Pediatric Referrals to Psychiatry: I. Comparison of Referrals and Nonreferrals

1977 ◽  
Vol 7 (3) ◽  
pp. 241-247 ◽  
Author(s):  
Arthur P. Froese

Age, sex and duration of hospital stay of 220 patients consecutively referred to psychiatry (Group I) and of their fellow 2065 nonreferred patients (Group II) were compared. Overall, Group I was significantly older, remained in hospital longer, and included more girls than boys, whereas Group II included slightly more boys than girls. Separation of Group II into those whose primary discharge diagnosis was psychiatric or nonpsychiatric revealed that mean age and duration of hospital stay of the former were almost identical, and the sex distribution was similar, to those of Group I. These findings suggest that children referred for psychiatric evaluation differ from their nonreferred fellows discharged with a nonpsychiatric diagnosis but not from nonreferred fellows discharged with a psychiatric diagnosis.

2011 ◽  
Vol 2011 ◽  
pp. 1-8 ◽  
Author(s):  
Kamran Montazeri ◽  
Mohammadali Vakily ◽  
Azim Honarmand ◽  
Parviz Kashefi ◽  
Mohammadreza Safavi ◽  
...  

The purpose of this human study was to investigate the effect of oxygen pretreatment in living kidney donors on early renal function of transplanted kidney. Sixty living kidney donor individuals were assigned to receive either 8–10 L/min oxygen (Group I) by a non-rebreather mask with reservoir bag intermittently for one hour at four times (20, 16, 12, and 1 hours before transplantation) or air (Group II). After kidney transplantation, urine output, blood urea nitrogen (BUN), serum creatinine, need to additional diuretics (NTADs) in the first 24 hours after transplantation, delayed graft function (DGF), the creatinine clearance (CrCL) on 10th day, and duration of hospital stay from the first posttransplant day till normalization of renal function was recorded and compared in two groups. Mean CrCL in posttransplant day 10, NTAD after 24 hours of transplantation, and urine output during 6 hours after operation were significantly better in Group I compared with Group II (). Also, DGF during the first week after operation and duration of hospital stay was less in Group I compared with Group II. Intermittent exposure of human living kidney donor to hyperoxic environment may improve renal function following kidney transplantation.


2021 ◽  
pp. 219256822110137
Author(s):  
Hang Shi ◽  
Zhi-Hao Huang ◽  
Yong Huang ◽  
Lei Zhu ◽  
Zan-Li Jiang ◽  
...  

Study Design: Case-control study. Objectives: To compare the outcomes of 2 different criteria (time driven and output driven) for wound drain removal and identify which one is better. Methods: 743 patients who underwent posterior lumbar fusion with instrumentation involving 1 or 2 motion segments were enrolled in this study. Based on the different criteria for drain removal, the patients were divided into 2 groups. The drains were discontinued by time driven (postoperative day 2) in group I and output driven (<50 ml per day) in group II. Demographic characteristics, perioperative parameters and clinical outcomes were compared between the 2 groups. Results: The demographic characteristics in both groups were comparable. The postoperative drain output, total blood loss, postoperative timing of ambulation, and postoperative duration of hospital stay in group I were lower than those in group II ( P < 0.001). There was a higher proportion of patients requiring postoperative blood transfusion in group II, but not to a level of statistical significance ( P = 0.054). There was no statistical significant difference in the incidence of surgical site infection (SSI) or symptomatic spinal epidural hematoma (SEH) between the 2 groups ( P > 0.05). Conclusions: This study reveals that there are more benefits of wound drain removal by time driven than that by output driven for patients undergoing posterior 1-level or 2-level lumbar fusion with instrumentation, including less postoperative drain output, less total blood loss, earlier postoperative timing of ambulation and less postoperative duration of hospital stay without increasing the incidence of postoperative SSI or symptomatic SEH.


