Mean Length Of Hospital Admission Research Articles

Correlational study of Vitamin-D deficiency levels and its severity of community-acquired pneumonia in patients admitted into a tertiary care hospital

Background: Recent studies have emphasized that people who have low levels of Vitamin D are more prone to the development of infectious diseases, particularly of a community-acquired nature, which has differential morbidity and mortality. Aims & objectives: The present study aimed to determine the correlation between different levels of vitamin D deficiency and severity and outcomes in patients diagnosed with community-acquired pneumonia. Methods: In this study, the serum level of Vitamin D of 100 consecutively admitted community-acquired pneumonia patients was measured. Depending on the level of Vitamin D deficiency, patients diagnosed with community-acquired pneumonia (CAP) were assessed for severity of illness by CURB-65 score. Results & Discussion: In the study population, out of 100 patients, 82% of the study sample had deficient serum vitamin D levels. In the study sample, 41 patients with higher deficiency levels of serum Vitamin D have severe illness and scored high on CURB- 65, which is in the range of three to four on the scale. 59 patients with low deficiency levels of serum Vitamin D had low scores of one or two on the CURB-65. On severity assessment in patients with severe deficiency of Vitamin D, the mean length of hospital admission was 12.30±8.47 days compared to patients with mild deficiency of Vitamin D, where the average hospital stay was 8.58±4.04 days. Conclusion: As the severity of deficiency of Vitamin D increases, the frequency of CAP increases, and it is also observed that a severe degree of deficiency is associated with severe illness and prolonged hospital stay.

1070 Epidemiology and Incidence of Pelvic Fractures

Abstract Aim There is a lack of recent UK based literature reporting on the incidence of pelvic fractures, and the demographic associations with fracture locations. Our study reports the incidence and factors associated with pelvic fractures at a major trauma centre over a 7-year period. Method Data from pelvic fractures treated at a Level 1 Trauma Centre was collected from January 2015 to January 2022. Fracture location, patient demographics, and operative status were collected and analysed. Results A total of 3137 patients with pelvic fractures were included, with an incidence of 78.6/100,000 patients per year. The mean age was 63.0, 53% of patients were female and the mean BMI was 25.3. The mean length of hospital admission was 20.5 days. Patients with Pubis fractures had the highest mean age (65.55), whilst those with ilium fractures had the lowest (51.14), both significantly different from the mean (p<0.001). Female patients were more likely to have pubis (60.1%) fractures but less likely to have acetabulum (30.0%) fractures (p<0.01). Patients with acetabular fractures had a higher BMI (p<0.01) and the highest rate of operative fixation (48.5%). Conclusions Our study provides insight into the incidence and epidemiology of pelvic fractures in a UK major trauma centre setting, the first study in over 15 years in this context. This contributes to the literature, and allows inter-country comparisons to be conducted, and guidelines and policies to be more informed.

A novel method of skin graft fixation using adhesive hydrofiber foam.

Conventional skin graft fixation uses a tie-over bolus dressing with splint fixation. However, splints are highly uncomfortable and contribute considerably to medical waste. Previous study has shown positive results using hydrofiber for skin graft fixation. The aim of this study was to assess the effectiveness of using adhesive hydrofiber foam for skin graft fixation. In this retrospective study, patients reconstructed with split-thickness skin graft that was fixated only with adhesive hydrofiber foam from April 2017 until April 2019 were included. A total of 44 patients took part, of whom 32 were male and 12 female, with a mean age of 56±19 years. The mean operative time was 77.5±91 minutes. The average defect size was 42±37cm2. The mean skin graft take was 97±5%. The mean length of hospital admission after skin grafting until discharge was 8.5±9.2 days. Excluding those patients undergoing other procedures at the same time as the skin graft gave a total of 34 patients. Their mean operative time was 32±20 minutes, and mean length of hospital stay after skin grafting was 4.0±4.7 days. Adhesive hydrofiber foam for skin graft fixation was technically very easy to apply, resulting in a waterproof, non-bulky, secure dressing. Splints were not required. Patients were allowed to mobilise. This method resulted in increased patient comfort and decreased medical waste. From these findings, we believe that this is an extremely simple and effective method of skin graft fixation.

