971 resultados para Hospitalization
Resumo:
Dissertao de Mestrado apresentada ao ISPA - Instituto Universitrio
Resumo:
IntroductionThe acquired immunodeficiency syndrome (AIDS) epidemic is a worldwide phenomenon that has been modified with the implementation of effective antiretroviral therapy. The objective of this study was to determine the leading causes of hospitalization among human immunodeficiency virus (HIV)-positive individuals.MethodsA cross-sectional study with patients admitted to a general hospital in southern Brazil, between January 2007 and May 2012.ResultsMedical records of 550 hospital admissions (230 patients) were reviewed, with an average of 2.4 hospitalizations per patient. Infectious diseases were the most prevalent causes of hospitalization. Overall, 44.8% patients died and their deaths were associated with longer hospital stays.ConclusionsOpportunistic infections remained the leading causes of hospitalization.
Resumo:
INTRODUCTION: Rotavirus is the main etiologic agent of acute infectious diarrhea in children worldwide. Considering that a rotavirus vaccine (G1P8, strain RIX4414) was added to the Brazilian vaccination schedule in 2006, we aimed to study its effectiveness and safety regarding intestinal intussusception. METHODS: A quasi-experimental trial was performed in which the primary outcome was the number of hospitalizations that were presumably due to acute infectious diarrhea per 100,000 children at risk (0-4 years old). The secondary outcomes included mortality due to acute infectious diarrhea and the intestinal intussusception rates in children in the same age range. We analyzed three scenarios: Health Division XIII of the State of São Paulo (DRS XIII) from 2002 to 2008, the State of São Paulo, and Brazil from 2002 to 2012. RESULTS: The averages of the hospitalization rates for 100,000 children in the pre- and post-vaccination periods were 1,413 and 959, respectively, for DRS XIII (RR=0.67), 312 and 249, respectively, for the State of São Paulo (RR=0.79), and 718 and 576, respectively, for Brazil (RR=0.8). The mortality rate per 100,000 children in the pre- and post-vaccination periods was 2.0 and 1.3, respectively, for DRS XIII (RR=0.66), 5.5 and 2.5, respectively, for the State of São Paulo (RR=0.47), and 15.0 and 8.0, respectively, for Brazil (RR=0.53). The average annual rates of intussusception for 100,000 children in DRS XIII were 28.0 and 22.0 (RR=0.77) in the pre- and post-vaccination periods, respectively. CONCLUSIONS: A monovalent rotavirus vaccine was demonstrated to be effective in preventing the hospitalizations and deaths of children that were presumably due to acute infectious diarrhea, without increasing the risk of intestinal intussusception.
Resumo:
Abstract INTRODUCTION: Methicillin-resistant Staphylococcus aureus (MRSA) is a nosocomial pathogen in community settings. MRSA colonized individuals may contribute to its dissemination; the risk of MRSA infection is increased in human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) patients, although the prevalence of colonization in this group is not well established. The present study addressed this issue by characterizing MRSA isolates from HIV/AIDS patients and their healthcare providers (HCPs) to determine whether transmission occurred between these two populations. METHODS: A total of 24 MRSA isolates from HIV-infected patients and five from HCPs were collected between August 2011 and May 2013. Susceptibility to currently available antimicrobials was determined. Epidemiological typing was carried out by pulsed-field gel electrophoresis, multilocus sequence typing, and Staphylococcus cassette chromosome (SCCmec) typing. The presence of heterogeneous vancomycin-intermediate Staphylococcus aureus (hVISA) and heterogeneous daptomycin-resistant Staphylococcus aureus (hDRSA) was confirmed by population analysis profile. Isolates characterized in this study were also compared to isolates from 2009 obtained from patients at the same hospital. RESULTS: A variety of lineages were found among patients, including ST5-SCCmecII and ST30-SCCmecIV. Two isolates were Panton-Valentine leukocidin-positive, and hVISA and hDRSA were detected. MRSA isolates from two HCPs were not related to those from HIV/AIDS patients, but clustered with archived MRSA from 2009 with no known relationship to the current study population. CONCLUSIONS: ST105-SCCmecII clones that colonized professionals in 2011 and 2012 were already circulating among patients in 2009, but there is no evidence that these clones spread to or between HIV/AIDS patients up to the 7th day of their hospitalization.
