Longterm Acute Care Hospital

The Mini Nutritional Assessment (MNA) is a tool that was developed for use with elders to provide rapid assessment of nutritional risk. Although this screening tool has been validated and frequently used in longterm and acute-care settings in Europe, the MNA has not been used extensively within the United States. The MNA may need to be validated for use within U.S. nursing and acute-care facilities because validity may be affected by the acuity of illness, the use of aggressive nutrition support, which makes the scoring of the MNA difficult, and the age of patients admitted for care (acute care)...

PURPOSE: To evaluate the incidence and ocular effects of blunt trauma due to injury from airsoft gun pellets. METHODS: We conducted a non-comparative case series based on the files of 33 patients who suffered ocular injury from airsoft guns and were admitted to one university emergency eye clinic in Copenhagen during a 5-year period. RESULTS: A total of 33 eyes in 33 patients were examined. Thirty male and three female patients were affected...

PROBLEM: Neonatal and pediatric nurses and physicians care for newborn children who have been saved by technological support but who then spend extremely long periods of time in the hospital, perhaps never being able to be discharged to home. There has been little research identifying newborns who are too sick to be discharged from the health care setting and rare reports of staff or parental response to these long-term hospitalizations. PURPOSE: This study provides both the numerical data and description of acutely, chronically ill newborn children whose illnesses caused hospitalizations for greater than 6-months (179 days) in the US...

OBJECTIVE: Gout is a less commonly diagnosed rheumatic disease in China compared with Western countries, but its prevalence appears to be climbing. It is not known how Chinese physicians diagnose and treat their patients with gout, so we evaluated physician management of gout at a major academic healthcare center in Beijing, and investigated factors associated with better decision-making. METHODS: A 13-question anonymous survey was distributed and collected at a medical grand rounds and then at a rheumatology grand rounds at a major teaching hospital in Beijing...

This review illustrates the various types of workplace violence nurses can encounter in critical care settings. Lack of a clear definition of workplace violence impedes research on the topic; however, the typology offered by the UIIPRC provides a framework to guide further studies of physical and nonphysical workplace violence. Further investigation of individual and organizational factors will assist nurses and agencies in identifying effective methods to manage, prevent, educate, and respond to each type of workplace violence...

OBJECTIVE: We identified patients presenting with chest pain diagnosed as costochondritis by a consultant rheumatologist. The time taken to diagnosis was determined and the influence of diagnosis on subsequent management was assessed. We then estimated any cost benefits that early diagnosis and treatment of costochondritis might confer. Finally, we evaluated our current experience of sulfasalazine as a treatment for recurrent costochondritis. METHODS: This was a retrospective observational study of 25 consecutive patients (17 female), mean age 50 years (range 26-75), with costochondritis who initially presented with acute chest pain...

BACKGROUND: Few patients with Kawasaki's syndrome have been described in Norway. Different aspects of diagnosis and treatment are assessed in this article. MATERIAL AND METHODS: We retrospectively reviewed 26 cases of Kawasaki's syndrome at Haukeland University Hospital 1985-1999. RESULTS: 85% of the patients fulfilled all criteria for diagnosis and were treated as recommended; yet we found a high frequency of coronary aneurysms (22%). Children with aneurysms had delayed onset of treatment compared to patients without complications...

OBJECTIVE: To determine the independent effect of advancing age on prognosis after cardiopulmonary resuscitation (CPR). DESIGN AND SETTING: Retrospective analysis of clinical records of patients who received CPR in a geriatric department equipped with an intensive care unit. PATIENTS: A total of 245 patients (146 men, 99 women; mean age, 70+/-11 yrs) received CPR. Of these, 221 had a cardiocirculatory arrest (CA) in the intensive care unit and 24 had a CA in the general ward of the department...

OBJECTIVES: To compare the 6-month mortality rate of chronically ventilated patients treated either exclusively in a traditional acute-care hospital or transferred during hospitalization to a long-term acute-care facility. To analyze the hospital cost of care and estimate the amount of uncompensated care incurred by acute-care hospitals under the Medicare prospective payment diagnostic related groups system. DESIGN: Retrospective chart review and questionnaire. SETTING: Fifty-four acute-care referral hospitals and 26 longterm acute-care institutions...

BACKGROUND AND OBJECTIVE: The prognostically favourable effect of secondary prevention in patients with proven coronary heart disease (CHD: documented myocardial infarction, angiographically proven coronary artery stenosis > 60% and/[or] status after coronary artery surgery) has been demonstrated. But it has not been adequately shown to what extent the guidelines laid down by specialist societies is being followed in routine clinical practice. Nor have there been any large-size standardized investigations of whether in-hospital rehabilitation decreases cardiovascular risk factors...

