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Carga de trabalho de enfermagem em unidade de recuperação pós-anestésica; Nursing workload in the post-anesthesia care unit

Lima, Luciana Bjorklund de; Silva, Eneida Rejane Rabelo da
Fonte: Universidade Federal do Rio Grande do Sul Publicador: Universidade Federal do Rio Grande do Sul
Tipo: Artigo de Revista Científica Formato: application/pdf
POR
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Objetivos: Avaliar a carga de trabalho de enfermagem em unidade de recuperação pós-anestésica e relacionar com o índice de gravidade cirúrgico, tempo de permanência, porte cirúrgico e idade. Métodos: Estudo transversal conduzido em hospital universitário. A carga de trabalho foi avaliada pelo Nursing Activities Score e o índice de gravidade pelo Simplified Acute Physiology Score II aplicados na alta da unidade de recuperação. Resultados: Foram incluídos 160 pacientes, idade média 57±15 anos. A carga de trabalho para 50% dos pacientes foi de 45,6 minutos a cada hora de permanência na unidade. Não houve relação entre carga de trabalho e índice de gravidade. Contudo, houve correlações positivas entre carga de trabalho, tempo de permanência e porte cirúrgico. O índice de gravidade apresentou correlação com a idade. Conclusão: A carga de trabalho de enfermagem em unidade de recuperação pós-anestésica sofre influência do tempo de permanência e do porte cirúrgico.; Objectives: To assess nursing workload in the post-anesthesia care unit and its potential correlations with a surgical severity index, length of stay, magnitude of surgery, and patient age. Methods: Cross-sectional study conducted at a university hospital. Workload was assessed by the Nursing Activities Score...

Análise de polimorfismos em genes envolvidos no estresse oxidativo e associação com a severidade da doença em pacientes com anemia falciforme = : Analysis of polymorphisms in genes involved in oxidative stress and association with the severity of the disease in patients with sickle cell disease; Analysis of polymorphisms in genes involved in oxidative stress and association with the severity of the disease in patients with sickle cell disease

Gislene Pereira Gil
Fonte: Biblioteca Digital da Unicamp Publicador: Biblioteca Digital da Unicamp
Tipo: Dissertação de Mestrado Formato: application/pdf
Publicado em 21/08/2012 PT
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Embora a anemia falciforme (AF) resulte da homozigosidade de uma única mutação, no codon 6 do locus da ?-globina, fenotipicamente, essa doença é muito heterogênea, de modo que diferentes pacientes podem apresentar evoluções clínicas significativamente distintas. As complicações nestes pacientes normalmente são decorrentes de acometimento vascular causado pelo acúmulo de hemácias falcizadas nos vasos sanguíneos. Um dos eventos que vem sendo associados a complicações em diversas doenças é o mecanismo de estresse oxidativo, o qual apresenta- se exacerbado em pacientes com AF. Dentre as fontes de estresse oxidativo nestes pacientes estão os eventos de vaso-oclusão e isquemia reperfusão, os quais são muito frequentes. O estresse oxidativo em níveis elevados pode danificar várias moléculas e posteriormente prejudicar o organismo. Alguns polimorfismos em enzimas envolvidas na via de estresse oxidativo foram associados com doenças vasculares como, hipertensão, doença arterial coronária, doença arterial periférica. Considerando que os pacientes com AF apresentam complicações decorrentes de acometimento vascular, esses polimorfismos podem estar contribuindo para as várias manifestações clínicas e, consequentemente...

Severity of TMD Related to Age, Sex and Electromyographic Analysis

Mazzetto,Marcelo Oliveira; Rodrigues,Carolina Almeida; Magri,Laís Valencise; Melchior,Melissa Oliveira; Paiva,Guiovaldo
Fonte: Fundação Odontológica de Ribeirão Preto Publicador: Fundação Odontológica de Ribeirão Preto
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/02/2014 EN
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Temporomandibular disorders (TMD) are manifested as a group of signs and symptoms that affect a particular population profile. Some variables such as sex and age influence the clinical expression of this condition. This observational descriptive cross-sectional study aimed to correlate the severity of TMD established by the craniomandibular index (CMI) with the variables: age, sex and electromyographic activity of the masseter and anterior temporal muscles. Fifty-four subjects (15 males/39 females) aged between 16 to 65 years (mean age = 41 years) and diagnosed with TMD were evaluated. Severity was determined by the CMI. These subjects also underwent examination by surface electromyography of the masseter and anterior temporal muscles. No correlation was found between age and severity of TMD (p=0.19/r=0.16), however there was a trend of greater severity in young adults (25-50 years). The sex variable in the correlation was positive with the CMI (p=0.03/r=-0.96) and superior to women. A greater EMG activity of the anterior temporal in relation to masseter (p=0.01) was found and the left temporal activity had the highest average (161.5 ± 44.6 Hz). The electromyographic activity of the anterior temporal and right masseter muscles was positively correlated with the Dysfunction Index CMI (p=0.01). The use of CMI to quantify the severity of TMD and of EMG to assess the functionality of the masticatory muscles can be important allies to direct the treatment.

