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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
61

Transtorno de déficit de atenção/hiperatividade e epilepsia: eficácia e segurança do metilfenidato em crianças e adolescentes com crises epilépticas não controladas / Attention deficit/hyperactivity disorder and epilepsy: efficacy and safety of the methylphenidate in children and adolescents with uncontrolled epilepsy

Júlio Amaro de Sá Koneski 22 January 2010 (has links)
INTRODUÇÃO: O transtorno de déficit de atenção / hiperatividade (TDAH) é observado em 30-40% das crianças e adolescentes com epilepsia. Estudos recentes relataram a segurança do metilfenidato em pacientes com epilepsia controlada, porém há uma carência de estudos em pacientes com epilepsia não controlada. OBJETIVO: Estudar a eficácia e segurança do metilfenidato em crianças e adolescentes com diagnóstico de TDAH e epilepsia não controlada. MÉTODOS: Avaliação prospectiva de 24 pacientes de 7 a 16 anos, com diagnóstico de epilepsia e TDAH, no Ambulatório de Especialidades da Universidade da Região de Joinville (Univille), que preencham os seguintes critérios: pacientes com diagnóstico de epilepsia que tenham tido pelo menos duas crises epilépticas nos últimos seis meses; diagnóstico de TDAH com base nos critérios definidos pelo DSM-IV; que não tivesse recebido tratamento prévio com metilfenidato. RESULTADOS: A amostra foi composta de 24 pacientes, classificados pelo subtipo do TDAH em 41,7% desatento, 37,5% combinado e 20,8% hiperativo/impulsivo. Os pacientes apresentaram epilepsia parcial em 58,3% e epilepsia generalizada em 41,7%. A dose média do metilfenidato utilizada foi 0,52 mg/kg/dia (22,3 mg/dia). Tempo de seguimento foi de seis meses para todos os pacientes. Em 70,8% houve melhora dos sintomas do TDAH após seis meses de tratamento, e em 22 dos 24 pacientes (91,6%) não houve aumento da freqüência de crises epilépticas. CONCLUSÕES: metilfenidato demonstrouse efetivo no tratamento dos sintomas do TDAH em pacientes com epilepsia não controlada, e nos primeiros seis meses de estudo, não houve aumento significativo da freqüência das crises epilépticas. / INTRODUCTION: Attention Deficit and Hyperactivity Disorder (ADHD) is observed in 30 to 40 % children and adolescents with epilepsy. Recent studies demonstrate the safety of methylphenidate (MPH) in patients with controlled epilepsy. There is a lack of studies of patients with uncontrolled epilepsy. OBJECTIVE: to study the efficacy and safety of MPH in children and adolescents diagnosed with ADHD and uncontrolled epilepsy. METHODS: We evaluated 24 patients with ages of 7 and 16 years, diagnosed with epilepsy and ADHD, outpacient speciality clinic which took place in the Ambulatório de Especialidades of the Universidade da Região de Joinville (Univille). Inclusions criterias: at least two seizures in the previous 6 months; the diagnosis of ADHD based on DSM-IV criteria. RESULTS: The results of 24 patients have been evaluated, classified according to subtype ADHD as the following: 41.7 % inattentive type, 37.5 % combined and 20.8% hyperactive/impulsive type. The sample was distributed as the following: parcial epilepsy 58.3 % and generalized epilepsy 41.7 %. An average dose of MPH was 0.52 mg/kg/daily (22.3 mg daily). This was given for a period of 6 months to all patients. In 70.8 % the patients showed signs of improvement from ADHD symptoms and there was not increase of frequency of epileptic seizure in 22 of the 24 patients (91.6%). CONCLUSIONS: MPH was effective in the treatment of ADHD in patients with uncontrolled epilepsy. In the first 6 months of this study there was no increase of epileptic seizures.
62

Aspectos epidemiológicos de pacientes com doença renal crônica em programa de diálise peritoneal: levantamento de 22 anos / Epidemiological aspects of patients with chronic renal disease in a peritoneal dialysis program: a 22-year survey

