Ⅱ期经皮输尿管镜治疗输尿管上段结石梗阻致孤立肾急性肾功能衰竭

目的:探讨经皮肾微造瘘术后Ⅱ期经皮输尿管镜治疗输尿管上段结石致孤立肾急性肾功能衰竭的安全性与有效性。方法:从2004年7月～2009年5月,利用经皮肾微造瘘建立经皮肾通道,引流1周后肾功能明显好转,再行经皮肾输尿管镜碎石治疗孤立肾输尿管上段结石。结果:16例患者中,所有患者均为单通道取石,结石清除率例(81.2%),未出现高热、出血等并发症。术后1月复查13例无结石残留。结论:微创经皮输尿管镜分期治疗输尿管上段结石致孤立肾急性肾功能衰竭是安全、有效的,同传统经皮肾镜相比,具有对病人创伤小,易恢复等优点。     

舒适护理干预对经皮肾镜碎石取石术的临床效果观察

目的探讨舒适护理干预在经皮肾镜碎石取石术后患者康复中的临床应用效果。方法选取2015年1~10月我院泌尿外科收治行经皮肾镜碎石取石术(PCNL)的肾多发结石患者88例为研究对象,随机分为观察组和对照组各44例,对照组给予术后常规护理,观察组在常规护理上,同时进行体位训练和加强背部皮肤护理等干预措施,观察比较两组出血发生情况、肾造瘘管拔除时间、尿管拔除时间、住院时间、患者护理舒适度和满意度情况。结果观察组患者出血发生率低于对照组(P0.05),肾造瘘管拔除时间、尿管拔除时间、住院时间等均少于对照组(P0.05),舒适度和满意度均高于对照组(P0.05)。结论对经皮肾镜碎石取石术后患者实施舒适护理干预,可有效降低出血发生率,提高患者的舒适度和满意度,缩短了住院时间,节约卫生资源,提高了手术疗效。     

内毒素、PCT联合NLR对经皮肾镜碎石术后患者尿源性脓毒血症的预测价值

摘要 目的：探讨内毒素、降钙素原（PCT）联合中性粒细胞与淋巴细胞比值（NLR）对经皮肾镜碎石术（PCNL）术后患者发生尿源性脓毒血症的预测价值。方法：选取2020年5月-2023年5月于西安医学院第二附属医院和空军军医大学第一附属医院泌尿外科行PCNL的患者750例作为研究对象。根据尿源性脓毒症发生情况分为尿源性脓毒血症组（n=45）和非脓毒血症组（n=705）。检测PCNL术前血清内毒素、PCT、中性粒细胞与淋巴细胞水平，并计算NLR。对比两组血清内毒素、PCT水平及NLR。采用多因素Logistic回归模型分析PCNL术后患者发生尿源性脓毒血症的影响因素。绘制受试者工作特征（ROC）曲线分析血清内毒素、PCT联合NLR预测PCNL术后患者发生尿源性脓毒血症的临床效能。结果：与非脓毒血症组相比，尿源性脓毒血症组血清内毒素、PCT及NLR更高（P<0.05）。多因素Logistic回归模型分析结果显示，血清内毒素升高、PCT升高、NLR升高、尿白细胞阳性、术前发热及鹿角型结石是PCNL术后患者发生尿源性脓毒血症的独立危险因素（P<0.05）；ROC曲线分析结果显示，血清内毒素、PCT联合NLR检测预测PCNL术后患者发生尿源性脓毒血症的曲线下面积（AUC）为0.913，高于上述各指标单独检测。结论：PCNL术前血清内毒素、PCT和NLR升高可能与术后患者发生尿源性脓毒血症有关。血清内毒素、PCT水平升高、NLR升高、术前发热、尿白细胞阳性、鹿角型结石是PCNL术后患者发生尿源性脓毒血症的危险因素。血清内毒素、PCT联合NLR检测对PCNL术后患者发生尿源性脓毒血症具有较高预测价值。     

