ABSTRACT
Pyogenic liver abscess (PLA) can be caused by bacteria entering the liver via the portal vein or primary bacteremia, or it can be cryptogenic. Recently, Klebsiella pneumoniae has been increasingly found as a PLA pathogen. PLA due to this bacterium often leads to formation of extrahepatic abscesses. The treatment of choice is dual therapy with insertion of percutaneous catheter drainage and antibiotic therapy. We report 2 cases of PLA due to K. pneumoniae in immunocompetent children. We successfully treated patient 1 with percutaneous catheter drainage for 18 days and 6-week course of antibiotic therapy. Patient 2 was treated with percutaneous needle aspiration and antibiotic therapy for the same period. In both patients, the PLAs showed the ultrasound-confirmed resolutions after the dual therapy.
Subject(s)
Child , Humans , Abscess , Anti-Bacterial Agents , Bacteremia , Bacteria , Catheters , Drainage , Immunocompetence , Klebsiella pneumoniae , Klebsiella , Liver , Liver Abscess, Pyogenic , Needles , Pneumonia , Portal VeinABSTRACT
PURPOSE: The grade of complexity in the diagnosis related group (DRG) payment system is influenced by the secondary diagnosis of specific complication and comorbidity level, in which moderate or severe malnutrition is included. This study examined an existing proportion of patients with malnutrition who were supposed to be qualified for the complexity level and devised quality improvement measures to increase the proportion of qualifying complexity payments. METHODS: The goal of the activities was to increase the rate of complexity payment claims for patients with malnutrition (%). Cases ineligible for the DRG payment system and cases with no diagnosis of malnutrition were excluded. We established a collaborative system between the nutrition support team and departments related to each improvement factor (i.e., patient care, medical records, insurance review, and medical information). RESULTS: Before implementing the activities, this study investigated the current level of complexity payment claims for malnutrition patients who were discharged within a specific period (June 1, 2015~August 31, 2015). The results showed that complexity payment claims were filed in 10.00% (2 of the 20 malnutrition cases). After the activities, the rate of complexity payment claims for the patients with malnutrition within the study period (June 1, 2016~August 31, 2016) was 46.43% (26 out of 56), showing an approximately 364% increase from the pre activity rate. This change was statistically significant according to the chi-square test on Microsoft Excel 2010 (P < 0.01). CONCLUSION: Collaborative efforts by the related departments enabled the smooth implementation of each activity. In addition, moderate or severe malnutrition was revealed to be a variable in the complexity-specific payment system. In the future, hospital-wide awareness and effort are crucial to promot the steady practice of these activities and expand their implementation.
Subject(s)
Humans , Comorbidity , Diagnosis , Diagnosis-Related Groups , Insurance , Malnutrition , Medical Records , Patient Care , Quality ImprovementABSTRACT
An omental infarctions is an uncommon cause of an acute abdomen and a rare entity in children. The etiology is still unclear and the symptoms mimic acute appendicitis. We recently encountered a case of a 10-year-old boy who had a previous surgical history of a manual reduction for intussusception. He complained of abdominal pain and right upper quadrant tenderness without fever or anorexia. An abdominal ultrasonography suggested an omental infarction and computed tomography confirmed the diagnosis. Conservative management was adopted with a rapid and uneventful recovery. Non-operative treatment is a safe and effective treatment of choice for omental infarction.