Dying in the Neurointensive Care Unit After Withdrawal of Life-Sustaining Therapy: Associations of Advance Directives and Health-Care Proxies With Timing and Treatment Intensity

2020 ◽  
pp. 088506662090679
Author(s):  
Frank Stachulski ◽  
Bob Siegerink ◽  
Julian Bösel
Keyword(s):  
Health Care ◽  
Advance Directives ◽  
Neurocritical Care ◽  
Neurointensive Care ◽  
University Hospital ◽  
Treatment Intensity ◽  
Neurointensive Care Unit ◽  
Significant Difference ◽  
Adjusted Incidence Rate ◽  
Health Care Proxies

Background and Purpose: Critically ill patients require a careful approach for prognosis and decision-making. The German health legislation aims to strengthen the role of advance directives (ADs) and health-care proxies (HCPs). Their impact within a dedicated neurocritical care setting is unknown. This study aimed to assess the practice of withdrawal or withholding of life-sustaining therapy (WOLST) in a German neurointensive care unit (NICU) focusing on whether AD or HCP is associated with timing and treatment intensity. Methods: Data on patients who died after WOLST at a dedicated NICU of a German university hospital, from 2010 to 2013, were retrospectively analyzed. Results: Of 400 deceased patients, 310 (77.5%) died after initiation of WOLST. Among them, 68 (21.9%) were identified to have AD or HCP or both (AD + HCP). WOLST patients with AD, HCP, or AD + HCP were older than those without (median age: 77 vs 72 years, P < .001) but did not show any other distinct baseline features. There was no difference in the specific neurocritical care measures between the groups. Poisson regression analysis showed no significant difference in the probability of time-dependent WOLST initiation between those with and without AD/HCP, after adjusting for age and sex (adjusted incidence rate ratio, 1.10; 95% confidence interval, 0.94-1.28; P = .244). Conclusions: In this single-center study of mainly cerebrovascular NICU patients, AD or HCP was neither associated with an earlier WOLST nor associated with a difference in treatment intensity before WOLST. Further prospective studies should assess the emerging concept of advance care planning in neurocritical care.

scholarly journals Prevalence and profile of daily smokers seen at three primary health care units in Pelotas, southern Brazil

2012 ◽  
Vol 34 (3) ◽  
pp. 154-160 ◽  
Author(s):  
Mariane Ricardo Acosta Lopez ◽  
Karen Jansen ◽  
Luciano Dias de Mattos Souza ◽  
Ricardo Tavares Pinheiro ◽  
Elaine Tomasi ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Total Sample ◽  
Tobacco Consumption ◽  
University Hospital ◽  
Daily Smoking ◽  
Southern Brazil ◽  
Cross Sectional ◽  
Primary Health ◽  
Significant Difference

Objectives: To estimate the prevalence of daily smoking among users of three primary health care units affiliated with a university hospital in the municipality of Pelotas, southern Brazil, and to identify factors associated with daily tobacco consumption. Methods: This cross-sectional study included all individuals over 14 years of age who sought treatment at the health care units between June 29, 2009, and February 23, 2010, and lived in the area covered by the unit. Interviews were conducted during home visits to collect data on sociodemographic characteristics and health behaviors; the Mini International Neuropsychiatric Interview (MINI) was used to assess the presence of mood disorders; and a question from the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) on the daily use of tobacco in the past 3 months was used to assess smoking. Results: The total sample comprised 1,848 individuals, mostly female (72.9%), aged between 46 and 60 years (28.5%), and belonging to socioeconomic class C (61%). The prevalence of daily smoking was 23.4% (n = 432), and there was a statistically significant difference between men and women: 27 vs. 22.1% (p < 0.050). Conclusion: Our findings confirm a high prevalence of smoking among users of primary health care units, underscoring the need for a more accurate process of diagnosis and treatment at these facilities.

Delays in treatment for colorectal cancer patients in an NCI-designated cancer center serving a Hispanic majority community.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18233-e18233
Author(s):  
Tamna Wangjam ◽  
Sherri L. Rauenzahn ◽  
Praveena Iruku ◽  
Stephanie Purkat Lindauer ◽  
Matthew James Butler ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Health Care ◽  
Median Time ◽  
Health Care Quality ◽  
Care Quality ◽  
University Hospital ◽  
Cancer Center ◽  
Definitive Therapy ◽  
Significant Difference ◽  
Hispanic Patients

