971 resultados para Hospitalization
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RESUMO - Enquadramento: Com o aumento da Esperana Mdia de Vida, e o consequente envelhecimento generalizado da populao portuguesa, envelhecer com boa sade e com elevada qualidade de vida, onde as pessoas com mais de 65 anos tenham a possibilidade de expressar todas as suas potencialidades e manterem um papel ativo na sua vida e na sociedade, vincadamente um dos maiores desafios da sociedade contempornea. Desta forma, foi imposto sociedade e aos sistemas de sade, a criao de novas estratgias, que promovessem a reabilitao, a autonomia e a qualidade de vida dos idosos. Nesta linha, surgiu em Portugal a criao da Rede Nacional de Cuidados Continuados Integrados, combinando os cuidados de sade com o apoio social adequado a esta populao. Objetivos: Num primeiro objetivo, pretende-se avaliar os diferentes domnios da autoperceo de qualidade de vida de indivduos com idade igual ou superior a 65 anos, que se encontrem em perodo de internamento nas diferentes tipologias de Unidades de internamento da RNCCI (Unidade de Convalescena, Unidade de Mdia Durao e Reabilitao e Unidade de Longa Durao e Manuteno), bem como o seu grau de (in) dependncia, de risco de falha de auto-cuidado, e de risco de quedas. Como segundo objetivo propomo-nos a avaliar o grau de satisfao desses mesmos utentes, relativamente equipa de profissionais de sade e aos aspetos organizacionais e servios prestados pela Unidade da RNCCI, onde se encontram internados. Por ltimo, pretendemos averiguar a existncia ou inexistncia de relao entre as demais variveis em estudo com a tipologia de Unidade de internamento onde o utente se encontra a receber cuidados. Mtodos: O presente estudo caraterizado como um estudo quantitativo, de carter exploratrio, e de ndole descritivo-correlacional, que visa descrever fenmenos e, posteriormente, identificar e explorar possveis relaes entre variveis. O estudo centrou-se em indivduos, com idade igual ou superior a 65 anos, internados em Unidades de Cuidados Continuados da Rede Nacional de Cuidados Continuados Integrados, tendo sido efetuados dois questionrios distintos: um de satisfao, e um segundo instrumento de perceo da qualidade de vida, denominado de EasyCare, estando este j cientificamente validado a nvel internacional e nacional. Foi obtida uma amostra de 35 utentes.
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INTRODUCTION: The outbreak occurred between February and June 2006 and included identification of the cases, analysis of medical records, cultures from environmental sources, resistance analyses and genotyping profile of Serratia marcescens. METHODS: The cultures were composed of 13 blood isolates, 17 rectal and hand swabs and air sampling. RESULTS: The data obtained by pulsed-field gel electrophoresis exhibited three strains that contaminated 24 patients. Systemic infection was the most common in neonates with lower weight, long periods of hospitalization, premature delivery and the use of mechanical ventilation. CONCLUSIONS: This investigation revealed the multifactorial nature of the outbreak. An endemic clone of S. marcescens was detected.
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RESUMO - Introduo: As Infees nosocomiais da corrente sangunea associada a cateter venoso central (INCS-CVC) provocam um aumento das despesas hospitalares, traduzindo num aumento dos dias de internamento, consumo de antibiticos e de meios complementares de diagnstico e teraputica (MCDT). O presente estudo pretende avaliar os custos das INCS-CVC nos servios de internamento do CHLO, no ano de 2012. Metodologia: Realizou-se um estudo retrospetivo de caso-controlo para determinar os custos adicionais inerentes s INCS-CVC. Foram identificados, em 2012, 32 doentes com infeo e 31 sem infeo. Os controlos foram extrados da populao tendo igual grupo diagnstico Homogneo (GDH), idade, sexo, servio e durao de internamento e presena de CVC. As principais fontes de informao foram os registos da Comisso Controlo de Infeo (CCI) e do processo clinico eletrnico (PCE). A estimativa dos custos teve em considerao a durao de internamento, consumo de antibiticos e de MCDT. Resultados: A idade mdia dos casos e controlos foi de 66 e 69, respetivamente (p=0,432), 50% dos casos e 51,6% dos controlos eram do sexo masculino. Um total de 22 casos foi comparado com 22 controlos. A durao mdia de internamento dos casos e controlos foi de 70,8 e 36,6 dias, respetivamente (p=0,000). Em mdia o custo adicional por doente com antibiticos foi de 256 (p=0,001). Nos casos o consumo de anlises clinica foi 2,5 vezes superior e de exames imagiolgicos 2 vezes superior aos controlos. O custo total mdio adicional por doente foi de 20.737,6. Concluso: A ocorrncia de INCS-CVC resultou num aumento significativo de utilizao de recursos hospitalares e consequentemente num aumento dos custos hospitalares.