Aline Junqueira Bezerra 10 November 2017 (has links)
A doença renal crônica (DRC) tem sido considerada um problema de saúde pública mundial. Estima-se que cerca de 17% da população adulta dos EUA apresente algum grau de comprometimento da função renal. No Brasil, um estudo realizado na cidade de Bambuí - Minas Gerais detectou-se alteração da função renal variando de 0,48% a 8,19%, sendo mais frequente nos pacientes idosos. Os pacientes que evoluem para DRC terminal necessitam de algum tipo de terapia renal substitutiva (TRS), sendo as opções disponíveis: a hemodiálise (HD), a diálise peritoneal (DP) e o transplante renal (TX renal). No caso da DP, a membrana peritoneal realiza a função de filtrar o sangue do paciente, e esta é utilizada através da implantação de um cateter na cavidade abdominal. No Brasil, segundo dados do Censo Brasileiro de Diálise (2016) existem aproximadamente 122.825 pacientes em diálise, sendo 8,6% em DP. O objetivo do estudo foi analisar a evolução dos pacientes que foram admitidos na Unidade de Diálise do HCFMRP para submeterem-se à DP nos últimos 22 anos. Os dados foram coletados dos prontuários dos pacientes atendidos no período de 1993 a 2015, de onde foram extraídas variáveis demográficas, clínicas e laboratoriais. É um estudo de coorte retrospectiva de 199 prontuários de pacientes atendidos na Unidade de Diálise do HCFMRP-USP. Os resultados demonstram que a população do estudo é em sua maioria do sexo feminino, com média de idade 57 anos. Foi encontrada a mudança de TRS para a hemodiálise como desfecho clínico mais frequente, seguida por óbito. A etiologia da DRC mais frequente foi a hipertensão arterial sistêmica (HAS), seguida por Diabetes mellitus (DM) tipo 2. Houve associação com menor média de idade de entrada em programa (48 anos), desfecho clínico óbito e maior tempo de seguimento (10 anos) com o grupo de pacientes que entraram em programa de diálise em 1993 (p<0,05). Encontramos associação do uso de medicamentos (Cloridrato de Sevelamer e Análogos da vitamina D3 com níveis categorizados de paratormônio, cálcio total e fósforo (p<0,05). CONCLUSÃO: Os pacientes que entraram em programa no período de 1993-2000 apresentaram menor média de idade e maior tempo de acompanhamento quando comparados aos demais grupos. O desfecho clínico mais frequente foi a transferência para HD, tendo como causa principal a ocorrência de peritonites. / INTRODUCTION: Chronic kidney disease (CKD) has been considered a worldwide public health problem, as well as the progressive increase of the population in renal replacement therapy (TRS). With the technological advances accumulated, the survival of patients on dialysis has increased greatly. Peritoneal dialysis (PD) is considered a safe and effective method of SRT, a challenge for the binomial patienthealth team. OBJECTIVES: To analyze the main characteristics and outcomes of patients in a PD program. METHODS: This was a retrospective cohort study of 199 patients submitted to PD in the Dialysis Unit of the HCFMRP-USP from 1993 to 2015. The primary source of data was the individual medical records. The variables were classified as: demographic, clinical and laboratorial. Statistical analyzes were performed using the Chi-square test, ANOVA and Kruskal Wallis. RESULTS: The mean age of the patients was 57 years, with a predominance of females (51.5%); the most frequent clinical outcome was the change in HRT for hemodialysis (37.2%). Type 2 diabetes mellitus (DM) was the most common cause of CKD (31,7). There was an association between lower mean age of program entry, clinical outcome and longer follow-up (10 years) in the group of patients who entered the dialysis program in the period from 1993 to 2000 (p <0.05). There was an association between the use of medications (Sevelamer\'s Hydrochloride and vitamin D3 analogues) with categorized values of parathormone, total calcium and phosphorus (p <0.05). CONCLUSION: Patients who entered the program in 1993-2000 had a lower mean age and longer follow - up when compared to the other groups. The most frequent clinical outcome was the transfer to HD, the main cause being the occurrence of peritonitis.
63

