ABSTRACT
Background: Gall stone disease remains one of the most common medical problem leading to surgical intervention. Cholecystitis accounts for 3-10% of abdominal pain worldwide. Acute cholecystitis is the most common complication of cholelithiasis accounting for 14 to 30% of cholecystectomies performed in many countries. Symptoms in cholecystitis are due to impaction of stone and subsequent distention of gallbladder with inflammation. Study is aimed to clarify the role of ultrasound guided transhepatic gallbladder aspiration in the early management of acute calculous cholecystitis.Methods: The study was conducted in total of 40 patients presenting with acute cholecystitis. 20 patients underwent ultrasound guided transhepatic aspiration of gallbladder with antibiotics (group A) and 20 patients were given antibiotics only (group B). Data were collected before intervention and post intervention duration of stay, pain according to visual analog scale, leucocytosis and fever were recorded for analysis. No complications were related to aspiration procedure.Results: Both groups were comparable. Group A patients had better pain relief (p=0.0001 day on 2 and p=0.004 on day 3 post aspiration), percentage reduction of leucocyte count (p=0.041 on day 3) and duration of hospital stay (p=0.004) which were statistically significant.Conclusions: Ultrasound guided transhepatic aspiration of gall bladder with antibiotics in acute cholecystitis results in better pain profile, faster reduction in leucocyte count and shorter duration of hospital stay when compared to antibiotics alone.
ABSTRACT
Background: Psychiatric patients who are admitted in to forensic psychiatric ward have frequent hospital admissions and prolonged length of hospital stay, may be due to the growing demands in health services and the limitation of resources of patients and their care takers. Aim and objectives: To study the mean duration of stay in psychiatric forensic wards and to study the socio demographic factors of the admitted patients and their clinical profile. Materials and methods: A total of 150 case records fulfilling criteria for study were taken. Semi - structured proforma for socio demographic and clinical variables were used and analyzed using SPSS. Results: Mean duration of hospital stay in closed ward patients was 92.47 and the mean duration of hospital stay was 21.9 days in patients whose reception order had a clear mention of free citizen and can be handed over to family members in comparison 38.9 days in “To be produced before the court”, 33.71 days in reception order having “Yet to be clarified”. Conclusion: Socio-demographic factors like educational level, clinical diagnosis, details of the reception order regarding discharge status, residential status after discharge are significant factors which influenced the duration of hospital stay in forensic ward patients. We also noticed that certain phrasings of the reception order have much significantly influenced the delay in the discharge.
ABSTRACT
Objetivo: Identificar o perfil de pacientes idosos em assistência ambulatorial no Núcleo de Atenção ao Idoso e as variáveis que interferem no tempo de permanência no serviço. Métodos: Realizou-se pesquisa quantitativa, descritiva, de corte transversal, baseada na análise de 1.194 prontuários médicos de pacientes atendidos no período de 2000 a 2004. As variáveis foram: dados sociodemográficos, registros da avaliação médica e tempo de permanência do idoso no ambulatório. Para análise da relação entre variáveis clínicas e tempo de permanência, utilizou-se o modelo de regressão logística. Resultados: Em todas as faixas etárias, as mulheres (76,5%) foram mais numerosas que os homens (23,5%). Quanto à escolaridade, 12,9% eram iletrados e a categoria mais prevalente tinha primeiro grau incompleto (37,1%). O número de idosas viúvas (38%) foi três vezes maior que o de viúvos (12%). A maioria dos idosos (94,4%) tinha companhia de moradia e 84,4% não tinham plano de saúde. A média do tempo de permanência do idoso no serviço foi 2 anos e 8 meses, com desvio padrão de 1,5 ano. As variáveis que mais influenciaram o tempo de permanência foram: idade, queixa de tontura, distúrbios refracionais, auditivos, urinários, catarata, fraturas ósseas e antecedentes cirúrgicos. Conclusões: Por regressão logística, identificou-se que antecedentes cirúrgicos, distúrbios auditivos, urinários e fraturas ósseas atuaram aumentando o tempo de permanência, mas queixa de tontura, distúrbios refracionais e catarata reduziram a permanência do idoso no serviço.
Objective: To identify the profile of aged outpatients attended at the Núcleo de Atenção ao Idoso and the variables that interfere on duration of stay in theservice. Methods: A quantitative, descriptive, cross-sectional research was carried through, based on the analysis of 1,194 medical reports of aged outpatients attended from 2000 up to 2004. The variables were: sociodemographicdata, clinical registers in medical evaluation and duration ofstay of the aged outpatients at the clinic. A logistic regression was performed to analyze the relation between clinical variables and time of stay. Results: Women (76.5%) were more numerous than men (23.5%), in all age intervals. According to scholarship, 12.9% were illiterate and the most prevalent category (37.1%) had incomplete first degree. The number of aged widower women (38%) was three times those of widower men (12%). The majority of aged (94.4%) had a company of housing and 84.4% did not have health plan. The mean duration of stay in the service was 2 years and 8 months, with standard deviation of 1.5 years. The variables with major influence on duration of stay were: age, dizziness complaints, refractive, hearing and urinary disturbances, cataract, and bone fractures. Conclusions: According tothe logistic regression, surgical history, hearing and urinary disturbances, aswell as bone fractures contributed to increase duration of stay, but dizzinesscomplaints, refractive disturbances and cataract reduced the stay of theelderly in the service.
ABSTRACT
OBJECTIVES: The purpose of the study is to investigate the factors affecting adequate provision of mental health care services to the psychiatric patients in mental hospitals and to suggest the introduction of a new reimbursement schedule for treatment of chronic Medicaid patients in order to avoid long-term hospitalization and to meet rising cost. METHOD: Five hundred and seventy-five psychiatric patients chosen by the stratified random sampling in six hospitals in Korea; three mental hospitals and three general hospitals, have been classified into three groups: two groups were selected from mental hospitals with the national health insurance system and Medicaid, while only one group from general hospitals with the national health insurance system. They were investigated about mental health care services provided for one week, which are transformed into financial cost by using Korean Resource Based Relative Value Scale points. The severity of their psychiatric symptoms were assessed with RAI-MH(Resident Assessment Instrument-Mental Health). RESULTS: When the Medicaid was compared to the health insurance in mental hospitals, sixty-seven percent was the relative ratio. Mental hospitals compared to general hospitals under health insurance, it was only 31%. The longer the hospitalization, the lesser services they received in all three groups. CONCLUSION: The significant factors affecting supply of mental health care services in Korean mental hospitals were duration of hospitalization, type of hospital, type of reimbursement. The introduction of Medicaid system, differentiated by duration of stay, may induce short-term hospitalization and prohibit deficient service care, especially in acute patients under Medicaid system.