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RESUMO - Objetivos: Caracterizar a evoluo do consumo de medicamentos da rea cardiovascular entre 2002 e 2011. Caracterizar a evoluo dos internamentos com diagnstico principal cardiovascular, da taxa de mortalidade intra-hospitalar e da idade mdia dos doentes no episdio de internamento. Estabelecer relao entre o consumo de medicamentos e os episdios de internamento. Metodologia: Por consulta base de dados do Infarmed, determinar a evoluo do consumo de medicamentos por distrito de Portugal continental, medido em embalagens consumidas/1000 habitantes. Por consulta base de dados de GDH, determinar a evoluo do n de internamentos por doena cardiovascular dos residentes em cada distrito, determinado em internamentos/1000 habitantes. Determinar a evoluo da taxa de mortalidade dos episdios, avaliada em mortes/ 100 episdios. Determinar a evoluo da idade mdia. Correlao estatstica entre o consumo e n internamentos, mortalidade e idade. Regresso linear simples entre o consumo e n internamentos, mortalidade e idade. Resultados: O consumo de cardiotnicos e antiarrtmicos diminuiu, -26,45% e -16,48%, respetivamente. O consumo de anti hipertensores, vasodilatadores e antidislipidmicos aumentou, respetivamente, 78,73%; 11,18% e 180,91%. A incidncia de EAM aumentou 0,03%, a de IC 0,97% e a de AVC diminuiu -21,42%. A mortalidade diminuiu para EAM, IC e AVC, respetivamente, -31,48%; -18,03% e -15,06%. A idade mdia de ocorrncia de EAM manteve-se, a de IC aumentou 2,2 anos e a de AVC aumentou 1,5 anos. 23,9% da variao da incidncia de AVC pode ser explicada pelo consumo. A variao da taxa de mortalidade por EAM, IC e AVC que pode ser explicada pelo consumo de 30,9%; 13,0% e 32,9%. O consumo explica 48,3% e 73,5%, da variao da idade mdia de ocorrncia de internamentos por IC e AVC, respetivamente. Os anti hipertensores e os antidislipidmicos so as subclasses com correlao estatisticamente significativa mais relevante com a diminuio da taxa de mortalidade e aumento da idade mdia. Concluso: O consumo explica sensivelmente 50% do aumento da idade mdia, e em menor percentagem a evoluo do n de internamentos e da taxa de mortalidade. As subclasses dos anti hipertensores e dos antidislipidmicos so as principais responsveis pelo aumento do consumo, mas tambm so as que tem correlao estatisticamente significativa mais forte com os ganhos em sade.
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INTRODUCTION: A time series study of admissions, deaths and acute cases was conducted in order to evaluate the context of Chagas disease in Pernambuco. METHODS: Data reported to the Information Technology Department of the Brazilian National Health Service between 1980 and 2008 was collected for regions and Federal Units of Brazil; and microregions and municipalities of Pernambuco. Rates (per 100,000 inhabitants) of hospitalization, mortality and acute cases were calculated using a national hospital database (SIH), a national mortality database (SIM) and the national Information System for Notifiable Diseases (SINAN), respectively. RESULTS: The national average for Chagas disease admissions was 0.99 from 1995 to 2008. Pernambuco obtained a mean of 0.39 in the same period, with the highest rates being concentrated in the interior of the state. The state obtained a mean mortality rate of 1.56 between 1980 and 2007, which was lower than the national average (3.66). The mortality rate has tended to decline nationally, while it has remained relatively unchanged in Pernambuco. Interpolating national rates of admissions and deaths, mortality rates were higher than hospitalization rates between 1995 and 2007. The same occurred in Pernambuco, except for 2003. Between 2001 and 2006, rates for acute cases were 0.56 and 0.21 for Brazil and Pernambuco, respectively. CONCLUSIONS: Although a decrease in Chagas mortality has occurred in Brazil, the disease remains a serious public health problem, especially in the Northeast region. It is thus essential that medical care, prevention and control regarding Chagas disease be maintained and improved.
