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138 records – page 1 of 14.

5-year morbidity among very preterm infants in relation to level of hospital care.

https://arctichealth.org/en/permalink/ahliterature119186
Source
JAMA Pediatr. 2013 Jan;167(1):40-6
Publication Type
Article
Date
Jan-2013
Author
Liisi Rautava
Janne Eskelinen
Unto Häkkinen
Liisa Lehtonen
Author Affiliation
Department of Pediatrics, Turku University Hospital, 20520 Turku, Finland. liisi.rautava@utu.fi
Source
JAMA Pediatr. 2013 Jan;167(1):40-6
Date
Jan-2013
Language
English
Publication Type
Article
Keywords
Child, Preschool
Cohort Studies
Female
Finland - epidemiology
Humans
Incidence
Infant, Newborn
Infant, Premature
Infant, Premature, Diseases - epidemiology - etiology - therapy
Intensive Care, Neonatal
Logistic Models
Male
Odds Ratio
Outcome and Process Assessment (Health Care)
Patient transfer
Registries
Secondary Care
Tertiary Care Centers
Tertiary Healthcare
Abstract
To determine whether birth and care in the highest-level hospitals (level III) compared with birth in or postnatal transfer to lower-level hospitals (level II) are associated with 5-year morbidity in very preterm children.
A cohort study.
Finland.
All surviving 5-year-old children born very preterm (gestational age
PubMed ID
23128961 View in PubMed
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A 10-year retrospective study of interhospital patient transport using inhaled nitric oxide in Norway.

https://arctichealth.org/en/permalink/ahliterature269280
Source
Acta Anaesthesiol Scand. 2015 May;59(5):648-53
Publication Type
Article
Date
May-2015
Author
C. Buskop
P P Bredmose
M. Sandberg
Source
Acta Anaesthesiol Scand. 2015 May;59(5):648-53
Date
May-2015
Language
English
Publication Type
Article
Keywords
Administration, Inhalation
Adolescent
Adult
Aged
Bronchodilator Agents - administration & dosage - adverse effects - therapeutic use
Child
Child, Preschool
Critical Care
Equipment Failure - statistics & numerical data
Extracorporeal Membrane Oxygenation
Female
Humans
Infant
Infant, Newborn
Male
Middle Aged
Nitric Oxide - administration & dosage - adverse effects - therapeutic use
Norway
Respiratory Insufficiency - mortality - therapy
Retrospective Studies
Survival Analysis
Tertiary Care Centers
Transportation of Patients
Treatment Outcome
Young Adult
Abstract
Anaesthesiologists from Oslo University Hospital have transported patients with severe oxygenation failure with inhaled nitric oxide (usually 20?ppm) from other hospitals to a tertiary care centre since 2002 in an effort to reduce the number of patients that otherwise would require transport with ongoing extracorporeal membrane oxygenation. The aim of this study was to evaluate the patient safety during transport with inhaled nitric oxide.
All patient transports with ongoing nitric oxide treatment undertaken from 2003 to 2012 were identified in the transport database. The frequency of adverse events and their impact on patient safety were studied in addition to response to inhaled nitric oxide and adjusted intensive care treatment and time aspects of the transports. Information about in-hospital treatment and survival were extracted from the hospital patient records.
Adverse events were recorded in 12 of the 104 transports. Seven of the adverse events were due to malfunctioning technical equipment, three were related to medication other than the inhaled nitric oxide and two were related to ventilation. No adverse events resulted in permanent negative patient consequences or in discontinuation of the transport. Out of 104 patients, 79 responded to treatment with inhaled nitric oxide and other treatment changes by an increase in oxygen saturation of more than 5%. The 30-day mortality was 27% in the group transported with inhaled nitric oxide.
Transporting patients on inhaled nitric oxide is an alternative in selected patients who would otherwise require extracorporeal membrane oxygenation during transport.
PubMed ID
25782015 View in PubMed
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Accessibility of tertiary hospitals in Finland: A comparison of administrative and normative catchment areas.

