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Emerg Med (Fremantle). 2002 Dec;14(4):400-5.
Adverse events and complications among patients admitted to hospital in the home directly from the emergency department.

Liu AL, Taylor DM.

Emergency Department, Royal Melbourne Hospital, Melbourne, Victoria, Australia. anitaliluep.com

INTRODUCTION: The nature and incidence of adverse events and complications among patients admitted from the emergency department to hospital in the home has not been investigated. This study aimed to investigate this problem and make recommendations for prevention strategies. METHODS: This was an explicit retrospective chart review of patients admitted from the emergency department directly to hospital in the home between 22 February 1995 and 1 September 2000. A data extraction document was designed specifically for the study and used to extract data relating to patient demographics, diagnosis, past medical history and outcome. The outcomes of interest include adverse events, complications and death. An adverse effect is defined as an unintended injury or complication that results in disability, death or prolonged hospital stay and is caused by health care management. These adverse events may occur prior to or during the index admission and may be noted during or after the index admission. A complication is defined as an undesirable outcome that occurs during the management but not causing disability, death or prolonged hospital stay. RESULTS: Three hundred and fifty-seven patients were enrolled (51.3% male; median age 52 years, range 16-96 years). Fifty-five adverse events were identified: 49 adverse events (89%) were due to management prior to hospital in the home admission and six adverse events (10.9%) were directly attributable to hospital in the home management. This represents a rate of 1.7 adverse events per 100 hospital in the home admissions directly attributable to hospital in the home management. One hundred and eighteen complications were identified. Most complications were easily managed. Thirty-one patients had unplanned re-admissions and two patients died within 28 days of hospital in the home admission. CONCLUSION: Most patients admitted to hospital in the home from the emergency department were managed successfully. Few adverse events arose from hospital in the home treatment. Complications were common but minor in nature. Strategies for the prevention of phlebitis and constipation are recommended.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12534483&dopt=Abstract

Zhonghua Yi Xue Za Zhi (Taipei). 2002 Aug;65(8):398-402.
Neonatal Duhamel's pull-through for Hirschsprung's disease.

Liu CS, Chin TW, Wei CF.

Division of Pediatric Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC. cslightpe.gov.tw

BACKGROUND: Neonatal Duhamel's pull-through was compared with 2 other approaches to Hirschsprung's disease (HD) diagnosed in the neonatal period. METHODS: Fifty HD patients, undergoing Duhamel's pull-through, were divided into 3 groups. Group I had 14 patients with neonatal pull-through; group II had 9 patients with delayed one-stage pull-through; and group III had 27 patients with two-stage pull-through. Operative bleeding and time, complications, and functional results were analyzed. RESULTS: The operative bleeding and operative time were significantly more and longer in group III (p < 0.001). Post-operative enterocolitis and fecaloma occurred in 9 (18%) and 16 (32%) patients respectively, and neither of the complications were different among 3 groups (p = 0.826 and 0.868). The common wall of the rectal pouch in group I was eliminated by endo-GIA stapler in 11 patients, and clamp placement in 3. Of 4 patients of group I with fecaloma, only I used endo-GIA stapler. The functional results were good in 35 patients, with mild constipation in 15 and were not statistically different among 3 groups (p = 0.184). CONCLUSIONS: HD on neonates can be successfully treated by Duhamel's pull-through in neonatal period using endo-GIA stapler. The functional results are as good as those with the delayed one-stage or two-stage Duhamel's procedure, with the child usually benefitting by not having home enema or stoma.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12455810&dopt=Abstract

East Afr Med J. 2001 May;78(5):233-7.
Management of cancer of the stomach in Mulago Hospital Kampala, Uganda.

Ibingira CB.

Department of Anatomy, Makerere Medical School, Kampala, Uganda.

OBJECTIVE: To determine the clinical presentation, mode of investigation and management of gastric cancer at New Mulago Hospital. DESIGN: Prospective descriptive study. SETTINGS: Three general surgical wards, Department of Surgery, New Mulago Hospital. SUBJECTS: Thirty five patients were studied within 12 months. RESULTS: Gastric cancer was found to be prevalent in tribes inhabiting volcanic areas of south western Uganda especially the Banyankole (25%). The commonest mode of clinical presentation was epigastric pain, weight loss, constipation, epigastric tenderness, palpable epigastric mass and anaemia. The most accurate mode of investigation was by endoscopy followed by barium meal. The commonest locality was the pyloric atrium (40%) histologically adenocarcinoma (95.5%) predominated. Gastric cancer was found to be more common in patients with blood group O+ve. All patients had been subjected to some kind of medical treatment especially with antiacids, H2 receptor antagonists which contributed to the delay in presentation. The majority of patients (94.5%) presented with advanced disease and no curative surgery was possible. CONCLUSIONS: These results show that early diagnosis of gastric cancer is still a dream at Mulago hospital since most patients present with advanced disease. To address this problem, all health workers should be sensitised on symptoms and signs for early aggressive investigation or an early referral to enable early diagnosis of gastric cancer. The investigatory capacity of rural hospitals should be boosted to enable early detection of gastric cancer.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12002081&dopt=Abstract

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