Severity of illness and the relationship between intensive care and survival.

Scheffler, R M; Knaus, W A; Wagner, D P; Zimmerman, J E
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /05/1982 EN
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Currently about 15 per cent of hospital costs are attributed to intensive care. Research using statistical models has not adequately demonstrated that therapy in intensive care units (ICUs) is associated with reductions in the probability of death. In a study of 613 consecutive admissions to a multidisciplinary ICU, we reevaluate the relationship between ICU care and survival using a new acute physiology scoring system to control for the severity of illness of the patient population. When our severity of illness index was employed, we found a statistically significant and nonlinear relationship between the use of intensive medical care and the probability of survival. This statistical relationship produced a U-shaped curve with three distinct segments. The first segment exhibited an overall decrease in the probability of death with increasing therapy (275 admissions); the second segment, a fairly stable survival rate (281 admissions). Only in the third segment, where there were 57 admissions, did we find an overall increase in the probability of death as utilization of therapy increased. These findings suggest that quantitative measurement of severity of illness, when used in clinical studies, could produce improved insights into the relationship between therapy and health outcomes.

Measuring Severity of Illness: Comparisons Across Institutions

Horn, Susan Dadakis
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /01/1983 EN
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Conventional methods for classifying patients with respect to utilization of health care resources are based almost exclusively on diagnostic criteria. We review a new severity of illness index which is generic to most medical and surgical conditions in a hospital, and which has been found to produce subgroups of patients more homogeneous with respect to hospital resource use (as assessed by total charges, length of stay, routine charges, and laboratory charges) than diagnostic-related groups, staging, and generalized patient management paths. We use the severity of illness groups to compare total charges and length of stay across hospitals. We find that charges and length of stay in an academic teaching hospital are similar to those in community hospitals with and without teaching programs when controlling for severity of illness. (Am J Public Health 1983; 73:25-31.)

Testing Pattern Recognition as a Method for Measuring Severity of Illness

Trace, D.; Naeymi-Rad, F.; Carmony, L.; Chen, S.; Kerns, K.; Yarnold, P.; Tan, M.; Astiz, M.; Mecher, C.; Weil, M.H.; Evens, M.
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em 08/11/1989 EN
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This paper describes a multimembership Bayesian index of severity calculated by MEDAS (the Medical Emergency Decision Assistance System). This severity index measures the likelihood that the patient will die without immediate intervention. The MEDAS inference engine operates on binary features representing signs, symptoms, and laboratory results. As a basis for calculation of the severity index, severity weights, ranging from 0 to 9 were assigned to each feature by an expert physician in order to form a severity pattern.

13C-Urea breath test: Reproducibility and association with the severity of Helicobacter pylori-associated antral gastritis

Matthews, G.; Cummins, A.; Lawrence, A.; Johnson, B.; Campbell, F.; Butler, R.
Fonte: Blackwell Publishing Asia Publicador: Blackwell Publishing Asia
Tipo: Artigo de Revista Científica
Publicado em //2005 EN
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85.62%
BACKGROUND: The purpose of the present paper was to assess the reproducibility of the (13)C-urea breath test ((13)C-UBT) and its ability to reflect the level of Helicobacter pylori-associated inflammation. METHODS: Asymptomatic H. pylori-positive subjects (n = 21) performed the (13)C-UBT six times. The H. pylori-positive symptomatic subjects (n = 55) performed the (13)C-UBT and had antral biopsies taken for histopathology, culture, urease activity assay and myeloperoxidase activity assay. RESULTS: No significant intraindividual variation in (13)C-UBT results were observed for the asymptomatic subjects. The (13)C-UBT results were significantly higher in symptomatic subjects with a moderate to severe gastritis compared to a mild gastritis and to no inflammation (34.5 +/- 4.4 vs 17.7 +/- 2.8 vs 1.7 +/- 0.1, respectively, P < 0.01). The (13)C-UBT results significantly correlated with urease (r = 0.55) and myeloperoxidase activity (r = 0.82) but not with bacterial load. conclusion: The (13)C-UBT is a reproducible determinant of H. pylori infection and non-invasively assesses the severity of antral inflammation.; Matthews, Geoffrey M; Cummins, Adrian G; Lawrence, Andrew; Johnson, Bruce; Campbell, Fiona; Butler, Ross N

