Articles: hospitals.
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Intensive care medicine · Aug 2007
Multicenter StudyPediatric Index of Mortality 2 score in Italy: a multicenter, prospective, observational study.
To assess the performance of the Pediatric Index of Mortality (PIM) 2 score in Italian pediatric intensive care units (PICUs). ⋯ The PIM2 score performed well in this sample of the Italian pediatric intensive care population. It may need to be reassessed in the injury and postoperative groups in larger studies.
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Multicenter Study
Isoniazid-related hepatic failure in children: a survey of liver transplantation centers.
Isoniazid (INH) therapy for tuberculosis carries a known risk for hepatoxicity, and leads to hepatic failure in a small subset of patients. This incidence has been described for adults, but is uncertain in children. Our aim was to estimate the incidence of pediatric referrals for INH-related liver failure, and to describe the characteristics and outcomes of these patients. ⋯ While INH-associated liver failure in children is rare, discontinuation at the onset of symptoms does not assure recovery. This indicates a need for increased awareness of hepatotoxicity risk, expanded biochemical monitoring for children receiving INH, and prompt withdrawal in symptomatic patients.
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Several studies on the economic aspect of HAI have two major limitations: (1) the lack of distinction between resources attributable to the management of HAI and resources absorbed by the main clinical problem for which the patient was hospitalized, and (2) the lack of an adequate method for calculating the relative costs. The aim of the study was to test a cost modelling method that could overcome these limitations by applying Appropriateness Evaluation Protocol (AEP) to the medical charts and by using cost-centre accounting. ⋯ Moreover it becomes clear that the weight of the cost for the bed, or for the diagnostic services, or again for the pharmacological treatment, varied widely depending on the site of the HAI and the ward where the patient was hospitalized. Comparing cost of HAI calculated on the basis of the main total cost per day of hospitalization attributable to the HAI we have finally seen that some cases do not produce any costs, whereas others account costs due not to HAI (operating room) or more expensive costs than the really HAl-treatment-attributable ones, as sepsis in Urology ward (Euro 988.18 versus Euro 747.41) or UTI in General Surgery ward (Euro 603.77 versus Euro 479.30), in Neurology (Euro 4242.91 versus Euro 2278.48) and in Orthopedics (Euro 2328.99 versus Euro 1332.81).
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Multicenter Study
Disparities in health care are driven by where minority patients seek care: examination of the hospital quality alliance measures.
Racial/ethnic disparities in health care are well documented, but less is known about whether disparities occur within or between hospitals for specific inpatient processes of care. We assessed racial/ethnic disparities using the Hospital Quality Alliance Inpatient Quality of Care Indicators. ⋯ Disparities in clinical process of care measures are largely the result of differences in where minority and nonminority patients seek care. However, disparities in services requiring counseling exist within hospitals after controlling for site of care. Policies to reduce disparities should consider the underlying reasons for the disparities.
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Death is an emotional event that leaves lasting memories for the bereaved. This article describes the qualitative analysis of a mailed family survey addressing experiences with community hospital inpatient end-of-life care. Family members identified and appreciated symptom management and caring behaviors such as compassion and communication; they also noted the absence of these caring behaviors. Effective application of these behaviors to the dying experience should improve family satisfaction with end-of-life care.