Irish medical journal
-
Irish medical journal · May 2006
Audit of the management of patients admitted with community acquired pneumonia.
Community acquired pneumonia (CAP) is a major cause of morbidity and mortality worldwide. There is evidence that guidelines do guide and standardise management, but with less measurable effect on outcome. We prospectively audited the management of CAP in patients admitted to a Dublin hospital during the winter of 2003/04. ⋯ Appropriate antibiotic therapy was instituted within 8 hours of presentation in 123 (75.0%) cases. The rate of use of a severity assessment score to stratify patients with CAP based on recognized guidelines is low in our hospital. Despite this, the overall mortality rate of 8.5% is comparable with previous results.
-
Irish medical journal · May 2006
Letter Case ReportsThe aetiology of brachial plexus injury: what the paediatrician and obstetrician need to know.
The recognition of brachial plexus injury (BPI) after childbirth suggests to parents a causative rather than temporal relationship. This view is supported by textbooks of paediatrics, which state that: 1. "the mechanism of injury is a forceful separation of the head from the shoulder by lateral bending of the neck with simultaneous shoulder depression, during vaginal delivery"; and 2. "these injuries are due to traction on the brachial plexus during delivery."2 Although an obstetrician will talk to a parent when BPI occurs, the ongoing care of the child is within a mutidisciplinary team, where the paediatrician and obstetrician play leading roles. Parents will ask about aetiology, treatment and prognosis; but is the textbook explanation adequate? We illustrate the potential dilemma for the paediatrician and obstetrician through 2 cases of BPI and outline some data on BPI, which is not congruent with current paediatric texts.
-
Irish medical journal · Apr 2006
Outcome of accident and emergency room triaged patients with low risk non-variceal upper gastrointestinal haemorrhage.
An acute upper gastrointestinal haemorrhage (UGIH) is an expensive healthcare problem estimated to cost more than 2.5 billion dollars per annum in the United States. Recent British Society of Gastroenterology (BSG) guidelines (2002) advise that patients with low risk non variceal UGIH have a benign outcome and may be suitable for a relatively short hospital stay with attendant economic saving. We evaluated current clinical experience, endoscopy findings and length of hospital stay in our hospital. ⋯ The mean hospital length of stay (LOS) was 4.16, costing in excess of 1002,840 Euro. Following routine clinical practice for low risk non variceal UGIH, the subsequent duration of hospital stay was unnecessarily prolonged and costly. This highlights the need to initiate change, to monitor resource utilisation and implement early hospital discharge in appropriate patients.
-
Traumatic head injury continues to be a major problem facing the pediatric specialists despite efforts to reduce its incidence. Aims of our study were assessment of the incidence of hospital admissions of children with minor head injuries, their treatment and outcome. In this prospective study we included 101 patient with head injury. ⋯ The outcome was good for all patients. We conclude that majority of patients with minor head injury could be supervised and observed at home by a competent care giver. Admitted patients need radiological evaluation, preferably a CT scan.