Duration Of Hospital Treatment Research Articles

THE INTRANET-PATIENT IN MEDICAL INFORMATION SYSTEMS

The article considers a mathematical cluster analysis of data obtained in medical information system "qMS" for annual period of data registration in three medical institutions. To evaluate cost, duration of treatment and scope of examination of patients with hypertension heart disease a special software was developed by A.L. Mazelis using Python interactive environment. The clustering was implemented in two directions: according number of medical examinations and procedures (Series treatment) and according time of waiting for medical examinations and procedures (Series time). Two groups of patients were established according distribution of cost and duration of hospital treatment. Also, based on analysis of data of medical information system, a description of social medical portrait of patient with hypertensive heart disease was presented. A proposal was made of implementing adjustment of treatment standards considering medical social portrait of patient according to established actual demands of patients. In analyzed sampling almost equal attention is paid to examination of heart and gastrointestinal tract that testifies wide prevalence of gastrointestinal diseases that requires increased diagnostic attention to them as concomitant ones to hypertension disease.

Clinical and demographic characteristics of patients with nosocomial pneumonia against a background of severe traumatic brain injury

Introduction. Nosocomial pneumonia (NP) is one of the most dangerous infectious complications of severe traumatic brain injury (TBI). According to some researchers, NP formed 0.5–1 % of hospitalized patients and in patients of ICU – NP develops with a frequency from 15 to 65 %. The aim of our study was to determine the clinical and demographic characteristics of patients with NP, developed on the background of severe TBI. Materials and Methods. 166 patients had been examined, including 58 patients with isolated severe head injury (group 1) and 108 patients with traumatic brain injury, which were complicated by the development of NP (group 2). Results. Out of the first group patients 50 (86.2 %) were men, 8 (13.8 %) were women. The average age of patients in this group was 49.2 ± 15.2 years. Out of the first group patients 89 (82.4 %) were men, 19 (17.6 %) were women. The average age of patients in this group was 48.2 ± 16.7 years. The average length of in-patient treatment was 14.1 ± 6.2 days in patients of the 1 st group versus 38.7 ± 17.6 days in patients of the 2 nd group. In the 1 st group 41 (70.7 %) were non-smokers, 10 (17.2 %) smokers 10 cigarettes per day, 10 to 20 cigarettes per day – 3 (5.2 %), more than 20 cigarettes per day – 4 (6.9 %). In the 2 nd group 40 (37.0 %) were non-smokers, 33 (30.6 %) smokers 10 cigarettes per day, 10 to 20 cigarettes per day – 16 persons (14.8 %), more than 20 cigarettes per day – 19 (17.6 %). Conclusions. In demographic structure of the NP, developed on the background by TBI, young men were dominated. The mean duration of hospital treatment of patients with NP increased 2.7 times compared with the patients with TBI uncomplicated by NP. Most patients of both the 1 st and the 2 nd groups were overweight (more than 50 % of patients). There is a significant percentage of the unemployed. A larger percentage of people who consume alcohol in the 2 nd group of patients could be indicative of their poor social adaptation and difficult social conditions. Significantly greater number of smokers among the patients of the 2 nd group confirms the importance of smoking as a risk factor of the NP development on the background of TBI.

PREDICTION OF THE DURATION OF HOSPITAL TREATMENT OF PATIENTS WITH CATARACT

The aim of the paper was to evaluate and determine the duration of the hospital treatment of patients with cataract. Materials and methods of the investigation. 629 case histories were analyzed and 60 patients’ forms were also analyzed. The assessment of case histories was done according to the scheme: sex, age, the stage of cataract, the duration of hospital treatment, the cause of treatment which lasts more than 1 day (postoperative complication, treatment of concomitant eye diseases, patient’s desire), the type of complication. 60 surveyed patients with cataract required surgical treatment in order to work out the model of the duration of hospital treatment. The questionnaire contained several questions, which answers allow evaluating the social status of patients, somatic and optic status, peculiarities of the main disease and also the duration at the hospital after the operation. Results. It has been demonstrated that patient’s age, his or her financial status, the number of concomitant somatic and eye diseases are the main peculiarities for the prognosis for long-lasting stay at hospital after surgical treatment. Undetermined logics was used to create the model of prognosis of the duration of hospital treatment based on еру results of patients’ questionnaire, the method of clustering was used to receive undetermined rules. Conclusions. Ophthalmologic status of the patient, the presence of concomitant eye diseases, such as myopia alta, glaucoma, diseases of retina, and optic nerve and concomitant somatic disease play an important role in the choice of the type of treatment. The most informative indices for hospital treatment of patients with cataract after surgery are patient’s age, his/her financial status, the number of concomitant somatic and eye diseases.

