ABSTRACT
OBJECTIVE: To develop and assess Pediatric Appropriateness Evaluation Protocol for India (PAEP-India) for inter-rater reliability and appropriateness of hospitalization. DESIGN: Cross-sectional study. SETTING: The available PAEP tools were reviewed and adapted for Indian context by ten experienced pediatricians following semi-Delphi process. Two PAEP-India tools; newborn (≤28 days) and children (>28 days-18 years) were developed. These PAEP-India tools were applied to cases to assess appropriateness of admission and inter-rater reliability between assessors. PARTICIPANTS: Two sets of case records were used: (i) 274 cases from five medical colleges in Delhi-NCR [≤28 days (n=51); >28 days to 18 years (n=223)]; (ii) 622 infants who were hospitalized in 146 health facilities and were part of a cohort (n= 30688) from two southern Indian states. INTERVENTIONS: Each case-record was evaluated by two pediatricians in a blinded manner using the appropriate PAEP-India tools, and 'admission criteria' were categorized as appropriate, inappropriate or indeterminate. OUTCOME MEASURES: The proportion of appropriate hospitalizations and inter-rater reliability between assessors (using kappa statistic) were estimated for the cases. RESULTS: 97.8% hospitalized cases from medical colleges were labelled as appropriate by both reviewers with inter-rater agreement of 98.9% (k=0.66). In the southerm Indian set of infants, both reviewers labelled 80.5% admissions as appropriate with inter-rater agreement of 96.1% (k= 0.89). CONCLUSIONS: PAEP-India (newborn and child) tools are simple, objective and applicable in diverse settings and highly reliable. These tools can potentially be used for deciding admission appropriateness and hospital stay and may be evaluated later for usefulness for cost reimbursements for insurance proposes.
Subject(s)
Clinical Decision-Making/methods , Guideline Adherence/statistics & numerical data , Hospitalization/statistics & numerical data , Adolescent , Child , Child, Preschool , Clinical Protocols , Cross-Sectional Studies , Female , Humans , India , Infant , Infant, Newborn , Male , Observer Variation , Pilot Projects , Practice Guidelines as Topic , Single-Blind MethodSubject(s)
Anemia, Iron-Deficiency , Ferritins , Anemia , Child , Hemoglobins , Humans , Infant , Iron DeficienciesABSTRACT
A hundred and six clinically diagnosed cases of epidemic dropsy, admitted in June to August 1998 to the P-III unit of RML Hospital and the Department of Pediatrics, Safdarjang Hospital, were studied. All of them consumed mustard oil contaminated with Argemona mexicana, confirmed by ferric chloride and nitric acid tests. No specific sex predilection was seen. No child was affected below the age of 3 years. Pedal edema and reddish hyperpigmentation were the most consistent findings (100 per cent). Frank cardiac failure was seen in only 24 (22.64 per cent), yet persistent tachycardia was alarmingly high (104/106, i.e. 98.4 per cent). Notably ECG showed prolonged Q-T interval in 24 children (22.64 per cent), unrelated to serum Ca2+ level in patients with congestive cardiac failure (CCF). Color Doppler echocardiography showed biventricular dilatation in all the 24 patients with CCF. Wide pulse pressure was recorded in two patients only. Mortality occurred in only two patients (1.89 per cent). Eye involvement was a late finding. All those who survived (i.e. 104/106) recovered completely, except two patients who were left with sarcoid-like changes of skin telangiectasia.
Subject(s)
Disease Outbreaks , Edema/epidemiology , Heart Diseases/epidemiology , Plant Oils/adverse effects , Edema/chemically induced , Female , Food Contamination , Heart Diseases/chemically induced , Humans , India/epidemiology , Male , Mustard Plant , Plant Extracts/adverse effectsABSTRACT
The association of hypoxemia and cardiac arrhythmias with fiberoptic bronchoscopy (FOB) is known. The effects of various methods of inserting the bronchoscope on blood oxygen tensions, the true prevalence of arrhythmias, and the clinical significance of PaO2 and rhythm changes are poorly defined. Arterial blood gas values, oxygen saturation and cardiac arrhythmias detected by 24-hour Holter monitoring were compared in 20 male patients undergoing either transoral or transnasal FOB. No significant difference in oxygen saturation was found; however, PaO2 values fluctuated widely and unpredictably and were significantly higher in the eight patients in the transnasal FOB group. No life-threatening arrhythmias were induced during bronchoscopy; however, because of minor arrhythmias such as sinus tachycardia, the overall frequency of arrhythmias rose from 60% to 65%. The incidence of arrhythmias in this study was similar to that reported during pulmonary function testing.
Subject(s)
Arrhythmias, Cardiac/etiology , Bronchoscopy/adverse effects , Hypoxia/etiology , Adult , Aged , Blood , Bronchoscopes , Fiber Optic Technology/instrumentation , Heart Ventricles/physiopathology , Humans , Hydrogen-Ion Concentration , Male , Middle Aged , Oxygen/blood , Partial PressureABSTRACT
The source of massive pleural effusion was not apparent in a 58-year-old man who had cirrhosis but no demonstrable ascites. Intraperitoneal injection of technetium Tc 99m sulfur colloid established the presence of peritoneopleural communication. This diagnostic technique can be helpful in evaluating patients with cirrhosis of the liver and pleural effusion with or without ascites.
