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PubMed1992

Back transporting infants from neonatal intensive care units to community hospitals for recovery care: effect on total hospital charges.

Many neonates are referred to neonatal intensive care units (NICUs) for specialized care far from their parents' residence. This distance can add to the stress of the parents and reduce the contact of the parents with their newborn. Small studies have found that back transporting these neonates to hospitals closer to their homes is safe and cost-effective. Despite these findings, the reluctance of many insurers to pay for back transports prevents or delays many back transports. Insurers may not consider the findings of the previous studies to be conclusive, given that the comparisons were between small numbers of neonates back transported and neonates who remained in tertiary care, and the potential for differences in severity of illness between the groups is significant. In this study the effect on hospital charges of back transports was examined by comparing the charges for care in community hospitals with what these charges would have been in a tertiary care center. The advantage of this method is that it avoids case-mix differences between the groups and thus minimizes the potential for small-sample bias. Data were collected for all back transports from a NICU to non-tertiary care centers (n = 90) for a 9-month period. We were able to obtain the itemized bills for the care at community hospitals for 42 of these patients. Each bill was recalculated using the charges for the NICU to determine potential for savings. The average charges for recovery care were about $6200 lower at the community hospital than they would have been at the NICU.(ABSTRACT TRUNCATED AT 250 WORDS)

Convalescence↗
PubMed2006

Patient self-medication--a change in hospital practice.

AIMS AND OBJECTIVES: The purpose of this study was to evaluate the effectiveness of a self-medication programme (SMP) for inpatients of the Nursing Convalescent Unit, a 26-bed unit with medical and surgical patients. BACKGROUND: Self-medication is an important part of self-management of chronic illness. Self-medication is a way of allowing patients to give themselves their medications in hospital after receiving education instead of the usual practice of medications administered by a Registered Nurse (RN). DESIGN: The pilot study was undertaken over a six-month period to examine the relationship between a programme of self-medication and patient knowledge and adherence to medication regimens, number of medication errors, efficiency in relation to the number of nursing hours associated with the SMP, patient and nursing satisfaction. METHODS: A total of 220 patients participated in the study. The SMP included three levels of patient self-administration of medications: level one, medications administered by a RN; level two, self-medication directly supervised by a RN and level three, self-medication indirectly supervised by a RN. Outcome measures included staff and patient satisfaction, number of medication errors, time taken by nurses to undertake activities related to the SMP and the number of patients who achieved levels two and three. RESULTS: Study findings showed that 45% of patients remained on level one, 26% achieved level two and 29% achieved level three. There were no patient initiated medication errors during the study period. Efficiencies were identified in staff workload associated with patient discharge procedures. Overall, nurses perceived that the SMP increased their knowledge of medications and contributed to effective patient education. CONCLUSIONS: In selected patients, the SMP was an effective aid for improving adherence to medication regimens. Collaboration between nurses, medical staff, pharmacists, patients and carers is integral to the success of in hospital SMP.

Aged↗
PubMed2003

Short convalescence after vaginal prolapse surgery.

OBJECTIVE: Retrospectively to describe the recommended convalescence according to patients who had undergone vaginal prolapse surgery in 1996-98, and prospectively to describe the need for and limiting factors for convalescence after vaginal prolapse surgery in 1999-2000 at a Danish University Hospital. METHODS: The retrospective study included a validated, postal, questionnaire and review of patient files. In the prospective study, we followed consecutive women after vaginal surgery in a fast-track setting using a multimodal rehabilitation model with well-defined recommendations for the convalescence period. RESULTS: In the retrospective study, 188 women (79%) with a median age of 66 years (range, 30-88) answered the questionnaire. They had been recommended a convalescence of median 6 weeks (range, 1-12) for most activities. The subjective recurrence rate was 22% within median 6 months (range, 0-24) after first-time prolapse surgery. In the prospective study, there were 41 consecutive women with a median age of 69 years (range, 44-88). Convalescence was median <1 week for most non-strenuous activities, <2 weeks for light work and <4 weeks for sexual intercourse, sports and work with lifts exceeding 10 kg. Limiting factors were fatigue and pain. The 1-year subjective recurrence rate was 17%. CONCLUSION: Traditionally, recommended convalescence has been median 6 weeks after vaginal prolapse surgery. Convalescence has been shortened to 1-3 weeks with a multimodal rehabilitation model with revised, non-restrictive recommendations. Further studies are necessary to evaluate the impact of different convalescence recommendations on the recurrence of prolapse.

