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PubMed1995

Transperitoneal marsupialization of lymphoceles: a comparison of laparoscopic and open techniques.

This 2-center study compares the relative merits of laparoscopic and open surgical internal marsupialization of pelvic lymphoceles. Laparoscopic lymphocelectomy was performed in 12 patients (group 1). The results were compared with open lymphocelectomy performed in 13 contemporary patients (group 2) as well as 13 historical patients (group 3). Operative time was longer in group 1 compared to groups 2 and 3 (194.6 versus 176.9 versus 133.8 minutes, respectively). However, group 1 had a decreased blood loss (23.1 versus 74.6 versus 61.7 ml.), earlier resumption of oral food intake (0.9 versus 2.5 versus 2.1 days), shorter hospital stay (2 versus 6.1 versus 6.3 days) and abbreviated convalescence (2.2 versus 6.9 versus 4.5 weeks) compared to groups 2 and 3. Complications included cystotomy requiring open repair in 1 patient in group 1, prolonged ileus in 1 in group 2, transection of the ureter of a transplant kidney in 1 in group 3 and pneumonitis in 1 in group 3. Lymphocele recurred in no patient in group 1, 4 in group 2 and 3 in group 3. Mean followup in groups 1 to 3 was 12.8, 25 and 54.5 months, respectively. We conclude that laparoscopic lymphocelectomy is effective, results in minimal patient morbidity and allows for a more rapid recovery compared to open surgical lymphocelectomy.

Adult↗
PubMed1976

The role of the intermediate cardiac care unit.

After the introduction of a 22-bed, monitored intermediate cardiac care unit (ICCU), cardiac care unit admissions increased by 15.7%. A further increase in patient admissions of 37% was permitted by direct admissions to the ICCU from the emergency room. The duration of the hospital stay of patients with acute myocardial infarct was shortened by three days. The success rate of cardiac resuscitation improved, and potentially serious arrhythmias were treated more promptly. Hospital costs were substantially reduced by the use of a convalescent unit for patients whose ICCU stay was uncomplicated. Concentration of cardiac patients and specialized staff and equipment permitted more efficient care.

Acute Disease↗
PubMed1997

[Efficacy of pefloxacin in the treatment of complicated relapsing erysipelas].

The effect of antimicrobial agents on the clinical and immunological indices was comparatively studied in 30 patients with relapsing erysipelas complicated by pyoderma. The patients were treated with pefloxacin in a daily dose of 800 mg for 7-10 days (15 patients) and with the routine antibiotics such as benzylpenicillin, ampicillin and erythromycin (15 patients). The efficacy of the treatment was defined by disappearance of the clinical signs and normalization of the functional immunity status. The pefloxacin effect was evident at early stages of the treatment and observed at least for 3 months after the patient discharge from the hospital. Gradual elimination of the secondary immune deficiency in the convalescents due to sanitation of the infection chronic foci was recorded.

Aged↗
PubMed1997

[Primary angioplasty in acute myocardial infarction. A one-year experience in a small urban community].

The aim of this study was to assess the feasibility, safety and efficacy of primary angioplasty in acute myocardial infarction in a cardiology centre of a small urban community without on-site cardiac surgery. During 1995, 50 patients underwent angioplasty for MI in the first 12 hours. The average age was 66.7 +/- 12.6 years. Eighty six per cent of patients had at least one poor prognostic criteria (32% over 75 years of age, 70% anterior wall infarcts, 30% with heart rates > 100 min on admission). The angiographic result was successful in 45 patients (90%). The time between onset of pain and reopening the vessel was 240 +/- 116 min and between admission to the catheter laboratory and reopening 31 +/- 8 min. A coronary stent was implanted in 24 cases (48%) and intra-aortic balloon pumping was necessary in 14 cases (28%). Ischaemia recurred during the hospital phase in 7 cases (14%), 4 of which (8%) were caused by rethrombosis of the dilated artery: in 3 cases, the ischaemia was in another zone. No emergency coronary bypass surgery was required. The hospital mortality was 10%, always in patients over 80 years of age. The average duration of the hospital stay was 5.8 +/- 2.6 days with 15.7 +/- 7.3 days of convalescence. The average global cost was 61850 +/- 20686 F. These results were comparable to previously reported figures and confirm that primary angioplasty in acute infarction is possible and effective with an acceptable risk in a small urban community without on-site cardiac surgery.

