Outpatient Department Follow-up Research Articles

Influence of different treatment patterns on cost-effectiveness in treatment of acute myocardial infarction

To investigate the influences of different treatment patterns on the cost-effectiveness in treating acute myocardial infarction (AMI). Data about referral of AMI patients who called for help because of chest pain to the nearby hospitals from October 2003 to December 2005 were collected from the Guangzhou 120 Call Center. All these patients were followed up 6 months after discharge to survey the cost during hospitalization, major treatment, prognosis (death, re-infarction, stroke etc. ), and secondary prevention for coronary heart disease. We used SF-36 scale was used to quantify the health status. 101 AMI patients referred to grade 2 A hospitals (Group A) and 137 patients referred to grade 3 A hospitals (Group B) were successfully followed up. The cost during hospitalization of Group B was (33965 +/- 963) yuan RMB, significantly higher than that of Group A (18943 +/- 893) yuan, P = 0.021). 11 patients of Group B died, and 5 patients suffered from stroke with the mortality and stroke rate both significantly lower than those of Group A (18/101 and 12/101, P = 0.022, P = 0.015). There was no significant difference in the re-infarction rate between the 2 groups. The scores in physical function, general health status, vitality, social function, role-emotional, mental health of Group B were all significantly higher than those of Group A (all P < 0.05) , however, there were not significant differences in body pain and role-physical between these 2 groups. The smoking cessation rate, specialist outpatient department follow-up rate, statins use rate of Group B were significantly higher than those of Group A (P = 0.017, P = 0.016, P = 0.038). The 120-grade 3 A hospital CCU pattern is more cost-effective in treatment of AMI.

Bladder Leiomyoma Presenting as Voiding Dysfunction: A Case Report

Mesenchymal tumors of the urinary bladder are rare, and the majority of them are malignant. We report a case of leiomyoma of the urinary bladder presenting with symptoms of voiding dysfunction. We performed surgical resection of the leiomyoma and repair of the bladder. Small capacity of the bladder with right vesicoureteral reflux was noted in outpatient department follow-up. A review of the relevant literature is also provided.

Miller-Dieker Syndrome Associated With Tight Filum Terminale

An 8-year-old female was diagnosed with Miller-Dieker syndrome with typical facial presentation. Brain magnetic resonance imaging disclosed lissencephaly, and chromosome study revealed 17p13.3 deletion. She developed infantile spasms at an early age, and her seizures were poorly controlled by multiple antiepileptics. Recurrent urinary tract infections were diagnosed during routine out-patient department follow-up. Urodynamic study disclosed a neurogenic bladder. Spinal magnetic resonance imaging revealed a tethered cord resulting from tight filum terminale, and untethering surgery was performed. Four months after the surgery, repeated urine cultures indicated that she was free from the urinary tract infection. Urodynamic study after untethering surgery demonstrated improved compliance of the urinary bladder.

Database study for clinical guidelines of children with pneumonia who visited an emergency department

Purpose:Pneumonia is one of the most common infections in children who visit emergency departments(ED), but standard clinical guidelines for children with pneumonia in Korea have not been studied. This study was performed to collect and evaluate a data-base of children with pneumonia for establishing clinical guidelines in ED. Methods:This study reviewed 304 children who were diagnosed and treated for pneumonia in the ED at one tertiary hospital between January 2003 and December 2003 retrospectively by reviewing the charts and analyzing the clinical characteristics, laboratory findings, and radiologic findings between an admission group and a discharge group. Results:The 2 year-5 year age group was the top of age distribution and the peak incidence of monthly distribution was December. Two hundred forty seven(81.3 percent) children were hospitalized(admission group), and the mean length of hospitalization was 7.24±3.24 days. The most common indications of admission were fever, tachypnea and an age of less than three months. There was statistical differences in the outpatient department follow-up between the two groups(85.8 percent in admission group vs 35.1 percent in discharge group). Conclusion:More prospective studies are needed to establish clinical standard guidelines for children with pneumonia. This will be helpful in ED management and will aid the prevention of pneumonia

Retinopathy of prematurity: optimal timing of the initial check and progression after discharge.

Timely detection of the threshold retinopathy of prematurity (ROP) is very important. The goal of this study was to discuss the optimal timing of the initial screening for ROP as well as ROP progression in the outpatient department (OPD) follow-up after discharge. Herein we retrospectively review the charts of 224 preterm babies with gestational ages (GAs) of less than 35 weeks or birth weights (BWs) of less than or equal to 2000 g. These babies were admitted to Taipei Veterans General Hospital from January 1998 to December 2000. The relationship between the severity and the time course of ROP with respect to various BWs was recorded. These infants were also divided into groups according to the ROP stage of the last retinal examination before discharge, and the recorded results of OPD follow-up. In this study, there was a total of 41 infants with stage III ROP, of which 36 progressed to threshold ROP, including 13 (13/41, 31.7%) and 10 (10/36, 27.8%) who were respectively detected after discharge. In 89 infants with positive findings, the postnatal age (PNA) at the time ROP was detected for the first time was about 7 weeks in extremely low birth weight (ELBW, BW < or = 1000 g) infants and about 4-5 weeks in larger infants; however the postconceptional age (PCA) was about 35 to 36 weeks, and this was not influenced by birth weight. The earliest PCA and PNA when infants with a BW of < or = 1,000 g or GA < or = 28 weeks reached the threshold ROP were 33 and 7 weeks; infants with a BW of 1,001-1,250 g or GA of 28-30 weeks, the times were 34 and 6 weeks; and for infants with a BW of > 1,250 g or GA of more than 30 weeks, they were 35 and 4 weeks, respectively. Although it seemed that ROP tended to develop at the same PCA, the dual criteria of 4 weeks of PNA or 33 weeks of PCA, whichever comes later, may be the optimal timing for the initial retinal examination for premature infants. It is also important to keep in mind that follow-up programs should not be interrupted because of discharge.

Parasuicide: A review of treatment interventions

From review of studies of treatment intervention in parasuicide it is concluded that: 1. (1) Suicide prevention centres do not lower the incidence of suicide. 2. (2) Retrospective follow-up studies of patients self-selected for treatment or no treatment find that patients who attend for treatment have a lower repeat rate of parasuicide. This may have nothing to do with treatment. 3. (3) Intensive domicillary follow-up for 3–6 months after inpatient treatment in a specialised unit for parasuicide is no better at preventing further parasuicides than conventional follow-up in outpatient department or via the GP. 4. (4) A multidisciplinary outreach programme was effective in one study but not three others. 5. (5) Behaviour therapy was no better than insight oriented psychotherapies when administered intensely over 10 days for inpatients with a previous history of overdose. 6. (6) Medication in the form of depot flupenthixol, 20 mg every 4 weeks was significantly better than placebo for chronic repeaters (3 or more attemps) but Mianserin 30 mg/d was not. 7. (7) There was no relationship between improved symptoms, improved social circumtances or the repeat rate for parasuicide. In a controlled trial conducted by the authors in parasuicides, Mianserin 60 mg/d reduced depressive symptoms significantly more rapidly than Nomifensine or placebo but there was no difference by 6 weeks and the risk of repeat was not affected.