos , Hipersensibilidade a Drogas/tratamento farmacológico , Epinefrina/efeitos adversos , Feminino , Frequência Cardíaca Fetal/efeitos dos fármacos , Humanos , Injeções Intramusculares , Penicilinas/administração & dosagem , Penicilinas/efeitos adversos , Penicilinas/imunologia , Gravidez , Segundo Trimestre da Gravidez , Adulto JovemAssuntos
Angioedemas Hereditários/tratamento farmacológico , Proteína Inibidora do Complemento C1/uso terapêutico , Fator XII/genética , Laringe/patologia , Lábio/patologia , Mutação de Sentido Incorreto/genética , Complicações na Gravidez/tratamento farmacológico , Adulto , Angioedemas Hereditários/diagnóstico , Angioedemas Hereditários/genética , Anticoncepcionais Orais Hormonais/efeitos adversos , Terapia de Reposição de Enzimas , Feminino , Humanos , Linhagem , Gravidez , Complicações na Gravidez/diagnóstico , Adulto JovemRESUMO
Cold urticaria and cholinergic urticaria are two distinct entities. The presentation of exclusive cold-induced cholinergic urticaria is very rare. The patient described herein had experienced urticaria in the exclusive setting of exercising in a cold environment. Urticarial testing including laboratory and in-office testing was all negative. The patient has prevented urticaria symptoms with oral antihistamine therapy. Pure cold-induced cholinergic urticaria is rarely described in literature. This form of urticaria has yet to be described in a pediatric patient.
