Assuntos
Medicina de Família e Comunidade/normas , Pneumopatias/diagnóstico , Pneumopatias/etiologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Guias de Prática Clínica como Assunto , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Currículo , Educação Médica Continuada , Feminino , Previsões , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Estados UnidosAssuntos
Esgotamento Psicológico , Internato e Residência , Esgotamento Profissional , Humanos , MédicosAssuntos
Anemia/epidemiologia , Técnicas de Apoio para a Decisão , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hiponatremia/epidemiologia , Tempo de Internação/estatística & dados numéricos , Readmissão do Paciente , Comorbidade , Hemoglobinas/metabolismo , Hospitalização , Humanos , Medição de Risco , Índice de Gravidade de DoençaRESUMO
Crohn's disease is associated with treatment and non-treatment infectious complications. Among the treatment-related infectious complications, Histoplasma infection is interesting because of significant overlap between its symptoms and Crohn's disease exacerbation. It is often mistaken as Crohn's disease exacerbation. We present a case of disseminated histoplasmosis presenting as Histoplasma epiglottitis in a patient with Crohn's disease maintained on infliximab, prednisone, and azathioprine.
Assuntos
Doença de Crohn/complicações , Epiglotite/etiologia , Histoplasma , Histoplasmose/etiologia , Imunossupressores/efeitos adversos , Adulto , Anticorpos Monoclonais/efeitos adversos , Anticorpos Monoclonais/uso terapêutico , Antifúngicos/uso terapêutico , Azatioprina/efeitos adversos , Azatioprina/uso terapêutico , Doença de Crohn/tratamento farmacológico , Quimioterapia Combinada , Epiglotite/diagnóstico , Epiglotite/tratamento farmacológico , Histoplasmose/diagnóstico , Histoplasmose/tratamento farmacológico , Humanos , Imunossupressores/administração & dosagem , Imunossupressores/uso terapêutico , Infliximab , Masculino , Prednisona/efeitos adversos , Prednisona/uso terapêuticoRESUMO
BACKGROUND: Readmission and mortality after hospitalization for community-acquired pneumonia (CAP) and heart failure (HF) are publically reported. This systematic review assessed the impact of social factors on risk of readmission or mortality after hospitalization for CAP and HF-variables outside a hospital's control. METHODS: We searched OVID, PubMed and PSYCHINFO for studies from 1980 to 2012. Eligible articles examined the association between social factors and readmission or mortality in patients hospitalized with CAP or HF. We abstracted data on study characteristics, domains of social factors examined, and presence and magnitude of associations. RESULTS: Seventy-two articles met inclusion criteria (20 CAP, 52 HF). Most CAP studies evaluated age, gender, and race and found older age and non-White race were associated with worse outcomes. The results for gender were mixed. Few studies assessed higher level social factors, but those examined were often, but inconsistently, significantly associated with readmissions after CAP, including lower education, low income, and unemployment, and with mortality after CAP, including low income. For HF, older age was associated with worse outcomes and results for gender were mixed. Non-Whites had more readmissions after HF but decreased mortality. Again, higher level social factors were less frequently studied, but those examined were often, but inconsistently, significantly associated with readmissions, including low socioeconomic status (Medicaid insurance, low income), living situation (home stability rural address), lack of social support, being unmarried and risk behaviors (smoking, cocaine use and medical/visit non-adherence). Similar findings were observed for factors associated with mortality after HF, along with psychiatric comorbidities, lack of home resources and greater distance to hospital. CONCLUSIONS: A broad range of social factors affect the risk of post-discharge readmission and mortality in CAP and HF. Future research on adverse events after discharge should study social determinants of health.