Self-Assessment of Medical-Surgical Nurses’ Behavioral Healthcare Competency

Marine, Jeremey, Marine, Jeremey January 2018 (has links)
Millions of people in the United States are living with a serious mental illness or substance abuse disorder. These individuals suffer from a high rate of medical co-morbidities. Because of this, patients hospitalized on medical-surgical units for medical reasons often are living with psychiatric/substance abuse co-morbidities, which are not addressed during their medical hospital admission. These patients can be perceived as difficult and even dangerous by nurses who have not received training or education in mental health care. The purpose of this project is to measure medical-surgical nurse’s perceptions of their abilities to recognize psychiatric/substance abuse symptoms and their perception of self-competency to provide appropriate interventions. This project utilized the Behavioral Health Care Competency (BHCC) instrument to measure hospital nurse perceptions of behavioral healthcare competency to determine if additional education and training are needed. The BHCC tool was administered to 19 nurses working on two medical-surgical units in Southern Arizona. Findings support the need for educational intervention, especially in the areas of psychotropic medication recommendation and intervention for patients experiencing hallucinations.
64

The Top 25 Comorbidities Reported During Inpatient Stays for Pediatric Hematopoietic Stem Cell Transplant: Patient Demographics and Impact on Inpatient Mortality and Charges

Zulueta, Stacy, Clemans, Emily, Skrepnek, Grant January 2011 (has links)
Class of 2011 Abstract / OBJECTIVES: The purpose of this study was to analyze the impact of patient and hospital characteristics as well as selected comorbidities on inpatient mortality and charges in pediatric HSCT. We have determined the top 25 comorbidities reported during all inpatient stays for HSCT as well as for those stays ending in mortality. METHODS: All data was extracted from the AHRQ KID databases for the years 1997, 2000, 2003, and 2006. Two regression analyses were performed to determine the contribution of various independent variables on mortality and charges. Subjects of this study included all cases of HSCT reported in the Healthcare Cost and Utilization Project (HCUP) KID as ICD-9 41.XX. RESULTS: Factors accounting for larger increases in cost included death during hospital stay, the development of disseminated intravascular coagulation (DIC), pneumonia, and length of stay (LOS). The largest decreases in charges were seen for patients coming from a small or “micropolitan” location, patients cared for in teaching hospitals, and in hospitals with large bedsizes. Variables associated with increased risk of mortality on linear regression included development of DIC, sepsis, or pneumonia. CONCLUSION: Further study relating to HSCT is necessary to determine the contribution of specific comorbidities to mortality and charges. Importantly, DIC is associated with both greater risk of mortality and greater charges. It would be prudent to recommend increased monitoring and early treatment for DIC based on these results.
65

As crenças cognitivas e suas relações com sintomas de ansiedade social e depressão