Aged↗
PubMed2003

Early and late functional outcome assessments following endovascular and open aneurysm repair.

PURPOSE: To compare early and late functional outcomes, as well as survival and recovery, following endovascular or open repair of abdominal aortic aneurysm (AAA). METHODS: Between 1996 and 2000, 294 patients underwent AAA repair (141 open and 153 endovascular); 57 patients from each group had 12-month follow-up for functional outcome assessment. Recovery was measured as hospital length of stay, skilled nursing requirement, and hospital readmission within 1 year to determine cumulative hospital utilization. Early (<6 months) functional outcomes were measured by activity level and convalescence days following surgery. Late (>6 months) functional outcomes were measured as ambulation, independent living, and employment status pre- and postoperatively. RESULTS: Operative mortality for open repair was 5 (3.5%) compared to 1 (0.6%) after an endovascular procedure (p<0.05). The endovascular group had a shorter hospital stay (2.8+/-2.8 versus 8.3+/-4.5 days) and fewer skilled nursing requirements (0% versus 26%; p<0.001). Cumulative hospital utilization over 12 months was 3.8 days for endovascular patients and 13.8 days for open repair (p<0.001). Recovery time was 99.3+/-84.1 days (range 14-365) in conventionally treated patients and 32.1+/-43.5 days (range 7-180) in the stent-graft group (p<0.001). At 6 months, 43 (75%) open and 54 (95%) endovascular patients had full recovery (p<0.01). Activity levels decreased in 13 (23%) open and 3 (5%) endovascular patients after surgery (p<0.01). There were no differences in ambulation, independent living, or employment status before and after treatment. CONCLUSIONS: Periprocedural survival following aneurysm repair is improved with endovascular grafting compared to open surgery, and recovery is more rapid, with a 78% reduction in total hospital days. Early functional outcomes are markedly improved with endovascular repair, while there is no difference in late functional outcomes between the procedures.

Aged↗
PubMed1998

The "kaleidoscope" experience for elderly women living with coronary artery disease.

In recent years, there has been a rapid increase in the number of elderly women, over the age of 60 years, who experience manifestations of coronary artery disease (CAD) such as angina and myocardial infarction (MI). While quantitative research has indicated some significant findings concerning the risk factors and symptoms of CAD in men and women within hospital settings, the majority of studies have had under representative samples of elderly women. Little research has been conducted regarding the complex relationships that exist between the contexts, contingencies and conditions that influence the meaning that elderly women attach to cardiac illness. This qualitative study, which used a grounded theory approach, provides a theoretical analysis of the meaning that elderly women with CAD attach to their illness, home convalescence and social support needs. Eight women, between the ages of 61 and 87 years, who experienced acute exacerbations of CAD, were interviewed in their homes during the early home convalescence period (2 weeks and 4 weeks post discharge). In the theoretical analysis, finding a voice, the core variable, represents the basic social process employed by these elderly women during hospitalization and the early home convalescence period. Struggling for a new self is the transcending process that influences all aspects and interactions of this social process. The major supporting interlinkages of the transcending process include living with loss, conforming to tradition, striving for respect and blending the gaps. These women blended all of these transcending processes to find a voice that reflected their unique perceptions, past experiences, coping strategies and personal identity. This paper will discuss the salient issues arising from the literature on elderly women and heart disease, the theoretical analysis of the meaning these women attach to their illness, home convalescence and social support needs, and implications for future research, practice and educational pursuits.

Adaptation, Psychological↗
PubMed2004

[Dynamic changes of immunoglobulin G in convalescents who have suffered from severe acute respiratory syndrome patients].