Thrombophilias and adverse pregnancy outcome - A confounded problem!

Kist, W.; Janssen, N.; Kalk, J.; Hague, W.; Dekker, G.; de Vries, J.
Fonte: Schattauer GMBH-Verlag Medizin Naturwissenschaften Publicador: Schattauer GMBH-Verlag Medizin Naturwissenschaften
Tipo: Artigo de Revista Científica
Publicado em //2008 EN
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It was the objective of this study to analyse the influence of confounders, such as ethnicity,severity of illness and method of testing, in articles concerning the still moot relationship of thrombophilias to adverse pregnancy outcome (APO). Relevant casecontrol studies were identified using Medline and EMBASE databases between 1966 and 2006. Search terms were recurrent fetal loss, intrauterine fetal death, preeclampsia, HELLP-syndrome, eclampsia, fetal growth restriction, abruptio placentae, combined with maternal thrombophilias. Data was extracted from the articles per subgroup ofAPO regardless of confounder. These subgroups were tested if they fulfilled the heterogeneity testing criterion (I2 > 35%) to weigh the influence of the confounder. Confounders were selected and examined with Mantel- Haenszel method. Increased thrombophilia prevalence was confirmed in most adverse pregnancy outcomes. Ethnicity, genetic testing only and severity of illness were confounders in the various forms of APO. Stronger relationships between factor V Leiden and severity of disease were found in 2nd and 3rd trimester than 1st trimester recurrent fetal loss, in preeclampsia with: blood pressure ≥160/110 mmHg than ≥140/90 mmHg; proteinuria ≥5 grams per day than < 5 grams; onset before than after 28 weeks...

Dissociation between severity of takotsubo cardiomyopathy and presentation with shock or hypotension

Chong, C.R.; Neil, C.; Nguyen, T.; Stansborough, J.; Law, G.; Singh, K.; Horowitz, J.
Fonte: Clinical Cardiology Publ Co Publicador: Clinical Cardiology Publ Co
Tipo: Artigo de Revista Científica
Publicado em //2013 EN
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BACKGROUND: Takotsubo cardiomyopathy (TTC) is increasingly well-recognized as a cause of chest-pain syndromes, especially in aging females. The most common complications of TTC occur in the first 24 hours post onset of symptoms and include shock and/or arrhythmias. HYPOTHESIS: We tested the hypothesis that the severity of early hypotension in TTC reflects the extent of myocardial involvement and dysfunction. METHODS: In 80 consecutive TTC patients, correlates of blood pressure on the day of admission were sought via univariate followed by multivariate analysis. RESULTS: Mean systolic blood pressure (SBP) on day 1 was 120±24 (SD) mm Hg. During the first 3 days of admission, 39% of patients had SBP <90mm Hg, and 9% died and/or required intra-aortic balloon pump insertion. The extent of release of N-terminal pro-brain natriuretic peptide, with its potential correlate of associated vasodilator activity, varied inverselywith pulmonary-artery saturation, a measure of cardiac output. However, there was no significant relationship between normetanephrine release and SBP. On multivariate analyses there was no significant relationship between SBP and (1) wall-motion score index (as an index of left-ventricular systolic dysfunction) or (2) T2 enhancement on cardiac magnetic resonance imaging and peak N-terminal pro-brain natriuretic peptide (as indices of myocardial inflammation). CONCLUSIONS: Although severe hypotension and shock occur commonly during acute stages of TTC...

