Single Health System Research Articles

Evolution of clinical outcomes of metastatic pancreatic adenocarcinoma: A 10-year single-institution retrospective study.

e16760 Background: Pancreatic adenocarcinoma represents the fourth leading cause of cancer-related death in the United States. A majority of patients have locally advanced or metastatic disease at the time of diagnosis. For many years, gemcitabine monotherapy was the standard of care for advanced disease, until recent studies demonstrated survival benefits for FOLFIRINOX (5-FU, leucovorin, irinotecan, and oxaliplatin) and Gem/nab-P (gemcitabine/nab-paclitaxel). In this study, we evaluated the clinical outcomes in patients with metastatic pancreatic adenocarcinoma in a single health system before and after the incorporation of these newer treatments into practice. Methods: A retrospective study of metastatic pancreatic adenocarcinoma patients diagnosed between January 2009 to December 2018 with follow up until December 2019. Overall survival (OS) and progression-free survival (PFS) were calculated using Kaplan-Meier survival analysis. Univariate and multivariable Cox regression analyses were used to explore predictors of survival. Results: 394 patients were diagnosed with metastatic pancreatic adenocarcinoma at Sanford Health hospitals during the study period. There was no statistically significant difference in OS between the cohort diagnosed between 2009-2013 compared to 2014-2018, with median OS of 4.7 and 3.6 months respectively; in those receiving at least one line of chemotherapy, the median OS was 6.7 and 7.3 months. While subgroup analysis of all study population based on the type of first-line chemotherapy showed improved survival with FOLFIRINOX and Gem/nabP as compared to gemcitabine monotherapy [10.7, 6.9, 4 months respectively] (Wilcoxon Test of Homogeneity of Survival Curves p = 0.0002). Univariate and multivariate Cox regression analysis of all study data revealed that at the time of the diagnosis, age (HR: 1.021, p = 0.0013), ECOG performance status > 1 (HR: 3.47, p = 0.0001), serum albumin (HR: 0.708, p = 0.0002), Neutrophil-to-Lymphocytes ratio (HR: 1.076, p≤0.0001) and platelets-to-lymphocyte ratio (HR: 0.998, p = 0.0031) were predictors of survival. Conclusions: Although newer treatments appear to offer improved survival for eligible patients, overall outcomes for metastatic pancreatic adenocarcinoma in this cohort were similar before and after the incorporation of newer treatment regimens. Further advances in the treatment and early detection of pancreatic cancer are needed to improve clinical outcomes.

Prevalence of prescription medication use in preschool-age children seen in pediatric otolaryngology

ObjectiveTo examine the prevalence of daily medication use and prescribing patterns in preschool aged children presenting to otolaryngology clinics. Study designRetrospective summary of prescription-related data from PEDSnet database of two tertiary care children's hospitals within single health system. MethodsAll new patients between birth and 5 years of age seen in otolaryngology clinics from October 1, 2016 through September 30, 2017 were included. Existing diagnoses, active prescriptions at time of visit, prescription dates, and demographics were abstracted. Summary analysis was performed on medication prevalence, quantity and duration of use, comparing all variables between age, gender, and geographical regions. ResultsOf 7532 patient encounters, 20% presented with active daily medication use. Eustachian tube dysfunction and otitis media were the most common diagnoses regardless of daily medication usage. Corticosteroids, specifically hydrocortisone (Delaware) and Flovent (Florida), were the most common medication prescribed. The number of medications strongly correlated with the number of encounter diagnoses. Overall, patients in Delaware were 4.5 times more likely to have at least one prescription prior to encounter (p < 0.05, 95% CI 3.2–4.8). This pattern was preserved across age and gender. Patients with medication in Delaware and Florida had a median of 2 (IQR 3.0–1.0) and 1 prescriptions (IQR 2.0–1.0), respectively (p < 0.001). There were no differences based on insurance type and no correlations between medication count and age or gender. ConclusionChildren in Delaware presented to otolaryngology clinics with significantly more prescribed medications than in Florida. Regional differences were consistent across age and gender. Most children were on these medications for a significant duration.

