[The process of community disorganization by a decrease in population: a case of Tomiyama village in Aichi prefecture (author's transl)].
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Asia↗
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Results for “Community Development--complications”
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Randomized, comparative study of oral ofloxacin versus intravenous cefotaxime in spontaneous bacterial peritonitis.
BACKGROUND & AIMS: Treatment of spontaneous bacterial peritonitis currently involves intravenous antibiotic administration. To test the possibility of treating spontaneous bacterial peritonitis with oral antibiotics, oral ofloxacin was compared with intravenous cefotaxime in this infection. METHODS: One hundred twenty-three cirrhotics with uncomplicated spontaneous bacterial peritonitis (no septic shock, grade II-IV hepatic encephalopathy, serum creatinine level of > 3 mg/dL, and gastrointestinal hemorrhage or ileus) were randomly given oral ofloxacin (64 patients) or intravenous cefotaxime (59 patients). RESULTS: Infection resolution rate was 84% in the ofloxacin group and 85% in the cefotaxime group. Peak serum levels and trough serum and ascitic fluid levels of ofloxacin and cefotaxime measured on days 3 (23 patients) and 6 (11 patients) of therapy were greater than the minimal inhibitory concentration of isolated organisms. Hospital survival rate was 81% in each group of patients. Blood urea nitrogen and hepatic encephalopathy at diagnosis were associated with prognosis. None of the 36 nonazotemic patients with community-acquired spontaneous bacterial peritonitis and without hepatic encephalopathy developed complications during hospitalization, and all were alive at time of discharge. CONCLUSIONS: Oral ofloxacin is as effective as intravenous cefotaxime in uncomplicated spontaneous bacterial peritonitis. Nonazotemic cirrhotic patients with uncomplicated community-acquired spontaneous bacterial peritonitis and without hepatic encephalopathy have an excellent prognosis and may be treated with oral ofloxacin without requiring hospitalization.
Administration, Oral↗
Referrals for inadequate progress of labour from the midwife obstetric units to the referral hospitals in Cape Town.
Referrals for inadequate progress of labour from the Midwife Obstetric Units (MOUs) to the referral hospitals are responsible for a significant part (approximately 5%) of the workload of these institutions in the Peninsula Maternal and Neonatal Service Region in Cape Town. It is essential for the maintenance of community credibility in the MOUs that patients who develop complications are timely and speedily transferred to the appropriate referral hospital. A sample of 251 patients, who were transferred from the MOUs to the referral hospitals for inadequate progress of labour in the first half of 1992, was analysed. The study showed that midwives in the MOUs had largely adhered to the Departmental referral criteria for that potentially serious complication of labour and had kept excellent records. The referrals, in terms of eventual outcome for the patients and their infants, had been largely appropriate. Several areas of concern were identified. These included incomplete assessment of the stage of labour on admission and inadequate monitoring of the fetal heart in a number of patients. Provision of analgesia in labour was generally inadequate. Ambulance delay was disturbingly common. Recommendations for measures to redress these management deficiencies are presented.
Female↗
[Epidemiology of community-acquired pneumonia in the Health Area I of Navarra].
BACKGROUND: During one year (1988), a protocol study of the community-acquired pneumonias was carried out in patients referred to the Hospital Virgen del Camino in Pamplona (Health Area I or Northern Navarra), so as to have an epidemiological and microbiological knowledge of this disease in this geographic area. METHODS: A clinical protocol, microbiological investigation, 3 blood cultures, Gram stain and sputum culture and serological tests at admission and 20 days later (complement fixing antibodies and indirect immunofluorescence) were carried out. Chest radiographs were carried out on admission, on the third and seventh hospital days and subsequently depending on the evolution. RESULTS: The causative organism was found in 141 of the 225 included patients (62%). Two or more organisms were identified in 19 (8%). In 84 (38%) no microorganism was found. The results for the causative organisms and their frequency were: Pneumococcus 12%, mycoplasma 12%, other bacteria (including Legionella) 11%, Q fever 8%, viruses 7%, and psitaccosis 4%. In 59% of patients there was an underlying disease and 39% developed complications. 4% of patients died. CONCLUSIONS: 22% of the community acquired pneumonias were cared for in the hospital, representing 6% of the admissions to the Internal Medicine Service. The etiologic diagnosis was made in 62% of the community-acquired pneumonias. 23% were of bacterial origin (including Legionella) and 31% were nonbacterial. There was a high incidence of pneumonias caused by Mycoplasma pneumoniae and Coxiella burnetii.
