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Overt Hypothyroidism in Hospitalized Patients: Clinical Characteristics  [PDF]
Pnina Rotman-Pikielny, Oksana Borodin, Rivka Zissin, Yair Levy
Open Journal of Endocrine and Metabolic Diseases (OJEMD) , 2013, DOI: 10.4236/ojemd.2013.32019

Objectives: Hypothyroidism is usually detected in an outpatient setting, but might be diagnosed during hospitalization. The prevalent symptoms are not fully defined. This study aimed to determine the clinical characteristics of in-patients with overt hypothyroidism. Methods: The medical records of 23 inpatients (16F/7M, age 61.5 ± 21.8 years), who had 29 admissions with a primary diagnosis of hypothyroidism from January 1997 to December 2007 were retrospectively reviewed. They comprised 0.01% of all adult medical admissions during the study. Results: Fifty-five percent had a pre-admission diagnosis of hypothyroidism, 10% were nursing home residents and 38% had cognitive decline. Sixtynine percent presented with multiple complaints, mostly weakness and constipation, reported by 89% and 68%, respectively. Thyrotropin level was 74.3 ± 53.5 mIU/L (normal 0.23 - 4) and free thyroxine was 0.43 ± 0.29 ng/dL (normal 0.8 - 2). Elevated creatinine phosphokinase, anemia (hemoglobin < 12 g/dL) and hyponatremia (sodium < 135 mEq/L) were present in 89%, 62%, and 13%, respectively. Conclusions: Overt hypothyroidism during hospitalization occurs infrequently and mostly in patients with previously diagnosed hypothyroidism. Clinical manifestations include multiple non-specific symptoms, mainly weakness and constipation, while typical hypothyroid symptoms such as cold intolerance and weight gain are often overlooked. A high index of suspicion is needed to detect hypothyroidism in the hospital setting.

Intussusception in Japanese infants: Analysis of health insurance claims database  [PDF]
Masayoshi Miura, Keiko Sato, Hisao Muto, Kusuma Gopala, Katsiaryna Holl
Open Journal of Pediatrics (OJPed) , 2013, DOI: 10.4236/ojped.2013.34056

In order to better understand the possible impact of second-generation rotavirus vaccines on the incidence of intussusception (IS), robust knowledge of the baseline childhood epidemiology of IS from various sources is essential. This study estimated the overall and agespecific baseline incidence of IS among young Japanese children. Data on 57 IS cases from 42,438 screened children aged less than 12 months, born between January 2005 and April 2011 and covered by the health insurance claims database were retrospectively extracted (NCT01479491). IS cases were identified using the International Classification of Diseases, 10th revision (K56.1), with relevant examination and procedural codes. The extracted data were used to estimate the incidence of IS. Among all IS cases extracted, 51 (94.4%) were confirmed IS, of which 49/51 (96.1%) were hospitalized, 2/51 (3.9%) visited outpatient wards; 26/51 (51.0%) were males. The overall incidence of confirmed IS and IS hospitalizations among children aged less than 12 months was 143.5 (95% CI: 106.8 - 188.6) and 137.8 (95% CI: 102.0 - 182.2) per 100,000 children-years, respectively. Three (5.9%) IS cases were identified in children aged below 3 months. IS cases peaked between 6 - 11 months of age (40/51 [78.4%]) with the highest incidence (321.5 [95% CI: 138.8 - 633.4] per 100,000 children-years) observed at 10 months of age. The overall recurrence rate of IS was 3.7% (95% CI: 0.5 - 12.7). The baseline incidence of IS in Japanese children aged less than 12 months was higher than that observed in other countries prior to the introduction of second-generation rotavirus vaccines.

Clinical Outcomes Associated with Use of Subcutaneous Sliding Scale Insulin Compared to Other Insulin Regimens in Hospitalized Patients  [PDF]
Lama S. Alfehaid, Abdulmalik S. Alotaibi, Ahmed S. Alanazi, Rami T. Bustami, Razan El Melik
International Journal of Clinical Medicine (IJCM) , 2018, DOI: 10.4236/ijcm.2018.94023
Abstract: Background: Hyperglycemia in hospitalized patients is managed through one of the following approaches: sliding scale insulin (SSI) alone; SSI plus long-acting insulin and basal-bolus insulin (BBI). The optimal insulin treatment regimen is still debated. Objectives: To evaluate the clinical outcomes associated with the use of SSI compared to other regimens. Setting: The general medical wards in King Abdulaziz Medical City, Riyadh, Saudi Arabia. Methods: Medical charts for adult patients admitted between October 2014-December 2015 with type 2 diabetes or uncontrolled hyperglycemia with insulin treatment were reviewed. Data from capillary blood glucose were measured daily for the first 5 days of hospitalization and recorded. Demographics and blood glucose levels were compared by group using one-way ANOVA or Chi-square test. The number of hyperglycemic/hypoglycemic episodes was analyzed using the Kruskal-Wallis test. Results: A total of 240 patients were included. The three insulin regimen groups were not statistically different in terms of the number of days with episodes of hyper- or hypoglycemia (p > 0.05). However, a significantly bigger change from baseline (improvement) in random blood glucose (RBG) levels was observed in BBI and SSI plus glargine patients compared to SSI (p = 0.014). Conclusion: Our study showed no significant difference in the number of days with episodes of hyper- or hypoglycemia for SSI vs. other insulin regimens. However, SSI patients had less improvement in their RBG levels compared to other insulin regimen groups. Further studies with a larger sample size are needed to confirm these findings.