Experiencing the Surge: Report From a Large New York Radiation Oncology Department During the COVID-19 Pandemic

PurposeThe coronavirus disease 2019 (COVID-19) pandemic is affecting all aspects of life and changing the practice of medicine. Multiple recommendations exist on how radiation oncology practices should deal with this crisis, but little information is available on what actually happens when the COVID-19 surge arrives. New York City experienced the first surge of COVID-19 in the United States and is now the epicenter of the global pandemic. This study reviews how COVID-19 has affected aspects of medicine, nursing, radiation therapy, and administration in a hospital system in New York. Methods and MaterialsA retrospective review was conducted of the department of radiation oncology in a single health system in New York from March 1, 2020, to April 1, 2020. Collaboration was obtained from physicians, nurses, radiation therapy staff, and administration to recall their policies and effect on specific duties. A timeline was reconstructed to chronicle significant events. Numbers were obtained for patients on treatment, treatment breaks, and COVID-19 infections among staff and patients. ResultsThe COVID-19 surge has had a tremendous effect on the health system, such as cessation of all of surgeries, including oncologic surgery, and transfer of all inpatient oncology services to makeshift outpatient facilities. Radiation oncology has made aggressive efforts to reduce the number of patients in treatment to protect patients and staff and to reallocate staff and space for more acute clinical needs. Patients on-beam were reduced by 27% from 172 to 125 by April 1. Almost all visits were changed to telemedicine within 2 weeks. Infection rates and quarantine were quite low among staff and patients. The majority of residents were deployed into COVID-19 clinical settings. ConclusionsAlthough we “planned for the worst,” our health system was able to make necessary changes to still function at a reduced capacity. Our experience will give other departments a concrete experience to help them make their own policies and manage expectations.

Antibiotic Prescribing for Viral Respiratory Infections in the Pediatric Emergency Department and Urgent Care.

Viral acute respiratory tract infections (vARTI) are a frequent source of inappropriate antibiotic prescribing. We describe the prevalence of antibiotic prescribing for vARTI in the pediatric emergency department (ED) and urgent care (UC) within a health system, and identify factors associated with overall and broad-spectrum antibiotic prescribing. Retrospective chart review within a single pediatric referral health system. Visits of patients, 3 months- 17 years old, with a discharge diagnosis of a vARTI from 2010 to 2015. Data collected included specific vARTI diagnosis, site type (ED or UC), provider type [pediatric emergency medicine subspecialist or physicians, nurse practitioners, physician assistants (non-PEM)] and discharge antibiotics. Odds ratios and 95% confidence intervals (CI) were calculated where appropriate. There were 132,458 eligible visits, mean age 4.1 ± 4.3 years. Fifty-three percent were treated in an ED. Advanced practice providers, a term encompassing nurse practitioners and physician assistants, were the most common provider type (47.7%); 16.5% of patients were treated by a pediatric emergency medicine subspecialist. Antibiotics were prescribed for 3.8% (95% CI: 3.72-3.92) of children with vARTI; 25.4% (95% CI: 24.2-26.6) of these were broad-spectrum, most commonly first-generation cephalosporins (11%; 95% CI 10.2-11.9). Patients treated in an ED or by a non-PEM and those receiving chest radiograph (CXR) received antibiotics most frequently. Prescribing rates varied by specific vARTI diagnosis. Patients discharged from the pediatric ED or UC with vARTI receive inappropriate antibiotics at a lower rate than reported in other community settings; however, they frequently receive broad-spectrum agents.