Adolescent↗
Is community-led maternity care a feasible option for women assessed at low risk and those with complicated pregnancies? Results of a population based study in south Camden, London.
OBJECTIVE: to assess the feasibility of obstetric offering community-led maternity care to most women, both those assessed to be at low obstetric risk and those with complicated pregnancies at 'booking'. Community-led care is defined as appropriate care by community midwives and general practitioners during pregnancy, birth and the puerperium, with routine hospital care kept to a minimum. DESIGN: observational study. SETTING: South Camden, London, UK: University College Obstetric Hospital and community. PARTICIPANTS: 453 women, resident in South Camden, including those 'booked' for home births, who were 'booked' for maternity care at University College Hospital between October 1993 and April 1994. MEASUREMENTS AND FINDINGS: this paper assesses the extent to which community midwives and general practitioners were able to give local women community-led care and describes the amount of care provided to women by their 'named' community midwives and team. Most local women were eligible for community-led care and 85% planned to have it. The majority of care was given by the community midwives, but the amount of hospital input varied. Women who remained at low obstetric risk generally had their antenatal care in the community, only attending hospital for two or three routine assessments and occasional extra referrals. Women attending hospital more frequently usually had a complicated pregnancy. Care given by a woman's 'named' midwives was generally provided antenatally, but care from familiar midwives was less common in labour and postnatally. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: community-led maternity care can be provided to the majority of women, even those with a complicated pregnancy, as long as specialist opinion and facilities are accessible and women are referred as necessary. Although the majority of women had access to local antenatal care from staff they got to know, the 'named' community midwives and teams found it difficult to provide comprehensive care, particularly to the women who developed complications, so priorities need to be established. Further research is needed to compare alternative models of care and their costs.
Community Health Nursing↗
The epidemiology of influenza.
Influenza remains a globally important cause of febrile respiratory illness. Influenza virus activity in the community results in significant mortality, morbidity and economic disruption, particularly in those at high risk of developing complications, such as the elderly and those with underlying chronic medical conditions, including pulmonary disease and diabetes mellitus. The occurrence in Hong Kong in 1997 of avian influenza H5N1 in man, which resulted in six deaths, served to remind us of the importance of continuing surveillance and preparation for the next pandemic.
Antigenic Variation↗
Preventing morbidity and mortality from sickle cell disease. A public health perspective.
CONTEXT: Sickle cell disease is a group of conditions characterized by production of abnormal hemoglobin, with clinical manifestations that vary by genotype and age. OBJECTIVE: To discuss current public health issues associated with sickle cell disease, and approaches to preventing complications from these conditions in the United States. DESIGN: Literature review. RESULTS: Most clinical interventions for people with sickle cell disease discussed in the medical literature can be classified as tertiary prevention: for example, therapy to ameliorate anemia, reduce the frequency of pain crises, or prevent stroke recurrences. A form of secondary prevention, newborn screening, has emerged as an important public health approach to identifying affected children before they develop complications. Newborn screening is the starting point for simple public health strategies such as parental education, immunization, and penicillin prophylaxis. Identification of affected families by newborn or community screening programs has also been an entry point for genetic counseling, although utilization of prenatal testing has varied by factors such as geographic location. Public health agencies have had significant involvement with funding, policy making, and formulation of laboratory and clinical guidelines for sickle cell disease. Since the introduction of penicillin prophylaxis policies, newborn screening, new immunizations, and comprehensive medical care centers, the survival of young children with sickle cell disease has improved. CONCLUSIONS: Although the efforts of preventive medicine providers in public health programs are not solely responsible for the improved survival of children with sickle cell disease, such programs remain an important component in preventing sickle cell complications.
Anemia, Sickle Cell↗
Why do patients seek family physicians' services for cold symptoms?
