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PubMed2004

Seroprevalence of anti-H5 antibody among Thai health care workers after exposure to avian influenza (H5N1) in a tertiary care center.

After the initial atypical presentation of a patient with avian influenza (H5N1) infection, paired acute-phase and convalescent-phase serum samples obtained from 25 health care workers (HCWs) who were exposed to the patient were compared with paired serum samples obtained from 24 HCWs who worked at different units in the same hospital and were not exposed to the patient. There was no serologic evidence of anti-H5 antibody reactivity or subclinical infection in either of the groups.

Adult↗
PubMed2002

Elective laparoscopic splenectomy for grade III splenic injury in an athlete.

The safety and efficacy of laparoscopic splenectomy in the management of benign hematologic diseases is well established. Laparoscopic splenectomy for splenic trauma has been reported infrequently, and most consider a minimally invasive approach to be contraindicated. A heralded, standout college football player who sustained a grade III splenic laceration while playing football was referred for laparoscopic splenectomy so that he could convalesce rapidly, complete his final year of athletic eligibility, and prepare for the National Football League draft. The ethical issues regarding this patient's care were discussed extensively with the patient, his parents, and the hospital administration. After informed consent, the patient underwent a laparoscopic splenectomy with no intraoperative complications. He was discharged 20 hours after surgery. The patient played in a collegiate football game 12 days after surgery, was drafted into the National Football League 9 months later, and was on the opening day roster 12 months after his surgery. We do not advocate laparoscopic splenectomy for injuries to the spleen as the standard of care. This case, however, illustrates the potential for laparoscopic surgery to provide a safe and feasible alternative to traditional surgical approaches.

Adult↗
PubMed2005

The cost effectiveness of laparoscopic versus open gastric bypass surgery.

BACKGROUND: Over the last decade, laparoscopic gastric bypass (LGBP) has been proven to be a safe and well-tolerated approach to the Roux-en-Y gastric bypass, despite its increased cost when compared to the open approach (OGBP). This increased expense has led many to question whether LGBP is a cost effective alternative to OGBP. The aim of this study is to determine which approach is most cost effective, considering costs associated with the operation itself, perioperative complications, and income lost during convalescence. METHODS: A PubMed search of the National Library of Medicine online journal database was conducted. Studies that met predetermined criteria for selection were included in the analyses of patient demographics, perioperative complications, length of hospital stay, excess weight loss, and time to recovery. Data on 6,425 OGBP and 5,867 LGBP patients were used to compare the outcomes associated with each approach. RESULTS: Significant differences were found in the perioperative complication profiles, time to recovery, and overall expense of the two approaches. OGBP was associated with an increased incidence of major perioperative complications, especially extraintestinal complications, and greater perioperative mortality. LGBP was associated with shorter hospital stays, increased incidence of intestinal complications, and a 2.25% incidence of conversion to OGBP. Patient demographics and percent excess weight loss (%EWL) at 3 years follow-up were found to be similar with both OGBP and LGBP. CONCLUSION: LGBP is a cost effective alternative to OGBP for surgical weight loss. Despite the increased cost of LGBP, patients suffer fewer expensive and lifethreatening perioperative complications.

Adult↗
PubMed1998

[Surgical treatment of infective endocarditis].

OBJECTIVE: To summarize the experience of surgical treatment of infective endocarditis in 28 patients. METHOD: Open heart surgery under cardiopulmonary bypass was performed in all patients: valve replacement (24), VSD repair and tricuspid annuloplasty (3), and Bentall (1) 17 mechanical and 7 homograft valves were placed. RESULT: Two died in hospital, 4 died from infection, 1 had periprosthetic leakage and incompetence respectively. 22 survivors showed improved heart function. CONCLUSION: Combined medication and surgical treatment is superior to antibiotic treatment in long-term survival and convalescence. Infective reccurrence, reinfection and advanced heart failure are major risk factors after operation.

Adolescent↗
PubMed2003

[Role of the antioxidative defense system in the pathogenesis of acute viral hepatitides].