Analysis of the frequency of pediatric cancer in the Western Amazon (Brazil)

Objective: Analyzes the frequency of cancer in children and adolescents in the State of Rondônia / Western Amazon (Brazil), attended by public health services. Method: This is a descriptive, quantitative and cross-sectional study. We used an instrument developed by Paraguassú-Chaves et al [24], semi-structured, containing a series of variables, such as sex, age, histological types, types of cancer by location of the primary tumor, lymphomas, leukemias, clinical stage of the disease, diagnosis and previous treatment, among others. We asked the Research Ethics Committee to waive the Free and Informed Consent Term, because the study did not require patient intervention or collection of biological material and there was no possibility of constraints for patients and their families. Results: From 122 cases, 56 (45.9%) were female and 66 (55.1%) were male. Regarding the distribution of patients according to the age group, 38 (31.1%) were younger than 4 years, 21 (17.2%), 5 to 9 years, 24 (19.7%) from 10 to 14 and 39 (32.0%) from 15 to 19. The most frequent histological types by gender were myeloproliferative leukemias and myelodysplastic diseases with 39.31% of new cases, reticuloendothelial lymphomas and neoplasms 11.96%, carcinomas and other epithelial neoplasms 11.96% of cases and CNS and several cranial intra-neoplasms and intraspinal with 11.11% of new cases. Leukemia in the hematopoietic and reticuloendothelial system (C42) is the most frequent cancer in children and adolescents, with 46.2% of cancers in the studied period. 20.5% of the cases do not know the stage of the cancer and 79.5% of the patients do not have information about the stage of the disease. 99.38% of pediatric cancer cases are referred by the single public health system - SUS and only 0.11% non-SUS or private health system. 47.6% of children and adolescents who arrive at the cancer clinic of the public health system have no diagnosis or previous treatment. Conclusions: he results presented are similar to the studies carried out in Rondônia, Brazil and other countries and are in agreement with the studies by Paraguassú-Chaves et al [24], Paraguassú-Chaves et al [27] and Paraguassú-Chaves et al [28].Considering some parameters and indicators, it can be concluded that childhood cancer in Rondônia is a public health problem.

Epidemiologic Survey of Legionella Urine Antigen Testing Within a Large Wisconsin-Based Health Care System.

Legionella pneumophila pneumonia is a life-threatening, environmentally acquired infection identifiable via Legionella urine antigen tests (LUAT). We aimed to identify cumulative incidence, demographic distribution, and undetected disease outbreaks of Legionella pneumonia via positive LUAT in a single eastern Wisconsin health system, with a focus on urban Milwaukee County. A multilevel descriptive ecologic study was conducted utilizing electronic medical record data from a large integrated health care system of patients who underwent LUAT from 2013 to 2017. A random sample inclusive of all positive tests was reviewed to investigate geodemographic differences among patients testing positive versus negative. Statistical comparisons used chi-squared or 2-sample t-tests; stepwise regression followed by binary logistic regression was used for multivariable analysis. Positive cases identified by LUAT were mapped to locate hotspots; positive cases versus total tests performed also were mapped by zip code. Of all LUAT performed (n=21,599), 0.68% were positive. Among those in the random sample (n=11,652), positive cases by LUAT were more prevalent in the June-November time period (86.2%) and younger patients (59.4 vs 67.7 years) and were disproportionately male (70.3% vs 29.7%) (P<0.0001 for each). Cumulative incidence was higher among nonwhite race/ethnicity (1.91% vs 1.01%, P<0.0001) but did not remain significant on multivariable analysis. Overall, 5507 tests were performed in Milwaukee County zip codes, yielding 82 positive cases by LUAT (60.7% of all positive cases in the random sample). A potential small 2016 outbreak was identified. Cumulative incidence of a positive LUAT was less than 1%. LUAT testing, if done in real time by cooperative health systems, may complement public health detection of Legionella pneumonia outbreaks.

