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1.
J Psychiatr Res ; 160: 64-70, 2023 04.
Artigo em Inglês | MEDLINE | ID: mdl-36774832

RESUMO

BACKGROUND: Delirium in the intensive care unit (ICU) is a common but serious condition that has been associated with in-hospital mortality and post-discharge psychological dysfunction. The aim of this before and after study is to determine the effect of a multidisciplinary care model entailing daily ICU rounds with a psychiatrist on the incidence of delirium and clinical outcomes. OBJECTIVE: To assess the impact of a proactive psychiatry consultation model in the surgical ICU on the incidence and duration of delirium. METHODS: This was a prospective, single institution, observational controlled cohort pilot study of adult patients admitted to a surgical ICU. A control group that received standard of care (SOC) with daily delirium prevention care bundles in the pre-intervention period was compared to an intervention group, which had a psychiatrist participate in daily ICU rounds (post-intervention period). The primary outcome was delirium incidence. The secondary outcomes were: delirium duration, ventilator days, hospital and ICU length of stay, and in-hospital mortality. RESULTS: A total of 104 patients were enrolled and equally split between SOC and intervention groups; 95 contributed to analysis. The overall incidence of ICU delirium was 19%. SOC and intervention groups had similar rates of delirium (21% vs 18%, p = 0.72). None of the secondary outcomes statistically significantly differed between the two groups. CONCLUSION: Delirium in ICU patients is a potentially preventable condition with serious sequelae. There was no difference in delirium incidence or duration between patients receiving SOC or patients who had multidisciplinary rounds with a psychiatrist.


Assuntos
Delírio , Adulto , Humanos , Delírio/epidemiologia , Delírio/prevenção & controle , Estudos Prospectivos , Projetos Piloto , Incidência , Assistência ao Convalescente , Alta do Paciente , Unidades de Terapia Intensiva , Tempo de Internação
2.
J Emerg Med ; 38(3): 354-8, 2010 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-18584992

RESUMO

In this case report, ultrasound-guided radial artery catheterization and a modified Allen's test were performed by Emergency Department (ED) physicians to facilitate the management of an intubated, critically injured patient. Ultrasound was demonstrated to be a valuable tool in determining collateral circulation and guiding radial artery cannulation in a patient unable to cooperate with the traditional Allen's test. Ultrasound guidance may reduce the risk of radial artery catheterization in severely injured patients.


Assuntos
Cateterismo Periférico/métodos , Artéria Radial/diagnóstico por imagem , Ultrassonografia de Intervenção , Adolescente , Serviço Hospitalar de Emergência , Mãos/irrigação sanguínea , Humanos , Masculino
3.
Am J Trop Med Hyg ; 66(5): 605-10, 2002 May.
Artigo em Inglês | MEDLINE | ID: mdl-12201599

RESUMO

Between March and October 2000, 157 suspected cases of leptospirosis hospitalized with complications of Weil's syndrome and a mortality of 8% were identified in Salvador, Brazil. We conducted a population-based case-control study to identify risk factors for acquisition of leptospirosis in neighborhoods with high endemicity during the rainy season-associated urban epidemic. Sixty-six (65%) of 101 laboratory-confirmed cases and 125 age and sex-matched healthy neighborhood controls were interviewed. Residence in proximity to an open sewer (matched odds ratio [OR] = 5.15, 95% confidence interval [CI] = 1.80-14.74), peri-domiciliary sighting of rats (OR = 4.49, 95% CI = 1.57-12.83), sighting groups of five or more rats (OR = 3.90, 95% CI = 1.35-11.27), and workplace exposure to contaminated environmental sources (OR = 3.71, 95% CI = 1.35-10.17) were found to be independent risk factors for acquiring disease. Some of these risk factors are amenable to focused interventions, which include provision of closed drainage systems for sewage and reduction of rodent populations in the peri-domicilary environment. Environmental control of transmission may help to greatly reduce the incidence of severe leptospirosis.


Assuntos
Leptospirose/epidemiologia , População Urbana/estatística & dados numéricos , Adolescente , Adulto , Animais , Brasil/epidemiologia , Estudos de Casos e Controles , Surtos de Doenças , Reservatórios de Doenças , Emprego , Feminino , Humanos , Masculino , Ratos , Valores de Referência , Fatores de Risco , Saneamento/normas , Estações do Ano
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