Epidemiological and Survival Trends of Pediatric Cardiac Arrests in Emergency Departments in Korea: A Cross-sectional,Nationwide Report

Cardiac arrest (CA) in children is associated with high mortality rates. In Korea, cohort studies regarding the outcomes of pediatric CAs are lacking, especially in emergency departments (EDs) or in-hospital settings. This study was conducted to examine the trends in epidemiology and survival outcomes in children with resuscitation-attempted CAs using data from a cross-sectional, national, ED-based clinical registry. We extracted cases in which cardiopulmonary resuscitation and/or manual defibrillation were performed according to treatment codes using the National Emergency Department Information System (NEDIS) from 2008 to 2012. The total number of ED visits registered in the NEDIS during the 5-yr evaluation period was 20,424,530; among these, there were 2,970 resuscitation-attempted CAs in children. The annual rates of pediatric CAs per 1,000 ED visits showed an upward trend from 2.81 in 2009 to 3.62 in 2012 (P for trend = 0.045). The median number of estimated pediatric CAs at each ED was 7.8 (25th to 75th percentile, 4 to 13) per year. The overall rates for admission survival and discharge survival were 35.2% and 12.8%, respectively. The survival outcome of adults increased substantially over the past 5 yr (11.8% in 2008, 11.7% in 2010, and 13.6% in 2012; P for trend = 0.001); however, the results for children did not improve (13.6% in 2008, 11.4% in 2010, and 13.7% in 2012; P for trend = 0.870). Conclusively, we found that the overall incidence of pediatric CAs in EDs increased substantially over the past 5 yr, but without significantly higher survival outcomes.

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Five-Year Subjective Outcomes of Obstructive Sleep Apnea Surgery: A Multiinstitutional Study

Objectives

To evaluate the effect of obstructive sleep apnea (OSA) surgery on long-term (5-year) subjective outcomes, including sleep disordered breathing (SDB) symptoms and other complications, in patients with OSA.

Methods

We enrolled patients who underwent diagnostic polysomnography for OSA between January 2006 and December 2006 in ten hospitals. Patients either were treated for OSA or were not treated for OSA. All patients completed a brief telephone survey regarding their SDB signs and symptoms (e.g., snoring, apnea, nocturnal arousals, and daytime sleepiness), positive airway pressure (PAP) compliance, and any adverse effects of either the surgery or PAP. A positive subjective outcome for either surgery or no treatment was taken to be the alleviation of apnea, defined as a ≥50% increase in score. A positive subjective outcome (compliance) for PAP was defined as a PAP usage of ≥4 hours per night and ≥5 days per week.

Results

A total of 229 patients were included in this study. Patients were divided into three groups: a surgery group (n=87), a PAP group (n=68), and a control (untreated) group (n=74). The surgery group exhibited significant improvement in all SDB symptoms compared with the control group. The long-term subjective outcomes of the surgery (52.9%) and PAP (54.4%) groups were significantly better than those of the control group (25.0%). The subjective outcome of the surgery group was not significantly different from that of the PAP group. The overall surgical complication rate was 23.0% (20 of 87) in the surgery group, and 55.0% (22 of 40) of all patients with PAP experienced adverse effects.

Conclusion

The extent of SDB symptoms was consistently improved in patients with OSA at 5 years postsurgery. Information about the potential long-term subjective outcomes should be provided to patients when considering surgery.     

Long-Term Outlook after Successful Fibrin Glue Ablation of Cryptoglandular Transsphincteric Fistula-in-Ano

Purpose

Initial success rates for fibrin glue ablation of cryptoglandular transsphincteric fistulas have been disappointing. We examined long-term outcomes after initially successful fibrin glue ablation of cryptoglandular transsphincteric fistulas.

Methods

Retrospective review identified 36 adult patients with cryptoglandular transsphincteric fistula Tisseel VH® fibrin glue ablation that was performed from May 2000 to March 2005. Fibrin glue ablations were performed under supervision of fellowship-trained colorectal surgeons. Follow-up interval was based on time until recurrence of fistula or time of last fistula-free evaluation.