The Job of the Obstetrician Does Not End by the Delivery of the Fetus With Non-reassuring Status [38O

INTRODUCTION: Research generally focuses on neonatal outcomes when pregnancy is complicated by non-reassuring fetal status. Little attention has been directed to maternal outcomes after such deliveries. METHODS: A retrospective cohort study of 27,886 pregnancies at a single health system evaluated fetal status and postpartum maternal characteristics. Fetal heart tracing, arterial cord pH, maternal blood transfusion, and maternal ICU admission were among the evaluated characteristics. Multivariate logistic regression analyses were performed to assess correlation with markers of fetal well-being and maternal outcomes and adjusted odds ratios (AOR) were derived. RESULTS: Umbilical artery pH less than 7.0 was associated with transfusion (AOR 6.83 [95% CI 2.22–21.0, P&lt;.001]), cesarean delivery (AOR 5.76 [95% CI 3.63–9.15, P&lt;.0001]), and maternal readmission (AOR 12.6 [95% CI 2.26–69.8, P=.0039]). Fetal bradycardia events were associated with increased maternal ICU admission (AOR 3.22 [95% CI 1.23–8.46, P&lt;.017]), transfusion (AOR 2.13 [95% CI 1.26–3.59, P&lt;.005]) and readmission (AOR 4.17 [95% CI 1.16–15.0, P&lt;.029]). Late decelerations were associated with cesarean delivery (AOR 1.65 [95% CI 1.55–1.76, P&lt;.0001]), maternal readmission (AOR 1.24 [95% CI 1.01–1.53, P=.04]), chorioamnionitis (AOR 2.88 [95% CI 2.46–3.37, P&lt;.0001]), and maternal need for antibiotics (AOR 1.89 [95% CI 1.66–2.15, P&lt;.0001]). CONCLUSION: Non-reassuring fetal status is associated with significant risks to the mother as evidenced by significant increases in transfusions, ICU admissions, and readmissions. Obstetricians should remain vigilant after delivery for non-reassuring fetal status and focus on monitoring and optimization of maternal status.

Comparison of Accuracy of Patient and Physician Scar Length Estimates Before Mohs Micrographic Surgery for Facial Skin Cancers

Patients are satisfied when surgical outcomes meet their expectations. Dissatisfaction with surgical scars is one of the most common reasons that patients sue surgeons who perform Mohs micrographic surgery (MMS). To measure the accuracy of patient and physician estimations of scar length prior to skin cancer removal with MMS. This cross-sectional study was conducted between December 1, 2017, and February 28, 2018, at the MMS clinic of a single tertiary referral center health system. A total of 101 adults presenting for MMS for treatment of facial skin cancers volunteered for this study, and 86 surgeons who performed the MMS procedure participated. Patients and physicians independently drew the anticipated scar length on the patients' skin prior to surgery. Preoperative estimates by patients and surgeons were compared with actual postoperative scar length. Of the 101 patients who participated, 57 patients (56.4%) were men and 57 patients (56.4%) were aged 65 years or older. Eighty-four patients (83.2%) underestimated scar length, whereas 67 of the 86 surgeons (77.9%) correctly estimated the scar length (P < .001). The actual postoperative scar length was 2.2 (interquartile range, 1.5-3.6) times larger than the patients' preoperative estimate but only 1.1 (interquartile range, 1.0-1.2) times larger than the surgeons' preoperative estimate (P < .001). Preoperative consultation with the surgeon, a personal history of MMS, or patient-directed research about MMS were not associated with improvement of patients' estimations of scar length. This study's findings suggest that patients with facial skin cancers have unrealistic expectations regarding scars that measure, on average, less than half the length of the actual postoperative scars. Surgeons appear to accurately estimate the length of most surgical scars and have an opportunity to set realistic patient expectations about scar length before surgery.

Composite Score for Outcome Prediction in Gynecologic Surgery Patients.