Genetic variants regulating insulin receptor signalling are associated with the severity of liver damage in patients with non-alcoholic fatty liver disease

Dongiovanni, P.; Valenti, L.; Rametta, R.; Daly, A.; Nobili, V.; Mozzi, E.; Leathart, J.; Pietrobattista, A.; Burt, A.; Maggioni, M.; Fracanzani, A.; Lattuada, E.; Zappa, M.; Roviaro, G.; Marchesini, G.; Day, C.; Fargion, S.
Fonte: British Med Journal Publ Group Publicador: British Med Journal Publ Group
Tipo: Artigo de Revista Científica
Publicado em //2010 EN
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BACKGROUND/AIMS The aim of this study was to assess the effect of functional ENPP1(ectoenzyme nucleotide pyrophosphate phosphodiesterase 1)/PC-1 (plasma cell antigen-1) and IRS-1 (insulin receptor substrate-1) polymorphisms influencing insulin receptor activity on liver damage in non-alcoholic fatty liver disease (NAFLD), the hepatic manifestation of the metabolic syndrome, whose progression is associated with the severity of insulin resistance. PATIENTS AND METHODS 702 patients with biopsy-proven NAFLD from Italy and the UK, and 310 healthy controls. The Lys121Gln ENPP1/PC-1 and the Gly972Arg IRS-1 polymorphisms were evaluated by restriction analysis. Fibrosis was evaluated according to Kleiner. Insulin signalling activity was evaluated by measuring phosphoAKT levels by western blotting in a subset of obese non-diabetic patients. RESULTS The ENPP1 121Gln and IRS-1 972Arg polymorphisms were detected in 28.7% and 18.1% of patients and associated with increased body weight/dyslipidaemia and diabetes risk, respectively. The ENPP1 121Gln allele was significantly associated with increased prevalence of fibrosis stage >1 and >2, which was higher in subjects also positive for the 972Arg IRS-1 polymorphism. At multivariate analysis, the presence of the ENPP1 121Gln and IRS-1 972Arg polymorphisms was independently associated with fibrosis >1 (OR 1.55...

The presence and severity of chronic kidney disease predicts all-cause mortality in type 1 diabetes

Groop, P.H.; Thomas, M.; Moran, J.; Waden, J.; Thorn, L.; Makinen, V.P.; Rosengard-Barlund, M.; Saraheimo, M.; Hietala, K.; Heikkia, O.; Forsblom, C.
Fonte: American Diabetes Association Publicador: American Diabetes Association
Tipo: Artigo de Revista Científica
Publicado em //2009 EN
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OBJECTIVES This study aimed to identify clinical features associated with premature mortality in a large contemporary cohort of adults with type 1 diabetes. RESEARCH DESIGN AND METHODS The Finnish Diabetic Nephropathy (FinnDiane) study is a national multicenter prospective follow-up study of 4,201 adults with type 1 diabetes from 21 university and central hospitals, 33 district hospitals, and 26 primary health care centers across Finland. RESULTS During a median 7 years of follow-up, there were 291 deaths (7%), 3.6-fold (95% CI 3.2–4.0) more than that observed in the age- and sex-matched general population. Excess mortality was only observed in individuals with chronic kidney disease. Individuals with normoalbuminuria showed no excess mortality beyond the general population (standardized mortality ratio [SMR] 0.8, 95% CI 0.5–1.1), independent of the duration of diabetes. The presence of microalbuminuria, macroalbuminuria, and end-stage kidney disease was associated with 2.8, 9.2, and 18.3 times higher SMR, respectively. The increase in mortality across each stage of albuminuria was equivalent to the risk conferred by preexisting macrovascular disease. In addition, the glomerular filtration rate was independently associated with mortality...

Grape seed extract dose-responsively decreases disease severity in a rat model of mucositis; concomitantly enhancing chemotherapeutic effectiveness in colon cancer cells

