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PubMed2005

Ambulatory alveolar bone grafting.

BACKGROUND: Traditional practice for alveolar cleft closure requires postoperative hospital convalescence in an unfamiliar, disruptive hospital setting. An outpatient iliac crest alveolar bone grafting protocol was devised to optimize patient care. METHODS: A retrospective review of the senior author's experience over 5 years (1998 to 2004) of ambulatory alveolar cleft closure was compared with the previous 5-year period (1993 to 1998) of inpatient convalescence. An iliac crest donor site and standard techniques of alveolar grafting were followed in both groups. Although local analgesia with lidocaine and epinephrine was used in both groups, the ambulatory group received preemptive local anesthesia augmented with Marcaine. Postoperative nausea also was treated preemptively in the outpatient group with the addition of dexamethasone (Decadron) and ondansetron (Zofran), whereas the control patients were treated as needed. Patient charts were reviewed for demographic information, technical aspects, length of donor-site incision, bone graft volume, and time of operation. A Fisher's exact test was used for statistical analysis. Complications including morbidity, readmission, and reoperations were recorded. RESULTS: Twenty consecutive patients were treated on an outpatient basis. Eight consecutive patients were convalesced as inpatients in the previous 5-year period. The ambulatory series average patient age was 12.1 years (range, 8 to 15 years). Four bilateral procedures were performed. The follow-up period averaged 3.5 years (range, 5 to 76 months). Two minor complications were identified: cellulitis at a donor site and a recipient suture line dehiscence with minor graft exposure. There were no readmissions, revision operations, hernias, wound infections, or graft losses identified. In the inpatient series, the average stay was 1.8 days (range, 1 to 3 days). One gingival suture line dehiscence requiring no further intervention was identified, for an average complication rate of 12.5 percent, which was not significant compared with the ambulatory group (10 percent) (p = 1.00). CONCLUSIONS: Alveolar cleft bone grafting using the iliac crest donor site can be safely performed on an outpatient basis when local pain control is followed by predictable anesthetic recovery and sufficient oral intake, and reliable motivated parents or caregivers provide a comfortable postoperative setting. Safe outpatient surgery provides patients and family the opportunity to recover in the familiar home environment.

Adolescent↗
PubMed1994

The economic impact of transvenous defibrillation lead systems.

The purpose of this study was to compare implant charges and convalescence for transvenous and epicardial defibrillation systems. Hospital stay, intensive care utilization, professional fees, and hospital bills were compared in 44 patients who underwent implantation of a cardiac defibrillator between September 1991 and May 1993. Twenty-five consecutive patients received an epicardial lead system, while 19 consecutive patients underwent implantation of the entire transvenous defibrillation system in the electrophysiology laboratory. There were no significant differences between the two groups in mean age or left ventricular ejection fraction. There was a significant reduction in postoperative hospital convalescence from 7.2 +/- 2.0 days with epicardial systems to 3.1 +/- 1.5 days with transvenous systems (P < 0.001). Postoperative intensive care unit stay was significantly reduced with transvenous systems compared with epicardial systems (0.1 +/- 0.2 vs 1.5 +/- 0.9 days; P < 0.001). Hospital charges were also significantly reduced with the transvenous lead system implants. Mean implant charges were lower with transvenous systems: $32,090 +/- $2,620 vs $38,307 +/- $2,701 (P < 0.001); convalescence charges were lower: $5,861 +/- $5,010 $12,447 +/- $4,969 (P < 0.001); the total hospital bill was also significantly lower with transvenous systems: $53,459 +/- $12,588 vs $71,981 +/- $16,172 (P < 0.001). Professional fees for implantation ($4,131 +/- $1,724 vs $6,100 +/- 0, P < 0.001), convalescence care ($1,258 +/- $960 vs $2,846 +/- $1,770; P < 0.001), and total professional fees ($12,925 +/- $4,772 vs $15,731 +/- $4,055, P < 0.05) were lower in the transvenous defibrillation group.(ABSTRACT TRUNCATED AT 250 WORDS)

Convalescence↗
PubMed2006

Does access to bed-chair pressure sensors reduce physical restraint use in the rehabilitative care setting?