Resumo:
RESUMO - Introduo: No mbito das emergncias intra-hospitalares investigou-se a hiptese da presena da Equipa Emergncia Mdica Intra-hospitalar (EEMI) (DGS, 2010) num Centro Hospitalar (CH), contribuir para a reduo do nmero de mortos por Paragem Crdiorespiratria (PCR) intra-hospitalar, quando comparado com outro CH dotado de uma equipa tradicional de resposta PCR. Metodologia: Tratou-se de um estudo observacional, retrospetivo (2010 a 2014), com base nos dados do Grupo de Diagnstico Homogneo (GDH), analisado numa perspetiva de custo-efetividade no impacto sobre incidncia de PCR e taxa de mortalidade. Resultados: Observou-se que o CH com EEMI apresentou uma Reduo Risco Absoluto (RRA) de 9,01% de morte por PCR. A taxa de mortalidade calculada foi de 2,82 casos por 1000 episdios de internamento em que a incidncia de PCR foi de 28,24 casos por cada 10 000 habitantes, duas vezes menor que CH em comparao. Quando introduzidas manobras de Ressuscitao Crdiopulmonar (RCP), o mesmo CH teve um maior nmero de PCR revertidas, com uma taxa de mortalidade 2 vezes menor que o CH sem EEMI. Concluso: Resultados demonstraram que os dois CH apresentaram riscos diferentes, em que a probabilidade do doente hospitalizado de morrer aps ocorrncia de PCR foi menor no grupo exposto EEMI, com OR = 0,496 [IC 95% (0,372 a 0,662)] para dados populacionais (p = 0,0013), e OR = 0,618 [IC 95% (0,298 a 1,281)] para dados individuais, (p = 0,194). Face a melhores resultados em Sade, considerou-se a implementao da EEMI, uma medida custo-efetiva, uma vez que o principal requisito traduz-se por reorganizao das equipas tradicionais para uma vertente de preveno da PCR.
Resumo:
Oxacillin-resistant Staphylococcus aureus (ORSA) infection is an important cause of hospital morbidity and mortality. The objective of this study was to identify the main factors associated with death in patients colonized or infected with Staphylococcus aureus in a cancer center. A matched-pair case-control study enrolled all patients infected or colonized with ORSA (cases) admitted to the Hospital do Cncer in Rio de Janeiro from 01/01/1992 to 12/31/1994. A control was defined as a patient hospitalized during the same period as the case-patients and colonized or infected with oxacillin-susceptible Staphylococcus aureus (OSSA). The study enrolled 95 cases and 95 controls. Patient distribution was similar for the two groups (p > or = 0.05) with respect to gender, underlying diseases, hospital transfer, prior infection, age, temperature, heart and respiratory rates, neutrophil count, and duration of hospitalization. Univariate analysis of putative risk factors associated with mortality showed the following significant variables: admission to the intensive care unit (ICU), presence of bacteremia, use of central venous catheter (CVC), ORSA colonization or infection, pneumonia, use of urinary catheter, primary lung infection, prior use of antibiotics, mucositis, and absence of cutaneous abscesses. Multivariate analysis showed a strong association between mortality and the following independent variables: admission to ICU (OR [odds ratio]=7.2), presence of Staphylococcus bacteremia (OR=6.8), presence of CVC (OR=5.3), and isolation of ORSA (OR=2.7). The study suggests a higher virulence of ORSA in comparison to OSSA in cancer patients.