Cheah, K.Y.; Howarth, G.S.; Bastian, S.E.P.
Fonte: Public Library of Science Publicador: Public Library of Science
Tipo: Artigo de Revista Científica
Publicado em //2014 EN
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OBJECTIVE: Mucositis is a serious disorder of the gastrointestinal tract that results from cancer chemotherapy. We investigated the effects of increasing grape seed extract doses on the severity of chemotherapy in a rat model and its coincident impact on chemotherapeutic effectiveness in colon cancer cells. DESIGN: Female Dark Agouti rats were gavaged with grape seed extract (400-1000 mg/kg) or water (day 3-11) and were injected intraperitoneally with 5-Fluorouracil (150 mg/kg) or saline (control) on day 9 to induce mucositis. Daily metabolic data were collected and rats were sacrificed on day 12. Intestinal tissues were collected for histological and myeloperoxidase analyses. Caco-2 cell viability was examined in response to grape seed extract in combination with 5-Fluorouracil by 3-(4,5-Dimethylthiazol-2yl)-2,5-diphenyl-tetrazolium bromide) assay. RESULTS: Compared with 5-Fluorouracil controls, grape seed extract (400-1000 mg/kg) significantly decreased the histological damage score (P<0.05) in the jejunum. Grape seed extract (1000 mg/kg) increased jejunal crypt depth by 25% (P<0.05) in 5-Fluorouracil treated rats compared to 5-Fluorouracil controls, and attenuated the 5-Fluorouracil -induced reduction of mucosal thickness (25%, P<0.05). Grape seed extract (600 mg/kg) decreased myeloperoxidase activity by 55% (P<0.01) compared to 5-Fluorouracil controls. Grape seed extract was more effective at ameliorating 5-Fluorouracil induced intestinal injury...

Cost calculation and prediction in adult intensive care: A ground-up utilization study

Moran, J.; Peisach, A.; Solomon, P.; Martin, J.
Fonte: Australian Soc Anaesthetists Publicador: Australian Soc Anaesthetists
Tipo: Artigo de Revista Científica
Publicado em //2004 EN
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75.73%
The ability of various proxy cost measures, including therapeutic activity scores (TISS and Omega) and cumulative daily severity of illness scores, to predict individual ICU patient costs was assessed in a prospective “ground-up” utilization costing study over a six month period in 1991. Daily activity (TISS and Omega scores) and utilization in consecutive admissions to three adult university associated ICUs was recorded by dedicated data collectors. Cost prediction used linear regression with determination (80%) and validation (20%) data sets. The cohort, 1333 patients, had a mean (SD) age 57.5 (19.4) years, (41% female) and admission APACHE III score of 58 (27). ICU length of stay and mortality were 3.9 (6.1) days and 17.6% respectively. Mean total TISS and Omega scores were 117 (157) and 72 (113) respectively. Mean patient costs per ICU episode (1991 $AUS) were $6801 ($10311), with median costs of $2534, range $106 to $95,602. Dominant cost fractions were nursing 43.3% and overheads 16.9%. Inflation adjusted year 2002 (mean) costs were $9343 ($ AUS). Total costs in survivors were predicted by Omega score, summed APACHE III score and ICU length of stay; determination R2, 0.91; validation 0.88. Omega was the preferred activity score. Without the Omega score...

Increased severity of lower urinary tract symptoms and daytime somnolence in primary Sjögren's syndrome; Increased severity of lower urinary tract symptoms and daytime somnolence in primary Sjogren's syndrome

Walker, J.; Gordon, T.; Lester, S.; Downie-Doyle, S.; McEvoy, R.; Pile, K.; Waterman, S.; Rischmueller, M.
Fonte: J Rheumatol Publ Co Publicador: J Rheumatol Publ Co
Tipo: Artigo de Revista Científica
Publicado em //2003 EN
Relevância na Pesquisa
85.71%
OBJECTIVE: Functional antimuscarinic receptor autoantibodies have recently been described in both primary and secondary Sjögren's syndrome (SS) in a mouse bladder contraction assay. Most patients with these antibodies complained of severe lower urinary tract disturbances, which are not a recognized feature of SS. We compared the severity of self-reported urological symptoms, daytime somnolence, and fatigue between a cohort of patients with primary SS and controls with osteoarthritis (OA). METHODS: Female patients were recruited from rheumatology outpatient clinics at 2 hospitals. The American Urological Symptom Index (AUA-7), Epworth Sleepiness Scale, and FACIT-F fatigue self-administered instruments were employed. Results were obtained for 76 patients with primary SS and 43 controls (response rates 85% and 67%, respectively). The patient groups were matched for parity, hormone replacement and diuretic therapy, and number of bladder operations and urinary tract infections, although OA patients were slightly older. RESULTS: AUA-7 urological symptoms were more severe in patients with primary SS compared to OA controls (p = 0.039). Severe urological symptoms were reported by 61% of primary SS patients compared with 40% of OA controls. This difference was predominantly attributable to bladder irritability associated with urgency (p = 0.015) and not nocturia (p = 0.85). Epworth Sleepiness Scale scores were also more severe in primary SS patients compared to OA controls (p = 0.02)...

