Outcome and management of postoperative enterocutaneous fistula

Background: Approximately 75% of enterocutaneous fistula (ECF) occur following surgery. Due to the high morbidity and mortality associated with ECF, prompt and effective treatment is important. This study was conducted to study the outcome and management of patients with enterocutaneous fistula.Methods: Total 40 patients developing the enterocutaneous fistula following surgery were included. All patients were treated either conservatively or operatively by various means and varying period of time. Treatment was focused on the correction of dehydration, controlling sepsis, management of electrolyte imbalance and nutritional support.Results: Overall 40 patients were included in this observational study, comprising 26 were males and 14 were females. About 97.5% of ECF were postoperative. Ileum was found to be the most common site of ECF. Also, 42.5% of fistulas were high output and 57.5% were low output. Serum albumin levels correlated significantly with fistula healing and mortality. Surgical intervention was required in 37.5% of patients.Conclusions: Conservative management with emphasis on improvement of nutrition, control of sepsis, management of fluid and electrolyte balance and control of fistula output is first line of management. Operative intervention must be done in selectively after cases after aggressive and targeted measures for improvement of nutritional status and control of infection.

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Clinical study of enterocutaneous fistula

International Surgery Journal ◽

10.18203/2349-2902.isj20173705 ◽

2017 ◽

Vol 4 (9) ◽

pp. 2972

Author(s):

Mahadeo Namdeo Garale ◽

Yogesh Prabhakar Takalkar ◽

Karthik Venkatramani

Keyword(s):

Enterocutaneous Fistula ◽

Statistical Significance ◽

Intestinal Fistula ◽

Anatomical Location ◽

High Morbidity ◽

Chi Square ◽

Exact Test ◽

Colonic Fistula ◽

Key Aspects ◽

High Output

Background: An enterocutaneous fistulae (ECF) may be challenging to manage due to the large volume of fluid losses, that may result in severe dehydration, electrolyte imbalances, malnutrition and sepsis. It is imperative that this group of patients receive adequate nutrition, as malnutrition and sepsis are the leading cause of death.Methods: This descriptive study was conducted prospectively in the Department of Surgery between September 2004 and August 2010. Patients whom develop ECF after surgery were included in the study while patients with esophageal, biliary, pancreatic, and perianal fistulas were excluded. The description of fistula included cause, anatomical location, fistula output, complications, and outcome. Fistula output was quantified by direct measurement, in the presence of drain or by calculating number of dressing pads soaked per day. To examine the statistical significance of association between attributes, Chi-square test and Fisher's exact test were used. A probability value of less than 5% (P < 0.05) was considered significant.Results: A total of 42 patients were included in the study, of which 23 were males and 19 were females and the male:female ratio was 1.2:1. Most patients with ECF were aged 41-50 (mean age, 44.23±2.72). Of the 42 patients, 9 patients had colonic fistula and the remaining had small intestinal fistula; 16 ileal, 5 duodenal, and 12 jejunal. There were 22 patients with high-output fistula as compared to 20 patients with low output fistula. Mortality was significantly higher in patients with males, age >60 years, high-output fistula, mesenteric ischemia as underlying pathology, serum albumin <2.5g/dl and re-surgery.Conclusions: Early diagnosis and stabilization form key aspects of management of ECF as most patients are managed conservatively. Prompt nutritional supplementation alters the outcome of this disease. High output fistulae required mostly surgical management and had high morbidity and mortality.

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The importance of a holistic approach to stoma care: A case review

WCET Journal ◽

10.33235/wcet.39.1.23-32 ◽

2019 ◽

pp. 23-32

Author(s):

Melanie C Perez

Keyword(s):

Ileal Conduit ◽

Enterocutaneous Fistula ◽

Foley Catheter ◽

Holistic Approach ◽

Comprehensive Care ◽

Case Review ◽

High Output ◽

Stoma Care

This case review discusses the importance of providing a holistic approach to the care of a patient with two stomas and an enterocutaneous fistula. In this case, the stomas and fistula significantly affected the patient; not just physically but emotionally and socially. The different challenges that arose in pouching a high-output ileostomy, enterocutaneous fistula and ileal conduit with Foley catheter in situ are explored. It also delves into the various options for discharging a patient with complex ostomy complications requiring different needs and resources. Finally, it aims to highlight the therapeutic comprehensive care the stomal therapy nurse provided to the patient and their family.