O desenho na express?o de sentimentos em crian?as hospitalizadas
Silva, Josianne Maria Mattos da;
Fractal : Revista de Psicologia , 2010, DOI: 10.1590/S1984-02922010000800016
Abstract: the article is a reflection about the psychological attendance for hospitalized children. considers the drawing like a form of expression that facilitates the communication of children with the health professionals, especially when them enter the pre-operational stage of child development. the text understand the drawing like a projective instrument allowing the representation of the internal reality of child through symbol. the theme expands the possibility of intervention with children, encouraging the perception of new ways of dealing with them.
Stress materno e hospitaliza??o infantil pré-cirúrgica
Carnier, Luciana Esgalha;Rodrigues, Olga Maria Piazentin Rolim;Padovani, Flávia Helena Pereira;
Estudos de Psicologia (Campinas) , 2012, DOI: 10.1590/S0103-166X2012000300002
Abstract: the aim of this study was to evaluate the level of stress in mothers accompanying children hospitalized to have elective surgical procedures performed, relating it to demographic variables of the child and previous experience in this context. fifty-four mothers accompanying children hospitalized to have elective surgery performed participated in the study. the instruments used were the lipp stress symptoms inventory for adults, and a questionnaire drawn up for the study to survey the children's variables. the results pointed out tht 82% of the sample presented stress, with the stage of resistance and psychological symptoms prevailing. a statistically significant relationship was observed between the presence of maternal stress and the fact that the child had no previous experience of surgery (p=0.052). on the other hand, no statistically significant differences were observed between the presence of maternal stress and the child's age and gender. it was concluded that the impact of surgical procedures affects the child and family, which must be taken into consideration so that interventions can be proposed for pre-operative preparation.
Estado nutricional en ni?os internados en Salas de Cuidados Mínimos. Hospital de Ni?os de la Santísima Trinidad. Córdoba
Gomila,Andrés A; De Grandis,Elizabeth S.; Visconti,Graciela B.; Montero,Susana B.; Bertero,Marta I.; Marietti,Graciela; Crespo,Dolores; Pico,Ana N.; Bianchi,Myriam; Gomila (h),Andrés;
Archivos argentinos de pediatr?-a , 2009,
Abstract: introduction. malnutrition in children hospitalized has been informed in papers from argentina and others countries. it can affect inmunity and increases the rate of mortality when it is severe. the objective of the present study was to describe the nutritional status in children admitted in minimum care wards in a tertiary care children's hospital. population. children under 6 years (1-71.6 months) admitted in minimum care wards in hospital de ni?os de la santísima trinidad, between 15th october 2003 and 15th january 2004, with acute or potentially reversible and chronic medical or surgical conditions. material and methods. anthropometry compared with growth reference data from argentina and lab methods were used in order to test the nutritional condition in patients who met the inclution criteria (n= 439) carried out from the moment patients were admitted to the hospital. the prevalence of: a) malnutrition with p/e < p3 and modified waterlow criteria, b) overweigth and obesity by relative weigth and c) abnormal biochemical parameters were calculated. results. the prevalence of malnutrition taking into account p/e values < percentile 3 was 25.1% and modified waterlow criteria: 50.2%. among the malnourished children, 49.6% of them had acute evolution and 35.1% chronic evolution; 4.5% presented severe malnutrition (60% had a chronic illness); 29 patients (9.1%) were overweigth or obese. the haemoglobin values were low in 47.5% and the albumin level in 3.1% of the patients. conclusions. the prevalences of malnutrition and anaemia are high among the children admitted to the hospital; the prevalences of overweigth and obesity were low in the patients evaluated. a careful evaluation and nutritional care is required in hospitalized children.