Resumo:
RESUMO - Introduo: A integrao vertical de cuidados surge em Portugal em 1999 com a criao da primeira Unidade Local de Sade (ULS) em Matosinhos. Este modelo de gesto tem como principal objetivo reorganizar o sistema para responder de forma mais custo-efetiva s necessidades atuais. Objetivo: Analisar o impacto da criao das ULS nos custos do internamento hospitalar portugus. Metodologia: Para apurar o custo mdio estimado por episdio de internamento hospitalar utilizou-se a metodologia dos Custos Estimados com base na Contabilidade Analtica. Contudo, no foram imputados custos por diria de internamento por centro de produo, mas apenas por doente sado em determinado hospital. Para efeitos de comparao dos modelos de gesto organizacionais consideraram-se variveis demogrficas e variveis de produo. Resultados: Da anlise global, os hospitais integrados em ULS apresentam um custo mdio estimado por episdio de internamento inferior quando comparados com os restantes. Em 2004 os hospitais sem modelo de integrao vertical de cuidados apresentam uma diferena de custos de aproximadamente 714,00. No ano 2009, ltimo ano em anlise, esta diferena mais tnue situando-se nos 232,00 quando comparados com hospitais integrados em ULS. Discusso e Concluso: No existe uma tendncia definida no que respeita diferena de custos quando se comparam os diferentes modelos organizacionais. importante que em estudos futuros se alargue a amostra ao total de prestadores e se aprofundem os fatores que influnciam os custos de internamento. A compreenso dos indicadores sociodemogrficos, demora mdia, e produo realizada, numa tica de custo efetividade e qualidade, permitir resultados com menor grau de vis.
Resumo:
Intraventricular hemorrhage (IVH) is a severe complication in very low birth weight (VLBW) newborns (NB). With the purpose of studying the incidence of IVH, the associated risk factors, and the outcomes for these neonates, we studied all the VLBW infants born in our neonatal unit. Birth weight, gestational age, presence of perinatal asphyxia, mechanical ventilation, length of hospitalization, apnea crisis, hydrocephalus, and periventricular leukomalacia were analyzed. The diagnosis of IVH was based on ultrasound scan studies (Papile's classification) performed until the tenth day of life and repeated weekly in the presence of abnormalities. Sixty-seven/101 neonates were studied. The mortality rate was 30.6% (31/101) and the incidence of IVH was 29.8% (20/67) : 70% grade I, 20% grade III and 10% grade IV. The incidence of IVH in NB <1,000 g was 53.8% (p = 0.035) and for gestational age <30 weeks was 47.3% (p = 0.04), both considered risk factors for IVH. The length of hospitalization (p = 0.00015) and mechanical ventilation (p = 0.038) were longer in IHV NB. The IVH NB had a relative risk of 2.3 of developing apnea (p = 0.02), 3.7 of hydrocephalus (p = 0.0007), and 7.7 of periventricular leukomalacia (p < 0.00001). The authors emphasize the importance of knowing the risk factors related to IVH so as to introduce prevention schemes to reduce IVH and to improve outcomes of affected newborns.
Resumo:
In order to evaluate the obstetric care in the Obstetric Clinic of the Gynaecology and Obstetrics Department of University of So Paulo, the authors present a survey of the management of pregnancy during the 6-year period from 1993 to 1998. The number of deliveries increased during the study by 45% over the 6 years. During this same period the number of fetal deaths was 526 (4.48%), but there was a significant decrease (p < 0.05) in the incidence of fetal death. However, there was no concomitant increase in the proportion of pregnant women with prenatal care that could explain this improvement. Incidence of premature labor also decreased considerably. The authors believe that the increment in the number of deliveries was due mainly to the increasing number of pregnant women referred to our service. The efforts made by the service towards decreasing the time of hospitalization of both newborns in the nursery and the mothers in the hospital made this possible. Despite the increasing number of deliveries, there was a significant improvement in the management of pregnancy during the period of study. This improvement may be a consequence of the standardization of a protocol of management of pregnancy based on the recent progress in scientific and technological knowledge.