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RESUMO - Contexto: O presente estudo teve como objetivo apurar a demora mdia (DM) em doentes admitidos com pneumonia adquirida de comunidade (PAC), nos hospitais pblicos portugueses, que tiveram alta durante os anos de 2009, 2010 e 2011, identificar se esta influenciada por um grupo de fatores selecionados para o efeito e determinar se existe margem para a reduzir nos hospitais com uma DM mais elevada, atravs da comparao da mesma com as respetivas taxas de readmisso at 30 dias aps a alta. Metodologia: Para responder aos objetivos definidos recorreu-se base de dado dos resumos de alta, referente aos anos de 2009, 2010 e 2011, tendo-se selecionado, para o efeito, todos os episdios de internamento com diagnstico de admisso de PAC. O estudo considerou como medidas chave a DM e a taxa de readmisso at 30 dias aps alta. Para identificar a influncia de um conjunto de fatores na durao de internamento utilizaram-se duas abordagens: anlise descritiva dos dados e anlise estatstica dos dados, com recurso a uma Regresso Linear Mltipla. Numa ltima fase e com recurso anlise descritiva dos resultados obtidos, procedeu-se comparao da taxa de readmisso at 30 dias aps alta, por hospital, com as DM de internamento que mais se distanciaram das DM nacional e corrigida da populao em estudo. Resultados: Constatou-se que a no tratamento da PAC, em Portugal, entre 2009 e 2011, no sofreu em termos globais grandes oscilaes, tendo registado um valor de 9,47 dias nos trs anos em anlise. Concluiu-se ainda existir uma elevada variabilidade da DM entre hospitais e por hospital. Apesar das limitaes identificadas verificou-se que os fatores idade, sexo, quantidade de diagnsticos adicionais, quantidade de procedimentos, destino aps alta e tipo de hospital tm influncia sobre a durao de internamento dos doentes admitidos com PAC. Por fim conclui-se que os cinco hospitais com DM mais baixa apresentam, de uma forma geral e com exceo do hospital 44, uma taxa de readmisso at 30 dias aps alta inferior aos hospitais com DM mais elevada. Concluso: Os resultados apurados apontam no sentido de existir margem para reduzir a DM no tratamento da PAC, nos hospitais que registaram valores mais elevados entre 2009 e 2011, permitindo que os mesmos obtenham resultados mais custo-efetivos sem piorar os resultados em sade, medidos pela taxa de readmisses at 30 dias aps a alta e, simultaneamente garantindo que a qualidade dos cuidados prestados e a segurana do doente se mantm nos nveis desejados e exigidos. Sugere-se, no entanto, que em estudos futuros se detalhem algumas das matrias abordadas neste estudo com o objetivo de completar ou corroborar os resultados apresentados.
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RESUMO - O incio da crise econmica global colocou Portugal num contexto de restrio oramental que gerou repercusses em vrias reas, especificamente na sade mental das pessoas, evidenciadas a partir de 2009. O objetivo deste trabalho foi analisar o impacto da crise econmica no perfil de internamentos por Depresso Major na populao em idade ativa nos hospitais do SNS em Portugal Continental. Tratou-se de um estudo epidemiolgico, observacional, descritivo e transversal. Foi efetuada uma anlise individual, concretizada atravs da anlise dos episdios de internamento; e ecolgica, ao nvel de distritos; nos anos de 2008 e 2013. Foram analisados dados relativos aos episdios de internamento, populao em idade ativa e s camas de internamento de psiquiatria. Os resultados permitem afirmar que os distritos com menores ndices de urbanizao e de densidade populacional apresentaram taxas de internamento por Depresso Major, na populao em idade ativa, mais elevadas, e os seus habitantes apresentaram um risco de internamento superior, em ambos os perodos. Observou-se um aumento da taxa de internamentos e do risco de internamento por Depresso Major, na maioria dos distritos, no perodo de crise econmica. Adicionalmente, verificou-se que a taxa de internamentos foi influenciada positivamente pelo nmero de camas disponveis e ocorreu um aumento do nmero de internamentos por Depresso Major por cama de internamento disponvel, no perodo de crise econmica. Este estudo, de carater exploratrio e com limitaes identificadas, permitiu observar a variao geogrfica e temporal do internamento por Depresso Major fomentando a necessidade de investigao futura neste mbito.
