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Sample records for routine patient survey

  1. Real-Time Patient Survey Data During Routine Clinical Activities for Rapid-Cycle Quality Improvement

    PubMed Central

    Jones, Robert E

    2015-01-01

    Background Surveying patients is increasingly important for evaluating and improving health care delivery, but practical survey strategies during routine care activities have not been available. Objective We examined the feasibility of conducting routine patient surveys in a primary care clinic using commercially available technology (Web-based survey creation, deployment on tablet computers, cloud-based management of survey data) to expedite and enhance several steps in data collection and management for rapid quality improvement cycles. Methods We used a Web-based data management tool (survey creation, deployment on tablet computers, real-time data accumulation and display of survey results) to conduct four patient surveys during routine clinic sessions over a one-month period. Each survey consisted of three questions and focused on a specific patient care domain (dental care, waiting room experience, care access/continuity, Internet connectivity). Results Of the 727 available patients during clinic survey days, 316 patients (43.4%) attempted the survey, and 293 (40.3%) completed the survey. For the four 3-question surveys, the average time per survey was overall 40.4 seconds, with a range of 5.4 to 20.3 seconds for individual questions. Yes/No questions took less time than multiple choice questions (average 9.6 seconds versus 14.0). Average response time showed no clear pattern by order of questions or by proctor strategy, but monotonically increased with number of words in the question (<20 words, 21-30 words, >30 words)—8.0, 11.8, 16.8, seconds, respectively. Conclusions This technology-enabled data management system helped capture patient opinions, accelerate turnaround of survey data, with minimal impact on a busy primary care clinic. This new model of patient survey data management is feasible and sustainable in a busy office setting, supports and engages clinicians in the quality improvement process, and harmonizes with the vision of a learning health

  2. Factors Predisposing, Enabling and Reinforcing Routine Screening of Patients for Preventing Fetal Alcohol Syndrome: A Survey of New Jersey Physicians.

    ERIC Educational Resources Information Center

    Donovan, Carole L.

    1991-01-01

    Survey of 58 physicians revealed that they did not routinely ask their pregnant patients about alcohol consumption for several reasons: physician bias resulting from own abuse, lack of training, poor awareness of problem and effects, denial that Fetal Alcohol Syndrome occurs in private practice, time limitations, disinterest, fear of offending…

  3. Factors Predisposing, Enabling and Reinforcing Routine Screening of Patients for Preventing Fetal Alcohol Syndrome: A Survey of New Jersey Physicians.

    ERIC Educational Resources Information Center

    Donovan, Carole L.

    1991-01-01

    Survey of 58 physicians revealed that they did not routinely ask their pregnant patients about alcohol consumption for several reasons: physician bias resulting from own abuse, lack of training, poor awareness of problem and effects, denial that Fetal Alcohol Syndrome occurs in private practice, time limitations, disinterest, fear of offending…

  4. Routine versus selective intraoperative cholangiography during laparoscopic cholecystectomy: a survey of 2,130 patients undergoing laparoscopic cholecystectomy.

    PubMed

    Nickkholgh, A; Soltaniyekta, S; Kalbasi, H

    2006-06-01

    Routine use of intraoperative cholangiography (IOC) during laparoscopic cholecystectomy (LC) is a matter of debate. Data from 2,130 consecutive LCs and patients' follow-up during 9 years were collected and analyzed. During the first 4 years of the study, 800 patients underwent LC, and IOC was performed selectively (SIOC). Thereafter, 1,330 patients underwent LC, and IOC was routinely attempted (RIOC) for all. In the IOC group, 159 patients met the criteria for SIOC, which was completed successfully in 141 cases (success rate, 88.6%). Bile duct calculi were found in nine patients. All other patients with no criteria or failed SIOC were followed, and in nine patients retained stones were documented. Thus, the incidence of ductal stones was 1.1% and sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) for the detection of ductal stones were 50, 100, 98.6, and 100%, respectively. In the RIOC group, IOC was routinely attempted in 1,330 patients and was successful in 1,133 (success rate, 90.9%; p = 0.015). Bile duct stones were detected in 37 patients (including 14 asymptomatic stones). In two cases, IOC failed to reveal ductal stones (false negative). There was no false-positive IOC. Therefore, with RIOC policy, the incidence of ductal stones, sensitivity, specificity, NPV, and PPV were 3.3, 97.4, 100, 99.8, and 100%, respectively (significantly higher for success rate, incidence, sensitivity, and NPV; p < 0.05). Abnormal IOC findings were also significantly higher in the RIOC group. Common bile duct injury occurred only in the SIOC group [two cases of all 2,130 LCs (0.09%)]. RIOC during LC is a safe, accurate, quick, and cost-effective method for the detection of bile duct anatomy and stones. A highly disciplined performance of RIOC can minimize potentially debilitating and hazardous complications of bile duct injury.

  5. Outcome measures in European patients with haemophilia: Survey of implementation in routine clinical practice, perception of relevance and recommendations by European treaters in the EHTSB.