https://arctichealth.org/en/permalink/ahliterature291196
Source
Soc Sci Med. 2017 06; 182:60-67
Publication Type
Journal Article
Date
06-2017
Author
Tiina Huotari
Harri Antikainen
Timo Keistinen
Jarmo Rusanen
Author Affiliation
Geography Research Unit, University of Oulu, PO Box 3000, FI-90014, Finland. Electronic address: tiina.huotari@oulu.fi.
Source
Soc Sci Med. 2017 06; 182:60-67
Date
06-2017
Language
English
Publication Type
Journal Article
Keywords
Catchment Area (Health) - statistics & numerical data
Finland
Geographic Mapping
Health Services Accessibility - standards - statistics & numerical data
Humans
Tertiary Care Centers - organization & administration - statistics & numerical data - supply & distribution
Abstract
The determination of an appropriate catchment area for a hospital providing highly specialized (i.e. tertiary) health care is typically a trade-off between ensuring adequate client volumes and maintaining reasonable accessibility for all potential clients. This may pose considerable challenges, especially in sparsely inhabited regions. In Finland, tertiary health care is concentrated in five university hospitals, which provide services in their dedicated catchment areas. This study utilizes Geographic Information Systems (GIS), together with grid-based population data and travel-time estimates, to assess the spatial accessibility of these hospitals. The current geographical configuration of the hospitals is compared to a normative assignment, with and without capacity constraints. The aim is to define optimal catchment areas for tertiary hospitals so that their spatial accessibility is as equal as possible. The results indicate that relatively modest improvements can be achieved in accessibility by using normative assignment to determine catchment areas.
PubMed ID
28414937 View in PubMed
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Source
Scand J Gastroenterol. 2016 Nov;51(11):1326-31
Publication Type
Article
Date
Nov-2016
Author
Palle Bager
Mette Julsgaard
Thea Vestergaard
Lisbet Ambrosius Christensen
Jens Frederik Dahlerup
Source
Scand J Gastroenterol. 2016 Nov;51(11):1326-31
Date
Nov-2016
Language
English
Publication Type
Article
Keywords
Adult
Anti-Inflammatory Agents, Non-Steroidal - classification - therapeutic use
Decision Making
Denmark
Female
Humans
Inflammatory Bowel Diseases - drug therapy
Logistic Models
Male
Medication Adherence - statistics & numerical data
Middle Aged
Odds Ratio
Patient satisfaction
Quality of Health Care - standards
Risk factors
Surveys and Questionnaires
Tertiary Care Centers
Young Adult
Abstract
In inflammatory bowel disease (IBD), adherence to both medical treatment and other aspects of care has a substantial impact on the course of the disease. Most studies of medical adherence have reported that 30-45% of patients with IBD were non-adherent. Our study aimed to investigate the different aspects of adherence and to identify predictors of non-adherence, including the quality of care, for outpatients with IBD.
An anonymous electronic questionnaire was used to investigate different aspects of adherence, the quality of care, patient involvement and shared decision making among 377 IBD outpatients.
Three hundred (80%) filled in the questionnaire. The overall adherence rate was 93%. Young age (
PubMed ID
27311071 View in PubMed
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Adverse outcomes associated with delayed intensive care consultation in medical and surgical inpatients.

https://arctichealth.org/en/permalink/ahliterature123440
Source
J Crit Care. 2012 Dec;27(6):688-93
Publication Type
Article
Date
Dec-2012
Author
Louay Mardini
Jed Lipes
Dev Jayaraman
Author Affiliation
Montreal General Hospital, McGill University Health Centre, Montreal, Quebec H3G 1A4, Canada.
Source
J Crit Care. 2012 Dec;27(6):688-93
Date
Dec-2012
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Canada
Female
Humans
Intensive Care Units - statistics & numerical data
Length of Stay
Male
Middle Aged
Mortality
Patient Transfer - statistics & numerical data
Referral and Consultation - statistics & numerical data
Retrospective Studies
Socioeconomic Factors
Tertiary Care Centers - statistics & numerical data
Time Factors
Treatment Outcome
Abstract
The impact of delay in obtaining an intensive care unit (ICU) consult from inpatient wards is unclear. The goal of this study was to examine the effect of time to ICU consult from medical and surgical wards on mortality and length of stay (LOS).
This was a retrospective study of 241 adult medical and surgical inpatients admitted at 2 tertiary care ICUs in Canada between 2007 and 2009. Neither institution has medical emergency teams (METs). Patient demographics, time when the patient would have fulfilled MET calling criteria (MET time), time of ICU consult, and ICU admission were analyzed. The main outcome variables were 30-day mortality and ICU LOS.
Multivariate analysis demonstrated an increase in mortality (odds ratio, 1.8; 95% confidence interval, 1.1-2.9; P = .01) with increased duration from MET time to ICU consult for medical patients. There was no effect of this period on ICU LOS in medical patients. In contrast, in surgical patients, the MET time to ICU consult duration was associated with an increased ICU LOS (coefficient, 2.1 for delay; 95% confidence interval, 0.26-3.8; P = .02) but had no effect on mortality.
Increased duration to ICU consult from MET time is associated with adverse outcomes. These adverse outcomes are different between medical and surgical patients.
PubMed ID
22699035 View in PubMed
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Antibiotic resistance in isolates recovered from women with community-acquired urinary tract infections presenting to a tertiary care emergency department.