e18233 Background: Timeliness of cancer treatment is an important aspect of health care quality. Colorectal cancer (CRC) care requires the coordinated multidisciplinary effort of various aspects of the health care system, which can lead to delays between initial diagnoses to definitive therapy. Little is known about the time from diagnosis to cancer-directed treatment, neither about the factors that cause delays or its effect on patient outcomes. Delays to curative surgery beyond 12 weeks are associated with increased mortality in CRC. Longer time to adjuvant chemotherapy is associated with worse survival among patients with resected CRC. The objective of our study is to identify delays in initiation of CRC treatment and its causative factors. Methods: We retrospectively reviewed the medical records of CRC patients who were either initially diagnosed or had initial surgical resection at University Hospital and had further treatment at Cancer Therapy and Research Center, between 7/1/2010 and 12/22/2014. Data were collected on patient and disease characteristics, treatment timelines and outcomes, till pre-specified data cut-off date of 8/1/16. Results: Of 256 patients treated for CRC, majority were males (59 %), Hispanic (59 % ) and uninsured (34 %). Most had non-metastatic disease (70%). 72 % were still alive at the time of data cut-off. The median time from diagnosis to treatment (TDT) was 21 days, with most of te patients getting first treatment between 0-30 days of diagnosis (60 %). Median time from first treatment to first progression or recurrence was 12 months (range 0.9- 42 mos.). Median overall survival (OS) was 17 months (0.1- 51 months). There were no statistically significant difference between the progression or recurrence free survival and OS in patients with TDT < 30 days, 30-89 days and > 90 days. Compared to non-Hispanics, Hispanic patients were more likely to have a TDT of 31-89 days (31% vs 37%, p = 0.0003) and > / = 90 days (3% vs 7%, p = 0.0001). Conclusions: Hispanic patients were more likely to have a longer time from diagnosis to treatment compared to non-Hispanic patients. The factors for such disparities in health care quality and their effect on survival needs to be explored further.

High-dose benzodiazepine dependence among health-care professionals: A neglected phenomenon

2021 ◽  
Vol 61 (1_suppl) ◽  
pp. 42-45
Author(s):  
Laura Morbioli ◽  
Fabio Lugoboni
Keyword(s):  
Health Care ◽  
Cognitive Impairment ◽  
Health Care Professionals ◽  
University Hospital ◽  
High Dose ◽  
Work Related ◽  
Severe Withdrawal ◽  
Significant Difference ◽  
High Doses ◽  
The Impact

Chronic use of benzodiazepines (BDZs) is a widespread phenomenon which can lead to side effects such as tolerance, dependence and cognitive impairment, as well as resulting in accidents at work. High-dose BDZ dependence (HD-BDZ) is little studied, and it is mainly attributed to major psychiatric disorders and polydrug abuse. To date, few studies have investigated HD-BDZ among active workers, with none among health-care professionals (HPs). Tapering from high doses of BDZs can cause severe withdrawal symptoms, including seizures. The Addiction Unit of the University Hospital in Verona uses a protocol based on flumazenil slow infusion (FLU-SI), the safest and most effective treatment for HD-BDZ. Since 2003, 1281 patients have been detoxified from long-term use of high doses of BDZ using FLU-SI. The sample includes 139 (10.8%) HPs. Mean daily doses were 336 mg diazepam equivalent among HPs and 365 mg diazepam equivalent among non-HPs (no statistically significant difference). HPs are at higher risk of sleep disorders and work-related stress. Most of these HPs experience difficulties at work due to cognitive impairment, but they are often afraid of the potential legal implications and too ashamed to ask for help. It is important to study the prevalence of HD-BDZ among HPs and to investigate the impact on their working skills and working eligibility.

scholarly journals A comparative study between a single-dose and 24-hour multiple-dose antibiotic prophylaxis for elective hysterectomy

2020 ◽  
Vol 14 (11) ◽  
pp. 1306-1313
Author(s):  
Khalid Mohammed Akkour ◽  
Maria Abdulrahim Arafah ◽  
Mais Mohammed Alhulwah ◽  
Rana Saeed Badaghish ◽  
Hani Abdulmohsen Alhalal ◽  
...  
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Single Dose ◽  
Antibiotic Prophylaxis ◽  
Potential Risk ◽  
University Hospital ◽  
Prophylactic Regimen ◽  
Effective Manner ◽  
Significant Difference ◽  
Potential Risk Factors

