RESUMO
PURPOSE: The purpose of this study was to evaluate bladder self-management in transition to adult care for patients with spina bifida (SB) in 3 countries with similar clinical practice and different social, cultural, and economic milieu. STUDY DESIGN: Cross-sectional study. SUBJECTS AND SETTING: The sample comprised 90 participants: 27 reside in Brazil, 36 reside in Germany, and 27 reside in the United States. Demographic characteristics of the sample are based on country. The distribution of sex in the Brazilian sample was 18 males and 9 females, the German group had 11 males and 25 females, and the United States group had 8 males and 19 females. The age range of the cumulative sample was 13 to 29 years. The age of the German sample (mean 23.56, standard deviation [SD] 4.60 years) was significantly higher (analysis of variance, F(2, 87) = 13.62, P < .001) than the other 2 groups (Brazil mean 20.56 years, SD 5.24; US mean 19.44 years, SD 4.70). METHODS: Demographic, clinical, and social variable data were collected via an online questionnaire distributed to multiple regions of Germany and a multidisciplinary myelomeningocele clinic at the University of Michigan in the Midwestern United States. In Brazil, participants completed a printed version of the survey. In Germany and the United States, an electronic version of the survey was made available online. German and English versions of the survey, originally developed in Portuguese for persons residing in Brazil, were translated and validated. RESULTS: The majority of participants (94.4%) performed intermittent catheterization (IC), 76.5% performed IC independently, whereas 23.5% required assistance with IC or catheterized with aids (handles, leg spreaders, and penis or labia holder). There were no statistically significant group differences in independent self-catheterization by gender. There were significant national group differences in level of lesion (P = .016), use of shunt (P = .012), and medication for bladder management (P < .001). Among participants 18 years and older, there were significantly higher levels of education in the German and the US samples than in the Brazilian sample (P < .001). CONCLUSIONS: Although there were national group differences in medical characteristics and management of SB, differences in independent self-catheterization were not significant. Findings suggest that support from family/caregivers and health care providers appears to facilitate transition to independent self-care, regardless of national context.
Assuntos
Transferência de Pacientes/métodos , Autogestão/métodos , Disrafismo Espinal/complicações , Bexiga Urinária/fisiopatologia , Adolescente , Adulto , Análise de Variância , Brasil , Estudos Transversais , Feminino , Alemanha , Humanos , Cateterismo Uretral Intermitente/métodos , Cateterismo Uretral Intermitente/tendências , Masculino , Michigan , Transferência de Pacientes/tendências , Autogestão/tendências , Disrafismo Espinal/psicologia , Estatísticas não Paramétricas , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Few data exist on regional systems of care for the treatment of ST-segment-elevation myocardial infarction (STEMI) in developing countries. Our objective was to describe temporal trends in 30-day mortality and identify predictors of mortality among STEMI patients enrolled in a prospective registry in Brazil. METHODS AND RESULTS: From January 2011 to June 2013, 520 patients who received initial STEMI care at 23 nonspecialized public health units or hospitals, some of whom were transferred to a public cardiology referral center, were identified through a regional STEMI network supported by telemedicine and the local prehospital emergency medical service. We stratified patients into five 6-month periods based on presentation date. Mean age (±SD) of patients was 62.0 (±12.2) years, and 55.6% were men. The mean Global Registry of Acute Coronary Events (GRACE) score was 145 (±34). Overall mortality at 30 days was 15.0%. Use of dual antiplatelet therapy and statins increased significantly from baseline (January 2011) to period 5 (June 2013): 61.8% to 93.6% (P<0.001) and 60.4% to 79.7% (P<0.001), respectively. Rates of primary reperfusion also increased (29.1%-53.8%; P<0.001), and more patients were transferred to the referral center (44.7%-76.3%; P=0.001). Thirty-day mortality rates decreased from 19.8% to 5.1% (P<0.001). In multivariable analysis, factors independently associated with 30-day mortality were higher GRACE score, history of previous stroke, lack of transfer to the referral center, and lack of use of optimized medical therapy. CONCLUSIONS: Implementation of a regional STEMI system was associated with lower mortality and higher use of evidence-based therapies.
Assuntos
Mortalidade/tendências , Transferência de Pacientes/tendências , Programas Médicos Regionais , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Antagonistas Adrenérgicos beta/uso terapêutico , Idoso , Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Aspirina/uso terapêutico , Brasil , Cardiologia , Serviços Médicos de Emergência , Feminino , Fidelidade a Diretrizes , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/tendências , Inibidores da Agregação Plaquetária/uso terapêutico , Guias de Prática Clínica como Assunto , Estudos Prospectivos , Antagonistas do Receptor Purinérgico P2Y/uso terapêutico , Sistema de Registros , Telemedicina , Centros de Atenção TerciáriaRESUMO
Patients with spine-associated symptoms are transferred regularly to higher levels of care for operative intervention. It is unclear what factors lead to the transfer of patients with spine pathology to level I care facilities, and which transfers are indicated. All patients with isolated spinal pathology who were transferred from 2011 to 2015 were reviewed. Patients were divided into urgent transfers, defined as anyone who required operative intervention, and nonurgent transfers. Two hundred twenty-seven patients were transferred for isolated spinal pathology over 51 months; 109 (48.0%) patients required urgent intervention and 118 (52.0%) patients required nonurgent care. No significant differences were found between groups in terms of private insurance, age, sex, race, or Charlson comorbidity index. The urgent group was less likely to have a traumatic chief complaint (57.8% vs 78.0%, P = .001). More than half of all spine patients who were transferred to a tertiary care center required minimal intervention.