1例因尿瘘而出现精神症状患者的护理

20 0 2年 3月 2 8日我院收治 1例因尿瘘而出现精神症状患者 ,现将对该例患者的临床护理情况报告如下。1　临床资料　　患者 ,女 ,43岁 ,入院诊断为 :左肾切开取石术后尿瘘。于 2 0 0 2年 3月 2 8日上午 1 0 :0 0由家人护送入院 ,入院时病人表情淡漠 ,消瘦 ,喃喃自语。患者家属代述 :患者因左肾结石在当地卫生院行左肾切开取石术。术后切口愈合尚可 ,切口拆线及拔除造瘘管后出院。当时切口闭合尚可 ,无明显不适 ,出院后 4天后在无明显诱因下发现原手术切口疤痕后端有淡黄色液体持续渗出 ,渗出量日渐增多。病人每天都要更换好几次方巾。出现尿…     

肾包膜下积液的临床分析(附23 例报告)

目的:探讨肾包膜下积液的成因和治疗方法。方法:回顾分析23例肾包膜下积液的临床资料。结果:本组23例中,除1例因肿瘤致尿路梗阻放弃治疗,余均经治疗后肾包膜下积液治愈。结论:肾包膜下积液病因以梗阻性为多见,解除梗阻后可治愈;原因不明的特发性肾包膜下积液,肾包膜下穿刺引流术因创伤小,是首选方法,对穿刺引流术治疗后复发病例,可选择手术治疗。     

微通道经皮肾镜碎石术治疗感染性结石合并尿液CRPA感染两例

目的:总结一期行微通道经皮肾镜碎石术(microchannel percutaneous nephrolithotripsy,m PCNL)治疗上尿路感染性结石合并尿培养为耐碳青霉烯铜绿假单胞菌(carbapenem resistant pseudomonas aeruginosa,CRPA)的经验。方法:选择我院收治两例左肾结石合并尿培养为CRPA的患者,经积极抗感染治疗后,病例一行左侧经皮肾镜碎石术,病例二先行右肾穿刺造瘘术成功后行左侧经皮肾镜碎石术,观察分析两例患者术后结石清除情况,术中术后出现发热、腰痛、大出血、尿路损伤及肾功能衰竭等并发症情况。结果:两例患者术后复查双J管位置良好,结石基本清除;术中、术后均未出现发热、腰痛、大出血、尿路损伤及肾功能衰竭等并发症。结论:经过合适的围手术期处理,一期微通道经皮肾镜碎石术治疗感染性结石合并尿培养为耐药菌的患者是安全可行的。     

肾实质切开取石的术后护理

我院外科自 1 986年 9月至 2 0 0 2年 1 2月 ,对经中西医久治不愈的 2 0 0例复杂性肾结石 ,采用肾实质切开术治疗。其中肾背侧实质切开取石 1 5 3例 ,肾下极切开取石 2 0例 ,肾下极切开取石并肾部分切除 2 7例。 2 0 0例均获良好效果并保存了患肾 ,无 1例发生出血、尿瘘、感染等并发症 ,现将术后护理介绍如下。1　一般护理　　肾脏是一质脆、血液循环极为丰富的器官。肾实质切开取石术中在肾盂内留置有肾盂造瘘管 ,肾切开处放置有一多孔橡胶引流管和烟卷引流 ,因此患者术终回病房后 ,应将各引流管接于无菌袋中 ,严防脱落与扭曲 ,并须保持各…     

