Some of these risk assessment tools have been tested in environments other than those for which they were devel- oped [19-23], with disparate results, including difficulties for widespread use, serious validity discrepancies between the original authors’ version and successive ones , and in the heterogeneity of diagnostic accuracy in terms of cutoff points [22,25-27]. However, a recent Cochrane re- view showed that multifactorial interventions in hospitals reduce the rate of falls (rate ratio 0.69, 95% CI: 0.49 - 0.96), although risk assessment is addressed as one of many interventions, and it is not easy to isolate its specific effect . Hospitalized patients in the acute phase of their disease have specific characteristics. Changes in acuity of ill- ness and medication will affect mobility, physical status and cognition , requiring a special assessment in this setting in order to prevent falls. Moreover, an unknown environ- ment like the hospital can contribute to increase previous risk or generate new risk factors.
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Critically ill patients with hemodynamic instability are often at risk for acute liver injury (ALI) from a number of different causes with varying levels of clinical signifi- cance. ALI in this population can range from idiopathic or iatrogenic elevations in aminotransferases to distinct clini- cal entities such as hepatic congestion, sepsis-associated cholestasis, or at worst hypoxic hepatitis (HH). ALI has important ramifications for critically ill patients as liver dysfunction is associated with poorer outcomes inde- pendently of other organ dysfunction. 1
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Conclusions: Bacteriological isolation of patients with acute pyelonephritis was 54.5 %. The most common etiologic agents were E coli, Klebsiella and Enterobacter spp., perhaps related to the indiscriminate use of antibiotics without prescription. The high frequency of Enterobacter isolation in outpatients make necessary his identification for correct therapy. The delay to treat correctly ITU was associated with poor outcome with serious complications such as renal abscess. Keywords.
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compare the costs of patients on treatment with vancomycin while hospi- talized vs. those with oritavancin administered as outpatient regimen, in patients with SSTI and few or no comorbidities (Charlson Comorbidity In- dex [CCI] 0 or 1). The costs associated with the use of oritavancin in the Emergency Unit (3,409.46 $) and in the observation unit (4,220.27 $) were lower to those for vancomycin in hospitalized patients (5,972.73- 9,885.33 $). To switch a hospitalized patient on vancomycin to outpa- tient treatment with oritavancin could save 1,752.46-6,475.87 $ de- pending on the CCI, presence of systemic symptoms, and the use of the observation unit. If all patients hospitalized on vancomycin were treated with oritavancin at the Emergency Unit, savings per patient could be of 3,102.43 $. Assuming that some patients could be admitted to hospital after receiving treatment with oritavancin in the Emergency Unit, it is ex- pected that savings with oritavancin in the observation unit vs. treatment hospitalized with vancomycin will be 2,291.62 $.
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Patient satisfaction is defined as “the fundamental measure providing information on to what extent values and expectations of a patient are met and indicating the quality of the care in which the ma- jor authority is the patient” by Donabedian(6). Nursing care and the relevant satisfaction, howe- ver, were initially defined as “the harmony bet- ween ideal nursing care and the nursing care that a patient actually receives” by Risser in 1975(7,8). Patient satisfaction may vary depending on a va- riety of factors including physical and environ- mental conditions of a hospital, hospital staff, and features of a hospital(9). One of the most important factors influencing the satisfaction of hospitalized patients is the nursing care(7,8,10). Nursing is a profession whose field of interest is people and is based on care(1). The World Health Organization (WHO) defines nursing as “Nur- sing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings. It includes the promotion of health, the prevention of illness, and the care of ill, disabled and dying people”(11). Health care is fundamental for hu- man growth and development and is a lifelong requirement for each individual. Health care is not only unique to nursing, but also specific for nursing. The distinctive feature of health care as nursing care is that it combines moral and emo- tional aspects of care with professional knowledge and skills and then reflects it to the nurse-patient relationship. As the care involves independent functions of a nurse and functions helping an individual feel better, it is an important fac-
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Vaccination of the elderly is an important factor in limiting the impact of influenza in the com- munity. The aim of this study was to investigate the factors associated with influenza vacci- nation coverage in hospitalized patients aged 65 years hospitalized due to causes unrelated to influenza in Spain. We carried out a cross-sectional study. Bivariate analysis was performed comparing vaccinated and unvaccinated patients, taking in to account sociodemographic variables and medical risk conditions. Multivariate analysis was per- formed using multilevel regression models. We included 1038 patients: 602 (58%) had received the influenza vaccine in the 2013 – 14 season. Three or more general practitioner visits (OR = 1.61; 95% CI 1.19 – 2.18); influenza vaccination in any of the 3 previous seasons (OR = 13.57; 95% CI 9.45 – 19.48); and 23-valent pneumococcal polysaccharide vaccination (OR = 1.97; 95% CI 1.38 – 2.80) were associated with receiving the influenza vaccine. Vacci- nation coverage of hospitalized elderly people is low in Spain and some predisposing char- acteristics influence vaccination coverage. Healthcare workers should take these