AIM: To study the activity of antioxidative defense enzymes and the total plasma antioxidative activity in patients with viral hepatitis B, C, and mixed hepatitis B + C. MATERIALS AND METHODS: 77 patients with viral hepatitis B, 90 with viral hepatitis C, and 25 with mixed hepatitis B + C were followed up. The activity of superoxide dismutase and catalase of leukocytes, and the total plasma antioxidative activity were determined at the peak of the disease, alleviation of clinical symptoms, and before discharge from hospital. RESULTS: At the peak of the disease, the patients with viral hepatitides showed suppressed activities of superoxide dismutase and catalase of leukocytes and suppressed total plasma antioxidative activity with increased these parameters by early convalescence, but without their normalization. There were the most pronounced changes in patients with severe mixed hepatitis B + C. CONCLUSION: The changes found in the body's antioxidative defense have been ascertained to depend on the etiology, stage, and severity of viral hepatitis.

Acute Disease↗
PubMed1989

Differential diagnosis of viral hepatitis based on hepatitis viral markers.

192 patients of acute viral hepatitis (AVH) from three different hospitals of Madras metropolitan area during November 1985 to January 1986 were investigated for serologic markers of hepatitis A virus (anti HAVIgM) and hepatitis B virus (HBsAg, HBeAg, anti HBcIgM and anti HBs) by Enzyme linked immunosorbent assay (ELISA). While the overall pattern of AVH in Madras as revealed from the study showed Hepatitis A to be 36.4%, Hepatitis B 34.4% and Non-A Non-B 29.1%, the pattern differed significantly when areawise categorisation was done. The major AVH type in Government General Hospital was Hepatitis B (48.9%). While it was hepatitis A (46.9%) in Government Stanley Hospital and Non-A Non-B (40.0%) in Military Hospital. Using anti HBcIgM marker of Hepatitis B Virus and anti HAVIgM it was possible to make out that 13.5% of the cases, currently suffering from hepatitis A were either HBV carriers (8.3%) or cases convalescing from a previous Hepatitis B attack (5.3%). Various combinations of HBV markers positivity were observed and their diagnostic significance inferred.

Biomarkers↗
PubMed1988

A sensitive radioimmunoassay for circulating alpha-interferon in the plasma of healthy children and patients with measles virus infection.

The mean circulating alpha-interferon of healthy children aged 2 to 13.5 yrs as measured by a radioimmunoassay was 0.119 +/- 0.031 ng/ml, which was significantly lower than that of young adults. Circulating alpha-interferon of children with measles virus infection aged 1 to 11 yrs, on their first visit to the hospital when they were fully symptomatic, was 0.095 +/- 0.035 ng/ml (n = 39). It was 0.105 +/- 0.070 ng/ml (n = 21) on their second visit, 7 to 10 days after their first visit when the patients were convalescent. The difference was statistically insignificant. It is concluded that immunoreactive circulating alpha-interferon is low in children and reaches maximum level in young adults, subsequently declining gradually with age. Immunoreactive circulating alpha-interferon, a possible reflection of endogenous alpha-interferon, does not change significantly by the infection of measles virus.

Acute Disease↗
PubMedDate not supplied

[Late neurological sequelae of tick-borne encephalitis in the population of the Olsztyn province].

The authors studied the incidence of late and permanent neurological sequelae of tick-borne encephalitis in the population of the Province of Olsztyn. The investigations were carried out in a group of 103 patients who were affected in the years 1970--1974. The diagnosis was confirmed in all cases with epidemiological, clinical and laboratory investigations and serological evidence of tick-borne encephalitis. It was shown in these studies that tick-borne encephalitis caused development of permanent lesions in the central and peripheral nervous system in 25.3% of cases. It was observed, moreover, that a considerable part of neurological signs found in the acute stage of the disease disappear during hospital treatment but later on after discharge from the hospital the symptoms of nervous system damage reappear and new signs develop which had not been observed in the acute stage. In the light of these studies the authors conclude that a considerable proportion of convalescents have limited physical and intellectual efficiency making impossible their return to their previous work and causing not infrequently permanent loss of working ability which must be kept in mind by physicians from different specialities.