The LACE+ index is a well-studied metric that compacts patient data in an effort to assess readmission risk. Assess the capacity of LACE+ scores for predicting short-term undesirable outcomes in an entire single-center population of patients undergoing gynecologic surgery. Proactive identification of high-risk patients, with tools such as the LACE+ index, may serve as the first step toward appropriately engaging resources for reducing readmissions. This study was a retrospective analysis that used coarsened exact matching. All gynecologic surgery cases over 2 years within a single health system (n = 12,225) were included for analysis. Outcomes of interest were unplanned readmission, emergency room (ER) evaluation, and return to surgery. Composite LACE+ scores were separated into quartiles and matched. For outcome comparison, matched patients were assessed by LACE+ quartile, using Q4 as the reference group. Increasing LACE+ score reflected a higher rate of readmission (p = .003, p = .001) and visits to the ER at 30 postoperative days (p < .001). The data presented here suggest that LACE+ index is a viable metric for patient outcome prediction following gynecologic surgery.

Clinician-Level Variation in Three Measures Representing Overuse Based on the American Geriatrics Society Choosing Wisely Statement.

The extent of clinician-level variation in the overuse of testing or treatment in older adults is not well understood. To examine clinician-level variation for three new measures of potentially inappropriate use of medical services in older adults. Retrospective analysis of overall means and clinician-level variation in performance on three new measures. Adults aged 65years and older who had office visits with outpatient primary or immediate care clinicians within a single academic medical center health system between July 1, 2016, and June 30, 2017. Two electronic clinical quality measures representing potentially inappropriate use of medical services in older adults: prostate-specific antigen testing against guidelines (PSA) in men aged 76 and older; urinalysis or urine culture for non-specific reasons in women aged 65 and older; and one intermediate outcome measure: hemoglobin A1c less than 7.0 in adults aged 75 and older with diabetes mellitus treated with insulin or oral hypoglycemic medication. Sixty-nine clinicians and 2009 patients contributed observations to the PSA measure, 144 clinicians and 5933 patients contributed to the urinalysis/urine culture measure, and 42 clinicians and 665 patients contributed to the diabetes measure. Meaningful clinician-level performance variation was greatest for the PSA measure (intraclass correlation coefficient [ICC] = 0.27), followed by the urinalysis/urine culture measure (ICC = 0.18), and the diabetes measure (ICC = 0.024). The range of possible overuse across clinician quartiles was 8-54% for the PSA measure, 3-35% for the urinalysis/urine culture measure, and 13-49% for the diabetes measure. The odds ratios of overuse in the highest quartile compared with the lowest for the PSA, urinalysis/urine culture, and diabetes measures were 99.3 (95% CI 43 to 228), 15.7 (10 to 24), and 6.0 (3.3 to 11), respectively. Within the same health system, rates of potential overuse in elderly patients varied greatly across clinicians, particularly for the process measures examined.

Published Operative Times Do Not Reflect Surgeon Effort: A Novel Approach for Calculating Operative Times in Total Hip Arthroplasty to Better Quantify Surgeon Work

BackgroundCurrent estimates of operative time (OT) for total hip arthroplasty (THA) are reported as the mean OT across all procedures. This method does not reflect variability among surgeons and surgical settings and should not be used to infer individual surgeon work. We hypothesized that this method would underestimate the time it takes individual surgeons to perform THA. Therefore, we compared the mean OT for all THA cases (“overall OT”) with the mean OT for individual surgeons (“individual surgeon OT”) and examined which factors were associated with each. MethodsMean OT was calculated for 3972 primary THA cases (“overall OT”) by 41 surgeons from 2015 to 2018 in a single health system. The mean OT for each surgeon was determined (“individual surgeon OT”), averaged across surgeons, and compared with overall OT. Overall OT and individual surgeon OT were assessed for associations with surgeon-related (adult reconstruction fellowship training, THA volume, years’ experience), hospital-related (hospital type, trainee presence), and patient-related (age, body mass index category, American Society of Anesthesiologists physical status classification) factors (alpha = 0.05). ResultsMean individual surgeon OT was significantly longer (106 ± 21 minutes) than overall OT (96 ± 28 minutes) (P = .03), with 73% of individual surgeon OTs being greater than overall OT. Although all surgeon-, hospital-, and patient-related factors were associated with significant differences in overall OT, only hospital type was associated with differences in individual surgeon OT. ConclusionIndividual surgeon OT was longer than overall OT for most surgeons and provides a better estimate of surgeon work.