OBJECTIVE: To investigate the dynamic changes of the antibody specific to severe acute respiratory syndrome (SARS) coronavirus in convalescents who have suffered from SARS. METHODS: Samples of peripheral blood were collected twice during the first 2 weeks after discharge and then once every 2 - 4 weeks from 310 convalescents of SARS, 131 males and 179 females, aged 18 - 74, discharged from hospitals in Beijing April 3 to June 20 2003 with the average discharge date of June 10, to detect the level of immunoglobulin G (IgG) by ELISA. A curve of level of IgG was drawn to describe the change by the specific month in the year. RESULTS: Most of the 310 convalescents underwent successive or non-successive testing for 2 - 4 months and 15 were tested for 5 months, 15 for 6 months, and 2 for 7 months. IgG was detected in each sample with the mean of A value of 0.97 +/- 0.37 (0.197 - 1.849). The mean IgG level peaked in July (1.203), about 35 days after discharge, and then gradually declined to 0.857 in December, a decline by 27.3%. CONCLUSION: All SARS patients generate specific antibody against the coronavirus. However, the antibody level gradually decline with the lapse of time during the convalescence. Long-term surveillance of the change of antibody is necessary.

Adolescent↗
PubMed2002

Hospital-based diagnosis of hemorrhagic fever, encephalitis, and hepatitis in Cambodian children.

Surveillance was conducted for three clinical syndromes (hemorrhagic fever, encephalitis, and hepatitis) in Cambodian children admitted to the National Pediatric Hospital in Phnom Penh from July 1996 through September 1998. Acute- and convalescent-phase sera, and cerebrospinal fluid, when applicable, underwent diagnostic evaluation for infections with Dengue virus (DENV), Japanese encephalitis virus (JEV), and Hepatitis A, B, C, and E viruses. Of 621 children admitted with hemorrhagic fever, 499 (80%) were confirmed to have either primary or secondary DENV infection. DENV rates were as high as 10.6/100 hospital admissions in September 1998. Of 50 children with clinical encephalitis, 9 (18%) had serologic evidence of JEV infection. Forty-four children had clinical hepatitis, most (55%) due to Hepatitis A virus (HAV). One patient had Hepatitis B virus, and no patients had hepatitis C or E. This study identified a large number of children with vaccine-preventable diseases (JEV and HAV).

Adolescent↗
PubMed1993

[The clinical course of the immediate and late convalescent periods in viral meningoencephalitis].

The frequency and severity of residual phenomena after viral meningoencephalitis is to large degree determined by the premorbid background, etiology, severity of the acute period of the disease hospitalization terms. Among the residual phenomena functional disorders are more frequent while organic are rare and regress within 1.5-2 years. Complete cure of the patients should therefore be 1.5-2 years after discharge from the hospital.

Adenovirus Infections, Human↗
PubMed1978

Investigations on the fauna of beds in flats, children's sanatoria and old-age homes.

An analysis was carried of the fauna found in 338 beds from two old-age homes and from flats inhabited by asthmatic children. During hospitalization of these children the fauna in the flats was compared with that found in beds used by them in sanatoria. The most abundant species proved to be Dermatophagoides pteronyssinus that is also widely spread in other countries of Europe. The bed fauna in the sanatoria is very poor, corresponding to the improved state of health of patients during hospitalization. The authors assume that the low population density of fauna is influenced by constant airing of rooms and by strict separation of bedrooms from dining halls and other premises. Also the number of mites in different padding material used in mattresses was evaluated and an analysis of the general fauna per bed was carried out.

Aged↗
PubMed2005

[Outpatient laparoscopic cholecystectomy--two years of experience].

INTRODUCTION: By careful selection of both patients and surgeon, outpatient laparoscopic cholecystectomy can be performed in up to 90% of elective patients. The rate of same-day discharge in an unselected group scheduled for elective operation is, however, not clarified. MATERIALS AND METHODS: A clinical pathway for outpatient laparoscopic cholecystectomy was introduced as the standard procedure for all patients undergoing elective operation. The set-up allowed easy access to an overnight stay if needed. Hospital stay, complications, reasons for admittance, the need for medical advice after discharge, convalescence and patients" satisfaction were analysed. Prospective registrations were undertaken in a standard care plan, and a questionnaire was sent out after four weeks. RESULTS: During two years of the study, 535 patients had a cholecystectomy done. Of these, 403 were scheduled for elective laparoscopic operation and entered the clinical pathway. In 62% of the patients, the outpatient course was successfully completed, and 94% of the patients were discharged within 24 hours. In 2%, complications resulted in hospital stays longer than three days, and 2.7% of the operations were converted. About one third of the patients needed additional medical advice after discharge, and 4.3% of these were readmitted. Pain was among the most frequent complaints. The patients" satisfaction with the procedure was approximately 90%. DISCUSSION: In an unselected group of patients scheduled for elective laparoscopic cholecystectomy, about two thirds can be treated as outpatients with a high degree of safety and patients" satisfaction. Further development, especially in the multimodal treatment of pain, is still the most important area to focus on in order to reduce postoperative complaints and improve the course of convalescence.

