Impact of a multifaceted strategy in end-of-life care in a tertiary hospital: A quasi-experimental study

Objective To evaluate the impact of a multifaceted strategy for quality end-of-life care in a tertiary public hospital in Brazil. Methodology The study design was quasi-experimental. The multifaceted strategy was applied between January and June 2017, and involved training the healthcare team in end-of-life discussions, the creation and documentation of advance directives, and consultation with the team specialized in palliative care. The periods analyzed were the pre-test period (Time 1, July 2015 to June 2016) and the post-test period (Time 2, July 2017 to June 2018). Results Time 1 involved 302 deaths, with an average hospital stay of 21 days; Time 2 involved 410 deaths, with an average hospital stay of 16 days. Patients were prescribed morphine (44.04% vs. 36.3% [ p = 0.367]), methadone (9.60% vs. 4.39% [ p = 0.247]), midazolam (43.05% vs. 47.80% [ p = 0.73]), blood transfusions (31.13% vs. 24.63% [ p = 0.828]), enteral feeding (56.62% vs. 38.54% [ p = 0.59]) and antibiotic therapy (50.73% vs. 50.73% [ p = 0.435]). Conclusion This study found no changes in the end-of-life care quality indicators after the strategy was implemented. Multimodal educational strategies that develop communication skills in palliative care may enhance the quality of end-of-life care.

ANÁLISE DESCRITIVA DAS INTERNAÇÕES POR ASMA DE PACIENTES PEDIÁTRICOS NO ESTADO DO TOCANTINS DE 2016 A 2021.

OBJETIVO: A asma é uma doença crônica que possui alta incidência na população infantil e suas exacerbações estão associadas ao aumento nas taxas de internação, piora da qualidade de vida e aumento dos custos. Dessa forma, o objetivo do estudo é descrever o perfil epidemiológico das internações por asma em pacientes pediátricos, no estado do Tocantins, de janeiro de 2016 a maio de 2021. MÉTODO: Consiste em estudo epidemiológico transversal, retrospectivo temporal, descritivo das internações por asma em pacientes pediátricos por meio de coleta de dados disponíveis no Departamento de Informação e Informática do SUS (DATASUS) e Instituto Brasileiro de Geografia e Estatística (IBGE). Verificou-se a incidência das internações segundo mês e ano do atendimento, faixa etária (0-4, 5-9 e 10-14 anos), sexo, média de permanência das hospitalizações e valores médio e total do custo das internações. RESULTADOS: Foi verificado um total de 1.150 internações em menores de 14 anos, correspondendo a 64,83% das hospitalizações por asma no estado. A maior e menor taxa de internação foram em 2017 (69,60 internações/100.000 habitantes) e 2020 (28,39 internações/100.000 habitantes). A maior parte ocorreu em pacientes com até 4 anos (62,87%) e do sexo masculino (61,30%). 60,76% das internações foram no período de chuvas. A média de permanência hospitalar foi de 2,8 dias e valor total gastos foi de R$585.192,71, sendo R$508,43 por internação. CONCLUSÃO: A incidência das internações por asma foi maior em meninos e em lactentes e pré-escolares, grupos que apresentaram maior tempo de permanência hospitalar. Ademais, as internações foram mais frequentes nos meses chuvosos e na transição para a seca. A diminuição observada nos anos de 2020 e 2021 pode ter relação com a pandemia pelo COVID-19, contudo, são necessários mais estudos para o melhor entendimento dessa associação. Palavras-chave: Asma; Hospitalização; Criança Hospitalizada; Epidemiologia descritiva. ABSTRACT OBJECTIVES: Asthma is a chronic disease that has a high incidence in the child population and its exacerbation is associated with hospital admission rates growth, life quality worsening and cost increase. Thus, the objective of this paper is to describe the epidemiological profile of asthma related hospital admission in pediatric patients, located in the state of Tocantins, from january 2016 through may 2021. METHOD: It consists in a transversal epidemiological study, temporal retrospective and descriptive of the hospital admissions caused by asthma in pediatric patients through a data collection, having the Department of Information and Informatics of SUS (DATASUS) and the Brazilian Institute of Geography and Statistics (IBGE) as the sources. We verified the rate of admissions by month and year, age group (0-4, 5-9 and 10-14 years old), sex, average hospital stay and average and total of cost admissions. RESULTS: A total of 1.150 admissions were checked in the under 14 years old group, corresponding to 64,83% of admissions by asthma in the state. The highest and lowest rate of admissions were in 2017 (69,60 admissions/100.000 inhabitants) and 2020 (28,39% admissions/100.00 inhabitants). Most of it happened to 4 years old patients or younger (62,87%) and males (61,30%). 60,76% of admissions took place in the rainy season. The average hospital stay was 2,8 days and the total cost was R$585.192,71, each stay costing R$508,43. CONCLUSION: The admission rate by asthma was higher for boys and infants and pre-school children, and these groups that were in the hospital for a longer period of time. Besides, the admissions were frequent during the rainy months and in the transition period between rainy and dryer seasons. The decrease in admissions rate noticed in 2020 and 2021 might be related to the COVID-19 pandemic, even though more research is necessary to understand this correlation. Key-words: Asthma; Hospitalization; Child, Hospitalized; Epidemiology, Descriptive.