Badaró, Auxiliatrice Caneschi 09 February 2015 (has links)
Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-01-07T12:29:41Z No. of bitstreams: 1 auxiliatricecaneschibadaro.pdf: 1174342 bytes, checksum: 90ffe1861f7fbe186c32125c93aa2c1a (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-01-25T16:42:54Z (GMT) No. of bitstreams: 1 auxiliatricecaneschibadaro.pdf: 1174342 bytes, checksum: 90ffe1861f7fbe186c32125c93aa2c1a (MD5) / Made available in DSpace on 2016-01-25T16:42:54Z (GMT). No. of bitstreams: 1 auxiliatricecaneschibadaro.pdf: 1174342 bytes, checksum: 90ffe1861f7fbe186c32125c93aa2c1a (MD5) Previous issue date: 2015-02-09 / A Ansiedade Social tem sido subdiagnosticada na clínica de psicologia devido às comorbidades que apresenta. A depressão tem sido a comorbidade mais frequente relacionada à ansiedade social, e uma das mais graves também, podendo levar à morte do paciente. Nesses casos, os diagnósticos podem se confundir, comprometendo o tratamento. Objetivo: Esse estudo buscou entender melhor, a partir das crenças cognitivas, as semelhanças e diferenças desses transtornos e da influência de um sobre o outro, auxiliando na sua identificação e possibilitando melhores intervenções a partir de uma percepção mais direcionada. Teve como objetivo principal correlacionar os grupos de ansiosos sociais e deprimidos, e entender quais crenças eles compartilham e suas intensidades. Métodos: A população alvo se constituiu de maiores de 18 anos, atendidos pelo Centro de Psicologia Aplicada (CPA) – UFJF e pela Clínica Psicológica do CES, JF. Em acordo com a instituição e os terapeutas que iriam atender esses pacientes, foram selecionadas pessoas que iniciaram o atendimento no CPA e no CES com queixas que tendem a um diagnóstico de depressão ou ansiedade social. Posteriormente foram aplicados os seguintes instrumentos de pesquisa: Inventário de Ansiedade Social Liebowitz, Escala de Depressão Baptista para Adultos – EBADEP-A e Inventário da Tríade Cognitiva - ITC. Os dois primeiros rastrearam a possibilidade de um diagnóstico em ansiedade social e depressão, e o último avaliou as crenças cognitivas desses grupos. Resultados: Os resultados indicaram que deprimidos vivenciam crenças mais disfuncionais sobre si, o mundo e o futuro quando comparados com os ansiosos sociais, de forma que esses grupos se diferenciaram significativamente a partir desse critério. O grupo de comorbidade entre ansiedade social e depressão se mostrou mais comprometido que os outros em relação a essas crenças, se diferenciando do grupo de depressão apenas na crença de “futuro negativo”. Aqueles que apresentaram apenas alto escore em ansiedade social não se mostraram significativamente diferentes dos participantes que não obtiveram pontuações importantes no EBADEP-A e Liebowitz. / Social Anxiety has been underdiagnosed at psychology clinics due the comorbidities it shows. Depression appears frequently between those psychologycal disorders related to social anxiety, figuring as one of the most severe, capable of causing the patient's death. In these cases, diagnoses may be confusing, affecting treatment. Objective: this study sought to better understand, through cognitive beliefs, the similarities and differences between these disorders and its mutual influences, helping to identify them and to improve interventions through more focused perceptions. The main objective was to correlate the groups of social anxious and depressed, and understand which beliefs they share and its intensity. Methods: subjects of the study were people older than 18 years under treatment at the Applied Center of Psychology (CPA) - UFJF and at the Psychologycal Clinic of CES, JF. It was agreed with these institutions and the therapeuts to select those who started their treatment at CPA and CES, and whose complaints leans to a diagnosis of depression or social anxiety. Afterwards, it was applied the following instruments of research: Liebowitz Social Anxiety Inventory, Baptista Depression Scale for Adults - EBADEP-A and Cognitive Triad Inventory - ITC. The first two screened the possibility of social anxiety and depression diagnosis, and the last assessed cognitive beliefs in these groups. Results: the results indicate that depressed individuals experience more dysfunctional beliefs about themselves, the world and the future when compared with socially anxious individuals. Hence, both groups are significantly different concerning this criterion. The group of comorbidity between social anxiety and depression appeared much more affected than the others concerning these beliefs, differing from the depression group only in the "negative future" belief. Those who exhibited high scores only for social anxiety didn't differed significantly from subjects who didn't achieved substantial scores at EBADEP-A and Liebowitz.
66

Aspectos epidemiológicos de pacientes com doença renal crônica em programa de diálise peritoneal: levantamento de 22 anos / Epidemiological aspects of patients with chronic renal disease in a peritoneal dialysis program: a 22-year survey