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INTRODUCTION: This study aimed to determine the epidemiology of the three most common nosocomial infections (NI), namely, sepsis, pneumonia, and urinary tract infection (UTI), in a pediatric intensive care unit (PICU) in a developing country and to define the risk factors associated with NI. METHODS: We performed a prospective study on the incidence of NI in a single PICU, between August 2009 and August 2010. Active surveillance by National Healthcare Safety Network (NHSN) was conducted in the unit and children with NI (cases) were compared with a group (matched controls) in a case-control fashion. RESULTS: We analyzed 172 patients; 22.1% had NI, 71.1% of whom acquired it in the unit. The incidence densities of sepsis, pneumonia, and UTI per 1,000 patients/day were 17.9, 11.4, and 4.3, respectively. The most common agents in sepsis were Enterococcus faecalis and Escherichia coli (18% each); Staphylococcus epidermidis was isolated in 13% of cases. In pneumonias Staphylococcus aureus was the most common cause (3.2%), and in UTI the most frequent agents were yeasts (33.3%). The presence of NI was associated with a long period of hospitalization, use of invasive devices (central venous catheter, nasogastric tube), and use of antibiotics. The last two were independent factors for NI. CONCLUSIONS: The incidence of NI acquired in this unit was high and was associated with extrinsic factors.
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INTRODUCTION: Sequential antibiotic therapy (SAT) is safe and economical. However, the unnecessary use of intravenous (IV) administration usually occurs. The objective of this work was to get to know the effectiveness of an intervention to implement the SAT in a teaching hospital in Brazil. METHODS: This was a prospective and interventional study, historically controlled, and was conducted in the Hospital de Clínicas, Universidade Federal de Uberlândia, State of Minas Gerais, Brazil, a high complexity teaching hospital having 503 beds. In each of the periods, from 04/04/05 to 07/20/05 (pre-intervention) and from 09/24/07 to 12/20/07 (intervention), 117 patients were evaluated. After the pre-intervention period, guidelines were developed which were implemented during the intervention period along with educational measures and a reminder system added to the patients' prescription. RESULTS: In the pre-intervention and intervention periods, the IV antibiotics were used as treatment for a average time of 14.8 and 11.8 days, respectively. Ceftriaxone was the antibiotic most prescribed in both periods (23.4% and 21.6% respectively). Starting from the first prescription of antibiotics, the average length of hospitalization time was 21.8 and 17.5 days, respectively. The SAT occurred only in 4 and 5 courses of treatment, respectively, and 12.8% and 18.8% of the patients died in the respective periods. CONCLUSIONS: Under the presented conditions, the evaluated intervention strategy is ineffective in promoting the exchange of the antibiotic administration from IV to oral treatment (SAT).
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The increased frequency and dissemination of enterobacteria resistant to various antimicrobials is currently worldwide concern. In January 2010, a 94-year-old patient with chronic lymphocytic leukemia was admitted to the University Hospital. This patient died 21 days after hospitalization due to the clinical worsening. Klebsiella pneumoniae producing of extended-spectrum β-lactamases (ESBLs) was isolated of urine culture. This bacterium demonstrated resistance to ceftazidime, ciprofloxacin, levofloxacin, ertapenem and imipenem. Susceptibility to cefoxitin, cefepime, meropenem, colistin and tigecycline. This study reports the first case of infection by Klebsiella pneumoniae carrying the bla kpc gene in the State of Mato Grosso do Sul, Brazil.
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IntroductionThe objetctive of this study was to evaluate the 2009 Pandemic Influenza A (H1N1) in the elderly and identify the clinical characteristics, mortality and prognostic factors of the infection in these patients.MethodsThis was an observational, retrospective study. Data were collected from the National Notifiable Diseases (SINAN), from the Brazilian Ministry of Health. Only patients 60 years old or more that had laboratory confirmed infections were included. The socio-demographic and clinical variables and outcomes were evaluated to compare mortality rates in the presence or absence of these factors.ResultsWe included 93 patients in the study, 16.1% of whom died. The symptoms of cough and dyspnea, the use of the antiviral oseltamivir, influenza vaccine and comorbidities influenced the outcomes of cure or death. Chest radiography can aid in diagnosis.ConclusionsAlthough relatively few elderly people were infected, this population presented high lethality that can be justified by the sum of clinical, physical and immunological factors in this population. Treatment with oseltamivir and vaccination against seasonal influenza have significantly reduced rates of hospitalization and mortality.