Abdominal and Laparoscopic Cervical Carcinoma Therapy – a Comparative Economic Assessment

Objective The LACC (Laparoscopic Approach to Cervical Cancer) study revealed advantages in terms of overall survival and relapse risk favouring abdominal radical hysterectomy over the laparoscopic procedure. The present paper will compare the two surgical techniques from the economic point of view based on a process cost calculation. Material/Methods A retrospective cost analysis of all radical hysterectomies from the year 2018 was done at the Hanover University Medical School based on the bottoms-up method and guided by the clinical treatment pathway. Result Of 51 primary cases treated, 19 patients underwent radical hysterectomies, of which 8 were performed using the abdominal technique and 11 as endoscopic surgeries. 89.4% of the cancers were FIGO IB1 carcinomas. The total cost of a laparoscopic radical hysterectomy with an average hospital stay of 4.6 days came to € 2512.34, compared to an abdominal radical hysterectomy at € 2586.78 with an average hospital stay of 7.6 days. The greatest cost factor in which the laparoscopic method exceeded abdominal radical hysterectomy was the surgical procedure itself (€ 1836.75 vs. € 1411.21). Personnel represented the largest cost item in the surgical theatre (59%), so that surgery time was a significant multiplying factor. Average surgical time required for abdominal radical hysterectomy was 154 minutes, whereby the laparoscopic procedure required an average of 220.1 minutes. Inpatient care in the abdominal radical procedure cases was more costly by € 499.98 due to the longer hospitalization and additional medication required. Profit levels, including the DRG revenues, were higher with the abdominal method than with the laparoscopic method by € 186.21 despite longer hospital stays. Conclusion The present paper shows slightly greater profitability for the abdominal radical hysterectomy. On the other hand, this method entails longer hospitalization and a higher level of personnel deployment. Adequate occupancy management could make up for the revenue shortfall observed with the laparoscopic method.

This is the easy repair of Femoral Hernia

Introduction: Various techniques have been developed for the repair of femoral hernia. The technique with the Lichtenstein Plug since 1989 has allowed to obtain a lower rate of complications and recurrences. AIM: The aim of this work is to review the experience of our basic group of work in the surgical treatment of femoral hernia using this technique. Methods: A retrospective descriptive observational study was conducted in our basic work group from the surgery service of the General Teaching Hospital “Enrique Cabrera” between 2009 and 2020, to which this surgical technique was applied (Plug Lichtenstein). We study the anatomical variants of hernias as well as post-operative complications and clinical evolution. Results: The mean age of the patients was 58.7 years (19-92 years), being the female with the highest incidence 81,7%, as well as, the most frequent location the right, 64.7%. The prosthesis used in the hernioplasty was that of polypropylene. Local anesthesia was applied to 48 patients (67,6%) of them. The average surgical time was25 minutes, (15-65 minutes). Ambulation was early and the average hospital stay was lessthan 24 hours, in most patients. Only one infectionof the wound and one hernia recurrence in one patient was confirmed. Conclusion: Therefore, we believe that the Lichtenstein Plug technique should be considered among the techniques of choice in the treatment of femoral hernia