Activities of Daily Living↗
PubMed1985

Neonatal back-transport. Cost-effectiveness.

This study examines the cost-effectiveness of returning previously ill neonates to community hospitals after treatment in a tertiary center, a concept known as "back-transport." The authors compared the charges for medical care during convalescence of a group of back-transported infants (BT infants; n = 20) with a similar group of infants who remained in a tertiary center for convalescence (NT infants; n = 20). The total charges for convalescent care (inpatient plus transport charges) for 20 representative BT infants was $61,840, compared with $68,240 for 20 matched NT infants, an average savings of $320 per BT infant. The average daily bed charge and charges for laboratory tests and medications were significantly less for BT infants compared with NT infants, and these reductions offset the transport charges for BT infants. The authors conclude that back transport decreases the charges for medical care for most infants. Therefore, the decision to back-transport an individual infant usually can be based on factors other than cost.

Convalescence↗
PubMed1987

Optimal resources for carotid endarterectomy.

This review compares the results and costs of carotid endarterectomy (CE) done by a single surgeon over a 1-year period working at both a university hospital (UH) and a community hospital (CH). Hospital and financial records of 157 patients were reviewed, 78 at UH and 79 at CH. The patient populations were matched for age, associated illnesses, and presenting symptoms. The principles of patient management were identical at both hospitals except that shunting requirements were determined by electroencephalographic monitoring at UH. There were no differences in the complication rates, and the combined stroke/mortality rate was 0.6%. The cost of CE was 56% greater on a per patient basis at UH ($3918 versus $6126, p less than 0.001) and 23% greater on a per diem basis at UH ($611 versus $755, p less than 0.001). Patients stayed longer at UH (8.2 days versus 6.6 days at CH, p less than 0.03). These differences are largely explained by three types of delays at UH. First, patients with cardiovascular accidents at UH were kept in the hospital before surgery until maximum improvement occurred whereas patients at CH were allowed to convalesce at home before CE. Patients operated on after a cardiovascular accident spent an average of 17.6 days in UH while a similar group spent only 7.3 days in hospital at CH (p less than 0.03). Second, delays in obtaining angiograms of greater than 2 hospital days occurred in 28% of patients at UH compared with only 10% at CH (p less than 0.05). Third, delays in scheduling operating room time of greater than 2 hospital days occurred in 17% of patients at UH and in only 7% of patients at CH (p less than 0.05). When there were no delays, the cost of treating patients at each hospital was identical, $3483 at CH and $3520 at UH. UH must accept the fact that equally good results can be obtained at CH, and although the potential exists for equal costs at both types of hospitals, the CH provides the service at a lower cost. UH administrators must address these inefficiences if the UH is to compete effectively in the current marketplace.

Aged↗
PubMed2006

Meta-analysis: convalescent blood products for Spanish influenza pneumonia: a future H5N1 treatment?

BACKGROUND: Studies from the Spanish influenza era reported that transfusion of influenza-convalescent human blood products reduced mortality in patients with influenza complicated by pneumonia. Treatments for H5N1 influenza are unsatisfactory, and convalescent human plasma containing H5N1 antibodies could be an effective therapy during outbreaks and pandemics. PURPOSE: To determine whether transfusion with influenza-convalescent human blood products reduced the risk for death in patients with Spanish influenza pneumonia. DATA SOURCES: Manual search of English-language journals from 1918 to 1925. Citations from retrieved studies were also searched. STUDY SELECTION: Published English-language studies that had at least 10 patients in the treatment group, used convalescent blood products to treat Spanish influenza pneumonia in a hospital setting, and reported on a control or comparison group. DATA EXTRACTION: Two investigators independently extracted data on study characteristics, outcomes, adverse events, and quality. DATA SYNTHESIS: Eight relevant studies involving 1703 patients were found. Treated patients, who were often selected because of more severe illness, were compared with untreated controls with influenza pneumonia in the same hospital or ward. The overall crude case-fatality rate was 16% (54 of 336) among treated patients and 37% (452 of 1219) among controls. The range of absolute risk differences in mortality between the treatment and control groups was 8% to 26% (pooled risk difference, 21% [95% CI, 15% to 27%]). The overall crude case-fatality rate was 19% (28 of 148) among patients who received early treatment (after <4 days of pneumonia complications) and 59% (49 of 83) among patients who received late treatment (after > or =4 days of pneumonia complications). The range of absolute risk differences in mortality between the early treatment group and the late treatment group was 26% to 50% (pooled risk difference, 41% [CI, 29% to 54%]). Adverse effects included chill reactions and possible exacerbations of symptoms in a few patients. LIMITATIONS: Studies were few and had many methodologic limitations. No study was a blinded, randomized, or placebo-controlled trial. Some pertinent studies may have been missed. CONCLUSIONS: Patients with Spanish influenza pneumonia who received influenza-convalescent human blood products may have experienced a clinically important reduction in the risk for death. Convalescent human H5N1 plasma could be an effective, timely, and widely available treatment that should be studied in clinical trials.