BACKGROUND: The common use of physical restraints in older people in hospitals and nursing homes has been associated with injurious falls, decreased mobility and disorientation. By offering access to bed-chair pressure sensors in hospitalized patients with perceived fall risk, nurses may be less inclined to resort to physical restraints, thereby improving clinical outcomes. AIMS AND OBJECTIVES: To investigate whether the access of bed-chair pressure sensors reduces physical restraint use in geriatric rehabilitation wards. DESIGN: Randomized controlled trial. METHODS: Consecutively, patients admitted to two geriatric wards specialized in stroke rehabilitation in a convalescent hospital in Hong Kong, and who were perceived by nurses to be at risk of falls were randomly assigned to intervention and control groups. For the intervention group subjects, nurses were given access to bed-chair pressure sensors. These sensors were not available to control group subjects, as in usual practice. The trial continued until discharge. The primary outcomes were the proportion of subjects restrained by trunk restraint, bedrails or chair-board and the proportion of trial days in which each type of physical restraint was applied. The secondary outcomes were the proportions of those who improved in the mobility and transfer domains of modified Barthel index on discharge and of those who fell. RESULTS: One hundred and eighty subjects were randomized. Fifty (55.6%) out of the 90 intervention group subjects received the intervention. There was no significant difference between the intervention and control groups in the proportions and duration of having the three types of physical restraints. There was also no group difference in the chance of improving in mobility and transfer ability, and of having a fall. CONCLUSION: Access to bed-chair pressure sensor device neither reduced the use of physical restraints nor improved the clinical outcomes of older patients with perceived fall risk. RELEVANCE TO CLINICAL PRACTICE: The provision of bed-chair pressure sensors may only be effective in reducing physical restraints when it is combined with an organized physical restraint reduction programme.

Accidental Falls↗
PubMedDate not supplied

Influence of dental status on nutritional status of geriatric patients in a convalescent and rehabilitation hospital.

PURPOSE: To investigate 6 dental statuses as risk factors for malnutrition in geriatric patients admitted to a convalescent and rehabilitation hospital. MATERIALS AND METHODS: One hundred twenty (59 men and 61 women) geriatric patients admitted to a convalescent and rehabilitation hospital were recruited. Three biochemical and hematologic parameters (albumin, hemoglobin, and lymphocyte count) were used for analysis. Malnutrition was defined as Body Mass Index (BMI) below 18.5 and albumin level under 35 g/L. The number of natural or prosthetic teeth in the dentate patients, and the presence of one or both dentures in the edentate patients, were recorded. Risk factors associated with malnutrition were investigated, namely: (1) edentulism among all patients, (2) edentulism without a set of complete dentures among all patients, (3) edentulism without a set of complete dentures among the edentate patients, (4) decreased number (< 6) of occluding pairs of natural or prosthetic teeth among the dentate patients, (5) decreased number (< 5) of posterior occluding pairs of natural or prosthetic teeth among the dentate patients, and (6) absence of posterior occluding pairs of natural or prosthetic teeth among the dentate patients. One-way ANOVA and Bonferroni multiple comparisons were used to determine if significant differences in the anthropometric, biochemical, and hematologic parameters existed between the patients with different dental statuses. The odds ratio and significance of 6 dental statuses as risk factors of malnutrition were calculated (P = .05). RESULTS: BMI, albumin, and hemoglobin levels of the malnourished patients were significantly lower than those of nourished patients (P < .05). Lymphocyte count was not significantly different between the 2 patient groups (P > .05). The status of edentate patients without a set of complete dentures compared with other edentate and dentate patients was the only independent risk factor (P < .05) in the 6 statuses studied. CONCLUSION: Primary healthcare workers caring for hospitalized geriatric patients should identify edentate patients without a set of complete dentures for the possibility of malnutrition.

Aged↗
PubMed1978

Day care after operations for hernia or varicose veins: a controlled trial.

Alternative systems of care after operations for varicose veins or hernia were compared in a total of 360 selected patients, of whom 121 were allocated to be managed in an acute ward for 48 h, 122 in a convalescent hospital for 48 h and 117 to be discharged directly home to the care of the district nursing sister and general practitioner. There were no deaths or major complications. Anaesthetic or surgical problems caused 5 patients (3 convalescent and 2 day care) to be retained in hospital on the day of operation. Minor complications were recorded in approximately one-third of the patients. The majority of these were effectively dealt with by the district nursing sister and only one-third of the complications needed the attention of the general practitioner. Two of the ward patients and 1 of the convalescent patients required readmission to hospital (1 per cent in all). No significant difference was demonstrated in the medical outcome between the three groups after operation. Day care was the most economical of the three systems of care. Inquiry into the patients' opinions elicited the highest proportion of favourable responses in the day care group.

Clinical Trials as Topic↗
PubMed1981

Resection of primary solid hepatic tumors.

