Background We sought to evaluate the satisfaction of surgical patients in order to identify predictors of patient satisfaction, using a cross-sectional surgery patients' survey in 24 public hospitals ...in Spain and a total of 15,539 inpatients and 7,899 outpatients. Results Seventy-seven percent of inpatients and 88.3% of outpatients were satisfied (χ2 = 509.31; P < .0001). Case-mix and hospital size were associated with satisfaction in inpatients (χ2 = 19.31; P = .013). Older inpatients tended to be more satisfied (χ2 = 80.54; P = .001), whereas; younger outpatients showed higher satisfaction levels (χ2 = 51.73; P = .004). The most influential factors on inpatient satisfaction were information at admission (odds ratio OR, 4.05; 95% confidence interval CI, 2.91–5.63), knowing what type of professional one was dealing with at any given time (OR, 4.01; 95% CI, 3.01–5.34), and informed consent (OR, 3.37; 95% CI, 2.41–4.71). For outpatients, the most influential factors were informed consent (OR, 7.62; 95% CI, 3.68–15.80) and information about home care after discharge (OR, 7.010; 95% CI, 3.06–15.96). Conclusion We should consider the importance of patient information before and after treatment in the design of clinical pathways to offer better and more comprehensive care to surgical patients.
Abstract Objective Overcrowding is an important issue facing many emergency departments (EDs). Access block (admitted patients occupying ED stretchers) is a leading contributor, and expeditious ...placement of admitted patients is an area of research interest. This review examined the effectiveness of full capacity protocols (FCPs) on mitigating ED overcrowding. Methods A comprehensive literature search was undertaken to identify potentially relevant studies between 1966 and 2009. Intervention studies in which an FCP was used to influence ED/hospital length of stay and ED/hospital access block were included as a single program or part of a systemwide intervention. Two reviewers independently assessed citation relevance, inclusion, study quality, and extracted data; because of limited data, pooling was not undertaken. Results From 14 446 potentially relevant studies, 2 abstracts from the same comparative study were included. From 29 studies on systemwide intervention, 4 contained an FCP component. The included study was a single-center ED study using a before-after design; its methodological quality was rated as weak. One of the abstracts reported that an FCP was associated with less ED length of stay (5-hour reduction) when compared with the comparison period; the other reported that an FCP decreased ED and hospital access block (28% and 37% reduction, respectively). The ED triggers, format, and implementation of FCP protocols varied widely. Conclusion Although FCPs may be a promising alternative for overcrowded EDs, the available evidence upon which to support implementation of an FCP is limited. Additional efforts are required to improve the outcome reporting of FCP research using high-quality research methods.
...the speckle tracking strain parameters determined to be optimal for separating survivors from nonsurvivors still need to be validated in a prospective study of untreated patients. ...it should be ...recognized that treatment in AL cardiac amyloidosis is a fast-moving field, and a once universally fatal disease is now treatable, with long-term remission and a good quality of life achievable in many patients if they are treated in skilled centers.
Objectives This study sought to evaluate the 30-day and long-term clinical outcomes of patients with carotid obstructive disease (COD) and concomitant coronary artery disease (CAD) undergoing a ...combined percutaneous revascularization, in 4 high-volume centers skilled for the treatment of multilevel vascular disease. Background The optimal management of patients with COD and concomitant CAD remains controversial. A variety of therapeutic strategies, including coronary artery bypass grafting, alone or in combination with carotid artery revascularization, have been reported. Methods Between January 2006 and April 2010, 239 consecutive patients with COD (symptomatic carotid stenosis in 20.5%) and concomitant CAD were treated with staged or simultaneous carotid artery stenting and percutaneous coronary intervention, and enrolled in this prospective registry. The primary endpoint was the incidence of major cardiac and cerebrovascular events, including any death, myocardial infarction, or stroke occurring between the first revascularization procedure and 30 days after treatment of the second vascular territory affected. Results The incidence of the primary endpoint at 30 days was 4.2% (95% confidence interval CI: 2.02 to 7.56). The rate of death, myocardial infarction, and stroke at long-term follow-up (median 520 days) was 4.2%, 2.1%, and 3.8%, respectively. At long-term follow-up, patients with previous cardiovascular disease had significantly higher rates of major cardiac and cerebrovascular events than did patients with a first clinical episode (17% vs. 6%, hazard ratio: 3.34; 95% CI: 1.46 to 7.63; p = 0.004). Conclusions In patients with COD and concomitant CAD, a combined percutaneous treatment compares favorably with previous surgical or hybrid experiences. Such strategy may be particularly suited to complex patients at high surgical risk.