Antibodies, Viral↗
PubMed1985

Descriptive epidemiology of the autopsy in Connecticut, 1979-1980.

Knowledge of the differences between deaths for which autopsies are performed and all deaths is pertinent to epidemiologic investigation in such areas as disease trends, chronic disease incidence, and occupationally related disease. A population-based study was undertaken to evaluate these differences for deaths in Connecticut in 1979 and 1980. Analyses for 1979 and 1980 were comparable. Of 28,440 deaths in 1980, 14% underwent autopsy. Differences by sex, race, marital status, age, underlying cause of death, and place of occurrence of death were demonstrated when decedents who underwent an autopsy were compared with all decedents. Non-white men who died at 20 to 29 years of age were the most likely group to undergo an autopsy. Proportions of autopsies, by major category of underlying cause, did not parallel the leading causes of death. Deaths due to trauma accounted for a larger proportion of all autopsies (25%) than of all deaths (6%). If a death certificate indicated a circulatory disorder or neoplasm as the cause of death, an autopsy was less likely to be performed. A disproportionately high number of autopsies were performed for deaths occurring in hospitals; the converse was true for deaths occurring in nursing-convalescent homes. We conclude that knowledge of the ways in which autopsies are biased will permit broader use of the sensitive and specific information that can be obtained from them.

Adolescent↗
PubMed1989

[Changes in the function of external respiration and circulation in patients with acute pneumonia at the outpatient clinic stage of rehabilitation].

External respiration, circulation and gas exchange trends were investigated in acute pneumonia convalescents followed up on an outpatient basis. It was found that 72% of patients admitted to hospital for acute pneumonia, upon discharge demonstrated residual clinicoroentgenological effects. Cardiorespiratory distress, more pronounced in concomitant chronic bronchitis was recorded in 82% of acute pneumonia convalescents. Long-term tachycardia, hyperventilation, disturbed bronchial permeability, low aerobic productivity registered at outpatient stage of rehabilitation after acute pneumonia indicated ineffectiveness of the aftercare being a sign of a poor prognosis. Variations in cardiorespiratory basic parameters revealed suggest additional criteria of the assessment of the completeness of the recovery after acute pneumonia and promote more individualized approach to the patients' aftercare.

Acute Disease↗
PubMed2004

Comparison of retroperitoneal laparoscopic and open nephrectomy for benign renal diseases in children.

OBJECTIVES: To compare the results of retroperitoneal laparoscopic versus open nephrectomy for benign renal diseases in children. METHODS: From January 1999 to February 2003, retroperitoneal nephrectomy or nephroureterectomy was performed in 23 consecutive children (7 girls and 16 boys). The median patient age was 4 years (range 1 to 13). The disease was on the right side in 9 children and on the left side in 14. Operative and convalescence parameters, including operative time, blood loss, transfusion rate, resumption of oral intake, hospital stay, and complication rate, were evaluated in both groups. RESULTS: All laparoscopic cases were completed successfully without conversion to open surgery. The median operative time and estimated blood loss were not statistically different between the two groups. No major perioperative complications occurred in any child, but a wound site complication occurred in 1 child who had undergone open surgery. The median hospital stay of the open group was 4 days (range 3 to 14), significantly longer than that of the laparoscopic group (median 2.5 days, range 2 to 6; P = 0.018). The cosmetic results of the laparoscopic group were excellent; the scars from the trocar sites were barely discernible at the initial postoperative visit. Convalescence was uneventful in all patients. CONCLUSIONS: Retroperitoneal laparoscopic nephrectomy and nephroureterectomy may be performed for benign disease in children with minimal morbidity, improved cosmetic results, and a short hospital stay. Our findings indicate that retroperitoneal laparoscopic nephrectomy is appropriate in children and superior, in some instances, to open surgery.