Assuntos
Serviços Médicos de Emergência , Transferência de Pacientes/tendências , Traumatismos da Coluna Vertebral , Centros de Atenção Terciária , Adulto , Idoso , Feminino , Humanos , Masculino , Auditoria Médica , Pessoa de Meia-Idade , Transferência de Pacientes/estatística & dados numéricos , Estudos Retrospectivos , Traumatismos da Coluna Vertebral/cirurgiaAssuntos
Cesárea , Política de Saúde , Cobertura do Seguro , Seguro Saúde , Complicações na Gravidez/economia , Opinião Pública , Procedimentos Desnecessários/tendências , Analgesia Obstétrica/estatística & dados numéricos , Brasil/epidemiologia , Cesárea/economia , Cesárea/psicologia , Cesárea/estatística & dados numéricos , Cesárea/tendências , Feminino , Política de Saúde/legislação & jurisprudência , Política de Saúde/tendências , Hospitais Privados , Hospitais Públicos , Humanos , Parto , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Satisfação do Paciente/estatística & dados numéricos , Transferência de Pacientes/tendências , Gravidez , Complicações na Gravidez/diagnóstico , Resultado da Gravidez , Fatores Socioeconômicos , Esterilização Tubária/estatística & dados numéricosRESUMO
Critical care transport is a raising need in health care because patients who have medical conditions that exceed the capabilities of the initial treating facility require timely safe transport to referral centers. Therefore, indications for inter-hospital transfer include the need for specialist intervention, a critical bed not available or ongoing support not provided in the referring hospital. The aim of transferring a critically ill patient to a reference center is to improve prognosis, and this potential benefit must outweigh potential harm derived of eventual complications or adverse events that could happen during transportation, because critically ill patients have a high risk of morbidity and mortality during transport. The most frequent indications of transfer involve time-dependent pathologies, such as Cardiovascular and Neurologic Emergencies. Pre-transport evaluation and stabilization is critical, as it contributes to minimize in-transport risks, and it must consider aspects as adequate monitoring, transportation times and conditions...
Assuntos
Humanos , Masculino , Feminino , Cuidados Críticos/normas , Cuidados Críticos/tendências , Transferência de Pacientes/classificação , Transferência de Pacientes/métodos , Transferência de Pacientes/normas , Transferência de Pacientes/organização & administração , Transferência de Pacientes/tendências , Transferência de PacientesRESUMO
UNLABELLED: There is no standardised protocol for the transfer of injured patients in Jamaica, a process that is well known to be potentially hazardous. We undertook this study to evaluate the inter-hospital transfer process of injured patients in this developing country. MATERIALS AND METHODS: A prospective descriptive analytical study of all consecutive patients transferred to the University Hospital of the West Indies from other hospitals was conducted over six months. Data were collected on specially designed proformas and analysed using SPSS version 10.0. RESULTS: Of 122 patients studied, 79.5% were male and the mean age was 27.8+/-20.7 years. Most injuries resulted from road traffic accidents (40.2%), falls (27.1%) and assaults (26.2%). Several problems with the transfer process were identified. There was poor documentation of clinical parameters at referring institutions, with records of pulse rates in 13.1% (16/122), blood pressure in 9.8% (12/122), respiratory rate in 9.8% (12/122), Glasgow Coma Score in 10.6% (13/122) and pupillary reaction in 4.9% (6/122) of cases. Transfer arrangements were made by junior medical officers in 93.4% (114/122) of cases while consultants requested only 3.3% (4/122) of transfers. Public hospital ambulances transported 91.8% (112/122) of patients and 7.4% (9/122) were transported by helicopter. These vehicles were equipped with facilities for oxygen administration in 99.2% (121/122) of cases and sphygmomanometers in 91% (111/122) of cases, but functional capacity for suction was only present in 50% of vehicles. These critically ill patients were accompanied by physicians in only 11.5% (14/122) of cases, while 68.9% (84/122) were accompanied only by nurses. CONCLUSIONS: The transfer of injured patients is not being performed in a manner consistent with modern medical practice. There is urgent need for implementation of a standardised protocol for the transfer of such patients in Jamaica.
Assuntos
Resgate Aéreo/estatística & dados numéricos , Transferência de Pacientes/tendências , Ferimentos e Lesões/mortalidade , Ferimentos e Lesões/terapia , Acidentes de Trânsito/mortalidade , Adolescente , Adulto , Ambulâncias/estatística & dados numéricos , Criança , Estudos de Coortes , Países em Desenvolvimento , Serviços Médicos de Emergência/normas , Serviços Médicos de Emergência/tendências , Feminino , Escala de Coma de Glasgow , Hospitais Universitários , Humanos , Escala de Gravidade do Ferimento , Jamaica , Masculino , Pessoa de Meia-Idade , Avaliação das Necessidades , Avaliação de Resultados em Cuidados de Saúde , Transferência de Pacientes/normas , Estudos Prospectivos , Medição de Risco , Fatores Socioeconômicos , Análise de Sobrevida , Resultado do Tratamento , Ferimentos e Lesões/diagnóstico , Adulto JovemRESUMO
Se estudia la organización nacional existente para casos de catástrofes, haciendo referencia a resultados en la atención médica, en relación al tiempo de demora en prestar auxilio a los heridos en los 4 últimos grandes conflictos del siglo, de los cuales existe información disponible tabulada. Se analiza el Plan Nacional de Emergencia y las reacciones entre el Ministerio de Salud y ONEMI. Se presentan cifras estadísticas de las principales acciones de E.A.M. en Chile, hasta la fecha. Se discuten y comentan los principales conceptos de E.A.M. en relación a criterio clínico de selección de pacientes, clasificación y prioridades de los pacientes para E.A.M., embarque y desembarque de pacientes y por último, se analizan detalles y se estudian los actuales conceptos del "Triage"