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Clinico-bacteriological Profile and Outcome of Empyema Thoracis in Children at a Tertiary Care Hospital of Central Nepal

Journal of College of Medical Sciences-Nepal ◽

10.3126/jcmsn.v16i3.30661 ◽

2020 ◽

Vol 16 (3) ◽

Author(s):

Atanu Pan ◽

Debarshi Jana

Keyword(s):

Ct Scan ◽

Broad Spectrum ◽

Chest Tube ◽

Chest Tube Drainage ◽

Diagnostic Tools ◽

High Morbidity ◽

Care Hospital ◽

Empyema Thoracis ◽

First Line ◽

Tube Drainage

Background: Empyema thoracis (ET) is a serious infection of the pleural space. Despite the availability of broad spectrum antibacterial, improved vaccination coverage and better diagnostic tools, Empyema Thoracis remains associated with high morbidity worldwide. Delay in early diagnosis, failure to institute appropriate antimicrobial therapy, multidrug resistant organisms, malnutrition, comorbidities, poor health seeking behaviour and high treatment cost burden contribute to increased morbidity in children. The available treatment options include intravenous broad-spectrum antibiotics either alone or in combination with surgical procedure (thoracocentesis, chest tube drainage, fibrinolytic therapy, decortications with video assistedthoracoscopic surgery (VATS) and open drainage. Methods: Fifty Children between 1 month to 16 years admitted in the Pediatrics Ward, PICU of College of Medical Sciences, Bharatpur,Nepal. Data analysis was done by SPSS 24.0. Results: Present study found that according to blood culture, 3(6.0%) patients had enterococcus, 40(80.0%) patients had no growth, 2(4.0%) patients had pseudomonas, 4(8.0%) patients had staphylococcus and 1(2.0%) patients had streptococcus. We found that 20(40.0%) patients had done CT scan thorax, 30(60.0%) patients had not done CT scan thorax and 32(64.0%) patients had Amoxiclav first line antibiotic and 18(36.0%) patients had Ceftriaxone first line antibiotic. Conclusions: Suitable antibiotics and prompt chest tube drainage is an effective method of treatment of childhood empyema, especially in resource-poor settings. Majority of the patients progress on this conservative management and have good recovery on follow up.

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Experiences of job demand and control: A study of first line managers in for-profit psychiatric and addiction care

Work ◽

10.3233/wor-213540 ◽

2021 ◽

pp. 1-9

Author(s):

Linda Widar ◽

Erika Wall ◽

Sven Svensson

Keyword(s):

First Line ◽

Line Managers ◽

For Profit ◽

Job Demand ◽

Organizational Position ◽

Wide Range ◽

Line Manager ◽

Addiction Care ◽

And Control ◽

Demand Control

BACKGROUND: The complex position of a first line manager is characterized by heavy workload and contradictory demands. Little is known about how first line managers experience demand and control in their work. OBJECTIVES: The aim of this study was to explore experiences of demand and control among first line managers within psychiatric and addiction care. METHOD: In the present study, interviews with ten managers in for-profit psychiatric and addiction care in Sweden were analyzed with a phenomenographic approach. RESULTS: The managers experiences of demand and control implied varied and extensive responsibilities for a wide range of professions; regulation by organizational, economic, and political frameworks; creating balance in their work; and handling the emergence and consequences of acute crisis. These experiences of demand and control involved high and contradictory demands together with coexisting high and low levels of control. Many of their work characteristics could be described in terms of both demand and control. CONSLUSION: The first line managers experiences of demand and control are more complex than implied by the job demand control theory. Our results suggest that the organizational position and branch should be considered when identifying health hazards in the work environment of first line managers.

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Protocol for a two-arm pragmatic stepped-wedge hybrid effectiveness-implementation trial evaluating Engagement and Collaborative Management to Proactively Advance Sepsis Survivorship (ENCOMPASS)

BMC Health Services Research ◽

10.1186/s12913-021-06521-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Marc Kowalkowski ◽

Tara Eaton ◽

Andrew McWilliams ◽

Hazel Tapp ◽

Aleta Rios ◽

...