2017 ◽  
Vol 29 (2) ◽  
pp. 17-20
Author(s):  
Md Aziz Ullah ◽  
Soma Rahman

The aim of this study is to compare between the outcome of wedge excision of perforation site and trimming of perforation margin followed by primary repair in the management of ileal perforation in selected patients. This is an observational study with data from department of Surgery, Sir Salimullah Medical College and Mitford Hospital during February, 2007 to July, 2010. The study included 108 patients of ileal perforation of 15-67 years of age. All patients were treated by primary repair after either wedge excision of perforation site (Group I) or trimming of perforation margin (Group II). Perforation due to typhoid is common in both groups. Abdominal pain, fever, abdominal distention, constipation and vomiting were more frequent in both groups of patients. Signs of peritonitis were observed almost all the patients. Pneumoperitoneum was found 77.8% in group I and 66.7% in group II in X-ray. In ultrasonography ascitis and distended bowel loop was found 44.4% in group I and 66.7% in group II. Typhoid, tuberculosis, nonspecific ulcer and chronic nonspecific ulcer were found in histopathology. Post-operative complications were more in group II. Anastomotic leakage was found 18.5% in group I and 38.9% in group II. Prolonged ileus was observed 16.7% in group I and 33.3% in group II. Anastomotic leakage and Prolonged ileus difference were statistically significant (p<0.05). The mean duration of hospital stay was significantly (p<0.05) higher in group II, where the mean(±SD) duration of hospital stay was 14.2±7.2 days in group I and 18.1±8.9 days in group II. Mortality was observed 9.3% only in group II. So Wedge excision followed by primary repair is better in terms of post operative mortality and morbidity in the management of ileal perforation in selected patients.Medicine Today 2017 Vol.29(2): 17-20


2019 ◽  
Vol 101 (1) ◽  
pp. 21-29 ◽  
Author(s):  
M Arnous ◽  
H Elgendy ◽  
W Thabet ◽  
SH Emile ◽  
SA Elbaz ◽  
...  

BackgroundAlthough several surgical techniques for treatment of sacrococcygeal pilonidal sinus (SPND) have been described, there is no consensus on the optimal surgical procedure. In this study we compared excision with primary closure and Limberg flap in the treatment of SPND.MethodsThis was a prospective randomised clinical trial in patients with SPND who were randomly allocated to one of two groups: group I (excision and primary closure) and group II (Limberg flap technique). The primary outcome of the trial was recurrence of SPND whereas postoperative complications, return to work and cosmetic results were the secondary outcomes.ResultsSixty patients were included, with a mean age of 24.1 years and mean body mass index (BMI) of 26.8 kg/m2. Group 1 had significantly shorter operation time than group II. Both groups had similar hospital stay and comparable complication rates (43.3% vs 30%; P = 0.4). Group I had significantly higher recurrence rate (20% vs 0; P < 0.02) and significantly better cosmetic satisfaction score than group II. Being hairy (P = 0.04), positive family history (P = 0.03), diabetes mellitus (P = 0.005) and history of previous surgery for SPND (P = 0.01) were the significant predictors for recurrence.ConclusionsThe Limberg flap is an effective technique for the treatment of SPND with very low recurrence rate and comparable complication rate and hospital stay to excision and primary closure. Excision and primary closure offered the advantages of quicker healing time, earlier resumption of daily activities, better cosmetic results, which may render it more suitable for patients with low risk for recurrence.


2013 ◽  
Vol 26 (2) ◽  
pp. 68-71 ◽  
Author(s):  
Khurshida Tahmin ◽  
Shamsun Nahar Begum

This Randomised controlled clinical trial was undertaken to determine the suitable time of catheter removal after urogenital prolapse surgery in order to reduce the catheter related UTI and its long term sequel. Method: Total 80 patients undergoing vaginal hysterectomy with pelvic floor repair were enrolled and randomised into two equal groups by lottery method. Trans-urethral catheter was removed on 2nd & 5th post operative day in group I (n=40) and in group II (n=40) respectively. Post   voidal residual urine volume before operation and after removal of catheter was measured in   all patients by ultrasound scanning. Re-catheterisation was done for three more days if residual volume > 200ml after removal of catheter. Urine samples were taken before removal of catheter and send for routine microscopic examination and culture & sensitivity test to detect UTI.Results: Removal of catheter on 2nd post-operative day lead to significant reduction of rate of UTI. The rate of UTI following removal of catheter was 7.5% versus 42.5% in group I and in group II (p<0.001). But need for recatheterisation was significantly higher in group I (15%) than in group II (2.5%). The mean duration of catheterisation was 47.63 (±0.628) and 119.35 (±0.864) hours in group I and group II respectively. Majority of the patients in group I did not  require prolongation of catheterisation. Mean duration of hospital stay after operation was 5 days in group I and 7.95 days in group II (p<0.001). Conclusion: Short period catheterisation is associated with lower rate of UTI and shorter hospital stay. Disadvantages of prolonged catheterisation outweigh the advantages. Therefore removal of the catheter on the 2nd post-operative day after genital prolapse surgery is preferable than 5 days catheterization DOI: http://dx.doi.org/10.3329/bjog.v26i2.13782 Bangladesh J Obstet Gynaecol, 2011; Vol. 26(2) : 68-71