Post-COVID-19 syndrome in patients with primary Sjögren's syndrome after acute SARS-CoV-2 infection.

To analyse the frequency and characteristics of post-COVID-19 syndrome in patients with primary Sjögren's syndrome (pSS) affected by acute SARS-CoV-2 infection. By the first week of April 2021, all centres included in the Big Data Sjögren Consortium were contacted asking for patients included in the Registry diagnosed with SARSCoV-2 infection according to the ECDC guidelines. According to the NICE definitions, symptoms related to COVID-19 were classified as acute COVID-19 (signs and symptoms for up to 4 weeks), ongoing symptomatic COVID-19 (presence of signs and symptoms from 4 to 12 weeks) and post-COVID-19 syndrome (signs and symptoms that continue for > 12 weeks not explained by an alternative diagnosis after a protocolized study). We identified 132 patients who were followed a mean follow-up of 137.8 days (ranging from 5 days to 388 days) after being diagnosed with COVID-19. In the last visit, 75 (57%) patients remained symptomatic: 68 (52%) remained symptomatic for more than 4 weeks fulfilling the NICE definition for ongoing symptomatic post-COVID-19, and 38 (29%) remained symptomatic for more than 12 weeks fulfilling the definition of post-COVID-19 syndrome. More than 40% of pSS patients reported the persistence of four symptoms or more, including anxiety/depression (59%), arthralgias (56%), sleep disorder (44%), fatigue (40%), anosmia (34%) and myalgias (32%). Age-sex adjusted multivariate analysis identified raised LDH levels (OR 10.36), raised CRP levels (OR 7.33), use of hydroxychloroquine (OR 3.51) and antiviral agents (OR 3.38), hospital admission (OR 8.29), mean length of hospital admission (OR 1.1) and requirement of supplemental oxygen (OR 6.94) as factors associated with a higher risk of developing post-COVID-19 syndrome. A sensitivity analysis including hospital admission in the adjusted model confirmed raised CRP levels (OR 8.6, 95% CI 1.33-104.44) and use of hydroxychloroquine (OR 2.52, 95% CI 1.00-6.47) as the key independent factors associated with an enhanced risk of developing post-COVID-19 syndrome. This is the first study that analyses the frequency and characteristics of post-COVID-19 syndrome in patients affected by a systemic autoimmune disease. We found that 57% of patients with pSS affected by COVID-19 remain symptomatic after a mean follow-up of 5 months. The risk of developing post-COVID-19 syndrome in patients who required hospitalisation was 8-times higher than in non-hospitalised patients, with baseline raised CRP levels and the use of hydroxychloroquine being independent risk factors for post-COVID-19.

A Retrospective Cohort Study Evaluating Surgical Aptitude Over Time in a New Male-To-Female Penoscrotal Vaginoplasty Program

