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Pediatric status epilepticus: A perspective from Saudi Arabia

PEDIATRIC NEUROLOGY 1999年第5期20卷 364-369页

作者： Mah, JK Mah, AW King Khalid Natl Guard Hosp Dept Pediat Jeddah Saudi Arabia King Khalid Natl Guard Hosp Dept Med Jeddah Saudi Arabia

The purpose of this study was to assess risk factors and management of status epilepticus and non-status epilepticus seizures at a community hospital in Saudi Arabia, The research design was a prevalence study of a convenience sample of pediatric seizure episodes admitted to a 350-bed hospital from 1992 to 1997, The mean age at presentation was 2 years, 10 months, 43% of patients had no history of seizures, and 17% were transferred from other hospitals. Fifty-nine (28%) of 212 seizure episodes were status epilepticus (SE), These SE episodes were significantly more likely than non-SE episodes to be associated with a history of seizures, prior antiepileptic drug (AED) therapy, the presence of an acute etiology, and prolonged duration of seizures before hospitalization. SE episodes were also significantly more likely than non-SE episodes to receive an inappropriate AED, to require intensive care unit admission, to suffer morbidity, and to have SE recurrence at follow-up;however, the difference In mortality was not significant. In conclusion, children with SE were more likely than those with non-SE seizures to have a history of seizures and acute brain insults, prolonged seizure duration before hospitalization, and less optimal management and outcomes. Management of SE in this referral population can be improved by more rapid access to appropriate medical care. (C) 1999 by Elsevier Science Inc, All rights reserved.

关键词：方差分析抗惊厥药/治疗应用疾病恶化发热/并发症医院社区/统计学和数值数据回顾性研究危险因素沙特阿拉伯/流行病学发作/分类发作/流行病学发作/病因学统计数据癫痫持续状态/诊断癫痫持续状态/流行病学癫痫持续状态/病因学癫痫持续状态/治疗青少年儿童儿童学龄前女(雌)性人类婴儿婴儿新生男(雄)性

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The role of physical proximity in nosocomial diarrhea

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CLINICAL INFECTIOUS DISEASES 2000年第3期31卷 717-722页

作者： Chang, VT Nelson, K Univ Med & Dent New Jersey New Jersey Med Sch Sect Hematol Oncol 111Dept Med Vet Affairs New Jersey Hlth Care Syst E Orange E Orange NJ 07019 USA Good Samaritan Hosp Dept Med Baltimore MD USA Johns Hopkins Med Inst Sch Hyg & Publ Hlth Dept Epidemiol Baltimore MD 21205 USA

To examine physical proximity as a risk factor for the nosocomial acquisition of Clostridium difficile-associated diarrhea (CDAD) and of antibiotic-associated diarrhea (AAD), we assessed a retrospective cohort of 2859 patients admitted to a community hospital from 1 March 1987 through 31 August 1987. Of these patients, 68 had nosocomial CDAD and 54 had nosocomial AAD, In multivariate analysis, physical proximity to a patient with CDAD (relative risk [RR], 1.86;95% confidence interval [CI], 1.06-3.28), exposure to clindamycin (RR, 4.22;95% CI, 2.11-8.45), and the number of antibiotics taken (RR, 1.49;95% CI, 1.23-1.81) were significant. For patients with nosocomial AAD, exposure to a roommate with AAD (RR, 3.94;95% CI, 1.27-12.24), a stay in an intensive care unit or cardiac care unit(RR, 1.93;95% CI, 1.05-3.53), and the number of antibiotics taken OCR, 2.01;95% CI, 1.67-2.40) were significant risk factors. Physical proximity may be an independent risk factor for acquisition of nosocomial CDAD and AAD,

关键词：梭菌感染/微生物学梭菌难辨队列研究交叉感染/微生物学腹泻/化学诱导腹泻/微生物学环境暴露医院社区/统计学和数值数据多元分析回顾性研究危险因素成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Effects of hospitalists on cost, outcomes, and patient satisfaction in a rural health system

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AMERICAN JOURNAL OF MEDICINE 2000年第8期108卷 621-626页