Resumo:
Microlaparoscopy represents the development of endoscopic surgery towards a minimally invasive surgical procedure. The advantages include fewer surgical complications, faster return to daily activities, more comfortable postoperative recovery, and satisfactory aesthetic results. The possibility of performing surgery under sedation may result in shorter hospitalization, lower hospital costs, and easier anesthetic procedures. The authors report their preliminary experience with the use of microlaparoscopy, using optics and 2mm instruments, as well as a review of the literature since the introduction of this new technique. The report of these 16 cases demonstrates that microlaparoscopy is a feasible technique with satisfactory results. On the other hand, this new technique requires precise indications and a training period for the development of the skills necessary for performing these surgeries.
Resumo:
RESUMO - As mudanas na sade so cada vez mais rpidas e os servios de sade tm cada vez mais dificuldade em dar resposta aos problemas de sade dos portugueses. Responsveis por grande parte da despesa em sade, os idosos so a populao que mais utiliza os servios de sade e as respetivas unidades hospitalares e servios de urgncia. Estes tm estadias mais prolongadas e consomem mais recursos durante essas permanncias nas instituies de sade. Sabendo isto revelou-se oportuno encontrar as principais causas de internamento hospitalar, os principais diagnsticos secundrios, demoras mdias e a sua relao com as principais causas de morte na populao portuguesa com mais de 65 anos no perodo de 2003-2012. Para tal, optou-se por uma anlise descritiva de 3375817 episdios de internamento referentes a dez anos. Daqui retirou-se que os diagnsticos principais mais frequentes para todos os anos e todas as faixas etrias so o acidente vascular cerebral isqumico e a pneumonia, sendo que o primeiro o mais frequente at 2006, passando depois a ser a pneumonia o mais frequente. A demora mdia maior quanto mais diagnsticos secundrios associados houver e aumenta com a idade. Os diagnsticos secundrios mais frequentes so a hipertenso essencial e a diabetes mellitus. Estes dados so relevantes para o conhecimento da sade em Portugal, podendo-se alterar e uniformizar e melhorar prticas hospitalares e com isso progredir na qualidade dos tratamentos e aumentar a qualidade de vida com hiptese de diminuio da demora mdia.
Resumo:
Splenectomy is the best available treatment for severe forms of hereditary spherocytosis, idiopathic thrombocytopenic purpura, and other hematologic conditions when these prove refractory to conservative management. It has been employed for many decades with low mortality and favorable remission rates. The use of laparoscopic splenectomy in recent years has been rapidly and even enthusiastically adopted in this field. However, the exact role of laparoscopic versus open surgery for hematologic diseases is still debated. In this study of 58 adult patients, laparoscopic procedures were compared with conventional splenectomies for similar indications. METHODS: All patients were operated on within an 8-year period. Subjects underwent similar procedures under the supervision of the same surgical school and were compared regarding age, gender, body mass index, and diagnosis. Laparoscopically managed cases (Group I, n = 30) were prospectively followed according to a written protocol, whereas the same investigation was retrospectively done with regard to traditional laparotomy (Group II, n = 28). Methods included general and demographic findings, duration and technical steps of operation, blood loss, weight of spleen, need for conversion (in minimally invasive subjects), intraoperative and postoperative complications, time until realimentation, postoperative hospitalization, mortality, and late follow-up including recurrence rate. RESULTS: Idiopathic thrombocytopenic purpura was the surgical indication in over 50% of the patients in both groups, but familial spherocytosis, thalassemia, myelodysplasia, and lymphomas were also represented in this series. Laparoscopic procedures took more time to perform (P = 0.004), and postoperative hospitalization was 2 days shorter, but this difference was not statistically significant. Postoperative hematocrit and volume of blood transfusions was equivalent, although the laparoscopic cases had a somewhat lower preoperative hematocrit (NS) and displayed better recovery for this measurement (P = 0.03). More patients in Group I were able to accept oral food on the first day than subjects undergoing conventional operations (P < 0.05). Relatively few conversions were necessary during the minimally invasive surgeries (13.3%), and postoperative early and late complications as well as recurrences occurred in similar proportions. Also, the mean weight of the spleen was not statistically different between the groups, although there was a marked numerical tendency toward larger masses in conventional procedures. No spleen in Group I exceeded 2.0 kg, whereas in Group II values up to 4.0 kg occurred, and the mean weight was 50% higher in the latter group. CONCLUSIONS: 1) Minimally invasive splenectomy was essentially comparable to open surgery with regard to safety, efficacy, and late results; 2) Advantages concerning shorter postoperative hospitalization could not be shown, despite earlier food intake and a non-significant tendency toward earlier discharge; 3) This new modality should be considered an option in cases of hematologic conditions whenever the spleen is not hugely enlarged.
