Costs and length of hospitalization following kidney transplantation

We assessed the costs of hospital admissions and length of hospital stay in kidney allograft recipients admitted to our center, in order to rank hospitalization causes in terms of costly and prolonged admissions, to bring to light the respective correlates of costly and prolonged admissions, and to investigate the relationship between costs and length of rehospitalizations. Among rehospitalizations, 83.3% of those due to cerebrovascular accident were costly and 51% of those with graft rejection resulted in prolonged hospital stays. Costly admissions had a high regularity in cases of patients older than 60 years, end-stage renal disease due to diabetes mellitus, graft loss, intensive care unit admission, and hospitalizations accompanied by in death. Prolonged stays were more common in those who were admitted to intensive care unit and those who ultimately died. The Costs showed a significant correlation with the length of rehospitalization [r = 0.626, P = .001]. The strong correlation between the length of hospitalization and posttransplant hospitalization costs means that the former should be curtailed by focusing on such correlates of high-cost admissions as high age and diabetes mellitus as the cause of kidney failure

Marital adjustment in patients on long-term hemodialysis. A case-control study

This study was conducted to compare marital adjustment between patients on long-term hemodialysis and healthy controls and to determine whether the psychological symptoms correlate with marital adjustment in these patients. In a case-control study, 40 patients on long-term hemodialysis and 40 healthy participants were compared for the quality of marital relationship. The Revised Dyadic Adjustment Scale was used for interviews of marital relationship, which includes total marital adjustment and its subscales of marital consensus, affection expression, marital satisfaction, and marital cohesion. Symptoms of anxiety and depression and the Ifudu comorbidity scale were also assessed in the patients group. Marital consensus, affection expression, marital satisfaction, marital cohesion, and the overall marital relationship were significantly poorer in the patients on hemodialysis than in the controls. Also, symptoms of anxiety were more severe among the patients on hemodialysis in comparison with that in the controls. However, this was not the case for symptoms of depression. In the patients on hemodialysis, the severity of anxiety slightly correlated reversely with the total marital relationship score and marital satisfaction subscale. Depression correlated reversely with total marital adjustment, affection expression, marital satisfaction, and marital cohesion. Finally, some marital relationship subscales showed poorer results in men on dialysis, younger patients, and those with higher educational levels. Marital adjustment in patients on hemodialysis, which is linked with depressive symptoms and anxiety, is poorer compared to the healthy controls. This finding shows the necessity of an appropriate family approach for patients on long-term dialysis

Survival of rehospitalized kidney allograft recipients

Undergoing transplantation is extremely stressful, and a recipient is likely leave the hospital burdened with fears of an uncertain future. A paucity of knowledge on the long-term survival of rehospitalized kidney transplant recipients is the likely the reason that physicians fail to provide this group of patients with promising information and reassurance about their future. We sought to describe the long-term patient and graft survival after nonfatal rehospitalization in kidney recipients with a normal graft function after discharge. We reviewed the follow-up data [from the time of discharge after first rehospitalization] of 253 kidney transplant recipients who had been discharged from rehospitalization with a normal kidney function [serum creatinine less than 1.6 mg/dL]. Patient and graft survival rates 6 months and 1, 2, and 5 years after discharge were determined. The mean duration of follow-up [from the time of discharge after the first rehospitalization] was 38.9 +/- 11.2 months [range, 6 to 84 months]. The overall patient survival rates were 98%, 97%, 95%, and 93% at 6 months, 1 year, 2 years, and 5 years, respectively. Graft survival rates at these times were 88%, 82%, 77%, and 63%, respectively. After the first posttransplant rehospitalization, 54 patients [21.9%] experienced more hospitalization episodes [mean, 2.6 +/- 2.0 times], while 193 [78.1%] had no further hospitalizations during the follow-up period. Kidney transplant recipients who are rehospitalized should be reassured about favorable chances of survival if discharged with a normal graft function

Additional burden of intensive care to rehospitalizations following kidney transplantation. A study of rate, causes, and risk factors

Little information exists on the burden of intensive care unit [ICU] to the posttransplant rehospitalizations of kidney allograft recipients. We do not clearly know the extent of the need for ICU during rehospitalizations and causes of readmissions. In this study, we aimed to assess ICU admissions of kidney transplant recipients, to determine the risk factors of ICU admissions in rehospitalized patients, and to evaluate the additional burden of ICU admission. A total of 581 posttransplant rehospitalizations of kidney transplant recipients were assessed for ICU admission. Clinical characteristics of the patients and the length of hospital stay, transplantation-admission interval, hospitalization costs, and mortality rate were reviewed. Twenty-five rehospitalized kidney transplant recipients [4.3%] had been admitted to ICU with kidney dysfunction [36.0%], cerebrovascular accident [24.0%], sepsis [16.0%], brain tumor [8.0%], brain abscess [4.0%], diabetic ketoacidosis [4.0%], trauma [4.0%], and hemodynamic shock [4.0%]. The risk factors of referral to ICU were higher age [P = .001] and hospitalization for cerebrovascular accident [P = .001] and malignancy [P = .004]. Additional burdens were 1.8, 3.3, and 11.4 times as high as the rehospitalization burden for the length of hospital stay, hospitalization costs, and mortality rate, respectively. Age and some special causes of hospitalizations are risk factors of ICU admission of kidney transplant recipients, and this occurs in about 5% of rehospitalizations. Admission to ICU adds considerably to the burden of rehospitalizations, warranting measures to prevent conditions that lead to the need for intensive care in these patients

[Prehospital emergency service for internal medicine problems in pediatrics; causes, time indices and outcomes]

Although pediatric pre-hospital emergency medical services [EMS] are a main challenge of health care systems, few data exists over it. Current study of ambulance calls for medical causes relating to children in Tehran was conducted with the following aims: 1] assessment of the frequency of causes of EMS call, 2] assessment of time indices of service providing by EMS, and 3] to assess the correlation between outcomes and time indices. In this retrospective study, all calls to Tehran EMS system [Dial 115] for medical causes of children=<15 years old in Tehran between December 2005 and May 2006 were extracted. Demographic variables, accident type, patient outcome before hospital arrival, and ambulance time indices [response time, scene time, total run time, total run time hospital, transport time, round trip time] were registered. 1052 [15.5%] calls were for children. From these, 717 [68%] were due to problems of medic problems. The most frequent problem was epilepsy [26.8%], unconsciousness [18.1%] and respiratory disorders [15.2%]. 12 [5. 6%] subjects died before ambulance arrival, but no one died between scene and hospital arrival. Mean [SD] delay time, response time and scene time were 3.8 +/- 1.8, 15.1 +/- 6.9, and 23.5 +/- 10.9, respectively. The pre-hospital mortality was not correlated with any of the time intervals. One of six ambulance calls in Tehran is related to pediatric patients, most of them with a medical cause. Epilepsy, unconsciousness and respiratory disorders as the most frequent causes for EMS calls for medical problems highlights the need for planning for training of the EMS personnel with these problems. There is still a need for further improvement in time intervals of EMS services, which may be possible by proper management and equipping by more ambulances