Acute Disease↗
PubMed1984

Living with coronary artery disease. The nurse's role.

Patients returning home from the hospital after experiencing an acute myocardial infarction have to make adjustments in their lifestyle in living with coronary artery disease. This article addressed the nurse's role as it relates to the early and late convalescence of patients in helping them in their adjustments and in their participation in organized community "caring and sharing" groups. An essential element is to consider the patient as part of a family structure so that family needs might be assessed and met through individual or group sessions and by the use of appropriate resources.

Activities of Daily Living↗
PubMed2001

Convalescence in the first week after laparoscopic cholecystectomy: results from a detailed questionnaire on morbidity and recovery of daily activities.

BACKGROUND: The aim of this study was to evaluate postoperative morbidity and return to daily activities after laparoscopic cholecystectomy. METHODS: Thirty-five patients were asked to keep daily detailed structured diaries for 1 week. RESULTS: Half of the patients were discharged from hospital on the 1st postoperative day (POD1); another third were released on POD2. Distressing pain subsided on POD2, but disturbing pain occurred in 10% of the patients on POD5-7. On POD7, mild pain at rest appeared in 30% of the patients and when moving in 60% of them. Although pain was the most common complaint, the mean consumption of analgesics was low. Even though one-fifth of the patients felt nauseated on POD2-3, and one-seventh again as late as POD7, drinking and eating did not pose problems. At the end of the week, one-third of the subjects experienced slight disorders in night rest and vigilance. Moving and walking were disturbed in one-third of the patients, and bending over and lifting objects were relatively difficult for 60% of the patients on POD7. Thirty percent of the 21 patients who were employed reported that they were capable of returning to work on POD7. CONCLUSION: To account for the variability in the rate of convalescence, the length of sick leave after laparoscopic cholecystectomy should be individualized.

Adult↗
PubMed2000

HIV as a chronic disease: implications for long-term care at an AIDS-dedicated skilled nursing facility.

OBJECTIVE: To describe the characteristics and outcomes of the first 3 years of admissions to a dedicated skilled nursing facility for people with acquired immunodeficiency syndrome (AIDS). METHODS: Systematic chart review of consecutive admissions to a 30-bed, AIDS-designated long-term care facility in New Haven, Connecticut, from October 1995 through December 1998. RESULTS: The facility has remained filled to 90% or more of its bed capacity since opening. Of 180 patients (representing 222 admissions), 69% were male; mean age was 41 years; 57% were injection drug users; 71% were admitted directly from a hospital. Leading reasons for admission were (1) the need for 24-hour nursing/medical supervision, (2) completion of acute medical treatment, and (3) terminal care. On admission, the median Karnofsky score was 40, and median CD4+ cell count was 24/mm3; 48% were diagnosed with serious neurologic disease, 44% with psychiatric illness; patients were receiving a median of 11 medications on admission. Of 202 completed admissions, 44% of patients died, 48% were discharged to the community, 8% were discharged to a hospital. Median length of stay was 59 days (range 1 to 1,353). Early (< or = 6 months) mortality was predicted by lower admission CD4+ count, impairments in activities of daily living, and the absence of a psychiatric history; long-term stay (> 6 months) was predicted by total number of admission medications, neurologic disease, and dementia. Comparison of admissions from 1995 to 1996 to those in 1997 to 1998 indicated significantly decreased mortality rates and increased prevalence of psychiatric illness between the two periods (P < .01). CONCLUSIONS: A dedicated skilled nursing facility for people with AIDS can fill an important service need for patients with advanced disease, acute convalescence, long-term care, and terminal care. The need for long-term care may continue to grow for patients who do not respond fully to current antiretroviral therapies and/or have significant neuropsychiatric comorbidities. This level of care may be increasingly important not only in reducing lengths of stay in the hospital, but also as a bridge to community-based residential options in the emerging chronic disease phase of the AIDS epidemic.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Randomised controlled trial of laparoscopic versus open mesh repair for inguinal hernia: outcome and cost.