169例男性假两性畸形患者的治疗体会

目的:总结男性假两性畸形治疗的临床经验.方法:回顾性分析169例男性假两性畸形患者治疗后的临床资料.结果:169例男性假两性畸形患者,97例选择女性性别,72例选择男性性别,手术平均年龄为7岁.选择男性性别的患者术后阴茎平均长度为5.2 cm,35例出现尿后滴沥,18例再次行手术治疗,8例因阴茎小行手术,5例因尿瘘再行手术修补,5例因尿道狭窄行重吻合术,28例因尿道狭窄需行定期扩张,30例对治疗效果不满意,31例男性担心阴茎小,44例术后社会适应良好.选择女性性别的患者术后无尿失禁及排尿困难,2例再次行手术治疗,其中1例阴蒂肥大,1例尿道阴道瘘,17例因阴道狭窄需定期行阴道扩张(阴道成形术后2例),6例对治疗效果不满意,80例术后社会适应良好的.结论:男性假两性畸形治疗性别选择需在医生的指导下,根据患者及家庭意愿慎重决择,选择男性治疗难度大,术后并发症和社会适应困难比选择女性更明显.     

三种膀胱穿刺造瘘术在44例患者的比较

目的:探讨临床常用耻骨上膀胱穿刺造瘘的方法的优劣及需要注意的问题。方法:采用三件套穿刺套件行耻骨上膀胱穿刺造瘘16例,一次性穿刺套件19例,经皮肾穿刺套件9例,分析各组在手术时间,成本费用及并发症的差异。结果:44例病例均顺利完成手术操作,出现并发症15例次,严重并发症1例,出现并发症病例经适当处治后均治愈或好转。其中3件套组的手术平均用时(10±2.3)min、稍高于一次性组(6±1.4)min、但前者的费用明显低于后者(P<0.05);而经皮肾组的手术平均用时最长,但并发症明显低于其他两组(P<0.05)。结论:采用三件套穿刺套件手术时间短,成本低并发症少,经皮肾穿刺套件最为安全,膀胱穿刺造瘘术在充分术前准备,规范操作,严密术后随访是一种安全有效的治疗手段。     

尿道下裂术后两种不同尿液引流方式的临床护理和效果观察

目的探讨尿道下裂术后2种不同尿液引流方式的临床护理和效果。方法选取我院泌尿外科2014年8月~2016年8月收治的46例接受尿道下裂成形术治疗的患者为研究对象。根据术后尿液引流方式不同分为A、B两组,其中A组22例患者采用新尿道内留置支架管的方式引流,B组24例患者采用耻骨上膀胱造瘘管+新尿道内留置支架管的方式引流,两组患者均按照尿道下裂术后护理常规实施术后护理,并根据尿液的不同引流方式给予相关护理。结果两组患者均顺利完成手术治疗,术后采用耻骨上膀胱造瘘管+新尿道内留置支架管方式引流尿液的B组尿瘘及尿道狭窄发生率显著低于实施新尿道内留置支架管引流尿液的A组,两组比较差异有统计学意义(P0.05)。结论尿道下裂术后采用耻骨上膀胱造瘘管+新尿道内留置支架管方式引流尿液,能有效保持尿液及分泌物的充分引流,减少管道堵塞的发生,减少术后尿瘘和尿道狭窄的发生,提高了手术成功率,提高了患者满意度。     

早期康复护理对肠内营养治疗的高血压颅内出血患者预后的影响

目的：研究早期康复护理对肠内营养治疗的高血压颅内出血患者预后的影响。方法：选取2010年1月-2012年10月间入院诊治的高血压颅内出血并应用肠内营养支持治疗的患者120例,随机分为实验组（60例）和对照组（60例）。,对照组应用常规护理办法,实验组在其基础上应用早期康复护理,随访1年后观察两组患者预后的生活质量情况、GCS（格拉斯哥昏迷指数）评分以及并发症的发生情况。结果：随访1年后,实验组的生活质量显著高于对照组（P〈0．05）;护理干预前两组患者的GCS评分无差异,护理干预后实验组的GCS评分显著高于对照组（P〈0．05）;实验组在肺部感染、下肢静脉血栓、肩手综合征等并发症的发生例数均显著低于对照组（P〈0．05）。结论：针对肠内营养支持治疗的高血压颅内出血患者应用早期康复护理可有效改善患者的昏迷程度、预防并发症,有助于提高患者的生活质量。     