Resumo:
RESUMO - Introduo: As infeces associadas aos cuidados de sade so um importante problema de sade pblica. Entre elas, as infeces urinrias so as mais frequentes associandose a elevados custos e morbilidade. Pretendese caracterizar as ITU adquiridas no Hospital (ITUaH) ocorridas num servio de Medicina Interna de um hospital portugus. Mtodos: Efectuouse um estudo de coorte (histrica) para determinao da incidncia da ITUaH e da bacteriria assintomtica. Analisaram-se os dados correspondentes a uma amostra aleatria sistemtica de 388 doentes, representativa dos 3492 admisses ocorridas, em 2014, nesse Servio. Resultados: A taxa de incidncia global de ITUaH foi de 6,2% (24/388; IC 95%:[3,8--8,6%]). Ocorreram 19,76 ITU por mil dias de cateter vesical (ITUaCV) e 4,17 ITUaCV por mil dias de internamento. A taxa de incidncia de ITUaCV foi de 4% (15/388; IC 95%:[2%--6%]). Oitenta por cento destas infeces ocorreram em doentes sem indicao para a algaliao. Um quarto dos doentes desta coorte foram algaliados (24,7%; IC 95%: [20%--29%]), no se verificando indicao para o procedimento em 36,5% dos casos. Os principais factores de risco para a algaliao identificados foram a dependncia total (OR: 24,47; IC 95%: [5,50-- 108,87]; p<0,001) a dependncia grave (OR:11,43; IC 95% [2,56--50,93]; p=0,001) (escala de Barthel) e a carga de doena (OR: 1,19; IC 95% [1,03--1,38]; p=0,017) (ndice de comorbilidade de Charlson). Foram utilizados CV em 759 dias dos 3591 dias de internamento quantificados neste estudo (21%). A Taxa de incidncia de Bacteriria Assintomtica (BA) foi de 4,4% (IC 95%:[2--6%]). Cerca de 60% (10/17) desses doentes foram submetidos a tratamento contrariamente s recomendaes clnicas actuais. Concluses: Este estudo evidencia a necessidade de implementao de estratgias de preveno, das quais se destaca a reduo do nmero de algaliaes. O tratamento da BA deve ser evitado.
Resumo:
Hospitals are nowadays collecting vast amounts of data related with patient records. All this data hold valuable knowledge that can be used to improve hospital decision making. Data mining techniques aim precisely at the extraction of useful knowledge from raw data. This work describes an implementation of a medical data mining project approach based on the CRISP-DM methodology. Recent real-world data, from 2000 to 2013, were collected from a Portuguese hospital and related with inpatient hospitalization. The goal was to predict generic hospital Length Of Stay based on indicators that are commonly available at the hospitalization process (e.g., gender, age, episode type, medical specialty). At the data preparation stage, the data were cleaned and variables were selected and transformed, leading to 14 inputs. Next, at the modeling stage, a regression approach was adopted, where six learning methods were compared: Average Prediction, Multiple Regression, Decision Tree, Articial Neural Network ensemble, Support Vector Machine and Random Forest. The best learning model was obtained by the Random Forest method, which presents a high quality coecient of determination value (0.81). This model was then opened by using a sensitivity analysis procedure that revealed three inuential input attributes: the hospital episode type, the physical service where the patient is hospitalized and the associated medical specialty. Such extracted knowledge conrmed that the obtained predictive model is credible and with potential value for supporting decisions of hospital managers.
Resumo:
Tese de doutoramento em Cincias da Educao (rea Especialidade em Psicologia da Educao)