Objective To validate high serum procalcitonin (PCT) as a predictor of vesicoureteral reflux (VUR) in children with a first febrile urinary tract infection (UTI). Study design This secondary analysis ...of prospective hospital-based cohort studies included children ages 1 month to 4 years with a first febrile UTI. Results Of the 398 patients included in 8 centers in 7 European countries, 25% had VUR. The median PCT concentration was significantly higher in children with VUR than in those without: 1.6 versus 0.7 ng/mL ( P = 10−4 ). High PCT (≥0.5 ng/mL) was associated with VUR (OR: 2.3; 95% CI, 1.3 to 3.9; P = 10−3 ). After adjustment for all cofactors, the association remained significant (OR: 2.5; 95% CI, 1.4 to 4.4; P = 10−3 ). The strength of the relation increased with the grade of reflux ( P = 10−5 ). The sensitivity of procalcitonin was 75% (95% CI, 66 to 83) for all-grade VUR and 100% (95% CI, 81 to 100) for grade ≥4 VUR, both with 43% specificity (95% CI, 37 to 48). Conclusions High PCT is a strong, independent and now validated predictor of VUR that can be used to identify low-risk patients and thus avoid one third of the unnecessary cystourethrographies in children with a first febrile UTI.
To evaluate the surgical outcome of extraperitoneal paraaortic lymph node dissection compared with the traditional transperitoneal approach.
Retrospective review (Canadian Task Force classification ...III).
University hospital.
Women with gynecologic malignancies admitted to our hospital between 2007 and 2011 who underwent laparoscopic paraaortic lymphadenectomy.
Indication, diagnosis, and outcome according to type of surgery were evaluated.
Of 47 patients who underwent laparoscopic paraaortic lymphadenectomy because of gynecologic indications, 28 patients underwent extraperitoneal paraaortic lymph node dissection and 19 underwent the same procedure via the classic transperitoneal technique. The most frequent indication for extraperitoneal lymph node dissection was cervical cancer (71.4%), and for the transperitoneal technique was endometrial cancer (47.4%). The mean (SD) duration of surgery was 211 (38) minutes in the transperitoneal approach group, and 173 (51) minutes in the extraperitoneal lymphadenectomy group (p = .009). No significant differences between groups were found in the number of lymph nodes removed (15 5.9 nodes in the extraperitoneal group vs 17.4 8.6 in the transperitoneal group; p = .25). However, a higher rate of positive nodes was observed in the extraperitoneal group than in the transperitoneal group (42.8% vs 36.2%, respectively p = .001), and a significantly shorter stay in the intensive care unit in the extraperitoneal group (0.59 0.5 vs 1.1 0.5 days, respectively; p = .02). No significant differences in complication rate were found between groups.
Extraperitoneal paraaortic lymph node dissection is a minimally invasive procedure that is an excellent and safe approach to the paraaortic area, with a low complication rate, sufficient number of lymph nodes, and short hospital stay. It seems to be a good alternative to the classic transperitoneal approach.
Imaging Findings in Pulmonary Vasculitis Castañer, Eva, MD; Alguersuari, Anna, MD; Andreu, Marta, MD ...
Seminars in ultrasound, CT, and MRI,
12/2012, Letnik:
33, Številka:
6
Journal Article
Recenzirano
Vasculitis is a destructive inflammatory process affecting blood vessels. Pulmonary vasculitis may develop secondary to other conditions or constitute a primary idiopathic disorder. Thoracic ...involvement is most common in primary idiopathic large-vessel vasculitides (Takayasu arteritis, giant cell arteritis, Behçet disease) and primary antineutrophil cytoplasmic autoantibody-associated small-vessel vasculitides (Wegener granulomatosis, microscopic polyangiitis, Churg–Strauss syndrome). Primary pulmonary vasculitides are rare, and their signs and symptoms are nonspecific, overlapping with those of infections, connective tissue diseases, and malignancies. The radiologic findings in primary pulmonary vasculitis vary widely and can include vessel wall thickening, nodular or cavitary lesions, ground-glass opacities, and consolidations, among others. Diffuse alveolar hemorrhage usually results from primary small-vessel vasculitis in the lungs. To diagnose vasculitis, medical teams must recognize characteristic combinations of clinical, radiologic, laboratory, and histopathologic features.
PDF