Delayed-immediate breast reconstruction

In patients with early-stage breast cancer who are scheduled to undergo mastectomy and desire breast reconstruction, the optimal timing of reconstruction depends on whether postmastectomy radiation therapy will be needed. Immediate reconstruction offers the best aesthetic outcomes if postmastectomy radiation therapy is not needed, but if postmastectomy radiation therapy is required, delayed reconstruction is preferable to avoid potential aesthetic and radiation-delivery problems. Unfortunately, the need for postmastectomy radiation therapy cannot be reliably determined until review of the permanent tissue sections. The authors recently implemented a two-stage approach, delayed-immediate breast reconstruction, to optimize reconstruction in patients at risk for requiring postmastectomy radiation therapy when the need for postmastectomy radiation therapy is not known at the time of mastectomy. Stage 1 consists of skin-sparing mastectomy with insertion of a completely filled textured saline tissue expander. After review of permanent sections, patients who did not require post-mastectomy radiation therapy underwent immediate reconstruction (stage 2) and patients who required postmastectomy radiation therapy completed postmastectomy radiation therapy and then underwent standard delayed reconstruction. In this study, the feasibility and outcomes of this approach were reviewed. Fourteen patients were treated with delayed-immediate reconstruction between May of 2002 and June of 2003. Twelve patients had unilateral reconstruction and two patients had bilateral reconstruction, for a total of 16 treated breasts. All patients completed stage 1. Tissue expanders were inserted subpectorally in 15 breasts and subcutaneously in one breast. The mean intraoperative expander fill volume was 475 cc (range, 250 to 750 cc). Three patients required postmastectomy radiation therapy and underwent delayed reconstruction. Eleven patients did not require postmastectomy radiation therapy. Nine patients had 11 breast reconstructions (stage 2), six with free transverse rectus abdominis musculocutaneous (TRAM) flaps, one with a superior gluteal artery perforator flap, and four with a latissimus dorsi flap plus an implant. The median interval between stages was 13 days (range, 11 to 22 days). Two patients who did not require postmastectomy radiation therapy have not yet had stage 2 reconstruction, one because she wished to delay reconstruction and the other because she required additional tissue expansion before permanent implant placement. Six complications occurred. The stage 1 complications involved two cases of mastectomy skin necrosis in patients who required post-mastectomy radiation therapy; one patient required removal of the subcutaneously placed expander before postmastectomy radiation therapy and the other patient had a subpectorally placed expander that only required local wound care. The stage 2 complications were a recipient-site seroma in a patient with a latissimus dorsi flap, a recipient-site hematoma in the patient with the superior gluteal artery perforator flap, and two arterial thromboses in patients with TRAM flaps. Both TRAM flaps were salvaged. Delayed-immediate reconstruction is technically feasible and safe in patients with early-stage breast cancer who may require postmastectomy radiation therapy. With this approach, patients who do not require postmastectomy radiation therapy can achieve aesthetic outcomes essentially the same as those with immediate reconstruction, and patients who require postmastectomy radiation therapy can avoid the aesthetic and radiation-delivery problems that can occur after an immediate breast reconstruction.     