Introduction: Surgical site infections (SSIs) are a major health issue in surgical specialties in terms of health care costs and patients’ clinical outcomes. At the level of the patient, prolonged hospital stays or readmissions for SSIs, can affect the patient’s quality of life. At the level of the health care system, it exhausts the hospital’s resources and increases the burden on the medical staff due to the need for continuous wound care, microbiological cultures, laboratory tests and medications. In this study, we assessed the effectiveness of two antibiotic prophylaxis regimens for the prevention of SSIs in patients undergoing elective hysterectomy surgeries. Methodology: A retrospective cohort, analyzing 141 patients, was conducted between November 2016 and January 2019 at a university hospital. We compared the efficacy of a single dose vs. 24-hour multiple doses of Cefazolin in patients who underwent elective hysterectomy for benign or malignant indications. The secondary objective was to identify potential risk factors associated with SSIs. Results: There was no statistically significant difference between both groups (p = 0.872). Obesity and a laparotomy surgical approach are risk factors to the development of SSIs (p = 0.001 and 0.014, respectively). Other potential risk factors include the duration of hospital stay, the duration of the surgery and the amount of blood loss. Conclusions: Although the rate of SSIs is not significantly different between both groups, risk stratification can be done after screening patients and the prophylactic regimen must be tailored for each patient in a cost-effective manner and using a multidisciplinary approach.

Patient safety culture among health care provider’s in a Tunisian university hospital

2019 ◽  
Vol 15 (3) ◽  
Author(s):  
Latifa Merzougui ◽  
Sarra Sghaier ◽  
Nedia Radaoui ◽  
Dhekra Chebil ◽  
Elyes Turki ◽  
...  
Keyword(s):  
Health Care ◽  
Patient Safety ◽  
Health Care Providers ◽  
Safety Culture ◽  
Patient Safety Culture ◽  
University Hospital ◽  
Care Providers ◽  
Cross Sectional ◽  
Significant Difference ◽  
Work Units

Patient safety is considered a major priority in health care systems. In Tunisia, few attempts have been made since 2011 to evaluate PS culture. The purpose of this study was to measure the patient safety culture level at Ibn El Jazzar hospital in Kairouan, Tunisia. This cross-sectional study was conducted over three months in 2015 in a Tunisian University hospital. The French model of the Hospital Survey On Patient Safety Culture “HSOPSC” was used to explore 10 dimensions of patient safety culture. The survey was distributed to 446 health care providers (physicians and nurses). A score per composite has been calculated. Then the results were compared according to professional categories and work units. The overall average positive response rate for the 10 PS culture composites of the HSOPSC survey was 61.65%. Areas with potential for improvement were overall perception of security (40.73%), leadership (30.9%), organizational learning (41.9%), communication openness (38.3%) and frequency of events reported (33.2%). The area of strength was teamwork within units (58.1%). Non-punitive response to error had the lowest score (29.6%). The comparison of the scores according to professional category showed a significant difference for one composite score, which was the non-punitive answer to the errors particular to nurses (16.3% vs 32.7%; p = 0.020). In contrast, no significant difference between work units was found for all composites scores in our study. Our results demonstrate that patient safety culture remains undeveloped and should be improved at Ibn El Jazzar hospital. Therefore, further studies should be conducted in the context of continuous assessment quality of care.

scholarly journals Antimicrobial Resistance and Virulence of Staphylococcus spp. in patients from oncologic and non oncologic hospitals of Recife City/PE

2021 ◽  
Vol 10 (10) ◽  
pp. e323101018951
Author(s):  
Marcelle Aquino Rabelo ◽  
Stephanie Targino da Silva ◽  
Jussyêgles Niedja da Paz Pereira ◽  
Natália Regina Souza da Silva ◽  
Vítor Hugo de Arimatéa Rocha ◽  
...  
Keyword(s):  
Health Care ◽  
Virulence Genes ◽  
University Hospital ◽  
Type I ◽  
Associated Bacteria ◽  
Major Infection ◽  
Antimicrobial Susceptibility Profile ◽  
Significant Difference ◽  
Vancomycin Resistant ◽  
Staphylococcus Spp

Staphylococcus spp. is one of the major infection-associated bacteria within health care, especially in intensive care units, and one of principal cause of complication in cancer patients. This study compared the antimicrobial susceptibility profile and frequency of resistance (mecA, blaZ, ermA and ermC) and virulence (icaA, icaD and hlg) genes in Staphylococcus spp. from patients of Oncology Hospital (OH) and University Hospital (UH). The type of the ccr complex was assessed by PCR among the mecA positive isolates from the UH. Higher percentage of susceptible isolates, except for oxacillin and cefoxitin was found among the UH isolates and 27,3% vancomycin-resistant isolates were identified through the screening spot; 41 isolates displayed the MLSBc phenotype and five the MSLBi phenotype, and one isolate from the OH displayed the constitutive phenotype ermC gene. The ccr types I and II were identified with a higher frequency of ccr type I. No statistically significant difference was found in the frequency of the genes between the two groups of patients or in the two hospitals. Regarding the virulence genes, there was statistically significant difference when comparing the two hospitals.