BackgroundGiven the burgeoning demand for gender affirmation surgery, there are few studies examining both surgical process variables and patient outcome variables. Knowing the learning curve for surgical teams who are beginning to perform this procedure will be important for patient safety and presurgical patient counseling as more institutions open transgender surgical programs. AimThe purpose of this study was to determine the demographics of patients pursuing penoscrotal vaginoplasty, to determine their postoperative course, and to determine a learning curve for the surgical team performing penoscrotal vaginoplasty. MethodsWe retrospectively reviewed charts of all 43 patients who underwent penoscrotal vaginoplasty from the commencement of a new male-to-female penoscrotal vaginoplasty program in March 2018 through July 2019. OutcomesPrimary outcomes included mean hemoglobin decrease from surgery and operative time. Mean time to neoclitoral sensation, length of hospital admission, complication rates, reoperation rates, length of narcotic use after surgery, and demographics were also evaluated. Associations between surgical team experience and outcomes were assessed with Spearman's rho and Cox regression, and curve-fitting procedures were applied to determine the relationship. ResultsThe mean operative time from initial incision to procedure finish was 225 minutes, and the mean decrease in hemoglobin was 3.3 g/dL. The mean time to neoclitoral sensation was 0.72 months. The time until neoclitoral sensation decreased as the surgical cases performed increased (Spearman's rho, −0.577 [P < .001]), with a power function best describing the learning curve. Operative time did not change with case number (Spearman's rho, 0.062 [P = .698]) but overall time in the operating room did (Spearman's rho, 0.631 [P < .001]). Mean length of hospital admission was 2.9 days. There were no intraoperative complications. 18 patients (42%) experienced a postoperative complication. 8 of 43 patients underwent reoperation (20%). Narcotics were used a mean of 9.5 days after surgery. Clinical ImplicationsA learning curve can be demonstrated in penoscrotal vaginoplasty for time to neoclitoral sensation and overall time in the operating room, plateauing between 30 and 40 cases. Strengths and LimitationsStrengths include assessing a learning curve for time to neoclitoral sensation, length of hospital stay, and length of postoperative narcotic use after penoscrotal vaginoplasty, which, to our knowledge, has not been reported elsewhere. Limitations include our overall low number of patients. ConclusionDespite a low number of cases, length of hospital stay was short and the postoperative complication rate was similar to that of long-standing penoscrotal vaginoplasty programs.Whynott RM, Summers K, Mickelsen R, et al. A Retrospective Cohort Study Evaluating Surgical Aptitude Over Time in a New Male-To-Female Penoscrotal Vaginoplasty Program. J Sex Med 2020;17:1787–1794.

Diabetic Limb Salvage With Endovascular Revascularisation and Free Tissue Transfer: Long-Term Follow up

Combining vascular bypass surgery with free flap coverage is one of the treatment methods for complex soft tissue defects in the ischaemic lower limb. Endovascular revascularisation has become the first line treatment for limb ischaemia in many centres. Surgeons now perform free tissue transfer after angioplasty. The early and long-term limb salvage rate in diabetic patients who had undergone infrapopliteal endovascular revascularisation and free flap reconstruction are assessed. This was retrospective study of all consecutive diabetic patients who had undergone endovascular revascularisation with free flap reconstruction for lower limb salvage between 2008 and 2014. They were followed up for at least 2 years or to death (mean follow up 39 ± 17 months). Cox regression analysis was used to analyse variables influencing outcome. There were 55 patients who had undergone 60 procedures. Five patients had undergone the procedure to the contralateral leg. All tissue lesions were Wagner–Meggit classification Grades 3 or 4. Thirty-six patients had TASC C lesions and 24 patients with TASC D lesions. Combined below knee triple vessel disease was seen in 30% of the cases, 28% involved both the anterior and posterior tibial artery, 7% and 2% involved the anterior tibial or the posterior tibial and the peroneal arteries. The free flap success rate was 95%. The peri-operative mortality was 1.7%. Twenty-one cases required surgical re-intervention. Mean length of hospital admission was 32 ± 9 days. One and five year amputation free survival rates were 94% and 68%, patient survival rates were 95% and 67%, limb salvage rates were 93% and 91% and respectively. The results show that excellent early and late limb salvage can be achieved with free tissue transfer based on endovascular revascularisation of infrapopliteal arteries. This can be a further treatment option in diabetic patients with complex soft tissue defects.