LOW PROFILE BIOPROSTHESIS FOR CARDIAC VALVE REPLACEMENT: EARLY CLINICAL RESULTS

Between May 1976 and April 1977, 100 patients underwent cardiac valve replacement with a unique low profile glutaraldehyde-treated porcine aortic xenograft. These patients were classified in four groups: Group I, 43 patients who underwent isolated mitral valve replacement (MVR); Group II, 27 patients who had isolated aortic valve replacement (AVR); Group III, 10 patients who had MVR and AVR; and Group IV, 20 patients who had MVR or AVR associated with other cardiac procedures. The operative mortality for Group I was 2.3% (1 of 43) and 15% (3 of 20) in Group IV. The total operative mortality was 4% (4 of 100) and the late mortality was 1.02% (1 of 96 survivors), who died apparently secondary to a cardiac arrhythmia. During a follow-up period extending for 16 months, thromboembolic complications occurred early in the postoperative period in 3% (3 of 100), one patient with neurological residual, and two patients with transient symptoms only. The embolic complications occurred only in Group I. Considering all patients in whom the mitral valves were replaced, the incidence of emboli was 4.9% (3 of 61). The 96 patients did not receive anticoagulant therapy. Reoperation was necessary in one patient because of periprosthetic leak. The incidence of endocarditis was 1.02% (1 of 96 survivors). We recommend anticoagulant therapy for eight to twelve weeks postoperatively in MVR patients after bioprosthetic insertion.     

经脐单孔腹腔镜手术患者的围手术期护理

目的:探讨经脐单孔腹腔镜手术的临床可行性及护理要点。方法:对我院2010年6月～2011年6月实施的6例经脐单孔腹腔镜手术患者的临床资料进行回顾性分析。结果:经脐单孔腹腔镜手术除常规治疗作用外,患者恢复快,花费少,同时美容效果也大大提高。结论:经脐单孔腹腔镜手术安全可行,腹部无明显瘢痕,美容效果明显;系统的围手术期护理,更有利于促进患者康复;随着相关技术不断成熟,必然会得到广泛应用。     

Multidisciplinary transmural rehabilitation for older persons with a stroke: the design of a randomised controlled trial

Background

Stroke is one of the major causes of loss of independence, decreased quality of life and mortality among elderly people. About half of the elderly stroke patients discharged after rehabilitation in a nursing home still experience serious impairments in daily functioning one year post stroke, which can lead to difficulties in picking up and managing their social life. The aim of this study is to evaluate the effectiveness and feasibility of a new multidisciplinary transmural rehabilitation programme for older stroke patients.

Methods

A two group multicentre randomised controlled trial is used to evaluate the effects of the rehabilitation programme. The programme consists of three care modules: 1) neurorehabilitation treatment for elderly stroke patients; 2) empowerment training for patient and informal caregiver; and 3) stroke education for patient and informal caregiver. The total programme has a duration of between two and six months, depending on the individual problems of the patient and informal caregiver. The control group receives usual care in the nursing home and after discharge.Patients aged 65 years and over are eligible for study participation when they are admitted to a geriatric rehabilitation unit in a nursing home due to a recent stroke and are expected to be able to return to their original home environment after discharge. Data are gathered by face-to-face interviews, self-administered questionnaires, focus groups and registration forms. Primary outcomes for patients are activity level after stroke, functional dependence, perceived quality of life and social participation. Outcomes for informal caregivers are perceived care burden, objective care burden, quality of life and perceived health. Outcome measures of the process evaluation are implementation fidelity, programme deliverance and the opinion of the stroke professionals, patients and informal caregivers about the programme. Outcome measures of the economic evaluation are the healthcare utilisation and associated costs. Data are collected at baseline, and after six and 12 months. The first results of the study will be expected in 2014.

Trial registration

International Standard Randomised Controlled Trial Register Number ISRCTN62286281, The Dutch Trial Register NTR2412

     

Factors and Models Associated with the amount of Hospital Care Services as Demanded by Hospitalized Patients: A Systematic Review

Background

Hospitals are constantly being challenged to provide high-quality care despite ageing populations, diminishing resources, and budgetary restraints. While the costs of care depend on the patients'' needs, it is not clear which patient characteristics are associated with the demand for care and inherent costs. The aim of this study was to ascertain which patient-related characteristics or models can predict the need for medical and nursing care in general hospital settings.

Methods

We systematically searched MEDLINE, Embase, Business Source Premier and CINAHL. Pre-defined eligibility criteria were used to detect studies that explored patient characteristics and health status parameters associated to the use of hospital care services for hospitalized patients. Two reviewers independently assessed study relevance, quality with the STROBE instrument, and performed data analysis.

