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1.
Health Sci Rep ; 6(10): e1564, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37841940

RESUMO

Background: It is known that nursing home patients who have sustained a previous fall are at a higher average risk for recurrent falls. Therefore, these patients require closer attention and monitoring for fall prevention. Methods: We conducted a retrospective review in our Level 1 Trauma Center, who sustained a ground-level fall in a nursing home from January 2017 to December 2018. Inclusion criteria involved patients aged 65 or older, admitted from nursing homes. Logistic regression analysis was performed to identify factors associated with recurrent fall. Results: A total of 445 patients were identified. Among them, 47 (10.6%) patients sustained recurrent falls, The median age was 83.3 years old and. The recurrent fall group was more likely to have chronic kidney disease (CKD) (27.1% vs. 13.1%, p = 0.02) and diabetes (47.9% vs. 31%, p = 0.02). The median number of medications taken by a patient was 8.78. Overall, 176 (39.5%) patients sustained any injury, and 25 (5.6%) patients died within the study period. The presence of CKD (odds ratio [OR], 2.34; 95% confidence interval [CI], 1.15-4.76, p = 0.02) and polypharmacy (number of medications of 9 or above) (OR, 2.07; 95% CI, 1.12-3.82, p = 0.02) were independent risk factors for recurrent falls. Conclusions: CKD and polypharmacy were associated with a risk of recurrent falls among nursing home patients. The incidence of falls has a multifactorial etiology, and it is important to identify such risk factors to better prevent the morbidities and mortalities associated with fall-related injuries.

2.
J Surg Res ; 282: 246-253, 2023 02.
Artigo em Inglês | MEDLINE | ID: mdl-36332303

RESUMO

INTRODUCTION: Patient satisfaction is an important indicator of quality in health care and is linked to clinical outcomes, patient retention, and professional satisfaction. Patients admitted to the hospital from the emergency department may not understand their diagnosis, reason for admission or plan of care, which can adversely impact their hospital experience. We aim to identify risk factors that contribute to poor patient-physician communication and to assess the effects of raising awareness of these issues to hospital providers. METHODS: From November 2020 to April 2021, patients admitted to the surgical floor were surveyed within 24 h of admission. Relevant data were extracted through retrospective chart review. Residents and attendings were debriefed regarding the improving communication. Surveys answered before and after the brief intervention were compared. RESULTS: One hundred thirty one patients who were admitted to the surgical floor were surveyed. Nineteen did not know their diagnoses (14.5%), 29 could not explain their diagnoses (22.1%), and 28 did not know their treatment plans (21.4%). A total of 38 (29.0%) patients answered "no" to at least one question. Trauma patients (P = 0.034), patients with pain score >4 at time of admission (P = 0.038), age >65 y (P = 0.047), and patients with >3 comorbidities were more likely to answer "no" to at least one of the questions. Postintervention, a 10% reduction in number of patients answering "no" was observed. CONCLUSIONS: Trauma patients, patients with poor pain control, the elderly, and those with multiple comorbidities are more likely to experience poor patient-physician communication. Raising awareness of the importance of this matter resulted in an improvement in communication.


Assuntos
Comunicação , Médicos , Humanos , Idoso , Estudos Retrospectivos , Satisfação do Paciente , Fatores de Risco , Dor
3.
Am J Surg ; 222(2): 264-269, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33612255

RESUMO

BACKGROUND: Drug-specific agents for the reversal of direct oral anticoagulants (DOACs) were recently approved. We hypothesized that the approval of these reversal agents would lead improved outcomes for trauma patients taking DOACs. METHODS: A multicenter, prospective (2015-2018), observational study of all adult trauma patients taking DOACs who were admitted to one of fifteen participating trauma centers was performed. The primary outcome was mortality. RESULTS: For 606 trauma patients on DOACs, those reversed were older (78 vs. 74, p = 0.007), more severely injured (ISS: 16 vs. 5, p < 0.0001), had more severe head injuries (Head AIS: 2.9 vs. 1.3, p < 0.0001), and higher mortality (11% vs. 3%, p = 0.001). Patients who received drug-specific agents (idarucizumab, andexanet alfa) had higher mortality (30% vs. 8%, p = 0.04) than those reversed with factor concentrates. However, the low usage of drug-specific reversal agents limits our ability to assess their efficacy and safety. CONCLUSIONS: DOAC reversal was not independently associated with mortality. At present, the overall usage of drug-specific reversal agents is too sparing to meaningfully assess outcomes in trauma.


Assuntos
Coagulantes/uso terapêutico , Inibidores do Fator Xa/administração & dosagem , Hemorragia/prevenção & controle , Ferimentos e Lesões/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Monoclonais Humanizados/uso terapêutico , Fatores de Coagulação Sanguínea/uso terapêutico , Fator Xa/uso terapêutico , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Estudos Prospectivos , Proteínas Recombinantes/uso terapêutico , Taxa de Sobrevida , Centros de Traumatologia , Ferimentos e Lesões/complicações , Ferimentos e Lesões/mortalidade
4.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33431447

RESUMO

A 30-year-old man walked into the emergency department after a suicide attempt by firing a nail from a pneumatic nail gun directed at his left temple. He was haemodynamically stable and neurologically intact, able to recall all events and moving all extremities with a Glascow Coma Scale of 15. CT of the brain showed a 6.3 cm nail in the right frontal region without major intracerebral vessel disruption. He was taken to the operating room for left temporal wound washout, debridement of gross contamination and closure with titanium cranial fixation plate. The foreign body was not accessible on initial surgical intervention and was left in place to define anatomy and plan for subsequent removal. Thin slice CT images were used to create 3D reconstructions to facilitate stereotactic navigation and foreign body removal via right craniotomy the following day. The patient tolerated the procedures well and recovered with full neurological function.


