Decrease In Number Of Hospitalizations Research Articles

Total esophagogastric dissociation (TEGD) in neurologically impaired children: the floor to parents

Total esophagogastric dissociation (TEGD) was proposed to treat gastroesophageal reflux disease (GERD) both as a rescue in case of fundoplication failure and as first-line surgery in neurologically impaired children (NIC). Aim of the study is to evaluate the impact of TEGD on the quality of life (QoL) of both NIC and their caregivers focusing on the parents’ point of view. A retrospective observational study was conducted on all NIC who underwent TEGD in our center between 2012 and 2022. A questionnaire centered on the parents’ point of view and investigating QoL of NIC and their caregivers was administered to all patients’ parents. Data were compared using Fisher exact test and Mann–Whitney test; a p-value < 0.05 was considered statistically significant. 12 patients were enrolled in the study. Parents reported improvements in weight gain (p = 0.03), sleep disorders, apnea, regurgitation and vomiting (p < 0.01). Caregivers also declared a decrease in number of hospitalizations, particularly related to severe respiratory infections and ab ingestis pneumonia (p = 0.01). We also documented a reduction of caregivers’ worries during food administration (p < 0.01). 50% of parents whose children were subjected to both fundoplication and TEGD would suggest TEGD as first line surgical treatment instead of fundoplication. According to parents’ point of view, TEGD improves significantly NIC QoL and 50% of them would enthusiastically suggest TEGD as first-line surgical approach to GERD in NIC.

Effects of Intensive Outpatient Integrative Medicine on Health Care Utilization on High Utilizer Patients at a Major Academic Health System.

Objective: To determine if integrative medicine (IM) involvement can reduce acute care utilization for patients with complex medical conditions and high health care utilization. Design: Prospective single-center cohort study. Interventions: Twenty-nine complex high utilizer patients were treated by the University of California, Los Angeles (UCLA) East-West Extensivist IM specialty clinic with acupuncture, trigger point injections, and Traditional Chinese Medicine dietary modifications. Number of hospitalizations, hospitalization days, and emergency room visits were tracked for 6 months. Results: There was a statistically significant decrease in number of hospitalizations (-31.4%, p = 0.021) and hospitalization days (-38.0%, p = 0.038) after 6 months. Subgroup analysis suggested greater improvement with more frequent visits. Conclusion: IM specialty care correlates with reduced hospitalization frequency and total hospitalization days among high utilizers of care.

Correction of Severe Anemia in a Patient with End Stage Renal Disease and Myelodysplastic Syndrome

Background: Anemia is a common complication of end-stage renal disease (ESRD) and is effectively managed by Erythropoietin Stimulating Agents (ESAs) and intravenous iron therapy. Management of anemia in ESRD patients with myelodysplastic syndrome (MDS) poses a unique challenge. ESAs even at extremely high doses do not result in a desired response, especially if the patients are iron-overloaded. Case: A 72-year-old man with history of ESRD and MDS on hemodialysis since September 2009 was severely anemic requiring massive doses of ESA in excess of 90,000 units/week. Iron saturation was consistently >60%; ferritin was >2500. Desferrioxamine (DFO) 125 mg IV/week was begun in November 2010. His PRBC transfusion and ESA requirements declined after the initiation of this therapy. He had 33 ER visits for PRBC transfusions (1 - 3 transfusions/visit) from September 2009 to November 2010 (average: 2.35/month), which decreased to 18 visits in 20 months (average: 0.9/month) after getting DFO. Conclusion: We report a case of MDS with ESRD on hemodialysis where anemia was managed with Desferrioxamine therapy along with ESA, after which it was noted that there was a significant reduction in the number of PRBC transfusions that the patient received along with a decrease in ESA requirements and a decrease in number of hospitalizations, which in the long term could be cost effective.

Management of recurrent sinus disease in children with cystic fibrosis: A combined approach

To determine whether a combined approach (CA) consisting of functional endoscopic sinus surgery (FESS), Caldwell-Luc operation, and medial maxillectomy is beneficial for children with cystic fibrosis (CF) with refractory sinonasal disease previously treated with endoscopic procedures alone. Retrospective review and comparison of outcomes of CA and FESS alone for each CF patient. sinonasal symptoms, endoscopic findings, number of hospitalizations, antibiotic courses, and forced expiratory volume in 1 second (FEV1). Referral hospital. Fifteen children underwent CA between 1996 and 2000 (7 males, 8 females; 13.8 years mean age; 42 months average follow-up period). Significant decrease in number of hospitalizations and intravenous antibiotic courses, with increased mean FEV1 (from 70.2% preoperation to 89.3% postoperation, P < 0.0001) were found. Marked clinical improvement persisted for several years. Applying the CA after multiple failed endoscopic procedures in CF patients reduced morbidity and resulted in successful management of sinonasal disease. CA is suggested after multiple failed endoscopic procedures. Further studies of CA as a first-line procedure for difficult sinus cases in children with CF is recommended. C-4.

Nutritional status: a continuous quality improvement approach.

Intradialytic parenteral nutrition (IDPN) has been used as nutritional repletion in severely malnourished patients with end-stage renal disease (ESRD). This study presents a retrospective look at hemodialysis patients with malnutrition who were followed-up in the process of continuous quality improvement (CQI). The costs of intravenous supplies, hospitalizations, and morbidity are reviewed. The application of continuous quality improvement was used to identify and follow-up malnourished patients. There were significant decreases in number of hospitalizations and days in the hospital.

EFFICACY OF PLASMIN-MODIFIED INTRAVENOUS GAMMA GLOBULIN IN THE MANAGEMENT OF HYPOGAMMAGLOBULINEMIA

Commonly used replacement therapies for patients with hyponammaglobulinemia are intramuscular gamma globulin (IM-GG) and plasma. Disadvantages of the former include discomfort of the injections and occasional reactions and, of the latter, the risk of henatitis. Intravenous gamma globulin altered enzymatically by plasmin(PT-GG) offers an alternative mode of treatment. In this study 175 infusions of PT-GG were administered to 14 patients with various forms of hypogammaglobulinemia. Our product had essentially no anticomplementary activity (1.1-1.4 CH50 units fixed/mg protein) with minimal fragmentation of the IgG molecule (<15%). Nine of the patients were studied in 2 treatment periods of 6 and 9 months with an intervening control period of 5 months on IM-GG. Frequency of infusion ranged from 2-4 weeks to maintain a serum IgG concentration of >2.5 mg/ml. Patient acceptance was uniformly positive. Eight of 11 patients maintained on IM-GG before entering the study had chronic pulmonary disease; 3 were removed from the study and placed on single donor plasma because of lack of improvement. The remaining patients had a significant decrease in number of hospitalizations and severe infections; 7 had diminution in sinusitis and otitis media. Five patients had one or more reactions (14/175 infusions). Symptoms abated rapidly with temporary interruption of the infusion. From these results we conclude that PT-GG represents a relatively safe, efficacious mode of replacement therapy in patients with hypogammaglobulinemia.