OBJECTIVE: To examine the frequency of presentation to family physicians' offices for cold symptoms, the reasons for presentation, and the duration of symptoms before presentation. DESIGN: Prospective cross-sectional survey. PARTICIPANTS: One hundred consecutive patient encounters in each of 15 family practices from January 27 to February 3, 1994, involving both academic and non-academic family physicians in the London region. Data were collected prospectively using a checklist attached to each chart. MAIN OUTCOME MEASURES: Proportion of patients presenting with cold symptoms, reasons for presentation, number of days patients had had symptoms, billing code. RESULTS: A total of 1421 checklists were analyzed, 822 from academic practices and 599 from community practices. Proportion of presentations for cold symptoms was 14.8%, but visits coded as common cold represented 5.7%. Median number of days patients waited before presentation was 7.0; older patients tended to wait longer. Many patients were worried about developing complications (51.0%) or were fed up with their symptoms (31.9%). Most patients were between the ages of 20 and 64 (44.6%), and 57.6% of all patients had developed complications requiring treatment. CONCLUSIONS: The proportion of visits coded as common cold was lower than Ontario averages. Most patients had complications rather than simple colds and had managed their symptoms on their own for a fairly long time.
Adolescent↗
Community- and hospital-acquired pneumonia in medical intensive care unit.
Seventy-four cases of pneumonia admitted to the Medical Intensive Care Unit of Chulalongkorn Hospital from January 1986 to December 1988 were analyzed. There were 52 males and 22 females with 46, 26 and 2 cases of community-, hospital- and combined-acquired pneumonia, respectively; the average age on admission was 58 +/- 18.1 years. The majority of the patients had abnormal host or underlying pulmonary diseases. Most of the cases with community-acquired pneumonia were admitted to the ICU because of respiratory failure (85%) and most of the cases with hospital-acquired pneumonia had ventilator-associated pneumonia (71.4%). The dominating pathogens in community- and hospital-acquired pneumonia were Gram-positive and Gram-negative organisms, respectively. There were no significant differences in initial clinical manifestations, laboratory data, complications, between the two groups. However, the duration on antibiotic, respirator, leukocytosis and stay in hospital were significantly longer in hospital acquired than community acquired pneumonias. Overall mortality was 63.5 per cent, the causes of which were progressive or uncontrolled pneumonia and mechanical ventilation complications in 37.8 and 25.7 per cent of the cases, respectively. High-risk factors of the non-surviving groups included pneumonia on assisted ventilation, mechanical ventilation complications, shock and the presence of Gram-negative bacilli. Our study indicates that the patients required assisted ventilation because of the severity of the underlying pulmonary conditions rather than the extent of the pneumonia itself. Gram-negative pneumonia predisposed the patients requiring mechanical ventilation to develop complications. The duration on mechanical ventilation, ICU admission and hospitalization were 13.84, 13.21 and 29.08 days, respectively.
Adolescent↗
Immunology of liver transplantation: clinical management aspects.
Orthotopic liver transplantation has developed into the treatment of choice for many patients who develop complications of end-stage liver disease. With improvements in surgical technique and overall survival since the inception of liver grafting, a major consideration in the longterm care of liver transplant patients has become the management of allograft rejection and immunosuppressive therapy. With an increasing number of patients having undergone successful transplantation in the community, practicing gastroenterologists will likely be called upon more frequently to render care to these patients. In this article, the immunobiology of transplantation and rejection is discussed with an emphasis placed on the T-cell-major histocompatibility complex interaction, cytokine stimulation, and adhesion molecule binding. Commonly used immunosuppressive medications and promising ones for the future are reviewed. Also, clinical aspects of the short- and long-term management of immunosuppression are explored.
Graft Rejection↗
Tricyclic antidepressant overdose: conservative management in a community hospital with cost-saving implications.
Reports of late-onset cardiovascular complications following tricyclic antidepressant (TCA) overdose have led to a very conservative approach to these patients. Many patients have been hospitalized for continuous cardiac monitoring, regardless of the clinical presentation. Management algorithms based on clinical predictors of outcome have recently been proposed. We used the algorithm developed by Tokarski and Young to retrospectively evaluate the care of 33 TCA overdose patients admitted to our hospital over a 3-year period. We then identified 11 patients who could have been treated on an outpatient basis had the algorithm been employed. Ten were admitted to a monitored unit and spent a mean of 31.6 +/- 15.64 hours on the unit. None of the 11 patients developed complications during their hospital stay. Use of the algorithm would have resulted in an estimated cost savings of 13 hospital days and $14,000.
Adolescent↗
Multiply resistant nontyphoidal Salmonella gastroenteritis in children.