Bezerra, Aline Junqueira 10 November 2017 (has links)
A doença renal crônica (DRC) tem sido considerada um problema de saúde pública mundial. Estima-se que cerca de 17% da população adulta dos EUA apresente algum grau de comprometimento da função renal. No Brasil, um estudo realizado na cidade de Bambuí - Minas Gerais detectou-se alteração da função renal variando de 0,48% a 8,19%, sendo mais frequente nos pacientes idosos. Os pacientes que evoluem para DRC terminal necessitam de algum tipo de terapia renal substitutiva (TRS), sendo as opções disponíveis: a hemodiálise (HD), a diálise peritoneal (DP) e o transplante renal (TX renal). No caso da DP, a membrana peritoneal realiza a função de filtrar o sangue do paciente, e esta é utilizada através da implantação de um cateter na cavidade abdominal. No Brasil, segundo dados do Censo Brasileiro de Diálise (2016) existem aproximadamente 122.825 pacientes em diálise, sendo 8,6% em DP. O objetivo do estudo foi analisar a evolução dos pacientes que foram admitidos na Unidade de Diálise do HCFMRP para submeterem-se à DP nos últimos 22 anos. Os dados foram coletados dos prontuários dos pacientes atendidos no período de 1993 a 2015, de onde foram extraídas variáveis demográficas, clínicas e laboratoriais. É um estudo de coorte retrospectiva de 199 prontuários de pacientes atendidos na Unidade de Diálise do HCFMRP-USP. Os resultados demonstram que a população do estudo é em sua maioria do sexo feminino, com média de idade 57 anos. Foi encontrada a mudança de TRS para a hemodiálise como desfecho clínico mais frequente, seguida por óbito. A etiologia da DRC mais frequente foi a hipertensão arterial sistêmica (HAS), seguida por Diabetes mellitus (DM) tipo 2. Houve associação com menor média de idade de entrada em programa (48 anos), desfecho clínico óbito e maior tempo de seguimento (10 anos) com o grupo de pacientes que entraram em programa de diálise em 1993 (p<0,05). Encontramos associação do uso de medicamentos (Cloridrato de Sevelamer e Análogos da vitamina D3 com níveis categorizados de paratormônio, cálcio total e fósforo (p<0,05). CONCLUSÃO: Os pacientes que entraram em programa no período de 1993-2000 apresentaram menor média de idade e maior tempo de acompanhamento quando comparados aos demais grupos. O desfecho clínico mais frequente foi a transferência para HD, tendo como causa principal a ocorrência de peritonites. / INTRODUCTION: Chronic kidney disease (CKD) has been considered a worldwide public health problem, as well as the progressive increase of the population in renal replacement therapy (TRS). With the technological advances accumulated, the survival of patients on dialysis has increased greatly. Peritoneal dialysis (PD) is considered a safe and effective method of SRT, a challenge for the binomial patienthealth team. OBJECTIVES: To analyze the main characteristics and outcomes of patients in a PD program. METHODS: This was a retrospective cohort study of 199 patients submitted to PD in the Dialysis Unit of the HCFMRP-USP from 1993 to 2015. The primary source of data was the individual medical records. The variables were classified as: demographic, clinical and laboratorial. Statistical analyzes were performed using the Chi-square test, ANOVA and Kruskal Wallis. RESULTS: The mean age of the patients was 57 years, with a predominance of females (51.5%); the most frequent clinical outcome was the change in HRT for hemodialysis (37.2%). Type 2 diabetes mellitus (DM) was the most common cause of CKD (31,7). There was an association between lower mean age of program entry, clinical outcome and longer follow-up (10 years) in the group of patients who entered the dialysis program in the period from 1993 to 2000 (p <0.05). There was an association between the use of medications (Sevelamer\'s Hydrochloride and vitamin D3 analogues) with categorized values of parathormone, total calcium and phosphorus (p <0.05). CONCLUSION: Patients who entered the program in 1993-2000 had a lower mean age and longer follow - up when compared to the other groups. The most frequent clinical outcome was the transfer to HD, the main cause being the occurrence of peritonitis.
67

Douleur et stéatopathie hépatiques, des manifestations systémiques sous estimées de la BPCO / Pain and Fatty liver disease, underestimated systemic manifestations of COPD