Use of Combined Corpodesis Technique in Degenerative Lumbar Spine Diseases

Efficacy of combined anterior corpodesis method elaborated by the authors (100 patients - main group) versus routine anterior corpodesis (98 patients - control group) in degenerative lumbar spine diseases has been analyzed. Combined method includes the use of selective approach to every spine segment and insertion of combined (intercorporal and interbody) autografts. Application of selective approach significantly decreases the operative trauma. Intercorporal insertion of autograft accelerates bone ingrowth, provides spine canal unloading, and excludes autograft migration. Additional interbody insertion of autograft strengthen fixation. In main group mean duration of bed rest was 7 days, in control group - 28 days, mean duration of hospital treatment was 14 and 56 days, respectively. Mean duration of working capacity restoration was 4-8 and 10-12 months, respectively. In main group the rate of complications was twice lower and hypostatic complications occurred rarely as compared to the control group. In main group good results were achieved 64%, satisfactory - 27%, unsatisfactory - 9%, in control group - 49, 38 and 13%, respectively.

Systemic thrombolysis with recombinant tissue plasminogen activator in acute ischemic stroke: first Croatian experiences

In September 2003, recombinant tissue plasminogen activator (rt-PA) for acute treatment of ischemic stroke was finally approved by the Croatian Ministry of Health. For the next 5years, only three stroke units in the country implemented this therapy in their routine practice until summer 2008, when neurological wards in most Croatian hospitals started to treat acute stroke patients with systemic thrombolysis. We present a 2-year experience of thrombolytic therapy (2006-2008) in the stroke unit of the University Hospital in Zagreb, Croatian largest hospital, serving nearly one-fifth of the citizens of Croatia. Obtained data (vitals at admission and before administration of rt-PA; NIHSS and MRS scores at admission, 2h and 7th day after rt-PA treatment, "time to door" and "door to needle" intervals, duration of hospital treatment as well as outcomes and complications of our 66 thrombolysed patients) are presented and discussed. We also present our results regarding benefits of this therapy as well as possible reasons for complications noticed.

Result of Laser Cordectomy in Early Glottic Cancer and Observation of Malignant Transformation from Precancerous Lesion

Background and Objectives : Laser cordectomy has been widely acknowledged to have advantages for the treatment of early glottic carcinoma. This study was performed to assess the results of laser cordectomy for its oncologic safeness, time-effectiveness, and to report a few interesting precancerous cases that have progressed to glottic cancer. Subjects and Method : Subjects (47) who had undergone laser cordectomy for the treatment of early glottic cancer from April 2006 to July 2009 were enrolled in this study. We analyzed the oncologic outcomes, the duration of hospital treatment after the surgery, and postoperative complications by reviewing of medical records. Results : For 47 cases, the mean age was 66 years and the mean follow up period was 22.6 months. The mean duration of treatment was 1.9 days. Among them, 24 cases were classified into T1a, 12 T1b, and 2 T2. Local recurrence was observed in 2 cases, so salvage treatments, such as radiation therapy or near total laryngectomy, were performed, and both of them were alive in the disease-free state. The most common complication was anterior commissure web, which was observed in 6 cases (15.8%), followed by granuloma observed in 5 cases (13.1%). Serious complications such as aspiration, respiratory distress, and dysphagia were not found in any of 47 cases. Also, we could observe 3 cases in which the precancerous glottic lesion had progressed to glottic carcinoma over a long period of time. Conclusion : Laser cordectomy might be the treatment of choice for patient's convenience because of its excellent oncologic outcomes, low morbidity, and time-effectiveness.

Chronic Subdural Hematomas : A Comparative Study of Three Types of Operative Procedures

Several surgical procedures have been reported for the treatment of chronic subdural hematoma (CSDH). We compared the results of treatments for CSDH obtained from one burr-hole craniostomy with closed system drainage with or without irrigation, two burr-hole craniostomy with closed system drainage with irrigation, and small craniotomy with irrigation and closed-system drainage. Eighty-seven patients with CSDH underwent surgery at our institution from January 2004 to December 2008. Our patients were classified into three groups according to the operative procedure; group I, one burr-hole craniostomy with closed system drainage with or without irrigation (n = 25), group II, two burr-hole craniostomy with closed system drainage with irrigation (n = 32), and group III, small craniotomy with irrigation and closed-system drainage (n = 30). Age distribution, male and female ratio, Markwalder's grade on admission and at the time of discharge, size of hematoma before and after surgery, duration of operation, Hounsfield unit of hematoma before and after surgery, duration of hospital treatment, complication rate, and revision rate were categories that we compared between groups. Duration of operation and hospitalization were only two categories which were different. But, when comparing burr hole craniostomy group (group I and group II) with small craniotomy group (group III), duration of post-operative hospital treatment, complication and recurrence rate were statistically lower in small craniotomy group, even though operation time was longer. Such results indicate that small craniotomy with irrigation and closed-system drainage can be considered as one of the treatment options in patients with CSDH.