Clinical and Hematological Characteristics of Patients with COVID-19 Co-infected with Bacteria

Objectives: To provide suggestions and treatment opinions by analyzing laboratory data of COVID-19 patients co-infected with bacteria. Methods: We analyzed 63 patients with COVID-19 admitted to the isolation ward of the First Affiliated Hospital of Wenzhou Medical University. COVID-19 was detected using PCR, and bacteria were identified using culture. Patients were divided into two groups, including those with and those without bacterial infections, and differences in hematologic indices between the groups were analyzed. Results: There were 63 patients with median age of 55.82 years. The average hospital stay was 22.56 days. Seven patients (11.11%) had coincident bacterial infections. Detection rates in sputum/alveolar lavage and blood were the highest, 60.52% and 21.05%, respectively. Klebsiella pneumoniae, Acinetobacter, and Stenotrophomonas maltophilia were the most common found in 31.58%, 18.42%, and 15.79%, respectively. Interleukin 6 (IL-6) levels were elevated in 84.13% of patients, while IL-10 levels were elevated in 69.84%, blood ammonia levels were elevated in 82.05%, lactate levels were elevated in 75.41%, and LDH levels were elevated in 69.84%. There were significant differences between the groups in terms of expression levels of IgG, C4, AST, LDH, IL-6, IL-10, percentage of neutrophils, percentage of lymphocytes, and platelets. Conclusions: For patients with COVID-19 suspected of having bacterial infections, empiric antibiotics should be given to cover K. pneumoniae, Acinetobacter, and S. maltophilia.

Perfil epidemiológico, clínico e desfecho de pacientes com traumatismo cranioencefálico / Epidemiological, clinical profile and outcome of patients with traumatic brain injury

Objetivo: Identificar o perfil epidemiológico, clínico e o desfecho dos pacientes com Traumatismo Cranioencefálico (TCE). Métodos: Pesquisa retrospectiva realizada com pacientes com idade maior ou igual a 18 anos, que estiveram internados na Instituição no ano de 2017, vítimas de TCE por qualquer etiologia. Resultados: Analisados 268 prontuários, sendo 78,7% do sexo masculino, com uma média de idade de 51 anos e maior incidência na faixa etária dos 31 a 50 anos (38,4%). A maioria (76,1%) chegou ao Pronto Socorro (PS) pelo Serviço de Atendimento Móvel de Urgência (SAMU), com uma média da Escala de Coma de Glasgow de 12 pontos, sendo que 78,0% apresentavam TCE leve (13 a 15 pontos), 14,2% apresentavam TCE grave (3 a 8 pontos) e 7,8% apresentavam TCE moderado (9 a 12 pontos). A maioria (57,5%) apresentou o TCE por queda, seguido de 16,0% por atropelamento, 12,0% por agressão, 5,9% por politrauma de mecanismos desconhecidos, 5,6% por acidente de moto, 1,9% por acidente automobilístico e 1,1% por ferimento por arma de fogo. A maioria (84,3%) ficou internada no hospital por até 10 dias, com uma média de internação hospitalar de seis dias, 92,9% receberam tratamento clínico (conservador) e 85,8% receberam alta hospitalar. Conclusões: Prevaleceram indivíduos do sexo masculino, com uma média de idade de 51 anos, encaminhados ao PS pelo SAMU, vítimas de TCE leve, ocasionado por queda, com uma média de internação hospitalar de seis dias, recebendo tratamento clínico e com desfecho de alta hospitalar.Palavras chave: Perfil de saúde, Lesões encefálicas traumáticas, Traumatismo cerebrovascularABSTRACTObjective: To identify the epidemiological, clinical profile and outcome of patients with Traumatic Brain Injury (TBI). Methods: Retrospective research conducted with patients aged 18 years or older, who were admitted to the Institution in 2017, victims of TBI due to any etiology. Results: 268 medical records were analyzed, of wich 78,7% were male, with an average age of 51 years and a higher incidence in the age group from 31 to 50 years (38,4%). The majority (76,1%) arrived at the Emergency Room (ER) through the Mobile Emergency Service (SAMU), with an average of the Glasgow Coma Scale of 12 points, with 78,0% having mild TBI (13 at 15 points), 14,2% had severe TBI (3 to 8 points) and 7,8% had moderate TBI (9 to 12 points). The majority (57,5%) presented TBI due a fall, followed by 16,0% due to being run over, 12,0% due to aggression, 5,9% due to polytrauma of unknown mechanisms, 5,6% due to motorcycle accident, 1,9% due to automobile accident and 1,1% due to firearm injury. The majority (84,3%) stayed in the hospital for up to 10 days, with an average hospital stay of six days, 92,9% received clinical treatment and 85,8% were discharged. Conclusions: Male individuals prevailed, with an average age of 51 years, referred to ER by SAMU, victims of mild TBI, caused by a fall, with an average hospital stay of six days, receiving clinical treatment and with outcome of discharge hospital.Keywords: Health profile, Traumatic brain injury, Cerebrovascular trauma