OBJECTIVE: To compare tension-free open mesh hernioplasty under local anaesthetic with transabdominal preperitoneal laparoscopic hernia repair under general anaesthetic. DESIGN: A randomised controlled trial of 403 patients with inguinal hernias. SETTING: Two acute general hospitals in London between May 1995 and December 1996. SUBJECTS: 400 patients with a diagnosis of groin hernia, 200 in each group. MAIN OUTCOME MEASURES: Time until discharge, postoperative pain, and complications; patients' perceived health (SF-36), duration of convalescence, and patients' satisfaction with surgery; and health service costs. RESULTS: More patients in the open group (96%) than in the laparoscopic group (89%) were discharged on the same day as the operation (chi2 = 6.7; 1 df; P=0.01). Although pain scores were lower in the open group while the effect of the local anaesthetic persisted (proportional odds ratio at 2 hours 3.5 (2.3 to 5.1)), scores after open repair were significantly higher for each day of the first week (0.5 (0.3 to 0.7) on day 7) and during the second week (0.7 (0.5 to 0.9)). At 1 month there was a greater improvement (or less deterioration) in mean SF-36 scores over baseline in the laparoscopic group compared with the open group on seven of eight dimensions, reaching significance on five. For every activity considered the median time until return to normal was significantly shorter for the laparoscopic group. Patients randomised to laparoscopic repair were more satisfied with surgery at 1 month and 3 months after surgery. The mean cost per patient of laparoscopic repair was 335 pounds (95% confidence interval 228 pounds to 441 pounds) more than the cost of open repair. CONCLUSION: This study confirms that laparoscopic hernia repair has considerable short term clinical advantages after discharge compared with open mesh hernioplasty, although it was more expensive.

Activities of Daily Living↗
PubMed1991

[What fate awaits convalescent units in the Czech Republic?].

The authors submit information concerning after-treatment units in the Czech Republic; these units are attached to specialized in-patient wards. These units have a small capacity and do not influence the expenditure of the department and only partly protract the period of hospitalization. The volume of curative and nursing care is balanced. Patients are hospitalized in these units for after-care or for other reasons, e.g. social reasons, lack of space in sanatoria for chronic patients, in old age pensioners' homes, etc. It would be better to replace the units for after-treatment by "day hospitals or departments" attached to in-patient departments or clinics.

Aftercare↗
PubMedDate not supplied

Appropriateness of laboratory tests: requests for atypical pneumonia serology in a teaching hospital.

The cost of providing medical care is ever-increasing but the resources available are at best static. Major savings can be made by reducing inappropriate investigations. Using serological testing for organisms causing atypical pneumonia as an example, we examined the appropriateness of requests and also physicians' understanding of the test. Of 119 patients tested, only 3 had titres indicative of acute infection. Most patients were tested within 2 days of hospital admission, before receipt of results excluding more likely diagnoses. Forty-five patients had no current or recent respiratory symptoms, in whom infection was highly unlikely. Titres were most often requested by the least experienced members of the clinical team. Of 70 patients with an acute illness in whom a definitive diagnosis, bacteriological or otherwise, was not made, in only 9 was a convalescent specimen sent for follow-up titres. Most requests for serology for organisms causing atypical pneumonia were inappropriate. Furthermore, in the majority of cases the test was incorrectly used.

Adolescent↗
PubMed1994

Comparative sensitivity of laboratory methods to diagnose dengue virus infections at Husada Hospital, Jakarta.