Viglino, Damien 14 September 2018 (has links)
La bronchopneumopathie chronique obstructive (BPCO) est une des maladies chroniques les plus fréquentes et constitue une des premières causes de mortalité dans le monde avec un impact sociétal majeur et des couts de santé considérables. La BPCO est aujourd’hui considérée comme une maladie multi-systémique dont le pronostic est lié en grande partie à ses comorbidités et à la survenue d’exacerbations. Les exacerbations qui vont ponctuer l’évolution de la BPCO précipitent le déclin de la fonction respiratoire et favorisent la décompensation des comorbidités et la survenue d’événements cardiovasculaires comme des infarctus du myocarde ou des accidents vasculaires cérébraux. La prise en charge moderne de la BPCO est basée sur la mise en place d’un soin intégré incluant la prise en charge des comorbidités et une meilleure détection et gestion des exacerbations.Dans ce travail de thèse nous abordons l’atteinte hépatique (stéatopathie hépatique non alcoolique - NAFLD) dans la BPCO comme une comorbidité sous-estimée (publication 1) alors qu’elle a probablement des implications pronostiques importantes (publication 2). La BPCO s'accompagne également de symptômes non respiratoires tel que des douleurs, dont les variations et localisations sont peu connues pendant et après l'exacerbation (publication 3). Le traitement de ces douleurs par des opiacés pourrait avoir un effet spécifiquement délétère dans cette population (publication 5). Les enjeux de réforme du système de santé avec une optimisation cout-efficacité incitent à développer et valider de nouvelles méthodes de prise en charge ambulatoire des exacerbations (publication 6).Dans une première partie de la thèse nous explorons les liens épidémiologiques entre BPCO et NAFLD. Nous explorerons également les conséquences d’une telle association sur le devenir cardiovasculaire des patients à moyen terme. Dans une deuxième partie, nous cherchons à définir les caractéristiques des douleurs avant et après exacerbation au cours de la BPCO, le lien entre douleur, anxiété et dépression chez ces patients et la sécurité d'emploi des morphiniques dans cette population fragile. Dans une dernière partie, nous aborderons la stratification du risque lié à une exacerbation de BPCO, et la possibilité d’une prise en charge ambulatoire extrahospitalière pour les exacerbations de sévérité modérée. / Chronic Obstructive Pulmonary Disease (COPD) is one of the most common chronic diseases and is one of the leading causes of death in the world with major societal impact and considerable health costs. COPD is now considered a multi-systemic disease whose prognosis is largely related to its comorbidities and the occurrence of exacerbations. The exacerbations that punctuate the evolution of COPD precipitate the decline of respiratory function and promote the decompensation of comorbidities and the occurrence of cardiovascular events such as myocardial infarction or cerebrovascular accidents. The modern management of COPD is based on the implementation of integrated care including the management of comorbidities and better detection and management of exacerbations.In this thesis we address liver injury (non-alcoholic fatty liver disease - NAFLD) in COPD as an underestimated comorbidity (publication 1), although it probably has important prognostic implications (publication 2). COPD is also associated with non-respiratory symptoms such as pain, the variations and locations of which are poorly known during and after exacerbation (publication 3). Treatment of this pain with opiates may have a specifically deleterious effect in this population (publication 5). The challenges of health system reform with cost-effectiveness optimization encourage the development and validation of new methods of outpatient management of exacerbations (publication 6).In a first part of the thesis we explore the epidemiological links between COPD and NAFLD. We will also explore the consequences of such an association on the cardiovascular outcome of patients in the medium term. In a second part, we seek to define the characteristics of pain before and after exacerbation during COPD, the link between pain, anxiety and depression in these patients and the safety of opioids in this fragile population. In the last part, we will discuss the stratification of the risk linked to an exacerbation of COPD, and the possibility of outpatient care for exacerbations of moderate severity.
68

Genetic Diagnoses and Extracardiac Comorbidities in Adults with Congenital Heart Disease: A Retrospective Chart Review

Edwards, Moriah 24 May 2022 (has links)
No description available.
69

Characteristics of the Middle-Age Adult Inpatient Fall: A Dissertation

Guillaume, Donna M. 26 August 2015 (has links)
Falls remain one of the most reportable, serious and costly type of adverse events costing an estimated $3,500 to $27,000 depending on the injury. The research often focuses on the elderly and their risk for falls and injury. Increasingly higher rates of falls are being reported in the middle-age inpatient 45 to 64 years of age. While predictors of falls and injuries have been studied across all adult inpatients, research has not specifically addressed fall risk characteristics in the middle-age. The World Health Organization’s (WHO), “Risk factor model for fall in older age”, framework was adapted for the middle-age inpatient. This framework identifies extrinsic and intrinsic variables from four risk factor groupings of biological, socioeconomic, behavioral, environmental and related outcomes to describe characteristics of the middle-age inpatient’s fall injury risk. Hitcho et al. (2004) seminal article was also used to identify pertinent inpatient characteristics. The purpose of this exploratory retrospective quantitative study described fall risk factors specific to the middle-age inpatient. The aims: (1) described risk factors of falls and fall injury; (2) described unit specific data, fall numbers with type of falls, injuries from falls, and prevention strategies (3) compare the incidence of fall and injury rates in the middle-age (45- 64) patients to the other hospital adult age-groups (ages 21-44 and 65-90). This study used retrospective hospital occurrence data to identify middle-age inpatient falls and related characteristics reported by staff. Chart review of inpatient falls identified 439 individual falls occurring from January 2012 through July 2014. The study sample included inpatients that fell either one-time or had a repeat fall during the study period. Analysis for data included use of descriptive statistics, crosstabs, and Poisson regression. Outcomes collected included demographics, admitting diagnosis, chief complaints, cormorbities, and discharge status, type of falls and areas of falls. There was no significant difference in rates of falls between units or in staffing ratios that had a bearing on the middle-age inpatient. Fall prevention interventions were found to be universally applied, not specific to the individual, nor based on outcomes of risk screening of anticipated physiological risk factors. In comparison of the middle-age inpatient population with those age 65 -90 years of age the rates per 1000 patient days for both falls (p=.637) and injuries (p=.626) had no significant difference. Males fell at a significantly higher rate (p=.000) than females in the middle-age inpatient and those aged 64-90 years. The middle-age inpatient fell at an alarming rate of 42% of all falls. This research provided insight into a population with acute and multiple chronic disease conditions and comorbidities that contribute to altered mental status, abnormal gait and frequently awaking at night to void. This population often overestimates their limitations and strives to maintain their autonomy. The age of the patient should not influence staff assessment of alertness and orientation. The findings of the characteristics in this research provide rich information for further research in how to include the middle-age patient in clinical decision making and education of this age group.
70