作者： Davis, KM Koch, KE Harvey, JK Wilson, R Englert, J Gerard, PD N Mississippi Hlth Serv Tupelo MS 38801 USA Mississippi State Univ Expt Stat Unit Starkville MS USA

PURPOSE: Previous studies have examined the effects of hospitalists in urban academic hospitals. We compared the outcomes of patients treated by hospitalists with those of patients treated by internists at a 647-bed rural community hospital. SUBJECTS AND METHODS: The 443 patients in the hospitalists' 10 most common diagnosis-related groups (DRGs) were compared with 1,681 patients in the same DRGs who were cared for by internists in fiscal year 1998. Length of stay, cost of care, patient illness severity, patient satisfaction, 30-day readmission rate, inpatient mortality, discharge status, and resource utilization were compared. RESULTS: The hospitalists' patients had a shorter mean (+/- SD) length of stay (4.1 +/- 3.0 days versus 5.5 +/- 4.9 days, P <0.001) and their cost of care was less than that of the internists' patients ($4,098 +/- $2,455 versus $4,658 +/- $4,084, P <0.001). Analyses that adjusted for patient age, race, sex, insurance status, severity of illness, and specific medical comorbidities confirmed these differences. The differences between hospitalists and internists were most apparent among very ill patients. Mortality rates were similar (4.5% for hospitalists versus 4.9% for internists, P = 0.80), as were the readmission rates (4.5% for hospitalists versus 5.6% for internists, P = 0.41). Patient satisfaction was similar for both groups. The internists used more resources in 8 of 11 categories. CONCLUSIONS:The hospitalists provided cost-effective care, particularly for the sickest patients, with good outcomes and patient satisfaction. (C) 2000 by Excerpta Medica, Inc.

关键词：卫生资源/利用医院费用/统计学和数值数据卫生设施管理人员/经济学卫生设施管理人员/统计学和数值数据医院社区/经济学医院社区/统计学和数值数据内科学/经济学内科学/统计学和数值数据住院时间密西西比结果评价(卫生保健) 病人满意度/统计学和数值数据乡村卫生服务/经济学乡村卫生服务/统计学和数值数据疾病严重程度指数人类

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Clostridial bacteremia in the community hospital

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SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 2000年第1期32卷 27-30页

作者： Haddy, RI Nadkarni, DD Mann, BL Little, DR Domers, TD Clover, RD Silvers, MJ Univ Louisville Sch Med Dept Family & Community Med Louisville KY 40292 USA Wright State Univ Sch Med Dept Family Med Dayton OH USA Univ Florida Coll Med Dept Community Hlth & Family Med Gainesville FL USA

Anaerobic infections are not commonly studied in the community hospital. The aim of this study was to determine demographic factors, the portals of entry and underlying disorders for clostridial bacteremia and to determine whether appropriate (recommended) treatment is effective, Medical records mere reviewed for 42 patients with clostridial bacteremia at 1 Florida, USA, hospital and 4 Dayton, Ohio, USA, hospitals. Fourteen (33.3%) of the patients had clostridial micro-organisms that were isolated in cultures with polymicrobial isolates, Only about half of the patients had fever at the onset of their bacteremia and only slightly more than half had elevated leukocyte counts. The most common portals of entry for the micro-organisms were gastrointestinal (42.9%), unknown (35.7%) and skin (16.7%), The most common underlying disorders were advanced malignancy (31.0%), diabetes mellitus (14.3%), none determined (12.0%) and acute cholecystitis (9.5%). The mortality rate was 23.8%. Timely appropriate treatment was started in only about half of the instances, Appropriate (recommended) treatment did not significantly affect survival (p = 0.469). Clostridial infections and bacteremia exist in the community hospital most commonly in severely ill patients. The fact that clostridia are commonly cultured in blood cultures positive for other bacterial pathogens and that appropriate treatment for clostridia did not affect patient survival, call into question the significance and pathogenicity of clostridial organisms. On the other hand, if clostridial bacteremia was not considered in half these patients with bacteremia, it is possible that more indolent clostridial infections are being overlooked.

