Parental values in the decision about cochlear implantation.

Parents of children who are deaf are required to make decisions shortly after diagnosis that will affect the child's method of communication and educational placement. This study examines the role of parental values and preferences in this decision making process. Twenty families with a deaf child participated in this study. Parents from 19 of these families completed a multi-attribute preference study, which assesses their preference for different outcomes in four domains, i.e. academic achievement, social life, communication, and emotional well being. In ten of these families, the child had received a cochlear implant. Results indicate wide variability in parental preferences, which do not appear to correlate with the parents' decisions to choose cochlear implantation. Interview data from the study provides some insight into the parents' motivations. The small size of the study limits further analysis of factors that influence parents' choices and suggests further study with larger numbers of families.

Uso del boton de gastrotomia como desderivacion temporal en pacientes con vesicostomia / Use of gastrostomy button as temporal dislead in patient with vesicostomy

La evaluación vesical funcional en los pacientes a los cuales se les va a cerrar la vesicostomía de manera definitiva, siempre ha sido difícil, al no obtenerse un adecuado cierre de la misma. Basados en los reportes de la literatura presentamos la experiencia con el botón de gastrostomía en el Hospital de la Misericordia. La evaluación de la función vesical, la cual es esencial antes de restablecer la continuidad de la vía urinaria, se hace mediante estudios radiográficos y urodinámicos. No obstante esta evaluación es técnicamente difícil de desarrollar en niños con vesicostomía y se presentan fallas para predecir con exactitud antes de su cierre, características como adaptabilidad, vaciamiento y continencia. Ha sido descrita en la literatura una nueva opción de cierrede esta con el botón de gastrostomía de Bard. Con el botón en posición fue posible evaluar con exactitud la función y comportamiento, así mismo las posibles alteraciones del tracto urinario superior

Routine portable chest radiographs in the medical intensive care unit: effects and costs.

OBJECTIVE: To determine the effects and net costs of routine chest radiographs in a medical intensive care unit (ICU). DESIGN: A prospective, cohort study. A survey of experts in critical care and pulmonary diseases was undertaken to assess the effect of routine radiographs on patient management. SETTING: Medical ICU of a university hospital. PATIENTS: Eighty randomly selected patients admitted to a medical ICU. Two hundred fourteen experts were surveyed; 118 (55%)/214 responded. MEASUREMENTS AND MAIN RESULTS: Daily interviews with medical ICU clinicians were conducted to assess the radiographic findings in the routine radiographs and actions taken based on these findings. Experts evaluated the findings, their importance, the actions taken, and the probability of complications if the actions had not been taken at that time. Experts also predicted increases in length of stay associated with these complications. Presence of radiographic findings, changes in management because of the findings, net costs of routine chest radiographs, cost per finding that prompted an action, and expected changes in length of stay resulting from the actions were also assessed. Seventy-two (33%) of 221 routine radiographs (95% confidence interval: 25% to 39%) had findings, of which 44 (61%) were judged important, and 18 (8%, 95% confidence interval: 5% to 12%) prompted actions. Experts predicted that each action averted, on average, 2.1 +/- 1.7 days (SD) in the medical ICU. Mean savings per routine radiograph was $98. Net savings from routine chest radiographs remained after sensitivity analysis for expected change in length of stay, percentage of patients with routine radiographs, and percentage of routine radiographs that produce changes in management. CONCLUSION: The policy of obtaining routine chest radiographs in the medical ICU is effective and results in net savings.

The economic cost of hip fractures in community-dwelling older adults: a prospective study.

OBJECTIVES: To evaluate the incremental cost in the year after hip fracture. DESIGN: Prospective cohort study. SETTING: Baltimore, Maryland. PARTICIPANTS: 759 community dwelling older patients who sustained a hip fracture and participated in the Baltimore Hip Fracture Study. MEASUREMENTS: Resource use for direct medical care, formal nonmedical care, and informal care in the 6 months before and the year after fracture was estimated from interviews with patients or proxy respondents. Costs in 1993 dollars were estimated by multiplying resources times national unit cost estimates. RESULTS: The annualized costs in the year before the fracture ranged between $18,523 and $20,928. The costs in the year after the fracture equaled $37,250. The incremental costs in the year after the fracture, compared with the costs in the year before the fracture, ranged between $16,322 and $18,727. The largest cost differences were attributable to hospitalizations, nursing home stays, and rehabilitation services. CONCLUSIONS: Because we compared the costs after a fracture with costs before, our estimates of the incremental cost of a hip fracture are lower than others in the literature. These results, obtained from interviews with patients enrolled in a cohort study, or their proxies, provide the best data available to date on the economic cost of hip fractures among community-dwelling older persons.

Hallazgos manométricos asociados a la enfermedad por reflujo gastroesofágico

Son múltiples las técnicas empleadas en la valorización y cuantificación del reflujo gastroesofágico, y no se cuenta aún con una prueba única que mida todas las variables a considerar en esta enfermedad. Se presenta este estudio que busca establecer la sensibilidad de la manometría esofágica asociada al test de perfusión ácida en el RGE. Se describen los principales hallazgos y se analizan por separado las características de los 30 pacientes estudiados. La manometría y el test con ácido tienen valor como pruebas suplementarias en la valoración de síntomas atípicos y para aclarar la fisiopatología