17 research outputs found
Home Hospitalization for Acute Decompensated Heart Failure: Opportunities and Strategies for Improved Health Outcomes
Importance: Heart failure (HF) is the leading cause of hospitalization among patients over the age of 65 in the United States and developed countries, posing a significant economic burden to the health care systems. More than half of the patients with HF will be readmitted to the hospital within 6 months from discharge, leading not only to increased health care related expenses but also functional decline, iatrogenic injuries and in-hospital infections. With the increasing prevalence of HF, there is a substantial need for innovative delivery care models that can provide hospital level of care at a patient’s home. Observations: Home hospitalization was originally used to safely manage chronically ill patients with general medical (stroke, chronic obstructive pulmonary disease, deep vein thrombosis, community acquired pneumonia) and surgical conditions and was associated with improved patient satisfaction and improvement in activity of daily living status. This had no clear effect on readmission or cost. When hospital at home care model was applied to HF patients it demonstrated increased time to readmission, reduced index costs and improved health related quality of life, with no significant differences in adverse events. Eligible patients should be selected based on multiple factors taking into consideration applicable limitations and comorbidities. Conclusions and Relevance: Providing in-hospital level care to the patient’s house presents a reliable alternative, yielding multiple benefits both for the patient, as well as the health care system. Formulating a well-defined model is necessary before wide implementation
Moya moya syndrome in a child with pyruvate kinase deficiency and combined prothrombotic factors
A 13-year-old Greek girl with pyruvate kinase deficiency and moya moya
angiographic pattern is reported. She also had raised serum lipoprotein
(a) concentration and was homozygous for the C677T mutation of the
methylenetetrahydrofolate reductase gene. She presented with neonatal
onset of anemia, hemolytic and aplastic crises, especially during
infections, stroke, and also progressive motor and mental deterioration.
A digital cranial angiography at 13 years revealed the typical
angiographic findings of moya moya angiopathy. This is likely the first
patient with pyruvate kinase deficiency and moya moya syndrome and also
the combination of elevated serum lipoprotein (a) concentration and the
C677T mutation of the methylenetetrahydrofolate reductase gene to be
reported. In patients with pyruvate kinase deficiency and moya moya
syndrome, a search for raised serum lipoprotein (a) concentrations and
the C677T mutation of the methylenetetrahydrofolate reductase gene
should be considered
Effect of sodium valproate monotherapy on serum uric acid concentrations in ambulatory epileptic children: A prospective long-term study
Purpose: Hyperuricemia has been shown to be related to cardiovascular
morbidity and mortality. There is controversial data about the effect of
sodium valproate (VPA) monotherapy on serum uric acid concentrations.
The purpose of this study was to investigate by a long-term, prospective
method, whether treatment with VPA monotherapy may alter serum uric acid
concentrations and liver function tests in ambulatory epileptic
children.
Material and methods: Serum uric acid concentrations were determined in
28 ambulatory epileptic children before and at 6, 12 and 24 months of
VPA monotherapy. Serum concentrations of biochemical markers of liver
and renal function, such as alanine aminotransferase (ALT), aspartate
aminotransferase (AST), lactate dehydrogenase (LDH),
gamma-glutamyltransferase (gamma-GT) and creatinine (Cr) were also
measured before and at 6, 12 and 24 months of VPA monotherapy. Serum VPA
concentrations remained within the therapeutic range (50-100 mg/L)
during the period of study.
Results: No statistically significant changes in serum Uric acid
concentrations were found at 6, 12 or 24 months of treatment. Serum ALT
concentrations were significantly increased at 6 and 12 months of
treatment, AST concentrations at 6 and 12 months of treatment and LDH
concentrations at 12 months of treatment.
Conclusions: VPA monotherapy does not have a significant effect on serum
uric acid concentrations in ambulatory epileptic children. Further
studies are needed to definitively address whether it would be useful
for physicians to routinely check for elevated serum uric acid levels in
children treated with VPA. (C) 2006 European Paediatric Neurology
Society. Published by Elsevier Ltd. All rights reserved