Home About us Contact
|
Home About us Contact | ||
|
|
||
Surgical Diagnosis (surgical + diagnosis)
Selected AbstractsPatient Problems, Advanced Practice Nurse (APN) Interventions, Time and Contacts Among Five Patient GroupsJOURNAL OF NURSING SCHOLARSHIP, Issue 1 2003Dorothy Brooten Purpose: To describe patient problems and APN interventions in each of five clinical trials and to establish links among patient problems, APN interventions, APN time and number of contacts, patient outcomes, and health care costs. Design and Methods: Analysis of 333 interaction logs created by APNs during five randomized controlled trials: (a) very low birthweight infants (n=39); (b) women with unplanned cesarean birth (n=61), (c) high-risk pregnancy (n=44), and (d) hysterectomy (n=53); and (e) elders with cardiac medical and surgical diagnoses (n=139). Logs containing recordings of all APN interactions with participants, APN time and type of patient contact were content analyzed with the smallest phrase or sentence representing a "unit." These units were then classified using the Omaha Classification System to determine patient problems and APN interventions. Groups were compared concerning total amount of APN time, number of contacts per patient, and mean length of time per APN contact. All studies were conducted in the United States. Findings: Groups with greater mean APN time and contacts per patient had greater improvements in patients' outcomes and greater health care cost savings. Of the 150,131 APN interventions, surveillance was the predominant APN function in all five patient groups. Health teaching, guidance, and counseling was the second most frequent category of APN intervention in four of the five groups. In all five groups, treatments and procedures accounted for < 1% of total APN interventions. Distribution of patient problems (N=150,131) differed across groups reflecting the health care problems common to the group. Conclusions: Dose of APN time and contacts makes a difference in improving patient outcomes and reducing health care costs. Skills needed by APNs in providing transitional care include well-developed skills in assessing, teaching, counseling, communicating, collaborating, knowing health behaviors, negotiating systems, and having condition-specific knowledge about different patient problems. [source] Early high C-reactive protein in infants with open abdominal wall defects does not predict sepsis or adverse outcomeACTA PAEDIATRICA, Issue 1 2010G Ramadan Abstract Aim:, To study CRP values and relate it to outcome in infants with antenatal diagnosis of gastroschisis, exomphalos and other surgical conditions. Methods:, Over five years, infants admitted to our neonatal unit with gastroschisis, exomphalos and other surgical diagnoses were identified. Serum CRP measurements in first 5 days were studied. Group one included 33 gastroschisis patients, group two, 18 exomphalos patients, and group three, 38 patients with other surgical diagnoses. Outcome measures included TPN days, time to full feeds and duration of hospitalization. Results:, Infants with gastroschisis were more premature (36.9 vs 38.1 weeks) with lower birth weights (2515 vs 3078 g), than infants with exomphalos. CRP values on admission in gastroschisis group were significantly higher than exomphalos and other diagnoses groups (33.7 ± 6.4 vs 8.8 ± 6.0 vs 5.7 ± 2.0, respectively, p < 0.05). All blood cultures were sterile. There was no relationship between high CRP and death or adverse outcome (TPN days, time to full feeds or duration of hospitalization) in the gastroschisis group. Conclusion:, Infants with gastroschisis exhibit high early CRP, which may not indicate sepsis or adverse outcome. This increase can complicate the assessment of these infants. Clinicians should be aware of this finding as it could inform management decisions in this group. [source] High prevalence of an active cytomegalovirus infection in the appendix of immunocompetent patients with acute appendicitisINFLAMMATORY BOWEL DISEASES, Issue 2 2008Mensur Dzabic Abstract Background Appendicitis is a very common surgical diagnosis with unclear pathology. Human cytomegalovirus (HCMV) can modulate our immune system and has been associated with inflammatory bowel disease (IBD) and various other inflammatory diseases. Methods We investigated the association between HCMV and acute appendicitis in 14 immunocompetent patients. Tissue sections from 10 AIDS patients with verified HCMV infection were used as positive controls, and uninflamed intestinal tissue sections from 12 patients were used as negative controls. Results Cells double positive for HCMV early antigens and IL-6/IL-8 were observed in the appendices of 64.3% of appendicitis patients (9 of 14) by immunohistochemical analysis. HCMV late antigen was found in the appendices of 42.9% of the acute appendicitis patients (6 of 14). Latent HCMV appendix infection, as verified by in situ hybridization, as well as HCMV IgG, was observed in 78.6% of patients (11 of 14). The study samples from all 6 healthy appendices were negative for HCMV early and late antigens, although 50% (3 of 6) were HCMV IgG and HCMV DNA positive. Conclusions We have shown that HCMV infection of the appendix is associated with acute appendicitis (P = 0.002) and possibly with the severity of the disease. Our study identified HCMV as a pathogen to be sought for in the appendicitis patient group, possibly allowing further medical treatment of these patients. (Inflamm Bowel Dis 2007) [source] Hotel NHS and the acute abdomen , admit first, investigate laterINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 12 2009K. Aryal Summary Aim:, To determine the financial consequences of a policy of admission first, followed by definitive investigation for patients with an admission diagnosis of suspected acute abdomen. Results:, Over a 1-month period, 122 patients were admitted with a suspected surgical diagnosis of acute abdomen (55 men, 67 women); age range 16,95 years (median: 56.5). Based on surgical operation required (n = 36), death after admission (n = 6, three postoperative deaths) and/or severe surgical illness (n = 17), 56 required surgical inpatient admission, while 66 did not. The patients who did not require admission spent significantly shorter time in hospital than those who required admission (median: 5 days vs. 8.5 days; p = 0.0000). Total hospital hotel and investigation cost (not including ITU or theatre costs) for all 122 patients was £330,468. Overall, £205,468 was consumed by these 56 patients who required admission, while £125,000 was spent on 66 patients whose clinical course did not justify admission; 92% of which was spent on hospital hotel costs and 8% on the cost of imaging and/or endoscopy. Discussion and conclusion:, On a national basis, emergency General Surgery admissions account for 1000 Finished Consultant Episodes per 100,000 population. The findings of this study suggest that this equates to a national NHS spend of £650 million each year, for the hotel costs of patients that could arguably avoid surgical admission altogether. Continuing to admit patients with a suspected acute abdomen first and then requesting definitive investigation makes neither clinical nor economic sense. [source] Diagnosis and medical management of endometriosisPRESCRIBER, Issue 24 2006Alex Swanton MRCOG The choice of treatment in endometriosis is dictated by symptom severity and whether the patient wishes to conceive. Our Drug Review describes the surgical diagnosis and medical and surgical treatment options, followed by sources of further information and the Datafile. Copyright © 2006 Wiley Interface Ltd [source] | ||||||||||