2019 ◽  
Vol 23 (2) ◽  
pp. 267-276
Author(s):  
K. A. Khyzhniak ◽  
Y. V. Volkova ◽  
K. Y. Sharlai ◽  
M. V. Khartanovych

The aim of the work was to analyze the results of the observation of the postoperative period in patients with surgical aortic pathology after surgical intervention using cardiopulmonary bypass. 118 patients with surgical aortic pathology (SAP) were examined. Patients were divided into 2 groups. Group I included 46 patients who were additionally prescribed a solution of meglumin sodium succinate (reamberin), group II included 46 patients who were additionally assigned a solution of D-fructose-1,6-diphosphate sodium hydrate salt (esophosphine). The control group (K) consisted of 26 patients who had surgical pathology of the aorta, all the criteria coincided with patients of groups I and II, but did not have additional substances as part of intensive care (IT) in order to prevent postoperative cognitive dysfunction (PСD). Analyzed the patient's condition on a scale of postoperative mortality prediction EuroSCORE II, the depth of anesthesia with a BIS monitor, the qualitative composition of the leukocyte formula, nasal and rectal temperature, blood gas composition, electrolyte level, glucose, lactate, coagulogram indices, hemolysis and phosphates; levels of autoantibodies to brain antigens (MBP, calcium binding protein S-100, NSE and GBA) were determined in the serum by ELISA a day before the operation and on the first, third, seventh and fourteenth day after surgery. The morphometric and functional properties of erythrocytes were investigated the day before the operation (starting level), 12:00 after the operation, and on the third day of hospital stay. The initial assessment of the cognitive abilities of the patients was made the day before the operation, on the third, seventh and fourteenth day of hospital stay. Used to determine the magnitude of the coefficient of linear Pearson correlation. In the analysis, no significant differences were found between the preliminary data on the phosphorus content in the patients' blood, however, the recovery dynamics of its numbers differed in the K, I and II patients. So, in group K and in group I, after 12:00 after surgery, the level of phosphatemia was 0.86 ± 0.21 mmol/l and 0.85 ± 0.18 mmol / l, on the 3rd day of hospital stay — 0,94 ± 0.08 mmol/l and 0.97 ± 0.04 mmol/l, on the 7th day — 1.04 ± 0.16 mmol/l and 1.07 ± 0.21 mmol/l and on The 14th day — 1.08 ± 0.12 mmol/l and 1.1 ± 0.14 mmol/l. It can be noted that the dynamics of blood phosphatemia in patients of groups K and I was identical, its figures almost coincided in terms of the level of phosphorus in the blood and the corresponding number of patients in the variation rows of patients in both groups. It may be noted that there is an unconditional positive effect on the course of the perioperative period of the option of infusion therapy in the IT complex in patients of group II.  


2021 ◽  
pp. 1

Background and objective: To evaluate the effectiveness of vacuum-assisted closure (VAC) in the treatment of Fournier gangrene (FG). Material and methods: Forty-eight male patients treated for Fournier gangrene were included in the study. The patients were divided into two groups (Group I: conventional dressing, Group II: VAC therapy). Characteristics of the patients, laboratory parameters, number of debridement procedures, daily number of dressings, visual analogue scale (VAS) during dressing, analgesic requirement, colostomy requirement, time from the first debridement to wound closure, wound closure method, length of hospital stay, and mortality rates were compared. Results: Group I comprised 33 patients and Group II comprised 15 patients. The number of dressings, VAS score and daily analgesic requirement were statistically significantly lower in Group II (p < 0.05) than in Group I. The number of debridement procedures, colostomy requirement, orchiectomy rate, time from first debridement to wound closure, length of hospital stay, wound closure method and mortality rate were similar between these two groups (p > 0.05). Conclusion: The clinical results of conventional dressing and VAC therapy were similar for treating FG. VAC therapy is an effective postoperative wound care method that offers less requirement for dressing changes, less pain, less analgesic requirement and more patient satisfaction compared to conventional dressing.