Factors that influence duration of hospital treatment of psychotic patients

Factors that influence duration of hospital treatment of psychotic patients

An important differential diagnosis for persistent back pain

Between 1/1994 and 12/1998 40 patients with a vertebral osteomyelitis were treated at the Orthopedic University Hospital of Witten/Herdecke. All data of 15 female and 25 male patients with an mean age of 61 years (25-87 years) were analyzed in a retrospective study. Diagnosis of vertebral osteomyelitis was made between 1 and 84 weeks after onset of symptoms. Before admissions in our hospital up to 4 hospitalizations without proper diagnosis were reported. The treatment consisted bed-rest in an individual orthesis and percutaneous discovertebral biopsy before systemic administration of antibiotics. In 11 from a total of 21 biopsies we could prove bacteria as follows: 6 times Staphylococcus aureus, 2 times E. coli and 3 times Mycobacterium tuberculosis. Radiological diagnosis was made by conventional x-ray in 2 dimensions and nuclear magnetic resonance. Together with radiological, histological, microbiological and laboratory investigation we found 11 patients with a specific tuberculosis of the spine, 25 patients with a pyogenic vertebral osteomyelitis and 4 patients with a post-nucleotomy osteomyelitis. 14 patients underwent operative treatment. All patients were mobilized in an individual brace after CRP and ESR indicated remission of inflammation. DURATION OF HOSPITAL TREATMENT: Duration of the hospital treatment lasted between 33 and 137 days. At follow-up 12 months after demission 35 patients were free of symptoms, two patients had still signs of osteomyelitis, two patients, one of them with recurrence of spondylitis, were reoperated because of dislocation of the implants, and one patient died after surgery suffering from severe peritonitis and multi-organ-failure. We report pathogenesis and the current diagnostic and therapeutic concept of treatment of the vertebral osteomyelitis. Despite modern diagnostic possibilities, diagnosis of vertebral osteomyelitis is often made very late. Vertebral osteomyelitis is an important differential diagnosis for persistent back pain and needs to be considered more often.

Outcome of Acute Renal Failure Following Surgical Repair of Ruptured Abdominal Aortic Aneurysms

Objectives: to establish the mortality of ARF following surgical repair of ruptured abdominal aortic aneurysms (AAAs) and to identify clinical variables which might assist in predicting outcome. Design, materials and methods: all cases of ARF complicating repair of ruptured AAAs treated at Leicester General Hospital between 1984 and 1996 were identified in a retrospective study based on review of clinical records. The main outcome measures were overall mortality, duration of hospital treatment and renal function in survivors. Results: in 65 cases identified, overall hospital mortality was 75%. Six patients did not receive RRT, since their clinical state was judged irreversible; all died. Of the 16 survivors, 11 were left with irreversible renal impairment and one patient required maintenance dialysis. Over half of the survivors had died at 5 years» follow-up. Non-survivors had more vascular disease (p=0.048), required more surgery during AAA repair (p=0.042) and were more likely to have developed multiple organ failure (p=0.01). A clinical severity score based on these three variables allowed stratification into prognostic groups. Conclusions: ARF following surgical repair of ruptured AAA has an overall hospital mortality of 75%. A clinical severity score, calculated at the time dialysis was considered, may assist in prediction of outcome.