The Effects of Perioperative Dexamethasone on Glycemic Control and Postoperative Outcomes

Objective: Perioperative glucocorticoids are commonly given to reduce pain and nausea in patients undergoing surgery. However, the glycemic effects of steroids and the potential effects on morbidity and mortality have not been systematically evaluated. This study investigated the association between perioperative dexamethasone and postoperative blood glucose, hospital length of stay (LOS), readmission rates, and 90-day survival. Methods: Data from 4,800 consecutive orthopedic surgery patients who underwent surgery between 2000 and 2016 within a single health system were analyzed retrospectively. Results: Patients with and without diabetes mellitus (DM) who were given a single dose of dexamethasone had higher rates of hyperglycemia during the first 24 hours after surgery as compared to those who did not receive dexamethasone (hazard ratio [HR] was 1.81, and 95% confidence interval [CI] was [1.46, 2.24] for the DM cohort; HR 2.34, 95% CI [1.66, 3.29] for the nonDM cohort). LOS was nearly 1 day shorter in patients who received dexamethasone (geometric mean ratio [GMR] 0.79, 95% CI [0.75, 0.83] for patients with DM; GMR 0.75, 95% CI [0.72, 0.79] for patients without DM), and there was no difference in 90-day readmission rates. In patients without DM, dexamethasone was associated with a higher 90-day overall survival (99.07% versus 96.90%; P = .004). Conclusion: In patients with and without DM who undergo orthopedic surgery, perioperative dexamethasone was associated with a transiently higher risk of hyperglycemia. However, dexamethasone treatment was associated with a shorter LOS in patients with and without DM, and a higher overall 90-day survival rate in patients without DM, compared to patients who did not receive dexamethasone. Abbreviations: BMI = body mass index; CAD = coronary artery disease; CI = confidence interval; DM = diabetes mellitus; GMR = geometric mean ratio; HR = hazard ratio; IV = intravenous; LOS = length of stay; POD = postoperative day.

Abstract WP178: The Presence of Arterial Stenosis in Posterior Reversible Encephalopathy Syndrome

Introduction: Posterior Reversible Encephalopathy Syndrome (PRES) is defined as reversible vasogenic cerebral edema in a characteristic posterior-dominant distribution in patients presenting with focal neurologic findings. It has been shown that some patients with PRES have transient arterial stenosis. Objectives: To determine the prevalence of arterial stenosis in PRES patients and demonstrate if patients with arterial stenosis define a subpopulation within PRES. Methods: We searched patients with PRES in electronic health records at a single health system from January 2008 to December 2018. Inclusion criteria were age 18 years or older with clinical and radiographic evidence of PRES and arterial imaging (CT or MR angiography or cerebral angiogram.) Age, presenting symptoms, comorbid conditions, and imaging findings were compared between those with arterial stenosis and those without. Results: Of 74 patients diagnosed with PRES, 46 had arterial imaging. Arterial stenosis was seen in 28.3% (13/46) of these patients. Stenoses improved in all 4 patients who had followup imaging, 3 with complete resolution. The arterial stenosis group was younger (median age 32 years with arterial stenosis vs 57.5 years without, p= 0.011.) Patients with arterial stenosis did not differ in frequency of presenting symptoms of seizure, encephalopathy, or focal neurologic deficits, nor did they differ in comorbid conditions of hypertension, immune suppression, eclampsia/preeclampsia, or antidepressant use. There were no differences in ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, or frequency of diffusion restriction on MRI between the groups. The occurrence of &gt;50% FLAIR reversibility was less frequent among those with arterial stenosis (40%) than in those without arterial stenosis (81%, p=0.04.) Conclusions: A quarter of patients with PRES had transient arterial stenosis. These patients represent a subgroup within PRES patients who are younger age, but lower frequency of reversibility of parenchymal imaging abnormality.