Several methods are available for diagnosis of dengue virus infections including a new commercially available dengue blot IgG assay. We conducted a study to compare the sensitivity of the dengue blot with the conventional diagnostic methods. Serum samples from suspected dengue patients were collected for virus isolation and the following serological assays: the hemagglutination-inhibition assay, an IgM/IgG enzyme-linked immunosorbent assay, and the dengue blot. When suspected dengue samples were tested by all methods, viral isolation detected the fewest dengue infections (10.5%), while the IgM/IgG ELISA was the most successful (46.3%) in diagnosing dengue infections. In a specific comparison between the IgM/IgG ELISA and the dengue blot, the dengue blot had an overall sensitivity of 48.8%, with a specificity of 88.7%. When patients were classified by their serological response, the dengue blot had a sensitivity of only 1.7% in those patients with a primary or recent dengue infection, however in secondary infections, the sensitivity of the dengue blot improved to 93.5%. Testing convalescent samples from patients with primary infections, only slightly changed the sensitivity of the dengue blot. The diagnosis of dengue is needed rapidly by clinicians to insure prompt treatment of patients. The dengue blot provides a rapid and easily performed assay, especially sensitive in secondary dengue infections which are most common in hospitalized cases in Asia.

Antibodies, Viral↗
PubMed1981

Consultation-liaison psychiatry in a chronic care hospital: the consultation function.

This paper describes psychiatric consultations in a chronic care and rehabilitation hospital. It reports that although 60% of consultation requests were for depression, only 8.6% of patients seen received a diagnosis of Affective Disorder. Many patients seen, 51.4%, did not receive a formal psychiatric diagnosis and were found not present problems in adapting to chronic disabling illnesses. These problems included difficulties with convalescent and rehabilitative tasks, manifested by pathological behaviours such as persistent denial and pseudoindependence, as well as characteristic reactions to specific catastrophic illnesses. It is important to recognize that in this population psychotropic medication should be used judiciously, and interpersonal and milieu approaches should be emphasized. It is also important for the psychiatric consultant to maintain an optimistic, therapeutic attitude in what often seem to be rather foreboding consultation settings.

Adult↗
PubMed2001

Randomized controlled trial of hand-assisted laparoscopic versus open surgical live donor nephrectomy.

BACKGROUND: Laparoscopic live donor nephrectomy for renal transplantation is being performed in increasing numbers with the goals of broadening organ supply while minimizing pain and duration of convalescence for donors. Relative advantages in terms of recovery provided by laparoscopy over standard open surgery have not been rigorously assessed. We hypothesized that laparoscopic as compared with open surgical live donor nephrectomy provides briefer, less intense, and more complete convalescence. METHODS: Of 105 volunteer, adult, potential living-renal donors interested in the laparoscopic approach, 70 were randomly assigned to undergo either hand-assisted laparoscopic or open surgical live donor nephrectomy at a single referral center. Objective data and subjective recovery information obtained with telephone interviews and validated questionnaires administered 2 weeks, 6 weeks, and 6-12 months postoperatively were compared between the 23 laparoscopic and 27 open surgical patients. RESULTS: There was 47% less analgesic use (P=0.004), 35% shorter hospital stay (P=0.0001), 33% more rapid return to nonstrenuous activity (P=0.006), 23% sooner return to work (P=0.037), and 73% less pain 6 weeks postoperatively (P=0.004) in the laparoscopy group. Laparoscopic patients experienced complete recovery sooner (P=0.032) and had fewer long-term residual effects (P=0.0015). CONCLUSIONS: Laparoscopic donor nephrectomy is associated with a briefer, less intense, and more complete convalescence compared with the open surgical approach.

Activities of Daily Living↗
PubMed1975

Lymphocytic choriomeningitis in university hospital personnel. Clinical features.

Clinical manifestations of lymphocytic choriomeningitis (LCM) virus infection in 15 patients are described. These patients were University Hospital personnel who had had contact with hamsters, subsequently shown to harbor the virus. Fever with striking myalgias, headache and rigors were the most common symptoms. Only 2 of the 15 patients had clinically overt and documented aseptic meningitis. Leuikpenia was observed in 10 of 11 patients and thrombocytopenia in 8 of 8 patients tested. A biphasic illness was seen in eight patients. In a patient who has been exposed to laboratory animals, particularly to hamsters, a nonspecific influenza-like febrile illness accompanied by leukopenia and thrombocytopenia may represent LCM virus infection.

Animals↗