ABSTRACT
Abstract Introduction: The standard management of orbital cellulitis is to administer a combination of intravenous broad-spectrum antibiotics along with treatment of associated sinusitis. Objective: The purpose of this study was to evaluate whether the addition of corticosteroids could lead to earlier resolution of inflammation and improve disease outcome. Methods: We independently searched five databases (PubMed, SCOPUS, Embase, the Web of Science, and the Cochrane database) for studies published as recent as December 2019. Of the included studies, we reviewed orbital cellulitis and disease morbidity through lengths of hospitalization, incidence of surgical drainage, periorbital edema, vision, levels or C-reactive protein, and serum WBC levels in order to focus on comparing steroid with antibiotics treated group and only antibiotics treated group. Results: Lengths of hospitalization after admission as diagnosed as orbital cellulitis (SMD = −4.02 [−7.93; −0.12], p -value = 0.04, I2 = 96.9%) decrease in steroid with antibiotics treated group compared to antibiotics only treated group. Incidence of surgical drainage (OR = 0.78 [0.27; 2.23], p -value = 0.64,I2 = 0.0%) was lower in the steroid with antibiotics treated group compared to the antibiotics only treated group. Conclusion: Use of systemic steroids as an adjunct to systemic antibiotic therapy for orbital cellulitis may decrease orbital inflammation with a low risk of exacerbating infection. Based on our analysis, we concluded that early use of steroids for a short period can help shorten hospitalization days and prevent inflammation progression.
Resumo Introdução: O tratamento padrão da celulite orbitária inicia-se com uma combinação de antibióticos intravenosos de amplo espectro concomitante ao tratamento do seio comprometido. Objetivos: O objetivo deste estudo foi avaliar se a adição de corticosteroides poderia levar a uma resolução mais precoce da inflamação e melhorar o desfecho da doença. Método: Fizemos uma pesquisa independente em cinco bancos de dados (PubMed, SCOPUS, Embase, Web of Science e o banco de dados Cochrane) em busca de estudos publicados até dezembro de 2019. Dos estudos incluídos, revisamos a celulite orbitária e a morbidade da doença através dos períodos de internação, incidência de drenagem cirúrgica, edema periorbital, visão, níveis de proteína C-reativa e níveis séricos de leucócitos com foco na comparação do grupo tratado com esteroides e antibióticos e do grupo tratado apenas com antibióticos. Resultados: Os tempos de internação após a admissão dos diagnosticados com celulite orbitária (SMD = -4,02 [-7,93; -0,12], p-valor = 0,04, I2 = 96,9%) diminuíram no grupo tratado com esteroides e antibióticos em comparação ao grupo tratado apenas com antibióticos. A incidência de drenagem cirúrgica (OR = 0,78 [0,27; 2,23], p-valor = 0,64, I2 =0,0%) foi menor no grupo tratado com esteroides e antibióticos em comparação com o grupo tratado apenas com antibióticos. Conclusão: O uso de esteroides sistêmicos como adjuvante da antibioticoterapia sistêmica para celulite orbitária pode diminuir a inflamação orbitária com baixo risco de agravar a infecção. Com base em nossa análise, concluímos que o uso precoce de esteroides por um curto período pode ajudar a encurtar os dias de internação e prevenir a progressão da inflamação.
Subject(s)
Humans , Orbital Diseases/complications , Orbital Diseases/drug therapy , Orbital Cellulitis/diagnosis , Orbital Cellulitis/etiology , Orbital Cellulitis/drug therapy , Steroids , Cellulitis/complications , Cellulitis/drug therapy , Retrospective Studies , Adrenal Cortex Hormones/therapeutic use , Inflammation , Anti-Bacterial Agents/therapeutic useABSTRACT
Resumen Las estancias de hospitalización prolongadas en las áreas de cuidado primario pediatricos implican una afectación física, psicologica y familiar para los niños y niñas que las experimentan, puesto que acarrean cambios en sus dinamicas familiares, sociales y personales. El objetivo de esta investigación fue reconocer las experiencias con base en las necesidades secundarias relacionadas con el desarrollo de la autonomía de niños, niñas y adolescentes con estancias hospitalarias en el área de cuidados primarios pediátricos del Hospital Departamental de Villavicencio (HDV). Se desarrolló a través de una metodología cualitativa con entrevistas a profundidad a un grupo de 60 niños, niñas y adolescentes entre los 5 y 14 años, las cuales fueron codificadas a través de matrices de análisis. El principal resultado fue reconocer los diferentes tipos de interpretaciones y prácticas que los participantes construyen para comprender su dignostico y experiencias dentro del contexto hospitalario. Como conclusión, se estableció la importancia de la autonomía como una necesidad primaria a satisfacer en los contextos hospitalarios, en términos de socialización, juego y tiempo libre, como una forma de garantizar la adherencia al tratamiento y procesos de resiliencia y adaptación.