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INTRODUCTION:Human immunodeficiency virus (HIV) coinfection with Leishmania infantum or Leishmania donovani, the agents of visceral leishmaniasis (or kala-azar), has become a fatal public health problem in the tropics where kala-azar is endemic.METHODS:The clinical presentation of patients with HIV and L. infantum coinfection is described using two unique databases that together produce the largest case series of patients with kala-azar infected with HIV in South America. First, a retrospective study paired the list of all patients with kala-azar from 1994 to 2004 with another of all patients with HIV/AIDS from the reference hospital for both diseases in the City of Teresina, State of Piau, Brazil. Beginning in 2005 through to 2010 this information was prospectively collected at the moment of hospitalization.RESULTS:During the study, 256 admissions related to 224 patients with HIV/L. infantum coinfection were registered and most of them were males between 20-40 years of age. Most of the 224 patients were males between 20-40 years of age. HIV contraction was principally sexual. The most common symptoms and signs were pallor, fever, asthenia and hepatosplenomegaly. 16.8% of the cohort died. The primary risk factors associated to death were kidney or respiratory failure, somnolence, hemorrhagic manifestations and a syndrome of systemic inflammation. The diagnosis of HIV and kala-azar was made simultaneously in 124 patients.CONCLUSIONS:The urban association between HIV and kala-azar coinfection in South America is worrisome due to difficulty in establishing the diagnosis and higher mortality among the coinfected then those with either disease independently. HIV/L. infantum coinfection exhibits some singular characteristics and due to its higher mortality it requires immediate assistance to patients and greater research on appropriate combination therapy.
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Introduction Methicillin-resistant Staphylococcus aureus (MRSA) is among the most important pathogens of nosocomial infections, mainly in intensive care units (ICUs), and accounts for 40-60% of all healthcare-associated S. aureus infections. We evaluated the incidence of nosocomial infection by S. aureus, identified the risk factors for MRSA infection, and evaluated the effect of resistance to methicillin on mortality in patients. Methods We conducted MRSA surveillance at a university hospital in Brazil from January 1, 2010, to December 31, 2010, and performed a retrospective case-control matched study to evaluate the frequency of subsequent MRSA bacteremia and death among patients. We evaluated and compared the risk factors between patients with MRSA and methicillin-sensitive Staphylococcus aureus (MSSA) infection. Results Sepsis was the most common cause of infection (17.7/1,000 patient-days), followed by surgical site (11.4/1,000 patient-days), pneumonia (4.1/1,000 patient-days), and urinary tract infection (2.4/1,000 patient-days). The significant risk factors were time of hospitalization, use of central vascular catheter (CVC), urinary catheter, nasogastric tube, parenteral nutrition, tracheostomy, mechanical ventilation, and previous antibiotic administration, the latter of which was the only independent risk factor for MRSA infection. Mortality was significantly higher in patients with MRSA. The number of antibiotics tested was not related to increases in the frequency of MRSA/1,000 patient-days. The incidence of mortality attributable to MRSA (bloodstream infection) BSI was 50%. Conclusions Surveillance results showed that the use of high levels of antibiotics was directly related to the development of MRSA infection, and the mortality attributable to MRSA in patients with bacteremia was significant.
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Introduction This study aimed to describe the clinical spectrum of dengue in children and adolescents from a hyperendemic region who were admitted for hospitalization. Methods A retrospective study was conducted on patients diagnosed with dengue infection upon admission to a reference center in Fortaleza, Brazil. Results Of the 84 patients included, 42 underwent confirmatory testing. The main symptoms were fever, abdominal pain and vomiting. The median level of serum aspartate aminotransferase was 143.5±128mg/dL. Conclusions A peculiar clinical profile was evident among children and adolescents with dengue infection in a reference center in northeast Brazil, including gastrointestinal symptoms and liver involvement.
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Introduction This study reports the pediatric epidemiology of respiratory syncytial virus (RSV), influenza (IF), parainfluenza (PIV), and adenovirus (ADV) at Hospital de Clínicas de Porto Alegre. Methods Cases of infection, hospitalizations in intensive care units (ICUs), nosocomial infections, and lethality rates were collected from 2007 to 2010. Results RSV accounted for most nosocomial infections. Intensive care units admission rates for ADV and RSV infections were highest in 2007 and 2010. During 2008-2009, H1N1 and ADV had the highest ICU admission rates. ADV had the highest fatality rate during 2007-2009. Conclusions Each virus exhibited distinct behavior, causing hospitalization, outbreaks, or lethality.