Assuntos
Hemorragia Cerebral Intraventricular/cirurgia , Craniotomia , Corpos Estranhos/cirurgia , Traumatismos Cranianos Penetrantes/cirurgia , Automutilação/cirurgia , Tentativa de Suicídio , Adulto , Encéfalo/diagnóstico por imagem , Encéfalo/cirurgia , Hemorragia Cerebral Intraventricular/diagnóstico , Hemorragia Cerebral Intraventricular/etiologia , Angiografia por Tomografia Computadorizada , Corpos Estranhos/etiologia , Traumatismos Cranianos Penetrantes/diagnóstico , Traumatismos Cranianos Penetrantes/etiologia , Humanos , Imageamento Tridimensional , Masculino , Automutilação/diagnóstico , Automutilação/etiologia , Crânio/diagnóstico por imagem , Crânio/lesões , Crânio/cirurgia
5.
J Emerg Nurs ; 45(2): 144-148, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30551800

RESUMO

BACKGROUND: ED boarding is a major issue in many hospitals. ED boarding occurs when there is insufficient hospital capacity to supply inpatient beds for admitted patients. ED boarding is not only a problem because of increased wait times for patients but also because it results in delays in administration of medication, higher rates of complications, and increased mortality. METHODS: In an attempt to improve patient flow and reduce time spent in the emergency department for patients requiring admission to the surgical intensive care unit (SICU), the emergency department, trauma service, and SICU collaborated on a guideline. The protocol developed focused on level I trauma-activated patients who were admitted directly from the emergency department to the SICU. We compared the transfer times before the protocol was initiated (January 1, 2016 to December 31, 2016) with the transfer times after initiation (January 1, 2017 to December 31, 2017) using a paired Students' t-test. Other outcome variables analyzed were hospital and intensive care unit (ICU) length of stay, mortality, complication rate, ventilator days, ventilator-free days, ICU-free days, and injury severity score (ISS). RESULTS: The average time to transfer for 2016 was 408.05 minutes (standard deviation 362.76) versus 142.73 minutes (standard deviation 101.90) for 2017. Emergency nurses saved 265.32 minutes per patient, totaling 8,755.56 minutes saved overall. Total amount of nursing hours saved was 146 hours. This was significant at P = 0.0015. No other variables analyzed were significant. CONCLUSION: We reduced the time to transfer from the emergency department to the SICU significantly by implementing a new protocol to expedite this transfer among level I trauma activations. Our protocol shows that a collaborative effort between the main emergency department and SICU can result in expedited care for injured and critically ill patients that not only increases care for the ill but also creates valuable space in a busy emergency department for better patient flow.


Assuntos
Enfermagem em Emergência/métodos , Serviço Hospitalar de Emergência , Unidades de Terapia Intensiva , Transferência de Pacientes/métodos , Melhoria de Qualidade , Ferimentos e Lesões/terapia , Estado Terminal , Humanos , Escala de Gravidade do Ferimento , Tempo de Internação/estatística & dados numéricos , Admissão do Paciente , Transferência de Pacientes/estatística & dados numéricos , Fatores de Tempo
6.
Am Surg ; 84(8): 1345-1349, 2018 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-30185314

RESUMO

With the advent of proton pump inhibitors and H. Pylori treatment, the old dogma "the most common cause of lower GI bleeding is upper GI bleeding" may no longer be valid. We sought to determine the most common causes of GI bleeding in patients without an obvious source and their clinical outcomes. We queried our hospital database for GI hemorrhage during 2015, excluding patients with obvious sources such as hematemesis or anal pathology. We collected data from patients with GI bleeding defined as bright red blood per rectum, melena, or a positive fecal occult blood test. The primary endpoints were etiology of GI bleed, amount of transfusions required, and types of interventions performed. Ninety-three patients were admitted with GI bleeding as defined previously: mean age was 74 years and mean hemoglobin was 8.2. Seventy-four per cent received blood transfusions with an average of 2 units transfused per patient; 22 per cent received 3 or more units of blood. The etiology of bleeding was 17 per cent upper GI source, 15 per cent lower GI source, and in 68 per cent, the source remained unknown. Bleeding stopped spontaneously in 86 per cent of patients and 9 per cent died. Endoscopy was performed in 71 per cent, but only 6 per cent underwent therapeutic endoscopic intervention. No patient had surgical or interventional radiologic procedures related to their GI bleed. Gastrointestinal bleeding, without an obvious source on presentation, rarely requires operative intervention or interventional radiologic procedure. Blood transfusions were not predictive of the need for therapeutic endoscopic intervention which was required in only 6 per cent of patients.


Assuntos
Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/uso terapêutico , Transfusão de Sangue , Endoscopia Gastrointestinal , Feminino , Hemorragia Gastrointestinal/terapia , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
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