Prognosis of postoperative complications using neural networks

Urgent Problems of Medical Prognosis. Prediction of postoperative complications is an urgent problem. Its solution allows the probability of severe complications resulting in a patient's disability to be decreased [1-3, 7-10]. In addition, correct medical prognosis is necessary for determining optimum antibiotic therapy in each individual case. Finally, prognosis of a patient's state allows the duration of patient treatment in hospital (resuscitation unit) to be decreased, which provides significant savings in the treatment cost [3, 7, 8, 10]. Prognosis of postoperative compilations can be used for optimizing the operating schedule of hospitals with high surgical activity. Besides, the results of prognosis can be of interest to medical insurance companies, because this allows the quality of surgery in general and preoperative treatment in each individual case to be assessed. Knowledge of mechanisms of postoperative complications is very useful for studying their causes and finding approaches for decreasing the probability of complications. Review of Prognostic Methods. Several approaches to the problem of predicting postoperative complications have been suggested. The most well known approach to the problem is based on the assessment of significance of various risk factors by experts [1, 7]. First, all possible risk factors are determined. Then, the significance of each risk factor is assessed quantitatively. The resulting total value of risk is then compared to several threshold values (usually, low, medium, and high risk) determined by experts. According to the second approach, statistical methods (in particular, discriminant analysis) are used for decreasing the effect of subjective factors on the results of assessment of the risk factor significances and threshold values [1, 8-10]. For this purpose, a representative sample of independent and uniform observations of

Effect of treatment in an active rehabilitation hostel on the need for hospital treatment

Aims and methodTo describe the work of the ‘Vron’, a seven-bed active rehabilitation hostel which has operated in Gloucester for the last 15 years. Such units have been acknowledged as a successful alternative to hospital care for patients with severe mental illness, but nationally are grossly under-provided.ResultsDemographic details, admission and discharge data were described for all 103 patients admitted over a 12–year period up to January 1996. Duration of hospital treatment fell from mean 105.8 days one year before and 138.0 days two years before admission to the Vron to: mean 28.6 days one year after and 57.1 days two years after discharge from the Vron. The change was highly significant for both one and two year analyses.Clinical implicationsResidential rehabilitation, provided as part of a comprehensive rehabilitation service, was effective at reducing requirement for hospital care. Clinical approaches which contributed to this success were described. The results point to the value of a range of residential hostels, which can through skilled deployment effectively target individual needs for a wide ranging, heterogeneous population.

Response of Patients With Major Depression and Silent Cerebral Infarction to Antidepressant Drug Therapy, With Emphasis on Central Nervous System Adverse Reactions

We previously found that silent cerebral infraction (SCI) is present in most patients older than 50 years with major depression. The present study was designed to clarify the response to antidepressant pharmacotherapy in patients with major depression associated with SCI. Using clinical charts, we retrospectively studied patients older than 50 years who were admitted for antidepressant drug therapy. Patients with bipolar affective disorder and those with focal neurological symptoms were excluded. All patients underwent magnetic resonance imaging and were classified as SCI-negative or SCI-positive. The SCI-positive group was subclassified into those with moderate SCI (either perforating area or cortical area) (n = 15) and those with severe SCI (both perforating and cortical areas) (n = 7). Duration of treatment in hospital and the incidence of central nervous system adverse reactions to the antidepressant drugs were compared between the two groups. The duration of hospital treatment in patients with severe SCI was significantly longer than in those with moderate SCI (P < .01). The percentage of patients with adverse central nervous system reactions to antidepressant drugs was significantly higher in the SCI-positive group than in the SCI-negative group (P < .05). Patients with severe SCI had significantly more adverse reactions than those with moderate SCI (P < .05). Depressed patients with severe SCI required longer hospital treatment and had more drug-related adverse reactions of the central nervous system. These findings suggest that the depression associated with severe SCI may be resistant to treatment.

Bronchopulmonary dysplasia in very low birthweight infants.

Twenty-four (6%) of 375 infants with birthweights less than or equal to 1500g developed bronchopulmonary dysplasia (BPD); 16 (15%) of 107 in those less than or equal to 100g and 8 (3%) of 268 in those greater than 1000g. The incidence was 10% in those who required assisted ventilation. Perinatal asphyxia, significant respiratory distress, pulmonary interstitial emphysema and patent ductus arteriosus were statistically more common in BPD infants compared with the remaining 351 very low birthweight infants. Hyaline membrane disease was the primary respiratory disease in 54% of BPD infants. The mean durations of oxygen and ventilatory therapy were 68 days and 37 days respectively. Twenty-nine percent did not require more than 60% oxygen for over 24 hours. Only 38% required a peak airway pressure of over 30 cmH2O. Early postnatal growth was satisfactory on parenteral nutrition support. No perinatal factor was found to be predictive of death from BPD. The prolonged duration of hospital treatment has obvious implications to the psychosocial and economic costs of BPD.

Fractures of the lumbar spine. Clinical and radiological results in 94 patients.

