Medication of Diseases News - Part 3

Variations in Pediatric Asthma Hospitalization Rates and Costs Between and Within Nordic Countries: Discussion

Variations in Pediatric Asthma Hospitalization Rates and Costs Between and Within Nordic Countries: DiscussionThe incidence of first hospital admissions, LOS, hospitalization cost, and RHR are given by geographic location in Table 1. Large variations in these measures of hospitalization patterns were observed between and within the countries. x2 tests showed no consistent pattern in LOS regarding rural vs urban areas nor gender. Denmark presented with the highest figures regardless of the measure, apart from the nonsignificantly higher RHR in Sweden. (Table 1).

Variations in Pediatric Asthma Hospitalization Rates and Costs Between and Within Nordic Countries: Results

The longitudinal, patient-specific data from Sweden, Denmark, and Norway were used to assess the RHR, defined as a separate admission to the hospital > 1 week after the first asthma discharge during the study period. At least 7 days between the hospitalizations were required in order to ensure that the second hospitalization was a consequence of a new exacerbation and not administrative transfer/shifting between departments (eg, emergency department to pediatrics) during the same episode. Ex ante sensitivity analysis revealed no significant differences in rate of rehospitalization when required gap was varied between 1 day and 7 days. The Cox proportional hazards model was used to estimate the RHR between age groups, regions and countries, controlling for asthma type (based on ICD, 10th Revision) and gender. The response variable was the length of time between subsequent hospitalizations during a 2-year period. Cox modeling is a semiparametric method, which uses the data on patients whose event of interest has occurred (eg, second hospitalization in a given time period), and also on patients who did not experience the event of interest (censored patients). It accounts for the timing of the outcome variable, such as second hospitalization in our example, vs regular nonlinear multivariate models, which only account for whether the event of interest occurred or not.

Variations in Pediatric Asthma Hospitalization Rates and Costs Between and Within Nordic Countries: Hospitalization

Variations in Pediatric Asthma Hospitalization Rates and Costs Between and Within Nordic Countries: HospitalizationData sources on cost per asthma episode were obtained from the Ministries of Health in respective countries, which routinely collect data for prospective budgeting purposes. The total number of children living in each county and country was obtained from the national statistical institutes for 1999, where centralized population census serves as a data collection tool. Counties were first classified into either urban or rural, according to the population density and presence of major urban centers, and later grouped into geographic regions.

Variations in Pediatric Asthma Hospitalization Rates and Costs Between and Within Nordic Countries: Materials and Methods

The study was designed as a 12-month retrospective database analysis on a regional, national, and overall Nordic level assessing inpatient resource use in Denmark, Sweden, Norway, and Finland in 1999. Two types of data on asthma-related hospitalizations were obtained from publicly available national inpatient registries (Danish National Board of Health and Welfare, Norwegian Patient Register, Finnish National Research and Development Centre for Health and Welfare, and Swedish National Board of Health and Welfare) for children < 15 years old. The first source included data on county-level aggregate inpatient services use according to gender and three age groups (< 2 years [infants], 2 to 5 years [young children], and 6 to 14 years [schoolchildren]) from Denmark, Sweden, Norway, and Finland.

Variations in Pediatric Asthma Hospitalization Rates and Costs Between and Within Nordic Countries

Variations in Pediatric Asthma Hospitalization Rates and Costs Between and Within Nordic CountriesOne of the main goals of long-term asthma management is to avoid asthma-related hospital admissions, which remain the second most common cause of hospitalizations in children. In addition, hospitalization costs account for 46 to 74% of the total direct cost of asthma management in the United States and Europe. Significant reductions in hospitalization and readmission rates have been reported during the recent decade from Denmark, and also from local regions within other Nordic countries.” However, a large proportion of children is still hospitalized each year despite extensive educational programs and use of preventive drugs, and the rate of variation within and between national health-care systems remains unknown. Denmark, Sweden, Norway, and Finland are relatively homogeneous in terms of culture, sociodemographic characteristics, and access to publicly funded care. Validated nationwide inpatient registries, based on the International Classification of Diseases (ICD), 10th Revision, and used for prospective hospital financing and policy development, also are available throughout the region, creating a favorable setting for clinical and health-services research.