From January, 1990, to December 31, 1990, 75 children with multiply resistant Salmonella gastroenteritis were studied at the Children's Hospital "Ricardo Gutierrez" of Buenos Aires. These children ranged from 1 month to 15 years of age. Infection was community-acquired in 20 (26.6%), nosocomially acquired in 50 (66.7%) and undetermined in 5. Thirty-nine (52%) had grossly bloody stools. Fever occurred at some point in the clinical course in 61 children (81.3%) with a duration of 1 to 33 days (mean, 6.7 days). The duration of diarrhea (1 to 69 days) was longer in those who developed complications (P < 0.001). Six (8%) developed enterocolitis (2 with bowel perforation), 1 had a pulmonary abscess and 8 (11.4%) had bacteremia; 4 children died (5.3%). Salmonella typhimurium was the most common serovar (85.3%). Ninety percent minimum inhibitory concentration studies demonstrated that all strains were resistant to ampicillin (> 128 micrograms/ml), cephalothin (> 128 micrograms/ml), cefuroxime (> 128 micrograms/ml), nalidixic acid (> 256 micrograms/ml), rifampin (> 256 micrograms/ml), gentamicin (> 256 micrograms/ml) and tobramycin (256 micrograms/ml); 77.3% of strains were resistant to ceftazidime (32 micrograms/ml), 97.6% to netilmicin (> 256 micrograms/ml), 92.8% to amikacin (256 micrograms/ml), 24.4% to isepamicin (32 micrograms/ml), 5.3% to chloramphenicol (4 micrograms/ml) and 2.7% to cefoxitin (2 micrograms/ml). The 90% minimum inhibitory concentration of cefotaxime and ceftazidime was reduced by the addition of clavulanate. Aggressive multiply resistant Salmonella strains are a major pediatric problem in Buenos Aires.
Adolescent↗
Using a home care model to monitor bilirubin levels in early discharged infants.
This article focuses on the importance of monitoring and identifying those early discharged infants who are at risk for developing complications of jaundice. By utilizing standing orders in monitoring babies within 24 hours of discharge, bilirubin levels can be assessed in the home setting, required interventions can be implemented, and unplanned, emergency room visits and hospital readmissions can be averted.
Bilirubin↗
Severe pneumonia in the elderly.
The elderly are more susceptible to pneumonia and more likely to die from this infection than younger populations. Older patients with pneumonia requiring hospitalization are more likely to develop complications necessitating longer hospital stays. This article focuses on features of common lower respiratory tract infections and physiologic and immunologic characteristics of elderly patients that might obscure classic clinical presentation of pneumonia. Treatment factors unique to elderly patients with severe pneumonia are also discussed.
Age Factors↗
The high morbidity of blunt cerebrovascular injury in an unscreened population: more evidence of the need for mandatory screening protocols.
BACKGROUND: Blunt cerebrovascular injuries are rare injuries causing substantial morbidity and mortality. The appropriate screening methods and treatment options for these injuries are controversial. We examined our experience with these injuries at a community Level I Trauma center over a 51 month period. STUDY DESIGN: A retrospective review and analysis was done of all patients with the diagnosis of a blunt cerebrovascular injury during this period. RESULTS: Fourteen patients had blunt carotid injury (0.40%) and three had blunt vertebral injury (0.09%) out of 3,480 total blunt admissions. The overall incidence of blunt cerebrovascular injury was 0.49%. The most common associated injuries were to the head (59%) and chest (47%) regions. The overall mortality rate was 59% (10 of 17), with death occurring in 8 of 14 (57%) blunt carotid injury patients and 2 of 3 (67%) blunt vertebral injury patients. Eight of ten (80%) deaths were directly attributable to the blunt cerebrovascular injury. Median time until diagnosis was 12.5 h (range 1-336 h) for the entire group and 19.5 h for nonsurvivors. Diagnosis was delayed > 24h in 7 patients and > 48h in 5 patients. All five patients whose diagnoses were delayed > 48 h developed complications, and four (80%) of these patients died. CONCLUSIONS: Blunt cerebrovascular injury is uncommon, but lethal; particularly when the diagnosis is delayed. Aggressive screening protocols based on mechanism of injury, associated injuries, and physical findings are justified to minimize morbidity and mortality. Head and chest injuries may serve as markers for blunt cerebrovascular injury. Most deaths are directly attributable to the blunt cerebrovascular injury and not to associated injuries.
Biomechanical Phenomena↗
Hematogenous staphylococcal pneumonia secondary to soft tissue infection.