Keyword(s):

Usual Care ◽

Best Practice ◽

Healthcare Delivery ◽

Collaborative Management ◽

High Morbidity ◽

Type I ◽

Stepped Wedge ◽

Sepsis Management ◽

Sepsis Survivors ◽

Sepsis Care

Abstract Background Sepsis survivors experience high morbidity and mortality, and healthcare systems lack effective strategies to address patient needs after hospital discharge. The Sepsis Transition and Recovery (STAR) program is a navigator-led, telehealth-based multicomponent strategy to provide proactive care coordination and monitoring of high-risk patients using evidence-driven, post-sepsis care tasks. The purpose of this study is to evaluate the effectiveness of STAR to improve outcomes for sepsis patients and to examine contextual factors that influence STAR implementation. Methods This study uses a hybrid type I effectiveness-implementation design to concurrently test clinical effectiveness and gather implementation data. The effectiveness evaluation is a two-arm, pragmatic, stepped-wedge cluster randomized controlled trial at eight hospitals in North Carolina comparing clinical outcomes between sepsis survivors who receive Usual Care versus care delivered through STAR. Each hospital begins in a Usual Care control phase and transitions to STAR in a randomly assigned sequence (one every 4 months). During months that a hospital is allocated to Usual Care, all eligible patients will receive usual care. Once a hospital transitions to STAR, all eligible patients will receive STAR during their hospitalization and extending through 90 days from discharge. STAR includes centrally located nurse navigators using telephonic counseling and electronic health record-based support to facilitate best-practice post-sepsis care strategies including post-discharge review of medications, evaluation for new impairments or symptoms, monitoring existing comorbidities, and palliative care referral when appropriate. Adults admitted with suspected sepsis, defined by clinical criteria for infection and organ failure, are included. Planned enrollment is 4032 patients during a 36-month period. The primary effectiveness outcome is the composite of all-cause hospital readmission or mortality within 90 days of discharge. A mixed-methods implementation evaluation will be conducted before, during, and after STAR implementation. Discussion This pragmatic evaluation will test the effectiveness of STAR to reduce combined hospital readmissions and mortality, while identifying key implementation factors. Results will provide practical information to advance understanding of how to integrate post-sepsis management across care settings and facilitate implementation, dissemination, and sustained utilization of best-practice post-sepsis management strategies in other heterogeneous healthcare delivery systems. Trial registration NCT04495946. Submitted July 7, 2020; Posted August 3, 2020.

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Preparedness for Mitigating Noncommunicable Diseases in Gaindakot Municipality, Nepal: Perspectives of Key informants

Birat Journal of Health Sciences ◽

10.3126/bjhs.v6i1.37567 ◽

2021 ◽

Vol 6 (1) ◽

pp. 1320-1324

Author(s):

Narayan Sapkota ◽

Damaru Prasad Paneru

Keyword(s):

Health System ◽

Health Workforce ◽

Prevention And Control ◽

Local Level ◽

Building Blocks ◽

Health System Strengthening ◽

High Morbidity ◽

Major Public Health Problem ◽

Screening Services ◽

And Control

Introduction: Non-communicable Diseases (NCDs) are the major public health problem that leads to high morbidity and mortality in the world including Nepal. Government of Nepal has launched the Multi-sectoral NCD Action Plan in 2014 and established NCD and Injuries Poverty Commission in 2016 for the management and control of NCDs nevertheless the implementation status and its outcomes are not identified till date at the local level. Objectives: To explore the preparedness of the local government for the prevention and control of NCDs at Gaindakot, Nawalpur, Nepal. Methodology: A qualitative study was conducted in the Gaindakot municipality; Nawalpur to document the key informant's perspectives on health system's preparedness to prevent the potential impacts of NCDs. Face to face Indepth interview was performed using open-ended questions. Interview guidelines were prepared on the basis of building blocks of health system. Information was processed basis on thematic analysis. Result: The study revealed that health section has NCD preparedness structure but need to strengthening for the better delivery of health services. The study highlights that screening services and the medicine for major NCDs like hypertension and diabetes were available at local level. Limited budget was allocated and health workforce was not trained for NCDs prevention and control. There was no reporting mechanism for NCD related data from local level. Conclusion: Basic medicine and screening services were provided from the local level to the selected NCDs such as hypertension and diabetes. There was no provision of reporting NCD related information and health workforce were not trained to respond NCDs. Local level health system strengthening is an urgent need to address the increasing burden of NCDs.

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Epidemiology and Outcomes of Nontyphoidal Salmonella Bacteremias from England, 2004 to 2015

Journal of Clinical Microbiology ◽

10.1128/jcm.01189-18 ◽

2018 ◽

Vol 57 (1) ◽

Cited By ~ 1

Author(s):

Shannon Katiyo ◽

Berit Muller-Pebody ◽

Mehdi Minaji ◽

David Powell ◽

Alan P. Johnson ◽

...