Relationship between life satisfaction and preventable hospitalisations: a population-based cohort study in Ontario, Canada

ObjectiveTo examine if low life satisfaction is associated with an increased risk of being hospitalised for an ambulatory care sensitive condition (ACSC), in comparison to high life satisfactionDesign and settingPopulation-based...

Effectiveness of Lifestyle Intervention for Type 2 Diabetes in Primary Care: the REAL HEALTH-Diabetes Randomized Clinical Trial.

Intensive lifestyle interventions (LI) improve outcomes in obesity and type 2 diabetes but are not currently available in usual care. To compare the effectiveness and costs of two group LI programs, in-person LI and telephone conference call (telephone LI), to medical nutrition therapy (MNT) on weight loss in primary care patients with type 2 diabetes. A randomized, assessor-blinded, practice-based clinical trial in three community health centers and one hospital-based practice affiliated with a single health system. A total of 208 primary care patients with type 2 diabetes, HbA1c 6.5 to < 11.5, and BMI > 25kg/m2 (> 23kg/m2 in Asians). Dietitian-delivered in-person or telephone group LI programs with medication management or MNT referral. Primary outcome: mean percent weight change. 5% and 10% weight loss, change in HbA1c, and cost per kilogram lost. Participants' mean age was 62 (SD 10) years, 45% were male, and 77% were White, with BMI 35 (SD 5) kg/m2 and HbA1c 7.7 (SD 1.2). Seventy were assigned to in-person LI, 72 to telephone LI, and 69 to MNT. The mean percent weight loss (95% CI) at 6 and 12months was 5.6% (4.4-6.8%) and 4.6% (3.1-6.1%) for in-person LI, 4.6% (3.3-6.0%) and 4.8% (3.3-6.2%) for telephone LI, and 1.1% (0.2-2.0%) and 2.0% (0.9-3.0%) for MNT, with statistically significant differences between each LI arm and MNT (P < 0.001) but not between LI arms (P = 0.63). HbA1c improved in all participants. Compared with MNT, the incremental cost per kilogram lost was $789 for in-person LI and $1223 for telephone LI. In-person LI or telephone group LI can achieve good weight loss outcomes in primary care type 2 diabetes patients at a reasonable cost. ClinicalTrials.gov Identifier: NCT02320253.

Violence against women in the single health system

OBJETIVO: Caracterizar a producao cientifica acerca da violencia contra mulher e suas repercussoes sociais, em periodicos online no âmbito da saude, publicados no periodo de 2011 a 2016. METODOS: Trata-se de uma revisao integrativa da literatura, realizada atraves das bases de dados Medical Literature Analysis and Retrieval System On-Line (MEDLINE), Literatura Latino-Americana e do Caribe em Ciencias da Saude (LILACS), Bases de Dados de Enfermagem (BDENF). RESULTADOS: A analise dos 15 artigos evidenciou a caracterizacao da violencia, a atuacao e percepcao dos profissionais de saude acerca da violencia e do aborto legal, destacando a relevância de estudar a violencia e suas repercussoes sociais, com o objetivo de proporcionar uma melhor assistencia. CONCLUSAO: Conclui-se que fortalecer as politicas de erradicacao da violencia contra a mulher, oferecer uma rede de apoio multiprofissional eficiente e a intensificar as politicas de conscientizacao sao imprescindiveis a nossa sociedade. DESCRITORES: Mulheres agredidas, Saude publica, Violencia sexual.

Dialysis in Pregnancy: Role of the Underlying Cause of Renal Failure on Peripartum Outcomes.