Adolescent↗
PubMed2000

[Respiratory syncytial virus infection in adult patients hospitalized with community-acquired pneumonia].

OBJECTIVE: To determine the incidence and distribution of infection caused by respiratory syncytial virus (RSV) in hospitalized adults with community-acquired pneumonia. PATIENTS AND METHODS: Patients were immunocompetent adults hospitalized with community-acquired pneumonia, who were prospectively studied in our hospital. As a part of the diagnostic protocol, we performed RSV serology with paired acute and convalescent phase sera of patients admitted between February 1995 and May 1997. Clinical and epidemiological characteristics of patients with and without acute infection were compared. RESULTS: Paired RSV serology was performed in 250 patients hospitalized with community-acquired pneumonia. 97% of them had presence of IgG antibodies but only 17 patients (6.8%) had serologic evidence of acute infection; of these, seroconversion was observed in eight and positive IgM in nine. Fourteen cases with acute infection (82%) occurred between November and May. Three patients had pneumococcal pneumonia, 2 Legionella pneumophila and 12 pneumonia of unknown etiology. There were no clinical differences between patients with and without RSV acute infection but those with acute infection had more frequently bilateral involvement in chest radiography and a greater proportion of pneumonias of unknown etiology. CONCLUSIONS: RSV is a cause of acute infection among adults hospitalized with community-acquired pneumonia, mainly between November and May. Further studies to assess the role of RSV as a causative agent of pneumonia in this population are needed.

Adult↗
PubMedDate not supplied

[Organizational appropriateness of recoveries: results of the evaluation of recoveries by AEP/PRUO at the Careggi Hospital in Florence in 1995-1998].

The organizational appropriateness of hospital stays is an expression of a hospital's efficiency and aim of the management control. The AEP (American Version)/PRUO (Italian Version) protocol is specific for measuring the organizational appropriateness of hospital stays. The aim of this study is the comparative analysis of the organizational appropriateness of hospital stays in Careggi Hospital of Florence and in all hospital Departments in 1995 and 1998. In 1998 the AEP/PRUO protocol was applied to 2148 samples of hospital stays out of 38,968 eligible hospitalizations, and in 1995 a sample of 1989 hospital stays out of 35,108. In 1998 2,148 admissions and 15,338 days of hospitalization were tested. In 1995, 1989 admission days and 12,264 days of hospitalization were tested, 63 departments were studied. In 1995 the first edition of the protocol was applied, in 1998 the second. A sample of 218 of the 1998 hospital stays was tested with both editions to evaluate the impact of differences. In 1998, with the second edition of the protocol, the inappropriateness rate of admission days and hospitalization days and the rate of in-patients inappropriate hospital stays was respectively 38.0%, 43.8% and 18.5%. Compared with 1995 results, the rates increased +6.2%, 6% and +7.5% respectively. Instead, with the first edition of the protocol, the rates were 29.7%, 37.6% and 10.7% and, compared with 1995, they were reduced -2.1%, -0.6% and -0.3%. The longitudinal multilevel analysis has allowed the evaluation of the performance of each department.

Convalescence↗
PubMed2001

Can recovering alcoholics help hospitalized patients with alcohol problems?