Relationship between the Nursing Workload and the Severity of the Patient’s Condition in Adult Intensive Care Units; Relación entre la carga laboral de enfermería y la gravedad del paciente en unidades de cuidado intensivo de adultos; Relação entre carga de trabalho de enfermagem e estado grave do paciente em unidades de cuidados intensivos para adultos

Romero-Massa, Elizabeth; Universidad de Cartagena; Lorduy-Bolívar, Johana Patricia; Universidad de Cartagena; Pájaro-Melgar, Carmen; Universidad de Cartagena; Pérez-Duque, Carolina Andrea; Universidad de Cartagena
Fonte: Aquichan Publicador: Aquichan
Tipo: Artigo de Revista Científica
SPA
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Objective: To determine the relationship between the demands of the nursing workload and the severity of the patient’s condition in adult intensive care units in the city of Cartagena during July 2008. Methodo: This is a longitudinal study with a sample comprised of 42 patients. TISS-28 (Therapeutic Intervention Scoring System) and Apache II (Acute Physiology and Chronic Health Evaluation) records were obtained. Arithmetic average, standard deviation and proportions were calculated, as was the Pearson correlation coefficient. Results: In this study involving a total of 42 patients, the average age was 58.2 years (IC 95% 52.1-64.4), and 51.3 percent of the patients in the sample were women. Forty-two (42) Apache II evaluations were obtained when the patients were admitted to the ICU, with an average of 28.9, and 66.7 percent if the patients (28) have a poor prognosis. There were 188 TISS-28 scores, with an average of 28.7 (IC 95% 25.7 - 31.7) per patient. The average TISS upon release from the ICU was 25.7 (95% CI 22.4 to 28.9) per patient. In all, 61.9 per cent of the patients were Class III. The nurse/ Class IV patient ratio was 0.57 less than 1:1. The study found a relationship of 0.55 between Apache II and TISS-28. (0.501-0.75) and a coefficient of determination equal to 0.38 (p; Objetivo: determinar la relación entre la demanda de carga laboral de enfermería y la gravedad del paciente en unidades de cuidados intensivos de adultos en la ciudad de Cartagena...

Profiles of physician practice and patient severity of illness.

Horn, S D; Horn, R A; Moses, H
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /05/1986 EN
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75.83%
We report on a study that examined physician practice profiles using two methods of patient classification: the Severity of Illness Index and diagnosis-related groups (DRGs). When used together with conventional management information and DRGs, the Severity of Illness Index permitted useful comparisons to be made among physicians; differences in both case-mix and severity could be estimated. In 37 per cent of the physicians studied, we found differences of more than $10,000 in the apparent impact of a physician on the hospital's financial position, depending on whether one controlled for severity or not. The extent to which these differences in impact could be due to quality of care differences is an area for future research. However, the findings that 37 per cent of the physicians in the study may be wrongly identified as over- or under-utilizers suggest long-term public health consequences of preparing physician profiles based on unadjusted DRGs.

The Severity of Illness Index as a severity adjustment to diagnosis-related groups

Horn, Susan D.; Horn, Roger A.; Sharkey, Phoebe D.
Fonte: CENTERS for MEDICARE & MEDICAID SERVICES Publicador: CENTERS for MEDICARE & MEDICAID SERVICES
Tipo: Artigo de Revista Científica
Publicado em /11/1984 EN
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75.72%
This article discusses the Severity of Illness case-mix groups, and suggests a refinement to diagnosis-related groups (DRG's) designed to accommodate the important element of patient severity. An application of the suggested refinement is presented in a discussion of the efficient production of hospital services.

Colonization by S. Aureus increases the EASI and the number of appointments by patients with atopic dermatitis: cohort with 93 patients

Lipnharski,Caroline; d'Azevedo,Pedro Alves; Quinto,Vanessa Petry; Bessa,Giancarlo; Bonamigo,Renan Rangel
Fonte: Sociedade Brasileira de Dermatologia Publicador: Sociedade Brasileira de Dermatologia
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/08/2013 EN
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75.81%
BACKGROUND: Atopic dermatitis leads to epidermal barrier dysfunction and bacteria colonization. The relationship of the last factor with the severity of the disease and the frequency of exacerbation is not fully known. OBJECTIVES: Verify the severity of the atopic dermatitis and the number of appointments generated by dermatosis, comparing patients colonized with patients not colonized by S. aureus. Verify the frequency of colonization by methicillin resistant Staphylococcus aureus acquired in the community. METHODS: Cohort study with a 12 months follow-up, in a sample of patients from Porto Alegre, RS public network. Cultures in active injuries and nasal cavities were carried out as well as methicillin sensitivity tests to S. aureus. The severity of atopic dermatitis was defined by Eczema Area and Severity Index (EASI). RESULTS: We included 93 patients, 43% female and 56% male, 26 colonized by S. aureus in the nasal orifices, 56 in the skin damage. The mean of initial Eczema Area and Severity Index was 5.5 and final 3.9. The initial Eczema Area and Severity Index of patients colonized by S. aureus in the skin and nasal cavity was larger than the number of patients without colonization(p< 0.05). During the period of one year...