https://arctichealth.org/en/permalink/ahliterature120800
Source
CJEM. 2012 Sep;14(5):295-305
Publication Type
Article
Date
Sep-2012
Author
Lyne Filiatrault
Rachel M McKay
David M Patrick
Diane L Roscoe
Grahame Quan
Jeff Brubacher
Ken M Collins
Author Affiliation
Department of Emergency Medicine, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada. filiatra@interchange.ubc.ca
Source
CJEM. 2012 Sep;14(5):295-305
Date
Sep-2012
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents - pharmacology
British Columbia - epidemiology
Community-Acquired Infections - drug therapy - epidemiology - microbiology
Drug Resistance, Microbial
Emergency Service, Hospital - statistics & numerical data
Escherichia coli - drug effects - isolation & purification
Escherichia coli Infections - drug therapy - epidemiology - microbiology
Female
Follow-Up Studies
Humans
Incidence
Microbial Sensitivity Tests
Middle Aged
Prospective Studies
Tertiary Care Centers - statistics & numerical data
Urinary Tract Infections - drug therapy - epidemiology - microbiology
Young Adult
Abstract
We sought to determine the antibiotic susceptibility of organisms causing community-acquired urinary tract infections (UTIs) in adult females attending an urban emergency department (ED) and to identify risk factors for antibiotic resistance.
We reviewed the ED charts of all nonpregnant, nonlactating adult females with positive urine cultures for 2008 and recorded demographics, diagnosis, complicating factors, organism susceptibility, and risk factors for antibiotic resistance. Odds ratios (ORs) and 95% confidence intervals (CIs) for potential risk factors were calculated.
Our final sample comprised 327 UTIs: 218 were cystitis, of which 22 were complicated cases and 109 were pyelonephritis, including 22 complicated cases. Escherichia coli accounted for 82.3% of all UTIs, whereas Staphylococcus saprophyticus accounted for 5.2%. In uncomplicated cystitis, 9.5% of all isolates were resistant to ciprofloxacin and 24.0% to trimethoprim-sulfamethoxazole (TMP-SMX). In uncomplicated pyelonephritis, 19.5% of isolates were resistant to ciprofloxacin and 36.8% to TMP-SMX. In UTI (all types combined), any antibiotic use within the previous 3 months was a significant risk factor for resistance to both ciprofloxacin (OR 3.34, 95% CI 1.16-9.62) and TMP-SMX (OR 4.02, 95% CI 1.48-10.92). Being 65 years of age or older and having had a history of UTI in the previous year were risk factors only for ciprofloxacin resistance.
E. coli was the predominant urinary pathogen in this series. Resistance to ciprofloxacin and TMP-SMX was high, highlighting the importance of relevant, local antibiograms. Any recent antibiotic use was a risk factor for both ciprofloxacin and TMP-SMX resistance in UTI. Our findings should be confirmed with a larger prospective study.
PubMed ID
22967697 View in PubMed
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Application of the Seattle heart failure model in patients >80 years of age enrolled in a tertiary care heart failure clinic.

