No abstract

Summary The acute‐subacute form of paracoccidioidomycosis (PCM) is a severe systemic mycosis that affects children and adolescents from endemic regions, leading to generalised lymphadenopathy, fever, weight loss, anaemia, eosinophilia, hypoalbuminemia and hypergammaglobulinemia. The objective of this study is to describe the clinical and laboratorial characteristics of acute‐subacute PCM, to determine a mortality risk factor and to propose a test for non‐survival hazard related to the disease. Children and adolescents diagnosed with PCM, under 15 years were included in the study. Their epidemiological, clinical and laboratorial data were obtained from the hospital records. Descriptive analysis, comparison of means, univariate logistic regression, multivariate logistic regression and a ROC curve were performed in order to identify significant information (P < .05). Through a period of 38 years, 141 children and adolescents were diagnosed with acute‐subacute PCM. The main antifungal agent used for the treatment was sulfamethoxazole‐trimethoprim (SMX‐TMP). The complication rate was 17%, the relapse rate was 7.8% and the mortality rate was 5.7%. A low albumin dosage was identified as a predictor factor for mortality. The cut‐off for serum albumin was 2.18 g/dL, above which, the survival rate is 99.1%. Thus, simple clinical and laboratorial examinations may lead to the diagnosis of acute‐subacute PCM, and the beginning of the treatment is encouraged even before the isolation of the fungus in biological samples, preventing unfavourable outcomes. Patients with an albumin dosage ≤ 2.18g/dL must receive special attention, preferably hospitalised, during the first four weeks of treatment for presenting an elevated mortality hazard.

No abstract

conversation detail documented. Individual interviews explored physician perceptions of documentation utility, with sampling stratified by physicians in emergency, internal medicine, hospital, and critical care. Transcripts were analyzed line-by-line and grouped by specialty. Results Of 175 documented SICP conversations, more elements were recorded for patients with a non-resuscitative GCD ('Medical': 2.42; 0.47-1.51; 'Comfort': 1.06; 0.42-0.24), except in the Goals/Values domain and fewer goals/values were documented for patients who did not understand/ speak English (0.89; IQR: 0.14-1.63). In emerging qualitative themes physicians find useful details of the medical context, patients' own values, and families' understanding and dynamics and identified a 'sweet spot' for length of content. ConclusionThe type and amount of content documented after SICP conversations is associated with a patient's GCD. Physicians value conversation documentation as a starting point for new clinical encounters. The study yielded recommendations about the TR template revisions and raises questions about the equity of SICP conversations with non-English speakers.

No abstract