Express?o da emo??o por meio do desenho de uma crian?a hospitalizada
Souza, Simone Vieira de;Camargo, Denise de;Bulgacov, Yara Lucia M.;
Psicologia em Estudo , 2003, DOI: 10.1590/S1413-73722003000100013
Abstract: the purpose of this paper is to report the experience of a case study of a kindergarten level hospitalized child. the center of interest in this study is the expression of emotion through the drawings performed by a child in psychotherapy sessions. drawing is considered an expressive activity. these drawings, in addition to the speech, are analyzed based on the cultural-historic concept. the results showed that drawings are one of the means a child uses to express emotions.
Desvelando o cotidiano do adolescente hospitalizado
Almeida, Inez Silva de;Rodrigues, Benedita Maria do R. D.;Sim?es, S?nia Mara Faria;
Revista Brasileira de Enfermagem , 2005, DOI: 10.1590/S0034-71672005000200003
Abstract: my experience in the adolescence was marked by the hospitalization process. currently, as a nursing professional that take care of hospitalized young, there arose inquietudes that originated this study. the investigation object was the significance of the hospitalization in the adolescence, having as objective to understand this significance for the hospitalized adolescent. it was used the qualitative approach in the light of the martin heidegger′s existential phenomenology. the setting was a specific internment unit for adolescents and the deponents were hospitalized young. this study made possible to understand that the adolescent unveiled himself as a being-with and understand of himself as a being in the world thrown to the death. the research pointed to the need of a real implementation of the public policies addressed to the hospitalized adolescent.
Subdiagnóstico de delirium en adultos mayores hospitalizados
Carrasco G,Marcela; Hoyl M,Trinidad; Marín L,Pedro Paulo; Hidalgo A,Jaime; Lagos D,Carmen; Longton B,Cristóbal; Chávez B,Pamela; Valenzuela A,Eduardo; Arriagada M,Domingo;
Revista médica de Chile , 2005, DOI: 10.4067/S0034-98872005001200006
Abstract: background: delirium is a common underdiagnosed and undertreated problem in elderly inpatients, associated to higher morbidity, mortality and health cost. aim: to evaluate the prevalence of delirium at hospital admission in medically ill elderly patients and the attending physician's diagnosis and treatment of delirium. patients and methods: in a prospective and descriptive study, consecutive patients aged 65 years or more, admitted to an internal medicine ward were evaluated by independent physicians, during the first 48 h of admission, to asses the presence of delirium. diagnosis of delirium was based on the confusion assessment method. medical and nurse records were reviewed. family was interviewed when necessary. results: one hundred eight patients (52% women, age range 65-94 years) with an apache ii score of 11.6±5, were evaluated. fifty seven patients (53%) had delirium (32% hyperactive, 72% hypoactive and 5% mixed). delirium prevalence was significantly higher in older patients (66% among those aged 75 years or older versus 30% in younger, p <0.05) and among patients with more severe conditions (88% among those with an apache score over 16 versus 47% below that value, p <0.05). medical records of patients with delirium showed that this diagnosis was present only in 32% and cognitive deficit was described in 73%. ten percent of patients with delirium received sedative medication and 38% were physically restricted. there were no environmental interventions to prevent or control delirium. conclusions: delirium in elderly inpatients at this unit is an extraordinarily prevalent problem, seriously under diagnosed (68%) and under treated. this study should alerts our medical community to improve the diagnosis and management of delirium in elderly inpatients (rev méd chile 2005; 133: 1449-54)
S. Mamishi,N. Kalantari B. Pourakbari
Acta Medica Iranica , 2007,
Abstract: Currently there is little information regarding septic arthritis and osteomyelitis in Iran. This retrospective study has been conducted to assess the clinical features and determine the pathogens responsible for septic arthritis and osteomyelitis in patients admitted to our hospital over a 10 year period between 1995 and 2005. A total of 145 cases of septic arthritis and osteomyelitis were studied. The mean age of patients was 18 month. 56.5% (82/145) were male and 43.5% (63/145) were female. The most frequent presenting symptom was pain reported by 69.6 % of the patients. Fever at presentation defined as an oral temperature above or equal to 38 C was present in 67.5 % of the patients. 71 of 145 (48.9%) cases of septic arthritis and osteomyelitis that reviewed in this investigation were culture positive that 71.8 % (51/71) of microorganisms recovered from synovial fluid culture. Moreover 8.4% (6/71) of microorganisms isolated from blood culture alone, while 19.7 % (14/71) of microorganisms recovered from both synovial fluid and blood culture. Staphylococcus aureus was the most common pathogen isolated, making up 60.5% of all positive culture. Coagulase negative staphylococci (CONS) and klebsiella sp. was found in 7 cases (9.8%) and 10 cases (14%) respectively. Group B streptococcus identified in 5 patients (7%). The present study highlights the importance of characterizing the profile of species causing septic arthritis or osteomyelitis in specific regions.
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