https://arctichealth.org/en/permalink/ahliterature121306
Source
Am J Cardiol. 2012 Dec 1;110(11):1663-6
Publication Type
Article
Date
Dec-1-2012
Author
Hanane Benbarkat
Karima Addetia
Mark J Eisenberg
Richard Sheppard
Kristian B Filion
Caroline Michel
Author Affiliation
Division of Cardiology, McGill University Health Center, Montreal, Quebec, Canada.
Source
Am J Cardiol. 2012 Dec 1;110(11):1663-6
Date
Dec-1-2012
Language
English
Publication Type
Article
Keywords
Aged, 80 and over
Confidence Intervals
Female
Follow-Up Studies
Heart Failure - epidemiology - therapy
Heart Transplantation
Heart-Assist Devices
Humans
Life expectancy
Male
Population Surveillance
Prognosis
Quebec - epidemiology
Retrospective Studies
Survival Rate - trends
Tertiary Care Centers
Time Factors
Abstract
The Seattle Heart Failure Model (SHFM) is 1 of the most widely used tools to predict survival in patients with heart failure. However, it does not accommodate very elderly patients. We decided to assess the applicability of the SHFM in patients >80 years old enrolled in a tertiary care heart failure clinic. We evaluated the difference between observed survival and mean life expectancy as predicted by the SHFM on 261 patients >80 years old enrolled in a heart failure clinic at the Jewish General Hospital, Montreal, Quebec, Canada from January 2002 through March 2010. Average age of the patient population was 85 ± 4 years (range 80 to 105). Sixty-two percent of the population consisted of men, 63% had ischemic cardiomyopathy (ICM), and average ejection fraction was 36 ± 18%. Median observed survival was 1.91 years (interquartile range 0.68 to 5.53) for the total population (n = 261). The SHFM (predicted median survival 6.7 years, interquartile range 3.8 to 11.2) overestimated life expectancy by an average of 4.79 years. For patients with ICM (n = 164) versus non-ICM (n = 97), the score overestimated survival by 4.29 versus 5.69 years, respectively. In conclusion, the SHFM overestimates life expectancy in elderly patients followed in a tertiary care heart failure clinic. Further studies are needed to more accurately estimate prognosis in this patient population.
Notes
Comment In: Am J Cardiol. 2013 Apr 15;111(8):123523558002
PubMed ID
22920927 View in PubMed
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Assessment of indications for percutaneous endoscopic gastrostomy--development of a predictive model.

https://arctichealth.org/en/permalink/ahliterature266282
Source
Scand J Gastroenterol. 2015 Feb;50(2):245-52
Publication Type
Article
Date
Feb-2015
Author
Marianne Udd
Outi Lindström
Harri Mustonen
Leif Bäck
Jorma Halttunen
Leena Kylänpää
Source
Scand J Gastroenterol. 2015 Feb;50(2):245-52
Date
Feb-2015
Language
English
Publication Type
Article
Keywords
Aged
Body mass index
Cause of Death
Death Certificates
Decision Support Techniques
Deglutition Disorders - therapy
Enteral Nutrition - mortality
Female
Finland
Gastrostomy - mortality
Head and Neck Neoplasms - therapy
Humans
Male
Middle Aged
Models, Theoretical
Multivariate Analysis
Postoperative Complications
Prognosis
Retrospective Studies
Tertiary Care Centers
Time Factors
Abstract
Percutaneous endoscopic gastrostomy (PEG) is used for long-term enteral nutrition in neurological patients with dysphagia (NEUR), in head and neck cancer patients prior to chemoradiation therapy (head and neck malignancy group [HNM]), or in cases of oropharyngeal or esophageal tumor obstruction or stricture (OBSTR). Considerable morbidity and overall mortality is reported. Aim was to analyze the complication rates and mortality with PEG and to identify subgroups with poor outcomes.
Patients underwent PEG (n = 401) in a single tertiary care center. Indications, characteristics, and causes of death were recorded.
Number of patients in groups: HNM 135 (34%), OBSTR 74 (18%), and NEUR 192 (48%); follow-up time median (interquartile range): 17 (39) months; the time PEG used for feeding: 4 (7) months. A total of 91 patients (23%) had 110 complications, 31 patients (8%) had early (=30 days) complications, and 49 patients (12%) major complications. Two deaths (0.5%, 2 peritonitis) were related to PEG. The 30-day mortality was 11% (n = 47). According to multivariate analysis, an increased 30-day mortality was associated with =75 years of age, American Society of Anesthesiologists (ASA) class IV, a Charlson comorbidity index (CCI) =4, body mass index (BMI)
PubMed ID
25540954 View in PubMed
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The association between nurse-administered midazolam following cardiac surgery and incident delirium: an observational study.