Results

Twenty-four men and 12 women patients had a mean age of 50 (range, 27–85) years. Twenty patients responded to initial fibrin glue ablation treatment. Two additional patients healed with secondary fibrin glue ablation. Sixty-six percent (22/33 patients) of cryptoglandular transsphincteric fistulas were closed at three months. Eleven patients failed fibrin glue ablation at a mean of 33 (range, 6–41) days. Seventeen of 22 short-term success patients (3 months) were available for long-term follow-up. Ninety-four percent (16/17 patients) remained healed at final long-term follow-up. The remaining patient recurred just before the six-month follow-up.

Conclusions

Despite the suboptimal early success rate of fibrin glue ablation for cryptoglandular transsphincteric fistulas, when a fistula does close for at least six months this appears to be a durable closure. A single patient recurred after appearing healed at the three-month check.

     

Persistent Truncus Arteriosus With Intact Ventricular Septum: Clinical,Hemodynamic and Short-term Surgical Outcome

Introduction:

Truncus arteriosus with intact ventricular septum is a rare and unique variant of persistent truncus arteriosus (PTA) which usually presents with central cyanosis and congestive heart failure in neonate and early infancy. Associated cardiac and non-cardiac anomalies may affect morbidity and mortality of these patients.

Case Presentation:

We describe clinical presentation, echocardiography and angiographic features of a 7-month old boy with PTA and intact ventricular septum who underwent surgical repair of the anomaly at our institution. Operative findings, surgical procedure and short-term outcome are reported.

Conclusions:

While our patient had systemic pulmonary arterial pressure at the time of complete surgical repair, it was improved after surgery.     

后路半椎体切除术治疗不同年龄先天性脊柱侧凸疗效比较

目的探讨后路半椎体切除术治疗5岁以下与5~10岁单个半椎体所致先天性脊柱侧凸的临床疗效。方法回顾性分析2003年1月至2012年1月在本院接受手术治疗的60例10岁以下单发半椎体所致先天性脊柱侧凸患儿临床资料,其中男37例,女23例,根据年龄将患儿分为两组:婴幼儿组(≤5岁)35例,儿童组(6~10岁)25例。两组均采用后路半椎体切除、椎弓根螺钉固定及植骨融合术。通过复习病历及术前、术后及末次随访时全脊柱正侧位X光片,记录手术时间、融合节段、出血量、术前、术后及末次随访冠状面节段性Cobb角、术前、术后及末次随访矢状面节段性后凸角。结果患儿术后均获得规律随访,随访时间:婴幼儿组平均65.0(29~127)个月,儿童组平均80.3(32~148)个月,差异无统计学意义(P0.05)。平均出血量:婴幼儿组285.8(100~700)mL,儿童组512.6(80~1 400)mL。融合节段数:婴幼儿组平均3.3(2~7)个,儿童组平均4.9(2~11)个。术前冠状面节段性侧凸Cobb角:婴幼儿组平均37.9°(21°~71°),儿童组平均45.8°(25°~94°)。不同年龄组间术中出血量、融合节段数、术前冠状面节段性Cobb角比较,差异有统计学意义(P0.05)。术前、术后及末次随访矢状面后凸角、术后及末次随访冠状面Cobb角、术前及术后冠状面及矢状面畸形率比较,差异均无统计学意义(P0.05)。婴幼儿组采用短节段融合比例与儿童组比较,差异有统计学意义(57.1%vs28%,P0.05)。婴幼儿组有2例围手术期及随访过程中发生并发症(椎弓根骨折1例,术后畸形失代偿行翻修术1例),儿童组有1例出现伤口脂肪液化,两组并发症的发生率比较无统计学意义(5.7%vs4.0%,P0.05)。结论后路半椎体切除术是治疗完全分节的半椎体所致先天性脊柱侧凸安全、有效的手术方式,可取得满意的术后及随访效果。但与婴幼儿组相比,儿童组畸形重,术中需要融合的节段更多,创伤更大;建议对于具有生长潜力的非嵌合型半椎体畸形,应在患儿能耐受手术的情况下尽早手术治疗。     

Which Relapse Criteria Best Predict the Mortality Risk of Treated Alcoholics?