During the past decade, the healthcare industry has seen a marked expansion of networked delivery. The norm is no longer a stand-alone hospital, but an "Integrated Healthcare Delivery System," in which a healthcare provider may offer services from acute care, ambulatory, longterm and home health care. Along with the IHDS comes the need to integrate the vast amount of information necessary to operate the network and service the patients. This article looks at the findings of a survey of IHDS information usage and needs...

SETTING: Accident and emergency department, General Hospital, Port of Spain, Trinidad and Tobago. OBJECTIVE: To measure the occurrence and clinical management of acute severe asthma. DESIGN: Data collected prospectively for consecutive attendees with asthma over a period of 3 months. RESULTS: Asthma accounted for 8.8% of attendances. Treatment for the acute attack included nebulised salbutamol in 1031 (85%) and nebulised atrovent in 769 (63%)...

A 10 years old male patient, DG, was admitted in the ICU because of continuous uncontrolled movements due to a neurologycal degenerative disease (Hallervorden-Spatz syndrome) able to determine reduction of spontaneous breathing efficacy. At admission he presented acute ventilatory failure, because of a Staphylococcus aureus broncopneumonia, so he had a tracheal tube and mechanical ventilation (pressure support). During hospitalization (4 months in ICU and 2 months in Pediatric Department) DG received tracheotomy and percutaneous gastrostomy, to obtain adequate spontaneous ventilation and artificial enteral nutrition; a satisfactory pharmacological control of choreo-athetosic movements, with not great interference with original sleep-awake cycle, was obtained...

BACKGROUND: Controversy still surrounds the management of fulminant acute necrotizing pancreatitis. Because mortality rates continue to be high, especially in patients with fulminant acute pancreatitis and infected necrosis, aggressive surgical techniques, such as open management of the abdomen and "planned" reoperations, seem to be justified. STUDY DESIGN: From 1988 through 1995, 28 patients with fulminant acute pancreatitis and infected necrosis were treated with open management of the abdomen followed by planned reoperations at our surgical intensive care unit...

BACKGROUND: Influenza causes increased morbidity and mortality among patients in longterm care facilities, but little information is available on the impact of influenza in acute care settings. We wished to have such information when revising our hospital influenza control policy. METHODS: We reviewed recent reports of influenza among patients in acute care hospitals and surveyed large (approximately 500-bed) acute care teaching hospitals by telephone to determine the nature of their influenza control policies...

OBJECTIVE: To determine short and longterm outcomes and prognostic factors for patients with systemic rheumatic diseases admitted to intensive care units in 4 teaching hospitals. METHODS: All adult intensive care unit admissions over a 12 year period for systemic rheumatic diseases were retrospectively assessed. One hundred and eighty-one patients with a mean age of 57 +/- 17 years were studied. RESULTS: The death rate in intensive care units was 33% (59/181) and in-hospital mortality was 43% (77/181)...

OBJECTIVE: To perform the first prospective longitudinal study of direct (health services utilized) and indirect costs (diminished productivity represented by income loss) incurred by patients with rheumatoid arthritis (RA) in Saskatoon and Montreal, followed for up to 12 and 4 years, respectively. METHODS: 1063 patients reported on health status, health services utilization, and diminished productivity every 6 months. RESULTS: Annual direct costs were $3788 (1994 Canadian dollars) in the late 1980s and $4656 in the early 1990s...

OBJECTIVES: Hospitalization of nursing home residents is a growing, poorly defined problem. The purposes of this study were to define rates, patterns, costs, and outcomes of hospitalizations from nursing homes and to consider implications for reducing this problem as part of health care reform. METHODS: Communitywide nursing home utilization review and hospital discharge data were used to define retrospectively a cohort of 2120 patients newly admitted to nursing homes; these patients were followed for 2 years to identify all hospitalizations...

This study examines the feasibility of using Quality-Adjusted Life Years (QALYs) to assess patient outcome and the economic justification of treatment in an Intensive Care Unit (ICU). 248 patients were followed for three years after admission. Survival and quality of life for each patient was evaluated. Outcome for each patient was quantified in discounted Quality-Adjusted Life Years (dQALYs). The economic justification of treatment was evaluated by comparing the total and marginal cost per dQALY for this patient group with the published cost per QALY for other medical interventions...

Denial may be prognostically favorable in patients with acute myocardial infarction. We analyzed the significance of denial in 26 patients referred to a tertiary care center for advanced therapy of unstable angina. Group A comprised 14 patients characterized as deniers on the Hackett--Cassem Denial Scale. Group B comprised 12 nondeniers. There were no differences between groups in multiple baseline social and demographic characteristics, cardiac history, or risk factors. Similarly, there were no differences in the number of diseased vessels or left ventricular function in those patients catheterized (11 Group A patients, 9 Group B patients)...