https://arctichealth.org/en/permalink/ahliterature124857
Source
Int J Nurs Stud. 2012 Sep;49(9):1064-73
Publication Type
Article
Date
Sep-2012
Author
Priscilla G Taipale
Pamela A Ratner
Paul M Galdas
Carol Jillings
Deborah Manning
Connie Fernandes
Jaime Gallaher
Author Affiliation
School of Nursing, The University of British Columbia, Vancouver, Canada. taipalep@interchange.ubc.ca
Source
Int J Nurs Stud. 2012 Sep;49(9):1064-73
Date
Sep-2012
Language
English
Publication Type
Article
Keywords
British Columbia
Delirium - chemically induced
Female
Humans
Hypnotics and Sedatives - administration & dosage - adverse effects
Male
Midazolam - administration & dosage - adverse effects
Nursing Staff
Tertiary Care Centers
Thoracic Surgery
Abstract
Post-operative delirium after cardiac surgery is an adverse event that affects patients' recovery and complicates the delivery of nursing care. Numerous risk factors for delirium are uncontrollable; however, nurses' pro re nata drug administration of sedatives may be a controllable risk factor.
This study examined the relationship between nurses' pro re nata administration of midazolam hydrochloride to cardiac surgery patients and the development of post-operative delirium.
Observational study.
Cardiac surgery intensive care and nursing units of a tertiary care center in Vancouver, Canada.
122 male and female patients requiring non-emergent surgery for coronary artery disease or valvular heart disease who did not have pre-existing cognitive impairment, severe hearing or visual impairment, substance misuse, alcohol intake exceeding 7 drinks per week, or renal impairment requiring hemodialysis.
Patients were assessed for delirium, on three occasions, with the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) during the first 72 h after surgery and through reviews of physicians' notes. Risk factor and midazolam dosage data were collected from medical records.
77.9% of the patients in this sample received midazolam hydrochloride post-operatively. The prevalence of delirium ranged from 37.7% to 44.3%. Almost all of the dosages of midazolam (85-87%) were given before the first indication of delirium; that is, most of the patients had received their entire dosage before the first signs of delirium were detected. Bivariate analysis with logistic regression models revealed that for every additional milligram of midazolam administered, the patients were 7-8% more likely to develop delirium. Multivariate logistic regression models demonstrated that the magnitude of the association between midazolam dosage and delirium was not confounded by established risk factors including age and peripheral vascular disease.
Nurses play an important role in the prediction, assessment and prevention of post-operative delirium. Sedatives should be administered with caution because they increase a patient's risk of developing delirium. Nurses' decisions regarding sedation administration must be informed by empirical knowledge, accurate assessment data and clear rationale with consideration of how these actions may contribute to the development of delirium.
PubMed ID
22542266 View in PubMed
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Association of age with polypharmacy and risk of drug interactions with antiretroviral medications in HIV-positive patients.

https://arctichealth.org/en/permalink/ahliterature105929
Source
Ann Pharmacother. 2013 Nov;47(11):1429-39
Publication Type
Article
Date
Nov-2013
Author
Alice Tseng
Leah Szadkowski
Sharon Walmsley
Irving Salit
Janet Raboud
Author Affiliation
Toronto General Hospital, University Health Network, ON, Canada.
Source
Ann Pharmacother. 2013 Nov;47(11):1429-39
Date
Nov-2013
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Aged
Aged, 80 and over
Anti-Retroviral Agents - administration & dosage - adverse effects - therapeutic use
Comorbidity
Cross-Sectional Studies
Drug Interactions
Female
HIV Infections - complications - drug therapy - epidemiology
Humans
Logistic Models
Male
Middle Aged
Ontario
Polypharmacy
Tertiary Care Centers
Young Adult
Abstract
Interactions between antiretroviral (ARV) therapy and medications to treat age-related comorbidities are a growing concern in the aging HIV population.
To investigate the association of age with potential drug-drug interactions (PDDIs) involving ARVs.
We studied ARV-treated patients attending a tertiary care center. PDDIs were classified as "red flag" (contraindicated) or "orange flag" (use with caution or dose adjustment). Logistic regression was used to determine the association of age with the occurrence of =1 PDDI.
Of 914 patients (78% male, median age 49 years), older patients (age =50 years) were on more drugs than younger patients (total 9 vs 7; P
PubMed ID
24285760 View in PubMed
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138 records – page 1 of 14.