Erectile Dysfunction Severity as a Risk Marker for Cardiovascular Disease Hospitalisation and All-Cause Mortality: A Prospective Cohort Study

Banks, Emily; Joshy, Grace; Abhayaratna, Walter P.; Kritharides, Leonard; Macdonald, Peter S.; Korda, Rosemary J.; Chalmers, John P.
Fonte: Public Library of Science Publicador: Public Library of Science
Tipo: Artigo de Revista Científica
Relevância na Pesquisa
85.71%
BACKGROUND Erectile dysfunction is an emerging risk marker for future cardiovascular disease (CVD) events; however, evidence on dose response and specific CVD outcomes is limited. This study investigates the relationship between severity of erectile dysfunction and specific CVD outcomes. METHODS AND FINDINGS We conducted a prospective population-based Australian study (the 45 and Up Study) linking questionnaire data from 2006-2009 with hospitalisation and death data to 30 June and 31 Dec 2010 respectively for 95,038 men aged ≥45 y. Cox proportional hazards models were used to examine the relationship of reported severity of erectile dysfunction to all-cause mortality and first CVD-related hospitalisation since baseline in men with and without previous CVD, adjusting for age, smoking, alcohol consumption, marital status, income, education, physical activity, body mass index, diabetes, and hypertension and/or hypercholesterolaemia treatment. There were 7,855 incident admissions for CVD and 2,304 deaths during follow-up (mean time from recruitment, 2.2 y for CVD admission and 2.8 y for mortality). Risks of CVD and death increased steadily with severity of erectile dysfunction. Among men without previous CVD, those with severe versus no erectile dysfunction had significantly increased risks of ischaemic heart disease (adjusted relative risk [RR] = 1.60...

Relief and Recurrence of Congestion During and After Hospitalization for Acute Heart Failure: Insights From Diuretic Optimization Strategy Evaluation in Acute Decompensated Heart Failure (DOSE-AHF) and Cardiorenal Rescue Study in Acute Decompensated Heart Failure (CARESS-HF).

Lala, A; McNulty, SE; Mentz, RJ; Dunlay, SM; Vader, JM; AbouEzzeddine, OF; DeVore, AD; Khazanie, P; Redfield, MM; Goldsmith, SR; Bart, BA; Anstrom, KJ; Felker, GM; Hernandez, AF; Stevenson, LW
Fonte: Universidade Duke Publicador: Universidade Duke
Tipo: Artigo de Revista Científica Formato: 741 - 748
Publicado em /07/2015 ENG
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85.58%
BACKGROUND: Congestion is the most frequent cause for hospitalization in acute decompensated heart failure. Although decongestion is a major goal of acute therapy, it is unclear how the clinical components of congestion (eg, peripheral edema, orthopnea) contribute to outcomes after discharge or how well decongestion is maintained. METHODS AND RESULTS: A post hoc analysis was performed of 496 patients enrolled in the Diuretic Optimization Strategy Evaluation in Acute Decompensated Heart Failure (DOSE-AHF) and Cardiorenal Rescue Study in Acute Decompensated Heart Failure (CARRESS-HF) trials during hospitalization with acute decompensated heart failure and clinical congestion. A simple orthodema congestion score was generated based on symptoms of orthopnea (≥2 pillows=2 points, <2 pillows=0 points) and peripheral edema (trace=0 points, moderate=1 point, severe=2 points) at baseline, discharge, and 60-day follow-up. Orthodema scores were classified as absent (score of 0), low-grade (score of 1-2), and high-grade (score of 3-4), and the association with death, rehospitalization, or unscheduled medical visits through 60 days was assessed. At baseline, 65% of patients had high-grade orthodema and 35% had low-grade orthodema. At discharge...