561 Outcome of Patients Undergoing Neck of Femur Fracture Surgery During COVID Period

Introduction The aim of the study is to determine the 7- and 30-day mortality rate, hospital stay period and pre- and post-operative symptoms in NOF fracture patients undergoing surgery and compare between COVID-19 positive and negative cohorts. Method This was a retrospective, descriptive study involving 188 NOF fracture patients who underwent operation from 21/03/20 to 21/07/20 in Mid Yorkshire Hospitals Trust. Only people who tested positive for COVID-19 within 30 days of operation were counted in the positive cohort. Result: Total 21 patient tested positive for COVID-19, 16 within 30 days of operation and 5 tested beyond 30-day period. 24 were not tested. 143 tested negative. The average age of patients was 79.02±11.163 years. Average hospital stay was 14.688±10.657 days (average stay for positive patients 22±13.789 days). 12 patients had pre-operative symptoms (respiratory symptoms, fever) out of which 2(16.67%) tested positive. 7-day post-op mortality was 2.128% (6.25% for COVID-19 positive patients). 30-day mortality was 6.383% (5.814% for untested/negative patients and 12.5% for positive patients). 41 patients (21 .81%) developed post-operative respiratory symptoms (56.25% for positive patients). 8.51% developed post-operative sepsis (25% of positive patients). Conclusions Mortality and morbidity rate was higher for NOF fracture patients with positive COVID-19 test.

Rib fractures, a public health issue-a multi regional retrospective study

We performed a retrospective study focusing on examining all rib fracture cases discharged from 4 thoracic surgery clinics in Romania. Over a period of 3 years, we analyzed data regarding the patients, diagnosis and number of days spent in the hospital. 2.417 patients were included in this study and all patient evolutions were taken into account. The most patients suffered from multiple rib fractures, involving four or more ribs. In total average hospital stay was 5.46 days. The pneumothorax was the most common encountered complication followed by hemo-pneumothorax, hemothorax and lung contusion. Men seem to be at a higher risk to develop a rib fracture than women. Fracture incidence increased with age in both sexes. The main goal when treating thoracic traumatic pathology is attaining less impairment of pulmonary functions and fast social reintegration. Management of rib fractures must be tailored to each individual case.

Case Series of Pneumomediastinum in COVID-19 Infection

Introduction: Pneumomediastinum is rare in viral infection of the lung however in COVID-19 patients it is more common. Study Design: Case series of 14 moderate to severe COVID cases complicated by Pneumomediastinum admitted to Saint George Hospital over 4 months. Data was collected retrospectively from medical charts of the patients. Results: Most of the patients were males. Average hospital stay was 15.21 days. Five patients (35.72%) developed pneumomediastinum without any kind of mechanical ventilation during hospitalization. Around 35.72% of the patients were discharged and the average time till death was 8.8 days. Conclusion: Pneumomediastinum can develop without any positive pressure ventilation in COVID-19 infection.