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The clinical profile of patients with preserved EF in our analysis corresponds to the previously described characteristics of HF-PEF population, with a higher prevalence of hypertension, atrial fibrillation, obesity, and female gender, and patients being older compared with HF-REF population. 2,3,10,11,12,13,14,15,19,20 Interestingly, although coronary artery disease (CAD) is a risk factor for the development of diastolic dysfunction, this ultimately progresses to systolic dysfunction in a vast number of patients with CAD; thus, the observed prevalence of CAD is higher in patients with HF-REF than in patients with HF-PEF. 2,12,13,14,21,22 Of note, many patients with HF-PEF may in fact exhibit impaired longitudinal and circumferential systolic LV function, despite preserved global EF. 20,23 Importantly, HF-PEF is typically accompanied by a number of noncardiac co-morbidities (including diabetes, sleep apnea, chronic obstructive pulmonary disease, chronic kidney disease, and anemia), which - on one hand - might be involved in its development, and - on the other hand - deteriorate prognosis in HF. 2,10,12,21,24,25
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The nutritional evaluation was carried out with the MNA within the first 24-72 hours of hospital admis- sion. This tool classifies patients as: normal nutritional status (24 points), at risk for malnutrition (from 17 to 23.5 points) and malnourished (less than 17 points). Weight and height were estimated in those patients in whom an objective measurement could not be obtained. Weight was estimated based on statements from the patient and/or family, and the height was esti- mated based on the elbow to styloid measurement. Calf and brachial circumferences were obtained with a non- elastic measuring tape in the non-dominant extremi- ties. The questionnaire was completed using the responses from the patient or their caregivers.
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Although serum creatinine levels are elevated in pa- tients with AKI, it poorly differentiates AKI types, serum creatinine levels are higher in patients with HRS com- pared to prerenal azotemia but similar to patients with in- trinsic acute kidney injury (iAKI), a finding that was reported in the previous manuscripts. 7 That’s why the di-
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This study has an advantage over other registries in Spain, some of them quite recent, 4,14,15 in that it allows direct comparison with other data in the European registry, of which it forms a part. All contributors to this cornerstone project of the ESC use identical methods. Furthermore, it is an active registry that continues to include patients and their follow-up. The situation regarding the true undertreatment rates in Spain is virtually the same as that reported for the overall European study 8 (including Spanish centers). However, although the percentage of patients reaching the target doses established in clinical trials is rather low throughout Europe, it is slightly lower in Spain. 3
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In summary, our findings highlight underuse of the main recommended processes of care in hospitalized CAP patients. We have found that a poorer health status along with confusion, and not age, was associated with lower compliance with quality of care in choice and administration time of antibiotics. These results should contribute to improving awareness of clinicians and targeting specific disabled patients who receive poorer quality of care and who are easily identifiable on initial evaluation, when our decisions are better able to affect outcome. Our findings may be useful for quality improvement aimed at better recognition of lack of compliance based on patient comorbid condition and clinical signs.
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Methods and results. The ESC‐HF‐LT Registry is a prospective, observational study collecting hospitalization and 1‐ year follow‐up data from 6629 AHF patients. Among AHF patients enrolled in the registry, 13.2% presented with pulmonary oedema (PO), 2.9% with cardiogenic shock (CS), 61.1% with decompensated heart failure (DHF), 4.8% with hypertensive heart failure (HT‐HF), 3.5% with right heart failure (RHF) and 14.4% with AHF and associated acute coronary syndromes (ACS‐HF). The 1‐year mortality rate was 28.1% in PO, 54.0% in CS, 27.2% in DHF, 12.8% in HT‐HF, 34.0% in RHF and 20.6% in ACS‐HF patients. When patients were classified by systolic blood pressure (SBP) at initial presentation, 1‐year mortality was 34.8% in patients with SBP <85 mmHg, 29.0% in those with SBP 85–110 mmHg, 21.2% in patients with SBP 110–140 mmHg and 17.4% in those with SBP >140 mmHg. These differences tended to diminish in the months post‐discharge, and 1‐year mortality for the patients who survived at least 6 months post‐discharge did not vary significantly by either clinical profile or SBP classification.