Staphylococcal pneumonia is rare, has a high mortality and morbidity rate, and occurs commonly during influenza epidemics (airborne) or during the course of right sided bacterial endocarditis in drug addicts (blood borne). In recent years, much emphasis has been given to the staphylococcal infections in intravenous drug abusers. This report describes ten patients with staphylococcal pneumonia resulting from soft tissue infection who were previously healthy and had no history of drug abuse. They were 12 to 45 years old. Eight were male patients. Soft tissue infection was community-acquired in nine and was most commonly located in the lower extremities. Three patients had diabetes. All presented with a clinical picture of acute pneumonia. Hemoptysis occurred in three. Chest roentgenogram showed multiple large or small round discrete densities in most of the patients. Lobar involvement was notably absent. Eight developed cavitary lesions in their lungs. The average length of hospital stay was 40 days. One patient died and six developed complications. Staphylococcal etiology should be suspected in patients with acute pneumonia who have soft tissue infection or have characteristic chest roentgenogram findings; antistaphylococcal agents should be included in the therapeutic regimens of such patients until the results of the cultures are known.
Adolescent↗
Handoscopic surgery: a prospective multicenter trial of a minimally invasive technique for complex abdominal surgery. Southern Surgeons' Club Study Group.
HYPOTHESIS: We hypothesized that hand-assisted laparoscopic surgery (a new technique that involves a surgeon's hand passing through a pneumoperitoneum-protecting sleeve device and assisting in laparoscopic surgery) is feasable and outcomes are comparable to purely laparoscopic procedures in selected cases. DESIGN: A prospective, multicenter, nonrandomized, noncontrolled study was conducted with the participation of expert laparoscopic surgeons. SETTING: Academic and community medical centers in 16 states. PATIENTS: Any patient 18 years or older requiring abdominal surgery and determined to be suitable for laparoscopic surgery. MAIN OUTCOME MEASURES: Incision size, duration of the procedure, conversion rate to an open technique, detection of subtle disease, return of bowel function, length of hospital stay, complication rate, and subjective evaluation. RESULTS: The device was used in 58 patients for 24 different procedures, most commonly during colectomy (n = 21) and splenectomy (n = 7). Twenty-two percent of cases required conversion to open technique because of failure to maintain pneumoperitoneum or failure to complete the anticipated operation by this method. Average incision size was 7.6 cm. Mean duration of all procedures was 223 minutes (range, 110-415 minutes) and for nonconverted procedures was 178 minutes (range, 65-540 minutes). Preoperatively undetectable, subtle disease was palpated in 14 patients (24%). Mean length of hospital stay for all patients was 7.9 days and for the nonconverted group was 6.7 days. Twenty-four percent of patients developed complications, most commonly either wound complications (n = 4) or prolonged ileus (n = 3). In 58% of cases, surgeons thought that the technique shortened surgery, and 88% of surgeons found the technique "helpful" in all the completed procedures. CONCLUSIONS: This technique seems to be a useful tool in the management of cases that either are too complex or take too long to be managed with purely minimally invasive techniques. To further define the potential benefits of this technique in selected procedures, prospective randomized trials are needed.
Abdomen↗
[Radiologic intervention in the biliary tract performed at a central hospital].
During the ten-year period 1987-96, 131 diagnostic percutaneous transhepatic cholangiographies (PTC) were performed in 103 patients due to obstructive jaundice. 54 cases of percutaneous transhepatic bile drainage (endoprosthesis) (PTBD) and 53 of percutaneous transhepatic external drainage (PTED) were also performed. In 89 patients (86%) the obstructive jaundice was caused by malignant disease. Puncture was done under fluoroscopic or ultrasonographic control. An 8 Fr. plastic endoprosthesis of 15 cm length was used for internal bile drainage, and a 7.6 Fr. 60 cm long catheter was used for external drainage. For combined external/internal drainage an 8.4 Fr. catheter of 60 cm length was used. 24 patients (23%) developed complications. Eight of these complications were serious, and three patients (2.5%) died as a result of the procedure. Three patients developed duodenal perforations. 11 out of 51 patients (20%) treated with endoprosthesis died within 30 days. Mean functioning time for endoprostheses was 128 days. Progress in radiologic intervention technique has changed the treatment of obstructive jaundice. In our view, endoscopic bile drainage should be the treatment of choice. Percutaneous transhepatic bile drainage is an alternative in cases where endoscopic therapy fails.
Adult↗