关键词：急性病抗菌药/治疗应用菌血症/流行病学菌血症/微生物学菌血症/治疗胆囊炎/并发症梭菌属/分离和提纯梭菌感染/流行病学梭菌感染/微生物学梭菌感染/治疗糖尿病并发症消化系统医院社区/统计学和数值数据纵向研究多中心研究(主题) 肿瘤/并发症皮肤存活率治疗结果美国/流行病学青少年成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Primary angioplasty for the treatment of acute myocardial infarction: Experience at two community hospitals without cardiac surgery

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 1999年第5期33卷 1257-1265页

作者： Wharton, TP McNamara, NS Fedele, FA Jacobs, MI Gladstone, AR Funk, EJ Exeter Hosp Div Cardiol Exeter NH 03833 USA Portsmouth Reg Hosp Div Cardiol Portsmouth Hants England

OBJECTIVES We sought to establish the safely and efficacy of primary percutaneous transluminal coronary angioplasty in patients with acute myocardial infarction (AMI) at two community hospitals without on-site cardiac surgery. BACKGROUND Though randomized studies indicate that primary angioplasty in AMI may result in superior outcomes compared with fibrinolytic therapy, the performance of primary angioplasty at hospitals without cardiac surgery is debated. METHODS Three experienced operators performed 506 consecutive immediate coronary angiograms with primary angioplasty when appropriate in patients with suspected AMI at two community hospitals without cardiac surgery, following established rigorous program criteria. RESULTS Clinical high risk predictors (Killip class 3 or ii, age greater than or equal to 75 years, anterior AMI, out-of-hospital ventricular fibrillation) and/or angiographic high risk predictors (left main or three-vessel disease or ejection fraction <45%) were present in 69.6%. Angioplasty was performed in 66.2%, with a median time from emergency department presentation to first angiogram of 94 min and a procedural success rate of 94.3%. The in-hospital mortality for the entire study population was 5.3%. Of those without initial cardiogenic shock, the in-hospital mortality;was 3.0%. Of 300 patients who were discharged after primary angioplasty, only four died within the first 6 months, with 97.7% follow-up. No patient died or needed emergent aortocoronary bypass surgery because of new myocardial jeopardy caused by a complication of the cardiac catheterization or angioplasty procedure. CONCLUSIONS Immediate coronary angiography with primary angioplasty when appropriate in patients with AMI can be performed safely and effectively in community hospitals without on-site cardiac surgery when rigorous program criteria are established. (C) 1999 by the American College of Cardiology.

关键词：血管成形术气囊冠状动脉/死亡率心脏外科手术冠状血管造影术心电描记术随访研究医院社区/统计学和数值数据心肌梗死/血液心肌梗死/诊断显像心肌梗死/治疗预后回顾性研究安全存活率治疗失败老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Characterization and clinical course of patients not receiving aspirin for acute myocardial infarction:: Results from the MITRA and MIR studies

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AMERICAN HEART JOURNAL 2001年第2期141卷 200-205页

作者： Frilling, B Schiele, R Gitt, AK Zahn, R Schneider, S Glunz, HG Gieseler, U Baumgärtel, B Asbeck, F Senges, J Herzzentrum Ludwigshafen Dept Cardiol D-67063 Ludwigshafen Germany Westpfalzklinikum Kaiserslautern Germany Kreiskrankenhaus Freital Freital Germany Stadt Krankenhaus Kiel Kiel Germany