Survival After Prolonged Submersion in Freshwater in Florida: Conclusion

Survival After Prolonged Submersion in Freshwater in Florida: ConclusionAlthough the ambient temperature was colder than normal for Florida, on interview his mother stated there was no ice formation evident. While the temperature of the water was not obtained, it can be presumed that it was sufficiently cold to have produced rapid cooling of the victim. The fact that his body temperature, as measured rectally, could not have been > 26.7°C at the time of admission to the ED corroborates this assumption. This decreased body temperature likely produced a very significant protective effect from the cerebral hypoxia that undoubtedly occurred during the submersion episode. The efficiency and promptness of bystander basic CPR by persons certified in CPR, and the transfer of the victim via air ambulance with advanced life support to a facility that has physicians with considerable experience in treating drowning victims, no doubt was key to the outcome as well.

Survival After Prolonged Submersion in Freshwater in Florida: Cardiac arrest

Because circulation is still present for a short time after submersion occurs during drowning, and inhalation of water may be delayed by breath-holding and/or laryngo-spasm, reoxygenation of blood can occur until the alveolar oxygen tension falls to dangerous levels. It has been shown in anesthetized animals that with total tracheal obstruction, the average Pa02 dropped to 40 mm Hg after 1 min of obstruction and to 10 mm Hg after 3 min. Thus, the length of time that one can be submerged before irreversible cerebral hypoxia occurs may be longer in drowning victims than in other victims of cardiac arrest.

Survival After Prolonged Submersion in Freshwater in Florida: CPR

Survival After Prolonged Submersion in Freshwater in Florida: CPRRapid cooling of the victim occurs not only because of the large gradient between the water temperature and body temperature, but also because of three physiologic considerations. A small child has a very large body surface area to weight ratio, thus resulting in more surface exposed to cold water than would exist with an adult. Secondly, when a significant volume of cold water is breathed or aspirated, the very large surface area of the alveoli and their immediate proximity to the pulmonary capillary circulation causes the lungs to act as a heat exchanger.

Survival After Prolonged Submersion in Freshwater in Florida: Discussion

Four days after hospital admission, the patient began to emerge from his deep coma, after which his cerebral status progressively improved. Initial evaluation by occupational and physical therapy personnel showed an inability of the patient to bear weight, drink, or eat. He appeared to hear but did not verbalize, did not follow commands, and demonstrated no eye contact. He had generalized weakness. He showed rapid recovery during the 2 weeks following the initial evaluation. He recovered his balance, was able to bear weight with full joint compression, and began to ambulate. He became more interactive, with some verbalization. He regained fine motor skills, with the ability to play “pat-a-cake,” open and close doors, and turn pages in a book. He was totally removed from all support devices and medications over a 3-week period.

Survival After Prolonged Submersion in Freshwater in Florida: Hemolysis

Survival After Prolonged Submersion in Freshwater in Florida: HemolysisArterial blood gas levels on admission to the ED while receiving mechanical ventilation with 100% oxygen and positive end-expiratory pressure were pH 7.06; Pao2, 219 mm Hg; Paco2, 31 mm Hg; HCO3~, 8.8 mEq/L; and base deficit, 21 mEq/L. His initial hemoglobin concentration was 12.8 g/dL, which, subsequently, fell to a low of 9.8 g/dL approximately 13 h after admission and his initial WBC count was 1,200/μL, which spontaneously returned to normal by the third hospital day. His admission serum sodium concentration was 128 mEq/L, his chloride was 98 mEq/L, and his potassium was 4.6 mEq/L. A chest radiograph showed pulmonary markings consistent with water aspiration. canadian neightbor pharmacy

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