We examined which relapse criteria best predict the mortality risk of treated male alcoholics. The subjects were 172 male alcoholics who had previously been hospitalized. Using three criteria which defined relapse as failure to maintain abstinence from alcohol, alcohol abuse, or dependence, the relapse of each subject had been evaluated during a previous 3-year outcome study. Relative mortality risks in the next 3 years classified by the three relapse criteria were compared. The follow-up rate was 93.6% and 31 subjects died. The age-corrected relative mortality risk for subjects failing to maintain abstinence compared with abstainers was 5.32, while the relative mortality risks for the group abusing alcohol and for the group suffering alcohol dependence were 2.23 and 2.56, respectively. These results suggest that relapse defined as failure to maintain abstinence predicts a higher relative mortality risk than do criteria defining in terms of alcohol abuse and alcohol dependence.     

产前门诊护理对高危孕产妇心理状态及分娩结局的影响

目的 评价产前门诊护理对高危孕产妇心理状态及分娩结局的影响。 方法 采用随机对照研究,选取产科门诊2016年1~6月高危孕产妇139例,采用随机数字表法将其分为对照组和实验组。对照组71例定期在门诊接受产前检查和指导,实验组68例除定期门诊产前检查外,还接受产前门诊护理,比较2组入组时、待产时焦虑水平、待产前分娩意愿及分娩结局。 结果 待产时实验组S-AI评分明显低于对照组(χ²=15.824,P<0.001)。2组分娩意愿和分娩方式选择比较,差异有统计学意义( χ²=23.682,P<0.001; χ²=17.274,P<0.001)。实验组产后出血发生率低于对照组(χ²=4.517,P=0.034)。 结论 对高危孕产妇给予产前门诊护理可降低待产时的焦虑水平,提高自然分娩意愿和顺产率,对改善分娩结局有显著的作用。     

Clinician and manager perceptions of factors leading to ward patient clinical deterioration

Background

Improving the timely recognition and response to clinical deterioration is a critical challenge for clinicians, educators, administrators and researchers. Clinical deterioration leading to Rapid Response Team review is associated with poor patient outcomes. A range of factors associated with clinical deterioration and its outcomes have been identified, and may help with early identification of deteriorating patients. However, the relative importance of each factor on the development of clinical deterioration is unknown.

Home-based nursing interventions improve knowledge of disease and management in patients with heart failure

OBJECTIVE:

to assess patient knowledge of heart failure by home-based measurement of two NOC Nursing Outcomes over a six-month period and correlate mean outcome indicator scores with mean scores of a heart failure Knowledge Questionnaire.

METHODS:

in this before-and-after study, patients with heart failure received four home visits over a six-month period after hospital discharge. At each home visit, nursing interventions were implemented, NOC outcomes were assessed, and the Knowledge Questionnaire was administered.

RESULTS:

overall, 23 patients received home visits. Mean indicator scores for the outcome Knowledge: Medication were 2.27±0.14 at home visit 1 and 3.55±0.16 at home visit 4 (P<0.001); and, for the outcome Knowledge: Treatment Regimen, 2.33±0.13 at home visit 1 and 3.59±0.14 at home visit 4 (P<0.001). The correlation between the Knowledge Questionnaire and the Nursing Outcomes Classification scores was strong at home visit 1 (r=0.7, P<0.01), but weak and non significant at visit 4.

CONCLUSION:

the results show improved patient knowledge of heart failure and a strong correlation between Nursing Outcomes Classification indicator scores and Knowledge Questionnaire scores. The NOC Nursing Outcomes proved effective as knowledge assessment measures when compared with the validated instrument.