Experience with surgical management of 60 solid hepatic tumors was analyzed with respect to the size and type of lesion, extent of resection, operative risk, postoperative complications and survival after resection. The present study concerns 46 primary hepatic malignancies and 14 benign lesions. Lesions varied in size from 5 to 29 cm (average 13). The extent of resection required for removal was related to both the size and location of lesions. Twelve trisegmentectomies, 33 hemihepatectomies and 15 major segmentectomies were done. There were three postoperative hospital deaths, two of which were related to extensions of tumor that precluded safe resection. Postoperative complications necessitated hospital convalescence for more than 21 days in 9 of the 57 surviving patients; the hospital stay of the remaining patients averaged 12 days. The 10, 5 and 3 year survival rates of patients who had resection of malignant lesions were 33, 36 and 65 percent, respectively. We conclude that aggressive treatment of primary hepatic malignancy is justified by acceptable operative risk and significant palliation or improved survival.

Adolescent↗
PubMed1996

The osteoporotic spine.

With an aging population, osteoporotic vertebral collapse is an increasingly common condition in both the Western and Eastern hemispheres. This review looked into the situation in Hong Kong with the aim of highlighting the major differences in data from the Western. Between 1989 and 1994, 497 patients with osteoporotic vertebral collapse, aged 65 to 94 years old, were admitted under the authors' care, with a female to male ratio of 5:1. More than 1/3 of the patients had fracture involving 1 single vertebra. The mean hospital stay was 5 days, with an additional 6 to 23 days in a convalescent hospital. Complication of spinal cord compression is uncommon and occurred in only 10 patients (2%) in this series who were treated mostly with anterior decompression and iliac crest graft with varying degrees of neurologic recovery. Despite the general benign nature of the problem, the high morbidity and the long hospital stays undoubtedly are significant drains on health care resources.

Aged↗
PubMed1980

Antiarrhythmic efficacy, pharmacokinetics and clinical safety of tocainide in convalescent myocardial infarction patients.

The antiarrhythmic efficacy and pharmacokinetics of tocainide, an oral analog of lidocaine, was evaluated in 18 hospitalized convalescing myocardial infarction patients. Holter ECG tapes were recorded daily during two-day placebo therapy preceding and succeeding two days of tocainide treatment. Left ventricular function was characterized from prior or subsequent arteriographic studies (ten cases) or from radionuclide scanning (eight cases). Tocainide dosage was 17.7 +/- 4.9 SD mg/kg/day. Plasma half-time of elimination was 19.1 +/- 6.8 hours (r = 0.9). Tocainide had no significant effect on heart rate, pulse rate, or QTC intervals and did not worsen chronic heart failure, even in patients with ejection fraction < 30%. In seven of 18 patients, tocainide significantly reduced ventricular premature beat (VPB) frequency as compared to predrug and postdrug placebo periods. Drug responders averaged a 200 to 545% reduction in VPB frequency at tocainide blood levels of > 3.5 microgram/ml.

Adult↗
PubMed1975

Psychological management of the myocardial infarction patient.

The acute coronary experience is divided into three parts. In the first, the pre-hospital phase, attention is devoted to the widespread phenomenon of patient delay. Evidence is given to indicate that the source of delay is entirely psychological and centers around the inability to decide whether or not to seek help. The second part, or hospital phase, describes the response of the patient to the various aspects of the coronary care unit, including monitoring, false alarms, witnessing and sustaining a cardiac arrest. The third phase, the post-hospital convalescence, centers on the principal psychological problem of this period, depression. Its causes, manifestations, and methods of management are discussed.

Adaptation, Psychological↗
PubMed1984

Long-term outcome after repair of fractured neck of femur. Comparison of subarachnoid and general anaesthesia.

One hundred and forty-eight patients undergoing "pin-and-plate" repair of fractured neck of femur received either subarachnoid blockade or general anaesthesia. The patients were followed up for 1 year after surgery. At the end of the year, 34% had died and 50% had returned home. Twelve per cent were either in hospital or in institutional care; 4% were lost to follow up. The mean duration of acute plus convalescent hospital bed occupancy was 84.4 days. There was a significantly lower mortality in the subarachnoid anaesthetic group by 14 days after surgery. The majority of the deaths in the general anaesthetic group were clustered between 6 and 16 days. However, at the end of 2 months the mortality rates were similar in both groups. It is conceivable that the difference in the distribution of deaths between the groups was a result of thrombo-embolism.

Aged↗