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PubMedDate not supplied

Back transfer: capability of community hospitals to serve chronically ill and convalescing infants.

Severe crowding in neonatal intensive care facilities may prevent many critically ill newborn infants from receiving optimal care. Crowding could be alleviated by back transferring chronically ill or convalescing infants to intermediate-level community hospitals where community-based care can be delivered. The purpose of this study was to assess the ability of such hospitals in North Carolina to care for these children. A telephone survey was administered to all 35 intermediate-level community hospitals that had > or = 600 births per year. Hospital resources were assessed on the first call, and a 1-day census was taken for three successive months. Total daily nursery census was 288. Back-transferred infants (32) and infants whose stay exceeded 5 days (32) constituted 24% of the nursery population. Each hospital had a pediatric medical director and necessary equipment to care for back transfers, and 80% of the hospitals could accept a back-transferred infant who was in a neonatal incubator, tube fed, receiving oxygen, 1400 gm, with mild and infrequent apnea and bradycardia--a common clinical picture in such infants. The most severe limitation to accepting infants for back transfer was the shortage of nursing staff appropriately trained to care for this population. These data have implications for effective discharge planning and the development of appropriate community-based, service-delivery systems.

Chronic Disease↗
PubMed1996

Laparoscopic cholecystectomy in acute cholecystitis. What is the optimal timing for operation?

OBJECTIVE: To review the results of laparoscopic cholecystectomy (LC) in patients with acute cholecystitis with attention to cost and clinical outcome. DESIGN: Retrospective study. SETTING: Large private metropolitan teaching hospital. PATIENTS: Four hundred forty-six patients had LCs at our institution between January 1993 and February 1995. Acute cholecystitis, confirmed by clinical, laboratory, operative, and histopathological findings, was present in 60 patients. MAIN OUTCOME MEASURES: The medical history, laboratory findings, gallbladder ultrasounds, timing of operation from the onset of symptoms, conversion rates to open procedures, operative times, intraoperative findings, complications, postoperative length of stay, cost of operative procedures and hospitalizations, and convalescence times were collected. RESULTS: Laparoscopic cholecystectomy was attempted in 16 patients within 72 hours of the onset of symptoms of acute cholecystitis (group 1), in 19 patients with symptoms between 4 and 7 days (group 2), and in 25 patients with symptoms lasting more than 7 days (group 3). The only factor (eg, preoperative laboratory and ultrasound findings) that affected the outcome of the operation was duration of symptoms prior to operation. Patients who had LC done within 72 hours of the onset of symptoms had lower rates of conversion to open procedures, less difficult operations, shorter operative times, less costly procedures, and a shorter convalescence than those with symptoms for longer than 72 hours prior to operation. The conversion rates in patients operated within and after 72 hours were 12% and 30%, respectively. There were no bile duct injuries and no mortalities. CONCLUSIONS: Laparoscopic cholecystectomy can be performed safely in most patients with acute cholelithiasis. However, we found that the duration of symptoms prior to LC affected the outcome; the conversion rates, hospital costs, and convalescence times increased in operated-on patients with symptoms for more than 72 hours. In our opinion, interval cholecystectomy may be a superior option in this latter group of patients.

Acute Disease↗
PubMed1992

Move to outpatient settings may boost medical hotels.

The shift of surgeries to outpatient settings could be healthy for medical hotels, those amenity-equipped facilities originally developed to ease patients out of costly acute-care beds. Because fewer hospitals have a pressing need to use such alternative lodging, some medical hotels are hoping to hitch their fortunes to the outpatient trade, keeping patients overnight after surgeries that don't require hospital admission.

Ambulatory Surgical Procedures↗
PubMed1993

[The organization of medical care for patients with minor infectious pathology].

Taking into account the prognosticated modern character of combat actions, a new organic structure of Russian Armed Forces, and estimated structure of infectious diseases in war period, it was stressed that anti-infectious platoons (inside medical companies of Brigades) would perform the main part of diagnosis and treatment of minimally sick patients (85% from all infectious cases). There are proposals towards elaboration of a new organic structure of the military field infectious hospital.

Afghanistan↗
PubMed1994

Complications of therapeutic laparoscopy.

Laparoscopic surgery holds great promise as a technique for reducing hospital stay and convalescence. Although advantages in hospital cost cannot be shown for all such procedures, improvements in technique and operator experience will undoubtedly improve the situation. Analysis of the pertinent physiologic aspects and complication rates indicates that laparoscopy is not minimally invasive, but rather exposes the patient to many of the risks normally incurred by open procedures. Enthusiasm for the use of these techniques must be tempered by good judgment and scientific evidence supporting equivalent or better long-term results at equal or lower rates of morbidity and mortality.

Appendectomy↗
PubMed1990

Recovery centers gaining interest.

It wasn't long ago that California hospitals were brooding over the introduction of post-surgical recovery-care centers. But the centers' ability to treat patients at lower costs is enticing some hospitals to establish friendly ties.

California↗