Abstract Prolonged hospital stays in pediatric primary care areas imply a physical, psychological and family affectation for the children who experience them, since they entail changes in their family, social and personal dynamics. The objective of this research was to recognize the experiences based on the secondary needs related to the development of the autonomy of children and adolescents with hospital stays in the primary pediatric care area of the Departmental Hospital of Villavicencio (HDV, for its initials in Spanish). It was developed through a qualitative methodology with in-depth interviews to a group of 60 children and adolescents between 5 and 14 years old, which were codified through analysis matrices. The main result was to recognize the different types of interpretations and practices that the participants construct to understand their dignity and experiences within the hospital context. As a conclusion, the importance of autonomy was established as a primary need to be satisfied in hospital contexts, in terms of socialization, play and free time, as a way to ensure adherence to treatment and processes of resilience and adaptation.
ABSTRACT
BACKGROUND: Exacerbations of Chronic Obstructive Pulmonary Disease (ECOPD) are a major problem worldwide and usually a leading cause for hospitalizations and in some cases, indication for invasive mechanical ventilation (IMV). OBJECTIVE: The aim of this study was to determine the length of stay in hospital and outcome of ECOPD patients. We compared the length of hospital stay in the medical ward, intensive care unit (ICU) departments and discharges during a period of six months. METHODS: This was an observational, longitudinal prospective study of 242 COPD patients that were admitted with COPD exacerbation. In each patient, acute physiology and chronic health evaluation (APACHE) II score and serial arterial blood gases (ABG) were measured upon and during admission. RESULTS: Eighty per cent (194) of242 COPD patients were admitted to the medical department and most of them were discharged within five days. Forty-eight needed IMV and stayed in hospital more than ten days; overall mortality rate was about 5%. CONCLUSION: Most of the hospitalized patients with COPD exacerbation (60%) were discharged within five days, 20% needed IMV and stayed in hospital more than ten days.
ANTECEDENTES: Las exacerbaciones de la enfermedad pulmonar obstructiva crónica (EPOC) representan un problema grave en todo el mundo, constituyen generalmente una de las causas principales de las hospitalizaciones, y son en algunos casos la indicación de que se requiere ventilación mecánica invasiva (VMI). OBJETIVO: El objetivo de este estudio fue determinar la duración de la estancia en el hospital y el resultado de los pacientes de EPOC. Comparamos la duración de la estancia hospitalaria en la sala médica, las unidades de cuidados intensivos (UCI), y las altas producidas en un período de seis meses. MÉTODOS: Se trata de un estudio prospectivo, observacional, y longitudinal de 242 pacientes con EPOC que fueron ingresados con exacerbación de la EPOC. A cada paciente se le hicieron mediciones mediante la puntuación de la escala de Evaluación de la fisiología aguda y salud crónica (APACHE II) y la gasometría arterial seriada, tanto al momento de ingresar como durante el ingreso. RESULTADOS: El ochenta por ciento (194) de los pacientes 242 pacientes con EPOC, fueron ingresados en el departamento médico, y la mayoría de ellos fueron dados de alta en cinco días. Cuarenta y ocho necesitaron VMI, y permanecieron en el hospital más de diez días. La tasa de mortalidad general fue alrededor del 5%. CONCLUSIÓN: La mayoría de los pacientes hospitalizados con exacerbación de la EPOC (60%) fueron dados de alta dentro de cinco días. El 20% necesitó VMI, y se permaneció en el hospital más de diez días.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Patients' Rooms/statistics & numerical data , Pulmonary Disease, Chronic Obstructive/rehabilitation , Intensive Care Units/statistics & numerical data , Length of Stay/statistics & numerical data , Patient Discharge/statistics & numerical data , Respiration, Artificial , Prospective Studies , Pulmonary Disease, Chronic Obstructive/therapyABSTRACT
This study aims to describe the causes of medically unnecessary hospital stay at a teaching tertiary hospital, using modified version of Delay Tool in which the causes of delay are divided into six major categories ; delay related to test scheduling, test results, surgery, medical staff, patient/family, and administration. For the analysis of hospital stay, 6,479 inpatient-days were reviewed in two medical and four surgical departments for one month. Initially inappropriate hospital stays were identified using Appropriateness Evaluation Protocol(AEP), and causes of delay listed in Delay Tool were assigned to each of them. In both medical and surgical services, the most important cause of delay was related to medical staffs, ranging from 3.6% to 51.6% of total inpatient days. Next important category was delay related to test scheduling in medical services(4.7~9.2%), and delay related to surgery in surgical services(7.3~15.0%). Among subcategories of delay related to medical staffs, delay due to conservative care was the most important cause of inappropriate hospital stay(2.9~46.4%). Each clinical departments had different distribution among delay categories, which could not be fully justified by their clinical characteristics. The Delay Tool would be helpful in exploring factors related to the inefficient use of hospital beds. As a measurement tool of inappropriate hospital stay, however, the Delay Tool should be refined in the definitions of categories and its contents.