Usage of Non-steroidal anti-inflammatory drugs in a sample of New Zealanders with osteoarthritis : A cross-sectional study / Användning av icke-steroida antiinflammatoriska läkemedel i ett stickprov av Nya Zeeländare med artros : En tvärsnittsstudie

Swenson, Victor, Ekberg, Mattias January 2020 (has links)
Introduction Oral Non-steroidal anti-inflammatory drugs (NSAID) is an analgesia and is commonly used by people with osteoarthritis (OA). Oral NSAID is currently recommended as the second level of treatment for OA, and could be considered if physical activity, topical NSAID or paracetamol do not supply sufficient pain relief.   Aim To investigate how frequently oral NSAID is used in a sample of New Zealanders with OA and also to investigate the exposure to heightened risk of adverse events while using oral NSAID.   Method A cross-sectional survey was conducted to collect information about the use of oral NSAID by people with self-reported OA. The survey included 75 participants who were over the age of 45 with an average age of 70.6 years.   Results While having OA, 57,3% of the sample reported oral NSAID use. The results also show that 52% of the participants with cardiovascular (CV), gastrointestinal (GI) or renal comorbidities used oral NSAID, and 17,3% of them also combined that NSAID with medication for their comorbidity. Concerning the heightened risks of adverse events, 21% of the participants did acquire the analgesia over the counter (OTC), and 76,6% stated that they were over the age of 65.    Conclusion A majority of the participants in the study with self-reported OA take NSAID as an analgesia. Also, the study shows that NSAID is commonly used among participants with co-morbidity, which is similar to figures presented in previous studies in the area. However, the small sample size limits its generalizability to a larger population. / Introduktion Orala icke-steroida antiinflammatoriska läkemedel (NSAID) är en grupp smärtstillande mediciner som är vanligt använt av personer mer artros. Orala NSAID-preparat rekommenderas idag som en andrahandsbehandling och kan övervägas om fysisk aktivitet, topikala NSAID-preparat eller paracetamol inte ger tillräcklig smärtlindrande effekt.   Syfte Att undersöka hur vanligt användandet av orala NSAID-preparat är i ett stickprov av personer med artros i Nya Zeeland samt att undersöka exponering av orala NSAID-preparat i subgrupper med ökad risk för biverkningar vid användande av orala NSAID-preparat.   Metod En tvärsnittsstudie genomfördes för att samla in information kring användning av orala NSAID-preparat av personer med självrapporterad artros. Studiepopulationen bestod av 75 personer över 45 års ålder med en medelålder på 70,6 år.   Resultat 57,3% av deltagarna använder orala NSAID-preparat som behandling för sin självrapporterad artros. Gällande subgrupper med ökad risk för biverkning av NSAID användning visar studien att 52% av deltagare med kardiovaskulära, gastrointestinala eller njurpåverkade sjukdomar använder orala NSAID-preparat och av dessa kombinerar 17,3% NSAID-preparaten med medicin för sin samsjuklighet. Av deltagarna som uppgav att de använder orala NSAID-preparat erhåller 21% av dessa NSAID-preparaten receptfritt över disk. Av deltagare som var 65 år eller äldre uppgav 76,6% att de använder orala NSAID-preparat för behandling av artros.   Slutsats En majoritet av deltagarna med självrapporterad artros tar orala NSAID-preparat i smärtstillande syfte för sin artros. Studien visar också att NSAID ofta används bland deltagare med samsjuklighet, vilket motsvarar presenterade siffror från tidigare studier inom området. Den lilla stickprovsstorleken begränsar emellertid studiens generaliserbahet gentemot en större population.

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