Keyword(s):

Antimicrobial Agents ◽

High Morbidity ◽

First Line ◽

Data Set ◽

Content Type ◽

Increased Risk ◽

Resistance Patterns ◽

Prolonged Hospital ◽

Antibiotic Resistance Patterns ◽

Emergence Of Resistance

ABSTRACT Nontyphoidal Salmonella (NTS) bacteremia causes hospitalization and high morbidity and mortality. We linked Gastrointestinal Bacteria Reference Unit (GBRU) data to the Hospital Episode Statistics (HES) data set to study the trends and outcomes of NTS bacteremias in England between 2004 and 2015. All confirmed NTS isolates from blood from England submitted to GBRU between 1 January 2004 and 31 December 2015 were deterministically linked to HES records. Adjusted odds ratios (AOR), proportions, and confidence intervals (CI) were calculated to describe differences in age, sex, antibiotic resistance patterns, and serotypes over time. Males, neonates, and adults above 65 years were more likely to have NTS bacteremia (AOR, 1.54 [95% CI, 1.46 to 1.67]; 2.57 [95% CI, 1.43 to 4.60]; and 3.56 [95% CI, 3.25 to 3.90], respectively). Proportions of bacteremia increased from 1.41% in 2004 to 2.67% in 2015. Thirty-four percent of all blood isolates were resistant to a first-line antibiotic, and 1,397 (56%) blood isolates were linked to an HES record. Of the patients with NTS bacteremia, 969 (69%) had a cardiovascular condition and 155 (12%) patients died, out of which 120 (77%) patients were age 65 years and above. NTS bacteremia mainly affects older people with comorbidities placing them at increased risk of prolonged hospital stay and death. Resistance of invasive NTS to first-line antimicrobial agents appeared to be stable in England, but the emergence of resistance to last-resort antibiotics, such as colistin, requires careful monitoring.

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A HYPOTHETICAL DESIGN TO INHIBIT COVID 19 DISEASE DISASTER BY DIAGRAMMATIC MODEL

Journal of Experimental Biology and Agricultural Sciences ◽

10.18006/2021.9(3).311.324 ◽

2021 ◽

Vol 9 (3) ◽

pp. 311-324

Author(s):

Deepanwita Deka ◽

◽

Avra Pratim Chowdhury ◽

Arabinda Ghosh ◽

Moni P Bhuyan ◽

...

Keyword(s):

The United States ◽

Epidemiological Studies ◽

High Morbidity ◽

Disease Clusters ◽

The World ◽

Public Health Hazards ◽

And Control ◽

Present World ◽

Day By Day ◽

High Range

SARS-CoV-2 is a new entity in the globe studied vigorously in the present world. The estimated populations are around 47 million people who are affected by the virus and around 300,000 (16th May 2020) deaths resulted from the outbreak. The rate might keep on increasing due to the non-availability of a proper vaccine, following proper management with epidemiological studies, and displacement of contact individuals as a source of transmission in particular viral-prone regions. CoVID 19 is on its vigorous spread leading to a global impact on lots of sectors. The outreaching impacts play a role in international politics, scientific developments, and economic crises over the world, and global relations among the countries. This model attempts to determine the possible impacts and outcomes of the Pandemic over the international level and some possible ways to handle it effectively. An unpredictable catastrophe in the present scenario of the world is following a high range of public health hazards. Analytical plotted data assembles for imposing in multidisciplinary segments to cure and control morbidity, a mortality rate of disease clusters, and hotspots zone. The contagious outbreak was reprogrammed as a pandemic from Wuhan in China through the transmissible chain of human contacts. Currently, the infective chain is spreading day by day with high morbidity in the United States, Europe, Scandinavian countries, and India. The transmissible chain of the virus needs to break until any effective medicine or vaccine is launched.

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GANGGUAN KESEIMBANGAN AIR DAN NATRIUM SERTA PEMERIKSAAN OSMOLALITAS

JURNAL BIOMEDIK (JBM) ◽

10.35790/jbm.6.3.2014.6333 ◽

2014 ◽

Vol 6 (3) ◽

Author(s):

Glady I. Rambert

Keyword(s):