Adolescent↗
PubMed1987

Arboviral causes of non-specific fever and myalgia in a fever hospital patient population in Cairo, Egypt.

Fever and myalgia are non-specific clinical manifestations of illness which commonly occur in patients with arboviral disease. In Egypt, such illness is often mis-diagnosed as "influenza". To determine arboviral aetiology in patients admitted with fever and myalgia, acute and convalescent sera samples were obtained from 55 patients admitted with these clinical manifestations to the Imbaba Fever Hospital, Giza, Egypt, during October and November 1984. Based on viral isolation, and a comparison of acute and convalescent sera, 4 patients (7%) had acute arboviral infections. Haemagglutination inhibition and indirect immunofluorescence tests showed that one had West Nile virus (WNV) infection, 2 had sandfly fever virus-Naples (SFN), and 1 had sandfly fever virus-Sicilian (SFS) infection. SFN was isolated from the acute serum sample of 1 of the 2 patients with SFN infection.

Adolescent↗
PubMed1995

The sickle cell painful crisis in adults: phases and objective signs.

The severe sickle cell painful crisis that requires hospitalization in adults typically seems to evolve along four distinct phases: Prodromal, initial, established, and resolving. Each phase may to be associated with certain clinical and laboratory findings. Objective clinical and laboratory signs may not be evident in the initial phase of the crisis especially in the absence of reliable base line steady state data. Several clinical, hematological, biochemical, and rheological changes emerge as the crisis progresses. This sequence of events creates several logistic issues in the care of these patients. The absence of objective findings early in the crisis usually discourages health care providers from repeating such tests and makes some of them suspicious of the authenticity of the painful episode in question. Consequently, an atmosphere of mistrust may develop between the patients and their care providers. This review puts the sickle cell painful crisis in perspective and, based on available data in the literature, shows that it is a dynamic process characterized by several changes during its evolution. It is hoped that this review will dispel some misconceptions about the painful crisis, elucidate its clinical course, and encourage further research to answer the questions it raises.

Acute Disease↗
PubMed2005

The effects of disease severity, use of corticosteroids and social factors on neuropsychiatric complaints in severe acute respiratory syndrome (SARS) patients at acute and convalescent phases.

OBJECTIVE: To evaluate the effects of disease severity, corticosteroids and social factors on neuropsychiatric complaints in severe acute respiratory syndrome (SARS) patients, both during acute and convalescent phases. SUBJECTS AND METHODS: Self-administered mail questionnaires survey to 308 SARS patients after discharging from hospital. Both patients and their families were asked about symptoms related to various neuropsychiatric domains, and the questions covered both acute and convalescent phases. RESULTS: Among the 102 (33%) valid replies, 65% had strong symptoms in convalescent phase as indicated by GHQ28 score >/= 5. In multiple linear regression analysis, use of pulse steroid and total dosages of pulse steroid during hospitalisation were predictive for anxiety-depression, psychosis and behavioural symptoms in acute phase, the effects persisted in convalescent phase. Disease severity had direct correlation with symptoms in all neuropsychiatric domains at acute phase and anxiety-depression and cognition at convalescent phase. Health care workers had more neuropsychiatric complaints in both phases. Severity of symptoms, corticosteroids and social factors explained about half of the variances (R(2) = 52) in anxiety-depression at acute phase and 33% at convalescent phase. CONCLUSION: Severe disease, high dose corticosteroids and being health care workers were independent predictors of neuropsychiatric complaints in both acute and convalescent phases.

Adult↗
PubMed1995

The effects of oral droperidol versus oral metoclopramide versus both oral droperidol and metoclopramide on postoperative vomiting when used as a premedicant for strabismus surgery.