Editor's Choice – Diabetic Limb Salvage With Endovascular Revascularisation and Free Tissue Transfer: Long-Term Follow up

Combining vascular bypass surgery with free flap coverage is one of the treatment methods for complex soft tissue defects in the ischaemic lower limb. Endovascular revascularisation has become the first line treatment for limb ischaemia in many centres. Surgeons now perform free tissue transfer after angioplasty. The early and long-term limb salvage rate in diabetic patients who had undergone infrapopliteal endovascular revascularisation and free flap reconstruction are assessed. This was retrospective study of all consecutive diabetic patients who had undergone endovascular revascularisation with free flap reconstruction for lower limb salvage between 2008 and 2014. They were followed up for at least 2 years or to death (mean follow up 39±17 months). Cox regression analysis was used to analyse variables influencing outcome. There were 55 patients who had undergone 60 procedures. Five patients had undergone the procedure to the contralateral leg. All tissue lesions were Wagner-Meggit classification Grades 3 or 4. Thirty-six patients had TASC C lesions and 24 patients with TASC D lesions. Combined below knee triple vessel disease was seen in 30% of the cases, 28% involved both the anterior and posterior tibial artery, 7% and 2% involved the anterior tibial or the posterior tibial and the peroneal arteries. The free flap success rate was 95%. The peri-operative mortality was 1.7%. Twenty-one cases required surgical re-intervention. Mean length of hospital admission was 32±9 days. One and five year amputation free survival rates were 94% and 68%, patient survival rates were 95% and 67%, limb salvage rates were 93% and 91% and respectively. The results show that excellent early and late limb salvage can be achieved with free tissue transfer based on endovascular revascularisation of infrapopliteal arteries. This can be a further treatment option in diabetic patients with complex soft tissue defects.

Do Groin Drains Reduce Postoperative Morbidity in Women Undergoing Inguinofemoral Lymphadenectomy for Vulvar Cancer?

Sentinel lymph node biopsy has been widely adopted in the surgical management of women with early-stage vulvar cancer, but many patients require inguinofemoral lymphadenectomy (IFL). Following IFL, many surgeons drain the groin to prevent lymphocyst formation despite a lack of evidence to support this practice. Our objective was to investigate whether groin drains after IFL are associated with reduced postoperative morbidity in women undergoing surgery for vulvar cancer. A retrospective cohort study of women diagnosed as having primary vulvar cancer who underwent vulvectomy/radical local excision and unilateral or bilateral IFL was conducted. Cases were ascertained from the weekly outcome reports of a statewide tertiary gynecologic oncology tumor board. Data including postoperative outcomes were abstracted from medical records. Patients were stratified into 1 of 2 groups according to whether a groin drain had been used. Seventy-one patients were included. Inguinal drains were used in 48 patients (67.6%) and 23 patients (32.4%) did not have their groin wound(s) drained. The most common postoperative complications recorded were wound infection (59.2%), groin lymphocyst (32.4%), and cellulitis (25.4%). The mean length of hospital admission was 11.5 days (2-40 days). Compared with patients in whom inguinal drains were placed, those in the "no drain" group had a significantly lower incidence of postoperative groin cellulitis (8.7% vs 25.4% P = 0.039). No significant differences were observed between patients in the "drain" and "no drain" groups in lymphocyst formation, wound infection, return to the operating room, duration of hospital stay, readmission post-discharge, and lower-limb lymphedema. In this study of patients undergoing inguinofemoral dissection for primary vulvar cancer, postoperative cellulitis occurred less frequently in patients without an inguinal drain. The incidence of other postoperative complications was no different whether or not a groin drain was used. Prospective studies may be warranted.