2018 ◽  
Vol 42 (3) ◽  
pp. 130-137 ◽  
Author(s):  
Khandaker Tarequl Islam ◽  
Abid Hossan Mollah ◽  
Abdul Matin ◽  
Mahmuda Begum

Background: Acute bronchiolitis is leading cause of hospitalization in infants below 2 years of age. Bronchiolitis being a viral disease, there is no effective treatment. 3% nebulized hypertonic saline and 0.9% nebulized normal saline are often used, although there is disagreement over their efficacy. The aim of this study was to evaluate the efficacy of 3% hypertonic saline in children with acute bronchiolitis in reducing clinical severity and length of hospital stay. Methodology: A randomized control trial carried out in the Department of Pediatrics, Dhaka Medical College Hospital from January 2013 to December 2013.Ninty children from 1 month to 2 years of age hospitalized with clinical bronchiolitis were randomized to receive 3% nebulized hypertonic saline(Group-I) or 0.9% nebulized normal saline (Group-II). Nebulization was done 8 hourly until discharge. Outcome variable were clinical severity score, duration of oxygen therapy and length of hospital stay. Results: Baseline clinical severity score and O2 saturation were in group-I 9.0±1.0 and 94.9±1.7 and in group- II 9.3±1.8 and 94.6±2.6 respectively (p>0.05). At 72 hours, the mean severity score for the group-I was 1.64±0.99 and that for the group-II was 3.0 ± 1.48 (95% CI -2.17 to - 0.53, p=0.002). The cases of group-I required a shorter duration of oxygen therapy compared to those of group-II (15.0±6.0 hours vs 26.4±5.37 hours, 95% CI -20.35 to -2.44, p<0.05). Forty two (93.3%) of the group-I children recovered by the end of72 hours and discharged whereas 26 (57.8%) of the group-II children recovered during the same period (p<0.05). Length of hospital stay was shorter in group-I compared to group-II (58.1±22.0 hours vs 74.7±27.2 hours, 95% CI -26.89 to- 6.17, p=0.002). None of the cases encountered any side-effects. Conclusion: Nebulization with 3% hypertonic saline significantly reduced clinical severity, length of hospital stay and duration of oxygen therapy in case of acute bronchiolitis in comparison to 0.9% normal saline and was safe. Bangladesh J Child Health 2018; VOL 42 (3) :130-137


2018 ◽  
Vol 33 (2) ◽  
pp. 126-133
Author(s):  
Afzalur Rahman ◽  
Mohammad Arifur Rahman ◽  
Farhana Ahmed ◽  
Rezvey Sultana ◽  
Nabil Amin Khan

