RESUMO
Effective discharge planning should serve to reduce length of stay (LOS) and lower readmission rates. A combined prospective/retrospective study was undertaken to assess the effectiveness of anticipated discharge order forms in decreasing LOS for staff pediatric patients. Resident physicians provided advance notice of the planned discharge date to nursing staff and patient family members. Patient selection was random, and the data were collected prospectively. These subjects were matched with patients for whom the order form was not used, and the data was collected retrospectively. Matching variables included: diagnosis, age, gender, race, and method of payment. There were 103 matched pairs. LOS was collapsed into low and high categories. There was a significant difference when comparing subject groups (chi 2 = 8.5; P = 0.005). Whereas only 14% of experimental patients were categorized as high LOS, 32% of control patients were classified as such. Physician prediction of discharge date helped decrease patient LOS.
Assuntos
Controle de Formulários e Registros , Departamentos Hospitalares/organização & administração , Tempo de Internação , Alta do Paciente , Adolescente , Criança , Pré-Escolar , Feminino , Departamentos Hospitalares/estatística & dados numéricos , Humanos , Lactente , Internato e Residência , Masculino , Pediatria , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Tempo , Estados UnidosRESUMO
One hundred and twenty eight children suffering from leukaemia were admitted to King Fahd Hospital of the University in the Eastern Province of Saudi Arabia during the period of January 1982-December 1992. Acute lymphoblastic leukaemia was the most common whilst chronic granulocytic leukaemia the least common among the studied group.
Assuntos
Leucemia , Adolescente , Distribuição por Idade , Criança , Pré-Escolar , Hospitais Universitários , Humanos , Incidência , Lactente , Recém-Nascido , Leucemia/classificação , Leucemia/epidemiologia , Leucemia/patologia , Arábia Saudita/epidemiologia , Distribuição por SexoRESUMO
Hemoglobinopathies are a major public health problem in Saudi Arabia. We studied the effect of splenectomy in 16 Saudi Arabian children with compound hemoglobinopathies. Seven patients no longer require regular blood transfusions, and transfusion requirements were decreased by 30 to 60% in the other eight patients. Three patients whose heights and weights were below the 5th percentile before splenectomy reached the 25th percentile 1 year after the surgery. In spite of preoperative pneumococcal vaccination and the penicillin prophylaxis after the surgery, one patient died of Haemophilus influenzae Group B bacteremia, and three others had six episodes of pneumonia.
Assuntos
Hemoglobinopatias/cirurgia , Esplenectomia , Anemia Falciforme/complicações , Anemia Falciforme/cirurgia , Criança , Suscetibilidade a Doenças , Hemoglobinopatias/complicações , Hemoglobinopatias/epidemiologia , Hemoglobinopatias/genética , Heterozigoto , Humanos , Lactente , Estudos Retrospectivos , Arábia Saudita/epidemiologia , Esplenectomia/efeitos adversos , Talassemia/complicações , Talassemia/cirurgia , Trombocitose/etiologiaRESUMO
Thirty-three children with leukemia who had neutropenia and fever were randomized to receive cefataxim and amikacin, versus the same antibiotics plus intravenous gammaglobulin (i.v. IgG). Duration of neutropenia, hospitalization and the interruption of chemotherapy were not different in the two groups; however, duration of fever was significantly shorter in the i.v. IgG group.
Assuntos
Agranulocitose/complicações , Amicacina/administração & dosagem , Cefotaxima/administração & dosagem , Febre/complicações , Imunoglobulina G/administração & dosagem , Leucemia Mieloide Aguda/complicações , Neutropenia/complicações , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações , Amicacina/uso terapêutico , Antineoplásicos/efeitos adversos , Cefotaxima/uso terapêutico , Criança , Quimioterapia Combinada/uso terapêutico , Febre/induzido quimicamente , Humanos , Imunoglobulina G/uso terapêutico , Imunoglobulinas Intravenosas , Controle de Infecções , Leucemia Mieloide Aguda/tratamento farmacológico , Neutropenia/induzido quimicamente , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológicoRESUMO
Serum immunoglobulin (IgG, IgA, IgM) and complement (C3, C4) levels were determined in 61 sickle cell anaemia patients of various age groups and both sexes in their steady state by nephelometry. Serum IgG was found to be consistently elevated in 46% cases of all age groups. Increase in the levels of IgA, IgM and in the complement values (C3, C4) was also observed. Although the mechanism responsible for these variations was unclear, however, this study gave an idea about the general pattern of serum immunoglobulin and complement levels in sickle cell anaemia patients from the Eastern Province of Saudi Arabia.