V4-10 ROBOTIC-ASSISTED LAPAROSCOPIC URETERAL REIMPLANTATION: OUR TECNIQUE AND OUTCOMES

You have accessJournal of UrologyRobotics – Prostate/Novel Imaging1 Apr 2015V4-10 ROBOTIC-ASSISTED LAPAROSCOPIC URETERAL REIMPLANTATION: OUR TECNIQUE AND OUTCOMES Daniel Zainfeld, Andrew Windsperger, Moben Mirza, and David Duchene Daniel ZainfeldDaniel Zainfeld More articles by this author , Andrew WindspergerAndrew Windsperger More articles by this author , Moben MirzaMoben Mirza More articles by this author , and David DucheneDavid Duchene More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.722AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Robotic assistance has facilitated performance of many complex reconstructive procedures previously relegated to an open approach with numerous reported advantages. Distal ureteral reconstruction and reimplantation is one such procedure which is now often performed laparoscopically with robotic assistance using the da Vinci robotic surgical system. We evaluated perioperative and long-term outcomes among patients who underwent treatment with robotic-assisted laparoscopic ureteral reimplantation (RALUR) at a single center. METHODS Patients who underwent RALUR between 7/2006 and 10/2012 were identified. In all procedures, the distal ureter was spatulated for 1.5 centimeters. An approximately 1 centimeter cystotomy was created. The ureterovesical anastomosis was completed in a triangular fashion including two arms of 4-0 PDS suture up the sides of the spatulation and a third arm anteriorly following stent placement to form a widely patent, refluxing anastomosis. All procedures were performed at a single institution. A retrospective review of perioperative and clinical data was performed assessing operative time, estimated blood loss, length of admission, and success of procedure as indicated by the absence of obstruction on follow-up imaging. RESULTS A total of 21 patients underwent RALUR in the study period. Mean age of patients was 43.2 years. 20 of the 21 RALUR were completed robotically with conversion to open in one patient. Etiology of injury included 11 due to gynecologic procedural injury and three secondary to iatrogenic ureteral injuries. The remainder were comprised of congenital, non-gynecologic surgery, radiation, and idiopathic. 13 required psoas hitch procedure as well. Mean operative time was 237 minutes. Mean estimated blood loss was 85cc. Mean length of hospital admission was 3.1 days. Currently, all patients remain non-obstructed by Lasix renogram at mean follow-up of 12.4 months. CONCLUSIONS RALUR with psoas hitch (when indicated) is a safe and effective option for distal ureteral reconstruction. Further investigation will help to more clearly refine patient selection and delineate patient benefits in comparison to an open procedure. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e407 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Zainfeld More articles by this author Andrew Windsperger More articles by this author Moben Mirza More articles by this author David Duchene More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Impact of a randomized trial on maintenance tocolysis on length of hospital admission of women with threatened preterm labor in The Netherlands

IntroductionThe APOSTEL-II trial was a multicenter randomized placebo-controlled trial, assessing the effectiveness of maintenance tocolysis with nifedipine. The trial showed maintenance tocolysis not to have an effect on perinatal outcome. Objective of the current study is to evaluate the effect of a negative trial on the length of hospital admission of women with threatened preterm labor. Materials and methodsWe evaluated length of hospital admission of all patients admitted with threatened preterm labor with a gestational age <32 weeks in 8 perinatal centers that participated in the APOSTEL-II trial. We studied only the first admission with threatened preterm labor, readmissions were excluded. We distinguished between the period before, the period during and the period after the trial. In a subgroup analysis, we differentiated for the group of women who delivered and for the group of women who did not deliver during the initial admission. ResultsThe mean length of hospital admission was 9.3 days before the start of the trial, 8.4 days during the recruitment period and 8.1 days after the trial was completed. The difference in mean length of hospital admission before and during the recruitment period was significantly different (p<001). CommentsThe length of hospital admission of women with threatened preterm labor is found to be reduced during the recruitment period of the APOSTEL-II trial. This shows that the conduct of a randomized controlled trial itself has the potential to change daily practice.

Characterisation of antibody responses to Gal-positive and Gal-free biological heart valves

Characterisation of antibody responses to Gal-positive and Gal-free biological heart valves