OBJECTIVE: The researchers evaluated the relative effectiveness of 2 interventions for patients with alcohol problems. STUDY DESIGN: A nonrandomized intervention study was used to compare usual care (control) with a 5- to 15-minute physician-delivered message (brief intervention) and with the physician message plus a 30- to 60-minute visit by a recovering alcoholic (peer intervention). Telephone follow-up was obtained up to 12 months after hospital discharge that focused on patient behaviors during the first 6 months following discharge. POPULATION: The study included 314 patients with alcohol-related injuries admitted to an urban teaching hospital. OUTCOMES MEASURED: Researchers measured complete abstinence from alcohol during the entire 6 months following hospital discharge, abstinence from alcohol during the sixth month following hospital discharge, and initiation of alcohol treatment or self-help within 6 months of hospital discharge. RESULTS: Valid responses were obtained from 140 patients (45%). Observed success rates were: 34%, 44%, and 59% (P=.012) for abstinence from alcohol since discharge in the usual care group, the brief intervention group, and the peer intervention group, respectively; 36%, 51%, and 64% (P=.006) for abstinence at the sixth month following hospital discharge; and 9%, 15%, and 49% (P &it.001) for initiation of treatment/self-help. During the telephone follow-up interview, several patients in the peer intervention group expressed gratitude for the help they received with their drinking problems while in the hospital. A few patients dramatically changed their lives. They went from being unemployed and homeless to full-time employment and having a permanent residence. They credited the peer intervention as being the most important factor that motivated them to seek help for their alcohol use disorder. One of these individuals serves as a volunteer, visiting hospitalized patients with drinking problems. CONCLUSIONS: Among trauma victims with injuries severe enough to require hospital admission, brief advice from a physician followed by a visit with a recovering alcoholic appears to be an effective intervention. Although further study is needed to confirm these findings, in the meantime physicians can request that members of Alcoholics Anonymous (AA) visit their hospitalized patients who have alcohol use disorders. Interventions by recovering alcoholics are part of their twelfth-step work (an essential part of the AA program) and are simple, practical, involve no costs, and pose little patient risk. They can be arranged from the patient's bedside telephone. Some patients will show a dramatic response to these peer visits.

Adolescent↗
PubMedDate not supplied

Patients' knowledge of perioperative care.

BACKGROUND: Patient knowledge of perioperative care, particularly the role of the anaesthetist, appears limited. AIM: This study investigated patients' knowledge of common medical terms, of their surgical care, of the role of the anaesthetist, and their preoperative fears and concerns about postoperative pain. We examined the changes in their knowledge base as a result of the pre-anaesthetic visit and their inpatient stay. METHODS: Three hundred patients were surveyed on three separate occasions, before a routine pre-anaesthetic visit, two to three hours after this visit and on the day of discharge from hospital. RESULTS: Patients' knowledge of medical terms, their surgical procedure, and the role of the anaesthetist in their perioperative care were limited. There was little change following either the pre-anaesthetic visit or postoperative convalescence. Misconceptions, about such issues as postoperative pain, appeared to increase by the end of their hospital stay. Male patients, older patients and patients in lower socio-economic groups had poorer knowledge. A significant proportion of patients remained unaware that the anaesthetist was medically qualified. CONCLUSIONS: Patients' knowledge of perioperative care is limited, with very little change during hospital stay. Novel educational approaches may be required to increase basic medical knowledge.

Anesthesia↗
PubMed1993

Control of early postoperative pain with bupivacaine in adult local tonsillectomy.

Early postoperative pain following tonsillectomy remains a significant obstacle to speedy recovery and smooth convalescence. Inadequate analgesia causes poor oral intake and occasionally requires overnight hospitalization in same-day surgery practices. Although several otolaryngologists anecdotally support intraoperative infiltration with long-acting anesthetic agents for postoperative pain control, to our knowledge, no previous study confirms this claim. In a prior investigation, we found no difference between bupivacaine hydrochloride and saline placebo in pediatric patients undergoing tonsillectomy. In this trial, we performed a similar study in an adult population. Fifty-one patients undergoing tonsillectomy with local anesthesia were randomized into bupivacaine or saline placebo groups. Patients provided the following data: (1) pain level; (2) oral intake; (3) number of pain medication doses; and (4) level of pain on jaw opening, all at 10 hours postoperatively. Bupivacaine administration resulted in no adverse effects. No difference was noted in pain level, amount of oral intake, or pain on full jaw opening. Bupivacaine group patients received fewer though not statistically significant doses of pain medication than placebo group patients. We conclude that bupivacaine is a safe medication but offers no advantage in the control of early postoperative pain in adult patients undergoing local tonsillectomy.

Adult↗