Assuntos
Anemia Falciforme/imunologia , Complemento C3/análise , Complemento C4/análise , Imunoglobulinas/análise , Adolescente , Adulto , Anemia Falciforme/sangue , Anemia Falciforme/complicações , Criança , Pré-Escolar , Feminino , Humanos , Hipergamaglobulinemia/etiologia , Lactente , Masculino , Pessoa de Meia-Idade , Arábia SauditaRESUMO
Thirty-four cases of inherited bleeding disorders are reported. All are Saudi patients from the Eastern Province of Saudi Arabia. There were 15 haemophiliacs, 1 factor VII deficiency, 1 factor X deficiency, 12 Glanzmann's thrombasthenia, and 5 unidentified platelet function disorders. Consanguinity was common among the families of these patients. Different age groups were affected and the severity of bleeding varied in the different conditions reported.
Assuntos
Transtornos da Coagulação Sanguínea/genética , Transtornos Plaquetários/genética , Difosfato de Adenosina , Adolescente , Adulto , Ácido Araquidônico , Ácidos Araquidônicos , Transtornos da Coagulação Sanguínea/epidemiologia , Transtornos Plaquetários/epidemiologia , Criança , Pré-Escolar , Colágeno , Consanguinidade , Epinefrina , Feminino , Humanos , Lactente , Masculino , Agregação Plaquetária/efeitos dos fármacos , Ristocetina , Arábia SauditaRESUMO
We describe two cases of sickle cell anemia who were admitted in the hospital with the complaint of backache. X-ray examination and bone scan revealed pathological fracture of vertebral column. These cases are of interest since sickle cell anemia in the Eastern part of Saudi Arabia is reported to run a relatively 'benign' course.
Assuntos
Anemia Falciforme/complicações , Fraturas Espontâneas/etiologia , Vértebras Lombares/lesões , Criança , Humanos , Masculino , Arábia SauditaRESUMO
A Saudi Arabian infant with severe factor X deficiency who had had two intracranial haemorrhages is described. Attempts to raise his factor X level and improve his prothrombin time (PT) and partial thromboplastin time (PTT) by using vitamin K, oestradiol and danazol have failed. New therapeutic trials are necessary for patients with severe forms of this rare disorder.
Assuntos
Hemorragia Cerebral/etiologia , Deficiência do Fator X/congênito , Hipoprotrombinemias/congênito , Transfusão de Sangue , Pré-Escolar , Danazol/uso terapêutico , Estradiol/uso terapêutico , Deficiência do Fator X/complicações , Deficiência do Fator X/terapia , Humanos , Masculino , Tempo de Tromboplastina Parcial , Tempo de Protrombina , Vitamina K/uso terapêuticoRESUMO
The cellular immunity of 49 children between the ages of five months and 17 years with acute lymphoblastic leukemia (ALL) in remission was studied in vitro by stimulating the lymphocyte cultures with phytohemagglutinin (PHA). The mitogenic responses of the lymphocytes were followed for seven days in short term tissue culture and the maximum peak days were correlated to the disease-free period. The patients who had the maximum mitogenic response on day five or later had a significantly better prognosis than patients who peaked on day four or earlier.
RESUMO
Twenty-five children with previously untreated stage IV non-Hodgkin's lymphoma (NHL) were studied. At the time of evaluation 16 patients were disease-free (64%), with a median observation time of 23 months. Intensive chemotherapy for childhood NHL provides a better outlook for these patients, including those who would be considered high-risk acute lymphoblastic leukemia (ALL).
Assuntos
Linfoma/patologia , Antineoplásicos/uso terapêutico , Medula Óssea/patologia , Criança , Pré-Escolar , Feminino , Humanos , Contagem de Leucócitos , Linfonodos/patologia , Linfoma/tratamento farmacológico , Linfoma/mortalidade , Masculino , PrognósticoAssuntos
Neoplasias/terapia , Adolescente , Neoplasias Encefálicas/terapia , Carcinoma Hepatocelular/terapia , Criança , Pré-Escolar , Neoplasias Oculares/terapia , Feminino , Humanos , Lactente , Neoplasias Renais/terapia , Neoplasias Hepáticas/terapia , Masculino , Meduloblastoma/terapia , Neoplasias/diagnóstico , Neoplasias/patologia , Neuroblastoma/terapia , Osteossarcoma/terapia , Neoplasias Ovarianas/terapia , Retinoblastoma/terapia , Rabdomiossarcoma/terapia , Sarcoma de Ewing/terapia , Neoplasias de Tecidos Moles/terapia , Neoplasias Testiculares/terapia , Tumor de Wilms/terapiaRESUMO
Six children with grade II astrocytomas were treated with combination chemotherapy consisting of 1,3 bis(2-chloroethyl) 1-nitrosourea (BCNU). Vincristine (VCR), intrathecal Methotrexate (i.t. MTX), and Dexamethasone. Of the children, 3 showed a partial remission, and 1 other showed clinical improvement. Our data suggest that chemotherapy is effective in low-grade astrocytomas, and there is now a need for larger trials in low-grade astrocytomas to document the role of chemotherapy accurately in these tumors. It is suggested that trials of chemotherapy as adjuvant to surgery and radiotherapy should be initiated.