Médecine et recommandations de bonnes pratiques. Une suggestion

The APOSTEL-II trial was a multicenter randomized placebo-controlled trial, assessing the effectiveness of maintenance tocolysis with nifedipine. The trial showed maintenance tocolysis not to have an effect on perinatal outcome. Objective of the current study is to evaluate the effect of a negative trial on the length of hospital admission of women with threatened preterm labor.We evaluated length of hospital admission of all patients admitted with threatened preterm labor with a gestational age <32 weeks in 8 perinatal centers that participated in the APOSTEL-II trial. We studied only the first admission with threatened preterm labor, readmissions were excluded. We distinguished between the period before, the period during and the period after the trial. In a subgroup analysis, we differentiated for the group of women who delivered and for the group of women who did not deliver during the initial admission.The mean length of hospital admission was 9.3 days before the start of the trial, 8.4 days during the recruitment period and 8.1 days after the trial was completed. The difference in mean length of hospital admission before and during the recruitment period was significantly different (p < 001).The length of hospital admission of women with threatened preterm labor is found to be reduced during the recruitment period of the APOSTEL-II trial. This shows that the conduct of a randomized controlled trial itself has the potential to change daily practice.

Lung abscesses: Review of 60 cases

Lung abscesses (LA) carry with them severe clinical and social implications. The authors retrospectively analyse case files from a tertiary hospital.Admissions from 2000 to 2005 codified as LA were identified. Forty-five patients were males and the mean age was 56.2 (±15.1) years. The average duration of symptoms pre-hospitalisation was 23.0 (±50.2) days, with acute respiratory infection the initial syndrome in 36 patients. Clinical data show LA could have been suspected in 40 patients. Diagnosis was established 8.7 (±11.4) days after admission. A microbial pathogen was recovered in 26 cases. Primary LA was diagnosed in 27 patients. Dental disease and immunodeficiency were the main risk factors. Other co-morbidities were present in 34 patients. After LA diagnosis, intravenous (IV) antibiotic (AB) was prescribed for 16.5 (±10.9) days with mean total AB time 39.2 (±15.7) days. Ten options of AB were used and 23 patients had their initial IV AB changed to a second choice. Six patients needed surgery. Apyrexia was achieved after 6.4 (±6.4) days of treatment. 21 patients had complications and 7 died. The mean length of hospital admission was 27.5 (±16.3) days and 38 patients were called for a follow-up visit.These data are generally in accordance with the literature. The high male percentage agrees with the similarly high prevalence of alcoholism and lung neoplasms in males. Key facts to ameliorate in order to improve prognosis and length of hospital admission could be a swifter diagnosis and consensus on the AB treatment.

Abcessos pulmonares: Revisão de 60 casos

Lung abscesses (LA) carry with them severe clinical and social implications. The authors retrospectively analyse case files from a tertiary hospital.Admissions from 2000 to 2005 codified as LA were identified. Forty-five patients were males and the mean age was 56.2 (±15.1) years. The average duration of symptoms pre-hospitalisation was 23.0 (±50.2) days, with acute respiratory infection the initial syndrome in 36 patients. Clinical data show LA could have been suspected in 40 patients. Diagnosis was established 8.7 (±11.4) days after admission. A microbial pathogen was recovered in 26 cases. Primary LA was diagnosed in 27 patients. Dental disease and immunodeficiency were the main risk factors. Other co-morbidities were present in 34 patients. After LA diagnosis, intravenous (IV) antibiotic (AB) was prescribed for 16.5 (±10.9) days with mean total AB time 39.2 (±15.7) days. Ten options of AB were used and 23 patients had their initial IV AB changed to a second choice. Six patients needed surgery. Apyrexia was achieved after 6.4 (±6.4) days of treatment. 21 patients had complications and 7 died. The mean length of hospital admission was 27.5 (±16.3) days and 38 patients were called for a follow-up visit.These data are generally in accordance with the literature. The high male percentage agrees with the similarly high prevalence of alcoholism and lung neoplasms in males. Key facts to ameliorate in order to improve prognosis and length of hospital admission could be a swifter diagnosis and consensus on the AB treatment.Rev Port Pneumol 2009; XV (2): 165-178

The burden of rotavirus gastroenteritis in children presenting to a paediatric hospital