Sixty-six (70 per cent) of 94 patients with fracture of the lumbar spine (L2-L5), treated at the Central Hospital of Tampere in 1968--1975, were seen after an average interval of 5 years and 4 months. The mean age of the patients at the time of injury was 40.4 years. Somewhat less than half the fractures were sustained at home or in leisure hours and one third were due to traffic accidents. Two thirds were anterior wedge fractures. One patient died in the hospital of other injuries sustained in the same accident. Paraplegia was caused in one case, other neurological lesions in six cases. The treatment was mainly conservative and based on the principle of early functional exercises. Surgery was used in 2 cases of fracture-dislocation. The patients were mobilized after an average of 19 days. The mean duration of hospital treatment was 26 days. Seventy-nine per cent were able to return to work after an average of 3.6 months. No noteworthy changes in the neurological state occurred during follow-up. Half the followed-up patients considered the state of their back at least good. Poor end-results were more frequent in patients over 40 years old than in those under 40. Radiological deformities were more often observed in patients showing neurological symptoms. Increased interspinous distance and flexion or compression deformities had an unfavourable effect on the clinical result.

Injuries of the cervical spine. Clinical and radiological results in 119 patients.

Seventy-one patients of 119 with injury of the cervical spine were re-examined an average of 5 years and 5 months after the accident. The mean age of the patients was 39 years. There were 91 male and 28 female patients. The majority of injuries (51) were sustained by car drivers and passengers involved in traffic accidents. More than one cervical vertebra was damaged in 36 patients. Neurological lesions were observed in 59 patients; tetraplegia was present in 19 of these. The average duration of hospital treatment was 37 days. Twenty-four patients were treated at the intensive care unit. Skull traction was used in 69 cases for an average of 38 days to bring about reduction and immobilization. Reduction and anterior spondylodesis by Cloward's technique was performed on 13 patients. Of the operated patients, 11 showed root symptoms or incomplete cord lesions. The 19 tetraplegics were all conservatively treated. Fourteen patients died of their cervical spine injuries and 7 remained permanently disabled. Half the patients recovered to a pain-free state and one third became asymptomatic. Of the radiological deformities observed on admission, lowering of the disc space increased during follow-up, and forward sliding, increase in interspinous distance and narrowing of the vertebral canal decreased. The clinical result was poorer if flexion deformity, compression, forward sliding, narrowing of the vertebral canal or lowering of the disc space were observed at the last radiological examination.

Tuberculosis in the elderly: A report for the Joint Tuberculosis Council

A clinical and social investigation of tuberculous persons aged 60 and over in widely spread areas of England, Scotland and Wales in 1959 and 1960 has been carried out retrospectively. 2,307 patients of both sexes were studied. Notification and death rates of the country as a whole were considered in relation to these age groups. A number of factors were investigated which included hospital or clinic of origin, sex, age and marital condition, racial origin, occupational group, duration of hospital treatment, duration of symptoms, Ministry of Health classification; sputum and infectivity; drug sensitivity; contact history; the patients' co-operation; income and living conditions and their fitness for work. The main facts which emerge are the following: There is a great preponderance of elderly tuberculous males over females (4 to 1). The males have more serious disease and an earlier death. The continuous ageing of the population now occurring is liable to aggravate this problem. Great difficulty is experienced in persuading elderly people to attend for chest examination, but compulsion is not practicable. Full use should be made of the existing legislation and the co-operation of those dealing with old people, particularly the general practitioner, should be enlisted. Males of low social status with a cough or sputum form the essential target. Mass sputum examination may be of special value. If these elderly people with tuberculosis remain undiagnosed, they form a dangerous reservoir of infection and a menace to younger age groups. A moderate percentage of infectious patients known to the chest clinics harbour bacilli resistant to the standard drugs. They constitute a special danger, but one which is to some extent self-limiting, and futher it is to be hoped that with chemotherapy this problem will diminish. These patients are amenable to treatment by chemotherapy and it is felt that a sputum conversion rate approaching 100 per cent.should be achieved. This is to considerable extent dependent on early diagnosis and on patients taking their drugs conscientiously when at home. Many of these cases, perhaps surprisingly, show a fairly acute onset of their disease. A clear ches X-ray, therefore, is no contra-indication to further X-rays. Once diagnosed, the great majority co-operate well with treatment and supervision, but there is a small hard core of antagonistic patients who cause disproportionate trouble and risk of infection to others. At least 20 per cent.of these people, predominantly the under-65s, can be made fit for full-time employment. A certain number of these patients either live alone or become homeless during hospital treatment and need some form of institutional care. If their disease has been successfully treated they should be dealt with through the existing services, but remaining under clinic supervision, although it is appreciated that these services are now overloading in most areas. Patients remaining infectious should, if possible, be retained in hospital until the sputum is negative.