Results

From 2,168 potentially relevant articles, 17 met our eligibility criteria. These showed a large variety of factors associated with the use of hospital care services; models were found in only three studies. Age, gender, medical and nursing diagnoses, severity of illness, patient acuity, comorbidity, and complications were the characteristics found the most. Patient acuity and medical and nursing diagnoses were the most influencing characteristics. Models including medical or nursing diagnoses and patient acuity explain the variance in the use of hospital care services for at least 56.2%, and up to 78.7% when organizational factors were added.

Conclusions

A larger variety of factors were found to be associated with the use of hospital care services. Models that explain the extent to which hospital care services are used should contain patient characteristics, including patient acuity, medical or nursing diagnoses, and organizational and staffing characteristics, e.g., hospital size, organization of care, and the size and skill mix of staff. This would enable healthcare managers at different levels to evaluate hospital care services and organize or reorganize patient care.     

Tissue-specific, inducible, and hormonal control of the human UDP-glucuronosyltransferase-1 (UGT1) locus

The human UDP-glucuronosyltransferase 1 (UGT1) locus spans nearly 200 kb on chromosome 2 and encodes nine UGT1A proteins that play a prominent role in drug and xenobiotic metabolism. Transgenic UGT1 (Tg-UGT1) mice have been created, and it has been demonstrated that tissue-specific and xenobiotic receptor control of the UGT1A genes is influenced through circulating humoral factors. In Tg-UGT1 mice, the UGT1A proteins are differentially expressed in the liver and gastrointestinal tract. Gene expression profiles confirmed that all of the UGT1A genes can be targeted for regulation by the pregnane X receptor activator pregnenolone-16alpha-carbonitrile (PCN) or the Ah receptor ligand 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). In addition, the selective induction of glucuronidation activity toward lamotrigine, ethinyl estradiol, chenodeoxycholic acid, and lithocholic acid by either PCN or TCDD in small intestine from Tg-UGT1 mice corresponded to expression of the locus in this tissue. Induction of UGT1A1 by PCN and TCDD is believed to be highly dependent upon glucocorticoids, because submicromolar concentrations of dexamethasone actively promote PCN and TCDD induction of UGT1A1 in Tg-UGT1 primary hepatocytes. The role of hormonal control of the UGT1 locus was further verified in pregnant and nursing Tg-UGT1 mice. In maternal 14-day post-conception Tg-UGT1mice, liver UGT1A1, UGT1A4, and UGT1A6 were induced, with the levels returning to near normal by birth. However, maternal liver UGT1A4 and UGT1A6 were dramatically elevated and maintained after birth, indicating that these proteins may play a critical role in maternal metabolism during lactation. With expression of the UGT1 locus confirmed in a variety of mouse tissues, these results suggested that the Tg-UGT1 mice will be a useful model to examine the regulatory and functional properties of human glucuronidation.     

Management of early human bites of the hand: a prospective randomized study

A prospective, randomized study was undertaken to determine if mechanical care of early human bites alone is sufficient therapy in the compliant patient or if prophylactic antibiotics (oral versus parenteral) are indicated. Beginning in June of 1985, patients presenting with human bites of the hand were entered into the study if (1) the bite was less than 24 hours old, (2) the patient was free of infection, (3) the bite did not penetrate the joint capsule, and (4) there was no injury to tendon. Forty-eight patients were ultimately segregated into one of three study groups after standardized ER mechanical wound care. Fifteen patients received an oral placebo, with 7 developing infection (46.7 percent). Sixteen patients received an oral antibiotic, and 17 patients received parenteral antibiotics. No infections were found in either of these latter groups. The results statistically substantiate that mechanical wound care alone is insufficient therapy. Oral antibiotics appear to be equal to intravenous antibiotics for prophylaxis. From a cost-benefit standpoint, vigorous cleaning, debridement, and coverage with a broad-spectrum oral antibiotic are adequate care for an uncomplicated bite in the compliant patient.     