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Two hundred and fifty three HIV+ individuals were hospi- talized from February to November 2013; 65% (n = 164) answered a clinimetric evaluation. Most of them (87%, n = 142) completed the assessment at hospital admis- sion, and 71% (n = 117) at discharge. Missed discharge assessment were associated to hospital discharge before responding to clinimetric scales (n = 25). Two patients were not included in the analysis because they did not ful- fill all clinimetric assessment at hospital admission. Data analysis was made with 115 participants who completed both assessments.
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The study was able to evaluate the most important risk factors associated with candidemia in patients hospitalized in the neonatal unit: inpatient stay longer than seven days, the use of umbilical catheters, sur- gery, and treatment with meropenem. Although there are limitations in assessing risk factors, we decided to conduct a paired case-control study to reduce possible bias.
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Despite the importance of this issue, studies investigat- ing the influence of alcohol abuse on the outcome and prognosis of patients admitted to hepatology wards are scarce. Therefore, the aim of the present study was to de- termine the prevalence of alcohol consumption among hospitalized cirrhotic patients in a tertiary care hospital and its influence on clinical outcomes and mortality.
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By way of a conclusion, this study is important for Colombia since the prevalence of dual disorders observed is much higher than in other studies. Castaño and Sierra (2016) found prevalences of 7.2% in the general popula- tion; Peña-Salas et al. (2014) found a prevalence of 5.9% of alcohol dependence and a prevalence of 7.8% of abuse in a group of patients with social phobia, whereas Barrios-Ayola and Hurtado-Acosta (2012) reported a prevalence of 19.5% in a sample collected at three psychiatric institutions in two cities in Colombia. These differences may be due to the different population groups where the studies were carried out, the centers from which the samples were taken, and the mental and drug use disorders included, which should prompt further research on the characteristics of these co- morbidities in general populations and clinics, in order to develop appropriate intervention proposals for local so- cio-cultural and demographic contexts.
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This study has some limitations. We have excluded the nursing-home population and patients with CAP considered a terminal event in order to avoid a different population with different characteristics, more frequent nosocomial infections and/or multidrug resistant microorganisms and limited therapeutic efforts; therefore our findings are not applicable to that subset of population. Second, microbiological diagnosis with regard to viruses was incom- plete in a considerable subset of patients, the percentage of blood cultures was suboptimal (62.7%), and determination of S pneumoniae serotypes was not performed. The indications of microbiological tests in our study relied on the attending physicians. Third, the information regarding septic shock was not recorded. Nevertheless, our strengths are the large sample size and the prospective study design.
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with an average of medications administered of 7.77 (IC 95% ± 2.9). The first five causes of hospitalization correspond to cardiovascular disease (HTA, 25%; acute coronary disease, 12%; and heart failure, 10%), chronic renal insufficiency (16%), and AIDS (12%). The groups of medications prescribed most were cardiovascular drugs and analgesics. In the study, 99 adverse events were identified related to medications in 45 patients (IC 95%, 35.1-54.9), corresponding to probable ADRs (n=29), possible ADRs (n=21), and doubtful ADRs (n=49), after applying the Naranjo algorithm. None of the adverse events was classified as definite. Additionally, doubtful ADRs were not considered adverse effects to medications. In five patients, two ADR events were present simultaneously.
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10. Merkin A, Borisov I, Shushkevitch A, Dinov E, Brandt Y, Cheremushkin E, et al. Difficulties in diagnosing delirium in elderly patients in a general hospital. Asian J Psychiatr. 2014 ; 9: 85-6. 11. Cole MG, Ciampi A, Belzile E, Zhong L. Persistent delirium in older hospital patients: a systematic review of frequency and prognosis. Age Ageing. 2009 ; 38 (1): 19-26.
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Our study found that in a large cohort of patients hospi- talized with HE, there was no association between initial electrolyte levels and outcomes after adjustment for key factors including patients’ age, underlying kidney function, and progression of liver disease (as measured by the MELD-sodium score). Associations between electrolyte levels and outcomes in unadjusted analysis included bicar- bonate and admission to ICU, phosphorus and admission to ICU, phosphorus and 30-day mortality, and calcium and mechanical ventilation. However, these findings weak- ened notably when adjusting for confounding variables in multivariable analysis. No other notable associations be- tween serum electrolyte measurements and outcomes were observed.
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