The aim of this study was to determine the burden, management and outcomes of rotavirus infection in young children presenting to a tertiary paediatric hospital in Sydney, Australia. All laboratory-confirmed cases of rotavirus in children aged <5 years were identified and medical records reviewed. In 2004, 80 children aged <5 years presented to the hospital with rotavirus gastroenteritis confirmed by stool testing. Infants aged <24 months comprised 75% of cases, with more males than females affected. Most children (86%) acquired rotavirus infection in the community, with a mean length of hospital admission of 2.3 days. There were eight cases of nosocomial infection at a rate of 3/10 000 admissions. The rates of intravenous fluid management (46%) and antibiotic use (28%) were high, reflecting the severity of disease presenting in a hospital setting. These data will help inform the assessment of the recently introduced rotavirus vaccination programme in Australia.

Analgesic effects of botulinum toxin A: a randomized, placebo‐controlled clinical trial

Postoperative pain in children with spastic cerebral palsy (CP) is often attributed to muscle spasm and is difficult to manage using opiates and benzodiazepines. Adductor‐release surgery to treat or prevent hip dislocation in children with spastic CP is frequently performed and is often accompanied by severe postoperative pain and spasm. A double‐blinded, randomized, placebo‐controlled clinical trial of 16 patients (mean age 4.7 years) with a mainly spastic type of CP (either diplegic or quadriplegic in distribution) was used to test the hypothesis that a significant proportion of postoperative pain is secondary to muscle spasm and, therefore, might be reduced by a preoperative chemodenervation of the target surgical muscle by intramuscular injection of botulinum toxin A (BTX/A). Compared with the placebo, BTX/A was found to be associated with a reduction in mean pain scores of 74% (P&lt;0.003), a reduction in mean analgesic requirements of approximately 50% (P&lt;0.005), and a reduction in mean length of hospital admission of 33% (P&lt;0.003). It was concluded that an important component of postoperative pain in the patient population is due to muscle spasm and this can be managed effectively by preoperative injection with BTX/A. These findings may have implications for the management of pain secondary to muscle spasm in other clinical settings.

OUTCOME IN PATIENTS ON CONTINUOUS AMBULATORY PERITONEAL DIALYSIS AND HAEMODIALYSIS: 4-YEAR ANALYSIS OF A PROSPECTIVE MULTICENTRE STUDY

In a study in seven large renal units in England, the morbidity and mortality of all patients starting continuous ambulatory peritoneal dialysis (CAPD) and haemodialysis during 1983-85 were monitored prospectively over a 4-year period and related to reasons for choice of therapy and potential risk factors. 610 new patients (median age 52 years, range 3-80 years) started CAPD; 16% had diabetes mellitus and 21% cerebrovascular or cardiovascular disease. 329 patients (median age 48 years, range 5-77 years) started haemodialysis; 7% had diabetes mellitus and 17% cerebrovascular or cardiovascular disease. The KaplanMeier patient survival estimates at 4 years were 74% for haemodialysis and 62% for CAPD; technique survival figures for the same period were 91% for haemodialysis and 61% for CAPD. Cox's proportional hazards regression analysis showed that cerebrovascular/cardiovascular disease, age over 60 years, and diabetes mellitus were important predictors for survival in CAPD patients; there were no risk factors associated with permanent change to haemodialysis. In the haemodialysis group early change to CAPD was associated with presence of cerebrovascular or cardiovascular disease. The major cause of drop-out in both groups was transplantation. The mean length of hospital admission was 14.8 days per patient-year for CAPD and 12.4 days per patient-year for haemodialysis.

Toward Diagnostic Related Groups in Child Psychiatry: A Preliminary Study

Although prospective payment using diagnostic related groups (DRGs) has been implemented for certain medical services during the past year, psychiatry in general and child psychiatry services in particular have been exempted from such forms of reimbursement. Since it is generally expected that psychiatry will not continue to be so exempted indefinitely, a preliminary study of 15 potential DRGs in a group of 184 children who received inpatient care were compared with respect to their mean length of hospital admission. Implications of these data for mental health policy are discussed.