早期康复护理对肠内营养治疗的高血压颅内出血 患者预后的影响

目的：研究早期康复护理对肠内营养治疗的高血压颅内出血患者预后的影响。方法：选取2010 年1 月~2012 年10 月间入 院诊治的高血压颅内出血并应用肠内营养支持治疗的患者120 例,随机分为实验组（60 例）和对照组（60 例）。对照组应用常规护 理办法,实验组在其基础上应用早期康复护理,随访1 年后观察两组患者预后的生活质量情况、GCS（格拉斯哥昏迷指数）评分以 及并发症的发生情况。结果：随访1 年后,实验组的生活质量显著高于对照组（P<0.05）;护理干预前两组患者的GCS 评分无差异, 护理干预后实验组的GCS 评分显著高于对照组（P<0.05）;实验组在肺部感染、下肢静脉血栓、肩手综合征等并发症的发生例数均 显著低于对照组（P<0.05）。结论：针对肠内营养支持治疗的高血压颅内出血患者应用早期康复护理可有效改善患者的昏迷程度、 预防并发症,有助于提高患者的生活质量。     

Comparison of long-term care in an acute care institution and in a long-term care institution

BACKGROUND: Acute care hospitals in Quebec are required to reserve 10% of their beds for patients receiving long-term care while awaiting transfer to a long-term care facility. It is widely believed that this is inefficient because it is more costly to provide long-term care in an acute care hospital than in one dedicated to long-term care. The purpose of this study was to compare the quality and cost of long-term care in an acute care hospital and in a long-term care facility. METHODS: A concurrent cross-sectional study was conducted of 101 patients at the acute care hospital and 102 patients at the long-term care hospital. The 2 groups were closely matched in terms of age, sex, nursing care requirements and major diagnoses. Several indicators were used to assess the quality of care: the number of medical specialist consultations, drugs, biochemical tests and radiographic examinations; the number of adverse events (reportable incidents, nosocomial infections and pressure ulcers); and anthropometric and biochemical indicators of nutritional status. Costs were determined for nursing personnel, drugs and biochemical tests. A longitudinal study was conducted of 45 patients who had been receiving long-term care at the acute care hospital for at least 5 months and were then transferred to the long-term care facility where they remained for at least 6 months. For each patient, the number of adverse events, the number of medical specialist consultations and the changes in activities of daily living status were assessed at the 2 institutions. RESULTS: In the concurrent study, no differences in the number of adverse events were observed; however, patients at the acute care hospital received more drugs (5.9 v. 4.7 for each patient, p < 0.01) and underwent more tests (299 v. 79 laboratory units/year for each patient, p < 0.001) and radiographic examinations (64 v. 46 per 1000 patient-weeks, p < 0.05). At both institutions, 36% of the patients showed anthropometric and biochemical evidence of protein-calorie undernutrition; 28% at the acute care hospital and 27% at the long-term care hospital had low serum iron and low transferrin saturation, compatible with iron deficiency. The longitudinal study showed that there were more consultations (61 v. 37 per 1000 patient-weeks, p < 0.02) and fewer pressure ulcers (18 v. 34 per 1000 patient-weeks, p < 0.05) at the acute care hospital than at the long-term care facility; other measures did not differ. The cost per patient-year was $7580 higher at the acute care hospital, attributable to the higher cost of drugs ($42), the greater use of laboratory tests ($189) and, primarily, the higher cost of nursing ($7349). For patients requiring 3.00 nursing hours/day, the acute care hospital provided more hours than the long-term care facility (3.59 v. 3.03 hours), with a higher percentage of hours from professional nurses rather than auxiliary nurses or nursing aides (62% v. 28%). The nurse staffing pattern at the acute care hospital was characteristic of university-affiliated acute care hospitals. INTERPRETATION: The long-term care provided in the acute care hospital involved a more interventionist medical approach and greater use of professional nurses (at a significantly higher cost) but without any overall difference in the quality of care.