Southern medical journal
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To determine the epidemiologic characteristics of hospital-acquired infections (HAI) in pediatric burn patients, we retrospectively reviewed hospital charts of pediatric burn patients from two similar burn units. All patients less than 18 years of age admitted to the burn unit from January 1, 1980 to July 10, 1988, were enrolled. Charts were analyzed for age, sex, burn injury (type, depth, burn surface area), and hospital course (burn wound therapy, use of indwelling catheters or tubes, infectious complications, antibiotic use, cause of death if patient died). ⋯ As in adult patients, burn wound infections, pulmonary infections, and catheter-associated bacteremias are the most common infections in burned children. However, urinary tract infections are more frequent in the pediatric population. Risk factors (> or = 20% full-thickness burns, indwelling devices) and causative organisms are similar in both age groups.
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Southern medical journal · Apr 1994
Preoperative screening electrocardiography: predictive value for postoperative cardiac complications.
The purpose of this study was to evaluate the value of preoperative electrocardiography in predicting postoperative cardiac complications. Four hundred eighty-one patients having elective surgery were eligible. The patients' ages and specific ECG findings were recorded preoperatively. ⋯ Age, P wave abnormalities, and preoperative dysrhythmias were independent predictors of postoperative dysrhythmic events. These specific ECG findings may identify patients at risk of postoperative ischemia or dysrhythmia. These patients may benefit from aggressive preoperative cardiac evaluation or close postoperative cardiac monitoring.
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Although intracranial gliomas carry a poor long-term prognosis, retreatment at the time of tumor progression may prolong survival and maintain or improve the quality of life. Thirty-three patients who underwent retreatment with surgery, radiotherapy, and chemotherapy were reviewed retrospectively. Median survival after initiation of retreatment was 8 months for glioblastoma, 13 months for anaplastic astrocytoma, 22 months for astrocytoma, and 47 months for oligodendroglioma/mixed glioma. ⋯ Chemotherapy and radiotherapy produced expected adverse reactions. Retreatment of intracranial gliomas carries acceptable risk and is beneficial in selected patients. Decisions regarding retreatment must be carefully individualized with consideration of the quality of life and the wishes of the patient and family.
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Southern medical journal · Feb 1994
Comparative StudyEndotracheal tube misplacement: incidence, risk factors, and impact of a quality improvement program.
To assess the impact of a quality improvement program on the occurrence of serious complications related to endotracheal tube misplacement and to identify risk factors, we did a before and after comparison in the adult intensive care units of a military referral hospital. All adult patients requiring endotracheal intubation during two 12-month periods comprised the study population. After the identification of a sentinel case, a retrospective review identified 278 adult patients requiring endotracheal intubation over a 12-month period. ⋯ The incidence of serious complications related to endotracheal tube misplacement was significantly less during the implementation of the quality improvement program (0 of 246 patients) than during the retrospective period (5 of 278 patients). Multivariate analysis showed that a longer duration of endotracheal intubation, the lack of chemical paralysis, and the occurrence of cardiac arrest were independently predictive of endotracheal tube misplacement. These results suggest that a specific ICU quality improvement program can have a favorable impact on patient outcome.