Antidiuretic Hormone ◽

Water Distribution ◽

Freezing Point ◽

Urine Osmolality ◽

Body Fluids ◽

The State ◽

The Body ◽

Electrolyte Imbalance ◽

Electrolyte Balance ◽

Freezing Point Depression

Abstract: Water distribution in each compartment of the body involves concentration of solutes in body fluids, and the amount of dissolved substance in a solvent called osmolality. Electrolyte that has the biggest contributor in determining the serum osmolality is sodium, which is osmotically active. Hipoosmolality actually describes the state of hyponatremia, and hyperosmolality describes the state of hypernatremia. Examination of plasma and urine osmolality is very helpful in the management of patients with water and electrolyte imbalance, in addition to assess the antidiuretic hormone (ADH) abnormalities. Urine osmolality is important in evaluating the ability of the kidney to concentrate the urine, in addition to monitor the fluid and electrolyte balance. There are two ways of osmolality examination: 1) indirectly, by using osmometer (osmolality measurement) with a freezing point depression method; 2) directly, by using a formula (osmolality count).Keywords: water, sodium, osmolality, freezing point depression, osmolality countAbstrak: Distribusi air pada setiap kompartemen tubuh melibatkan kadar zat terlarut di dalam cairan tubuh, dan jumlah zat terlarut dalam suatu pelarut yang disebut osmolalitas. Elektrolit pemberi kontribusi terbesar dalam menentukan besarnya osmolalitas serum ialah natrium, yang aktif secara osmotik. Keadaan hipoosmolalitas sebenarnya menggambarkan keadaan hiponatremia, sebaliknya hiperosmolalitas menggambarkan keadaan hipernatremia. Pemeriksaan osmolalitas plasma dan urin sangat membantu penatalaksanaan pasien dengan gangguan keseimbangan air dan elektrolit, selain menilai kelainan antidiuretic hormone (ADH). Osmolalitas urin penting untuk mengetahui kemampuan ginjal memekatkan urin, selain memonitor keseimbangan cairan dan elektrolit. Terdapat dua cara pemeriksaan osmolalitas yaitu: 1) secara tidak langsung menggunakan osmometer (osmolalitas ukur) dengan metode freezing point depression; 2) secara langsung dengan menggunakan rumus (osmolalitas hitung).Kata kunci: air, natrium, osmolalitas, freezing point depression, osmolalitas hitung

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Mathematical modeling of ischemic stroke

Neurology neuropsychiatry Psychosomatics ◽

10.14412/2074-2711-2019-4-38-43 ◽

2019 ◽

Vol 11 (4) ◽

pp. 38-43

Author(s):

V. I. Ershov ◽

A. N. Chirkov ◽

A. P. Gonchar-Zaykin ◽

S. N. Lyashchenko ◽

T. Yu. Lozinskaya ◽

...

Keyword(s):

Ischemic Stroke ◽

Mortality Rate ◽

Diabetes Insipidus ◽

Prognostic Value ◽

Hormone Secretion ◽

Fatal Outcome ◽

Electrolyte Imbalance ◽

Electrolyte Balance ◽

Plasma Osmolarity ◽

The Impact

Objective: to determine the prognostic value of the indicators of fluid and electrolyte balance in the acutest period of severe ischemic stroke (IS). Patients and methods. A total of 150 patients with severe IS of various locations and pathogenetic subtypes were examined. The impact of plasma osmolarity or sodium levels on the course and prognosis of IS was studied on day 1 of the disease. Results and discussion. It has been established that in patients with severe IS, the most common type of fluid and electrolyte imbalance is hyperosmolar hypernatremic syndrome that develops at the onset of severe IS, serves as a factor for poor outcome, and is accompanied by high mortality. The rate of fatal outcomes in hypoosmolar syndromes is higher than that in normal plasma osmolarity, but significantly lower than that in hyperosmolar syndromes. Cerebral salt wasting (CSW) is associated with a higher mortality rate than syndrome of inappropriate antidiuretic hormone secretion (SIADH), which confirms a worse prognostic value in hypovolemia than in normo- and hypervolemia. The development of diabetes insipidus at the onset of IS reflects the degree of brainstem structural destruction and, accordingly, is associated with the highest rate of fatal outcomes. The cardioembolic pathogenetic subtype of IS is characterized by a more severe course and a higher probable mortality rate in both hypoosmolar and normosmolar conditions.Conclusion. Impaired fluid and electrolyte homeostasis is of significant prognostic value for the outcome of IS. In this case, the leading role is played by the hyperosmolar hypernatremic syndrome, in which the probability of a fatal outcome is highest and there is a need for continuous patient health monitoring and high-speed decision-making aimed to correct this condition. Therapeutic policy for diabetes insipidus depends on the duration of IS. The risk for fatal outcome in the cardioembolic pathogenetic subtype of IS is higher than that in atherothrombotic stroke, at any plasma osmolarity and sodium levels.

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