Pregnancy on dialysis is rare and few studies in this population exist. Currently, pregnancy outcomes are thought to be related to dialysis intensity. We hypothesize women requiring dialysis due to diabetes or lupus will have worse pregnancy outcomes compared with other indications for dialysis. All women receiving dialysis during pregnancy from 2012 to 2016 in a single health system were identified. Differences in perinatal outcomes among those with renal failure caused by diabetes or lupus and with other causes were evaluated. Sixteen women were identified, seven with diabetes or lupus causing renal failure; the remaining nine women had hypertension, focal segmental glomerular sclerosis, polycystic kidney disease, congenital hypoplastic kidneys, or neurogenic bladder. The rates of composite maternal morbidity were similar among the two groups. Composite neonatal morbidity was higher in those with renal failure caused by diabetes or lupus compared with other causes (100% vs. 29%, p = 0.028). Despite similar dialysis intensity, the composite neonatal morbidity was higher in women with renal failure caused by diabetes or lupus compared with other etiologies. Our findings suggest that pregnancy outcome in women receiving dialysis is dependent on both the intensity of dialysis as well as the etiology of renal failure.

Trend in hospitalization for burns in Santa Catarina in the Single Health System, Brazil, in the period 2008-2018

A Revista Brasileira de Cirurgia Plástica é o órgão oficial de divulgação da Sociedade Brasileira de Cirurgia Plástica (SBCP), tem como objetivo registrar a produção científica em Cirurgia Plástica, fomentar o estudo, aperfeiçoamento e atualização dos profissionais da especialidade.

Sexuality and associated risk factors in pregnant women.

to assess the sexual function of pregnant women and the influence of sociodemographic, obstetric, and behavioral factors on sexual dysfunction. cross-sectional study conducted with 141 pregnant women attended by the Single Health System and 120 by one private service, totaling 261 participants. A questionnaire containing sociodemographic, obstetric, and behavioral variables was applied, as well as the Female Sexual Function Index instrument, which was used to assess sexual function. Associations between variables and sexual dysfunction were made using the chi-square test, considering a statistically significant result when p < 0.05. among the participants, 32.1% had sexual dysfunction, and the variables "age", "income" and "type of health service" had an influence on sexual dysfunction. The prevalence of pregnant women was between 21 and 30 years old (p < 0.001), with an income between 1 and 2 minimum wages (p = 0.048) and used the public health system network (p = 0.000). the factors associated with sexual dysfunction are "young pregnant women", "low income" and "attended in the public health service".

Postoperative Surgical Site Infections: Understanding the Discordance Between Surveillance Systems.

To characterize agreement in the ascertainment of surgical site infections (SSIs) between the National Surgical Quality Improvement Program (NSQIP), National Healthcare Safety Network (NHSN), and administrative data. The NSQIP, NHSN, and administrative data are the primary systems used to monitor and report SSIs for the purpose of quality control and benchmarking of hospitals and surgeons. These systems have different methods for identifying SSIs. We queried the NHSN, NSQIP, and administrative data systems for patients who had an operation at 1 of 4 hospitals within a single health system between January 2013 and September 2015. The detection of an SSI during a postoperative hospitalization was the outcome of analysis. Any SSI detected by one (or more) of these systems was analyzed by 2 reviewers to determine the presence of discrete elements of documentation constituting evidence of SSI. Concordance between the 3 systems (NHSN, NSQIP, and administrative data) was analyzed using Cohen's kappa. After application of appropriate exclusion criteria, a cohort of 9447 inpatient operations was analyzed. In total, 130 SSIs were detected by 1 or more of the 3 systems, with reported SSI rates of 0.5% (NHSN), 0.7% (administrative data), and 1.0% (NSQIP). Of these 130 SSIs, only 17 SSIs were reported by all 3 systems. The concordance between these 3 systems was moderate (kappa values NSQIP-NHSN = 0.50 [0.40-0.60], administrative-NHSN = 0.36 [0.24-0.47], and administrative-NSQIP = 0.47 [0.38-0.57]). Chart review found that reasons for discordance were related to issues of different criteria as well as inaccuracies. There is significant discordance in the determination of SSIs reported by the NHSN, NSQIP, and administrative data. The differences and limitations of each of these systems have to be recognized, especially when using these data for quality reports and pay for performance.