Background Clinical trials have shown the efficacy of aspirin for acute myocardial infarction (AMI). However, not all patients receive aspirin for AMI. The aim of this study was to provide information on characteristics and clinical course of patients not treated with aspirin for AMI. Methods We analyzed the data of the Myocardial Infarction Registry (MIR) and the Maximal individual Therapy of Acute Myocardial Infarction (MITRA) registry. MITRA and MIR were prospective multicenter registries of patients with ST segment elevation myocardial infarction in Germany. Results of 22,572 patients registered from 1994 to 1998, 1767 (7.8%) did not receive aspirin within the First 48 hours after admission. Multivariate analysis revealed two main factors associated with withholding aspirin for AMI: relative contraindications to aspirin (gastric ulcer [odds ratio (OR) 4.9, 95% confidence interval (CI) 3.7-5.7], renal insufficiency [OR 1.4, 95% CI 1.1-1.8]), and critical clinical state at admission (cardiogenic shock EOR 1.5, 95% CI 1.2-2.1] and prehospital resuscitation [OR 1.8, 95% CI 1.4-2.2]). In addition, these patients were significantly less likely to receive reperfusion therapy and adjunctive medical therapy such as beta -blockers and angiotensin-converting enzyme inhibitors. In-hospital mortality after adjustment for baseline characteristics was 27.2% in patients without aspirin compared with 11.1% in patients treated with aspirin. Conclusions only a minority of AMI patients (7.8%) did not receive aspirin. Relative contraindications to aspirin and a critical clinical state at admission were the main factors associated with withholding aspirin for AMI. Even after adjustment for patient characteristics, the mortality of patients without aspirin was almost three times higher.

关键词：阿司匹林/治疗应用德国/流行病学住院/统计学和数值数据医院社区/统计学和数值数据心肌梗死/药物疗法心肌梗死/流行病学血小板聚集抑制剂/治疗应用前瞻性研究登记/统计学和数值数据存活率老年人女(雌)性人类男(雄)性

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Risk factors for acquisition of vancomycin-resistant enterococci among patients on a renal ward during a community hospital outbreak

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AMERICAN JOURNAL OF INFECTION CONTROL 2000年第4期28卷 282-285页

作者： Beltrami, EL Singer, DA Fish, L Manning, B Young, S Banerjee, SN Baker, R Jarvis, WR Ctr Dis Control Hosp Infect Program Natl Ctr Infect Dis Atlanta GA 30333 USA Community Hosp E Indianapolis IN USA

Background: During an outbreak of vancomycin-resistant enterococcal (VRE) infection and colonization at a community hospital in Indianapolis, Indiana, we performed a case-control study of patients on the hospital's renal unit to determine risk factors for acquisition of VRE among this potentially high-risk patient population. Methods: Twenty-four renal patients with VRE colonization/infection (ie, case-patients) were compared by univariate and multivariate analyses with 29 renal patients with nosocomially acquired vancomycin-susceptible enterococcal infection and colonization (ie, controls). Results: Age and length of hospitalization were similar between the VRE case-patients and the vancomycin-susceptible enterococcal control-patients, but case-patients had higher Acute Physiology and Chronic Health Evaluation II scores and received significantly greater numbers of antimicrobials and significantly more days of antimicrobials during the 60 days preceding the first positive enterococcal culture. In an assessment of the appropriateness of vancomycin use, one third of vancomycin orders were found to be inappropriate in both patient groups. Conclusions: Our data show that among renal patients, those who are severely ill and receive multiple and prolonged courses of antimicrobials are at greatest risk for acquiring VRE infection or colonization. The Centers for Disease Control and Prevention recommends that hospitals develop a comprehensive plan to prevent and control infection and colonization of patients with VRE. This plan should include prompt identification of affected patients, initiation of isolation precautions to prevent patient-to-patient transmission of VRE, and prudent use of antimicrobials, including vancomycin.

关键词：急性病生理学和长期健康评价方差分析病例对照研究交叉感染/流行病学交叉感染/微生物学交叉感染/预防和控制肠球菌属/药物作用肠球菌属/分离和提纯医院社区/统计学和数值数据印第安纳/流行病学危险因素泌尿科医院/统计学和数值数据万古霉素抗药性成年人老年人人类中年人

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The use of general practitioner elderly beds in community hospitals

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AGE AND AGEING 1998年第6期27卷 753-753页

作者： Rhodes, KM Qureshi, AS Foulkes, H Orpington Hosp Acad Dept Med Elderly Orpington BR6 9JU Kent England James Paget Hosp Dept Med Great Yarmouth England

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