scholarly journals The Impact of the Family and Health Workers on Psychosocial Adaptation and the Process of Treatment of Oncological Patients

2020 ◽  
Vol 8 (B) ◽  
pp. 779-783
Author(s):  
Olivera Kalajdžić ◽  
Jelena Pavlović
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Health Workers ◽  
Cross Sectional Study ◽  
Psychosocial Adaptation ◽  
University Hospital ◽  
Cross Sectional ◽  
Diseased Person ◽  
Significant Difference ◽  
The Impact

BACKGROUND: Psychological support for patients and their families is of great importance at times when they go through shock, stress, and fear at moments when confronted with diagnosis and treatment. AIM: Aim to this study was to examine the influence of family attitudes on psychosocial adaptation and the effect of treatment of patients with malignancies to preserve the integrity of the diseased person in Bosnia and Herzegovina. METHODS: The cross-sectional study included 100 patients who were hospitalized at Foca University Hospital, Department of Oncology between September 2019 and December 2019. The survey used a sociodemographic questionnaire as well as a standardized questionnaire to evaluate communication with patients with malignant diseases for the patient and family (CCAT-PF). RESULTS: More than half of the respondents (69%) accepted the malignancy. When it comes to communication between health-care professionals and patients, 51% are satisfied with the communication and 49% are not satisfied. Most respondents (62%) hesitate to talk about side effects during treatment with health-care professionals, with a statistically significant difference observed between male and female respondents (χ2 = 6,014; p = 0.014). CONCLUSION: The time devoted to the subjects by the physicians as well as the willingness to listen to the patient is important aspects that influence the adaptation of the disease as well as the treatment.

Parent’s Experiences from the Treatment of their Children at the Physic Children’s Surgery Clinic in Skopje.

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
M. Trajchevska ◽  
A. Lleshi ◽  
S. Gjoshev ◽  
A. Trajchevski
Keyword(s):  
Health Care ◽  
Health Status ◽  
Independent Predictor ◽  
Demographic Data ◽  
Parental Satisfaction ◽  
Pediatric Care ◽  
Simple Random Sample ◽  
Significant Independent Predictor ◽  
Cross Sectional ◽  
Significant Difference

Background: The respect of the needs and wishes of the patients is in the focus of the human health system. The experience of the parents in terms of child’s health care may be used as an indicator of quality of the health care. Material and methods: The research is a quantitative analytical cross-sectional study. In accordance with the inclusion and exclusion criteria, simple random sample of 207 parents / guardians is covered, whose children in the period of three months, had been hospitalized in the hospital department JZUU Pediatric Surgery Clinic in Skopje.It was used a two parted questionnaire. The first part is a standardized questionnaire (Parent Experience of Pediatric Care - PECP), and the second part concerns the general socio-demographic data of the parent/guardian. Statistical evaluation was performed using appropriate statistical programs (Statistics for Windows 7,0 and SPSS 17.0). Results: In accordance with the age of the parents, the survey respondents were divided into two groups: a) age ≤ 33 years - 107 (51.69%) and b) age> 33 years - 100 (48.31%).Significant independent predictor of parental satisfaction from the receipt of their child to the clinic research confirms the age of the parent under / over 33 years due to 4.1% of the change in satisfaction (R2 = 0,041). Parents generally believe that their children's room of the clinic is "good", without significant difference between parental satisfaction from both age groups (Mann-Whitney U Test Z = -0,9613 p = 0,3364). Significant independent predictor of parental satisfaction from the room of their child improves the health status after treatment due to 6% of the change in satisfaction (R2 = 0,060). Parents generally believe that testing and treatment of their children in the clinic was "very good" and an independent significant predictor is to improve the health status after the treatment - 7,8% (R2 = 0,078). Conclusions: Regardless of the generally good parental satisfaction about health care for their children, it is necessary to continuously monitor the status of the clinic in order to consider the possible deficiencies and needs of intervention.

PAROTITIS IN NEUROINTENSIVE CARE UNIT: CASE REPORT AND REVIEW OF THE LITERATURE

2014 ◽  
Author(s):  
Hatice Ture ◽  
Sevgi Bilgen ◽  
Ozgul Keskin ◽  
Ozge Koner ◽  
Sibel Temur ◽  
...  
Keyword(s):  
Case Report ◽  
Neurointensive Care ◽  
Review Of The Literature ◽  
Neurointensive Care Unit
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