STUDY OBJECTIVE: To compare the efficacy of oral droperidol versus oral metoclopramide, or both oral droperidol and metoclopramide, on postoperative vomiting when used as a premedicant for strabismus surgery. DESIGN: Double-blind, randomized, prospective study. SETTING: Academic children's hospital. PATIENTS: 154 ASA physical status I and II ambulatory patients, ages 1 to 15 years, scheduled for strabismus surgery. INTERVENTIONS: Patients were randomly assigned to receive colored sugar water containing either droperidol 300 mcg/kg orally, metoclopramide 0.15 mg/kg orally, both droperidol 300 mcg/kg and metoclopramide 0.15 mg/kg orally, or no active ingredient (placebo group) as a premedicant. The premedications were given orally 1 to 1.5 hours prior to the operation. MEASUREMENTS AND MAIN RESULTS: Patients were analyzed for the number of episodes of vomiting from the time of their emergence from anesthesia through the first 24 hours postoperatively, including the convalescent period at home. Patients were also analyzed for length of hospital stay. There were no statistically significant differences between groups regarding age, premedication time, surgery time, or discharge time. Droperidol and droperidol-metoclopramide were significantly more effective (p < 0.012) than either the metoclopramide group or the placebo group in preventing postoperative nausea and vomiting following strabismus surgery. CONCLUSIONS: Our data suggest that oral droperidol 300 mcg/kg and the combination of oral droperidol 300 mcg/kg and metoclopramide 0.15 mg/kg are effective in reducing the frequency of vomiting within the first 24 hours after strabismus surgery. The combination of oral droperidol and oral metoclopramide is highly effective in reducing the frequency of vomiting postoperatively in strabismus ambulatory surgery patients (p = 0.017). This combination seems to represent an inexpensive alternative to the more costly ondansetron.

Administration, Oral↗
PubMedDate not supplied

Ventricular fibrillation in two infants treated with amiodarone hydrochloride.

Antiarrhythmic agents may induce ventricular arrhythmias. Whereas amiodarone is a reported cause of ventricular fibrillation in children, there are no reported cases in infants. We observed two patients with atrial flutter and congestive heart failure who were treated with amiodarone. Both had anatomic heart defects and had failed conventional therapy. Ventricular fibrillation occurred 3 and 12 days after the initial dose. Q-T interval, electrolytes, digoxin level, and amiodarone level (one patient) were normal. Amiodarone may provoke life-threatening ventricular tachyarrhythmias during the convalescent period. Consideration should be given to monitoring in a hospital setting for at least 2 weeks following initiation of amiodarone therapy.

Amiodarone↗
PubMed2006

Fast-track surgery in laparoscopic radical prostatectomy: basic principles.

Fast-track surgery describes innovative treatment concepts ensuring a faster convalescence phase. The aim of this study was to allow hospital discharge 3 days after surgery without additional complications in patients receiving LRPE for localized prostate cancer. Twenty-five patients each were randomized in the study groups to verify if a fast-track regimen could be transferred into clinical routine. The perioperative data, early complications, hospital stay as well as readmission rate were analyzed. The mean postoperative stay was 3.6 days in the fast-track group versus 6.7 days in the conventional group. The overall complications were significantly less in the fast-track procedure. The readmission rate was low and not significant. Patients receiving an LRPE benefit from a suitable fast-track concept. The postoperative hospital stay could be shortened nearly by half with a significantly decreased overall complication rate. Thus, fast-track concepts might contribute to saving resources in the long term. However, more evidence based on larger prospective trials is needed to achieve optimal quality of life for patients perioperatively.

Aged↗
PubMed1984

The use of Lassa fever convalescent plasma in Nigeria.

Lassa fever convalescent plasma (LFCP) has been administered to 27 patients in hospitals at Jos and Vom, Nigeria. Among serologically or virologically confirmed cases of Lassa fever (LF) given plasma on or before the 10th day, all eight survived, as did two of three possible LF cases. Of eight patients given LFCP after the 10th day, five died, as did all three possible LF cases. LFCP was also administered to five patients subsequently shown not to have LF, and to a suspected case contact; all survived without complications of therapy. There were 15 cases of LF during this time who did not receive plasma; 11 survived. Most cases of LF who received plasma and survived showed a rapid response to therapy, in contrast with the gradual recovery in those who did not receive LFCP.

Adolescent↗
PubMed2003

Nurse-led intermediate care: patients' perceptions.

Intermediate care currently forms one of the UK Government's main initiatives for improving the quality of post-acute care. This paper examines patients' and carers' experiences of a nurse-led unit, which aims to provide intermediate care for people no longer acutely ill. Drawing on findings from qualitative interview data, we demonstrate that patients viewed this model of care as acceptable but that they had markedly inconsistent experiences of care and reported considerable variation in their perceptions of the Unit's purpose. Some possible reasons for this are explored. Implications for the development of good quality nurse-led intermediate care are outlined.

Aged↗