Introduction: The burden of CAD is increasing at a greater rate in South Asia than in any other region globally. Among them acute ST elevation myocardial infarction (STEMI) is one of the leading causes of death and disability. Major aspect of treatment of acute STEMI is reperfusion of the infarct related artery. Delay in reperfusion is associated with higher mortality and morbidity rates. While primary percutaneous coronary intervention (PCI) is the preferred mode of reperfusion, only few patients can get this form of reperfusion within recommended timelines. On the other hand, thrombolysis is easily available, economical and evaluated in several clinical studies. Thrombolysis is an important reperfusion strategy, especially when primary PCI cannot be offered to STEMI patients, with a time dependent fashion. Methods: This randomized controlled trial was conducted in the department of Cardiology of National Institute of Cardiovascular Diseases since January 2016 to June 2018. Objective of the study was to find out the outcomes of acute STEMI patients after getting on-shelve or purchased Streptokinase (STK). Initially there was no free supply of STK in our hospital as it is an expensive drug, later on fund was arranged and STK was made available at free of cost by the hospital authority. Total 300 patients fulfilling inclusion and exclusion criteria were included in the study. Group I: 150 patients received on-shelf STK when it was made free by the authority and Group II: 150 patients received purchased STK when it was not available at free of cost. Study populations were analyzed for LVF, Cardiogenic shock, MACE (re-infarction, stroke and death) and duration of hospital stay. Results: The mean age of the study population in group I and II were 53.88 ± 14.51 vs. 57.18 ± 15.28 years (p= 0.46). Mean door to injection time in group I and II were 25.51 ± 7.9 vs. 70.36 ± 16.6 minutes (p=<0.001). ST segment resolution was significantly higher in on-shelf STK group then purchased group which were 109 (72.7%) vs. 92 (61.3%), p=0.03. Considering the in-hospital outcome we found that in group I and group II LVF (killip III/IV) was 10 (6.7%) vs. 23 (15.3%) , Cardiogenic shock was 11 (7.3%) vs. 24(16%) , re-infarction was 9(6%) vs. 13 (8.7%) , Stroke was 6 (4%) vs. 8 (5.3%) and death was 12 (8%) vs. 23(15.3%). Among them LVF (killip III/IV), Cardiogenic shock and Death were significantly higher in group II (p=0.02, 0.01 and 0.04 respectively). Major adverse cardiac events (MACE) included re-infarction, Stroke and death, were significantly higher in group II [27 (18%) vs. 44(29.3), p= 0.02]. Mean hospital stay was significantly higher in group II (6.05 ± 1.81) then group I (5.33±1.26), (p=<0.001). Multivariate logistic regression analysis showed hypertension (p=.025) and door to injection time (p=.002) were statistically significant predictors for in-hospital major advance cardiac events (re-infarction, stroke and death) after streptokinase therapy. Conclusion: Despite the strength of evidence based medicine pertaining to the benefits of primary PCI in STEMI, treatment options in Bangladesh are often dictated by resources, logistics, availability and affordability. In our country, not many hospitals offer primary PCI services round the clock. So thrombolysis by streptokinase it the potential reperfusion strategy in our context. In our study it has been found that onshelf Streptokinase significantly reduce door to injection time which ultimately reduce cardiovascular mortality and mortality and also significantly reduce hospital stay. Hospitals intended to treat acute STEMI patients should have on-shelve Streptokinase to reduce door to injection time which affect the inhospital outcome by reducing significant cardiovascular mortality and morbidity. Bangladesh Heart Journal 2018; 33(2) : 126-133


2011 ◽  
Vol 145 (5) ◽  
pp. 742-747 ◽  
Author(s):  
Ruey-Fen Hsu ◽  
Pei-Yin Wu ◽  
Chi-Kung Ho

Objective. Descending necrotizing mediastinitis (DNM) is a serious form of mediastinitis with a high mortality rate. It is caused by the downward spread of an oropharyngeal or cervicofascial infection. The optimal surgical approach for this often fatal disease is controversial. This article describes the authors’ experience and characterizes the surgical strategies and treatment outcomes of patients with DNM. Study Design. Case series with chart review. Setting. A tertiary referral medical center. Subjects and Methods. This study conducted a retrospective chart review of patients with deep neck infections treated at a medical center from 1994 to 2007 and identified 29 patients with DNM. The clinical characteristics and outcomes were compared between patients treated with transcervical drainage alone (group I) and those with both cervical and thoracic drainage (group II). Results. There were 20 patients in group I and 9 patients in group II. The overall mortality rate was 10.3%. The mean duration of the hospital stay was 29.3 ± 15.5 days. There was no statistically significant difference in age, sex distribution, or duration from the appearance of symptoms to hospital admission between the 2 groups. The duration of hospital stay, tracheotomy rate, and mortality rate also did not differ significantly between the 2 groups. However, the numbers of surgeries were significantly higher in group II than in group I. Conclusion. Transthoracic mediastinal drainage is not a compulsory therapy, but timely, aggressive, transcervical mediastinal drainage with extensive debridement is very important for a good outcome when treating DNM patients.


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