    PubMed

    Hermans, C; Klamroth, R; Richards, M; de Moerloose, P; Garrido, R P

    2017-03-01

    This study was conducted to evaluate the current implementation of outcome measures in routine clinical haemophilia practice and to explore and appreciate the perception of the relevance of such measures by treaters. A survey was completed by 19 of the 26 physicians involved in the European Haemophilia Therapy Strategy Board (EHTSB). Employing an extensive inventory of outcome measures used in patients with haemophilia, information was collected about the frequency of data collection and the subjective appreciation of their importance during clinic review. The survey revealed that most treaters currently collect data that are mainly related to the haemostatic treatment (consumption of concentrates) and the bleeding symptoms (number and location of bleeds) in a non-uniform and non-standardized way. By contrast, functional, physical and quality of life scorings are rarely used and show considerable heterogeneity between treaters. Also, many disparities emerged between practice and perception, in particular quality of life data that are perceived as being important but for most of the time are not collected. This survey represents, in our view, the first attempt to evaluate the actual utilization of outcome measures in haemophilia care. While the value of outcome measures is appreciated, they are not assessed regularly. Therefore, there is a need to include appropriate performance indicators (outcome measures) of haemophilia care in routine clinical practice. Consensus recommendations to provide a framework for achieving this aim are provided. © 2016 John Wiley & Sons Ltd.

  6. Can staff and patient perspectives on hospital safety predict harm-free care? An analysis of staff and patient survey data and routinely collected outcomes.

    PubMed

    Lawton, Rebecca; O'Hara, Jane Kathryn; Sheard, Laura; Reynolds, Caroline; Cocks, Kim; Armitage, Gerry; Wright, John

    2015-06-01

    Patients have the potential to provide feedback on the safety of their care. Recently, tools have been developed that ask patients to provide feedback on those factors that are known to contribute to safety, therefore providing information that can be used proactively to manage safety in hospitals. The aim of this study was to investigate whether the safety information provided by patients is different from that provided by staff and whether it is related to safety outcomes. Data were collected from 33 hospital wards across 3 acute hospital Trusts in the UK. Staff on these wards were asked to complete the four outcome measures of the Hospital Survey of Patient Safety Culture, while patients were asked to complete the Patient Measure of Safety and the friends and family test. We also collated publicly reported safety outcome data for 'harm-free care' on each ward. This patient safety thermometer measure is used in the UK NHS to record the percentage of patients on a single day of each month on every ward who have received harm-free care (ie, no pressure ulcers, falls, urinary tract infections and hospital acquired new venous thromboembolisms). These data were used to address questions about the relationship between measures and the extent to which patient and staff perceptions of safety predict safety outcomes. The friends and family test, a single item measure of patient experience was associated with patients' perceptions of safety, but was not associated with safety outcomes. Staff responses to the patient safety culture survey were not significantly correlated with patient responses to the patient measure of safety, but both independently predicted safety outcomes. The regression models showed that staff perceptions (adjusted r(2)=0.39) and patient perceptions (adjusted r(2)=0.30) of safety independently predicted safety outcomes. When entered together both measures accounted for 49% of the variance in safety outcomes (adjusted r(2)=0.49), suggesting that there

  7. The routine collection of patient-reported outcome measures (PROMs) for long-term conditions in primary care: a cohort survey

    PubMed Central

    Peters, Michele; Crocker, Helen; Jenkinson, Crispin; Doll, Helen; Fitzpatrick, Ray

    2014-01-01

    Objectives To evaluate the feasibility of using patient-reported outcome measures (PROMs) for long-term conditions (LTCs) in primary care. Design A cohort postal survey conducted from September 2010 to April 2012. Setting Primary care practices (n=33) in London and the North-West of England. Participants 4484 patients with a diagnosis of asthma, chronic obstructive pulmonary disease, diabetes, epilepsy, heart failure or stroke were sent a survey at baseline. Main outcome The main outcome was to evaluate the feasibility of and the recruitment strategies for collecting PROMs data in LTCs by assessing the response rates for the baseline and follow-up surveys. Secondary outcomes were the evaluation of change scores of the EQ-5D index and visual analogue scale (VAS) between baseline and follow-up surveys. Results The baseline survey achieved a response rate of 38.4% (n=1721/4485) and at follow-up 71.5% (n=1136/1589). Response rates varied by LTC. Little change was found in health-related quality of life for the total sample (−0.001 for the EQ-5D index score and 0.12 for the EQ-5D VAS) between patients responding to both the baseline and follow-up surveys. Conclusions The response rate to the baseline survey was similar to that of other general practice surveys. Current UK policy aims to assess health service performance in LTCs by means of using PROMs. It thus would be desirable to improve response rates by making the invitation to self-reports of health-related quality of life more engaging for patients. Results on the EQ-5D score raise questions about optimal indicators for LTCs and appropriate timelines for assessment. PMID:24561495

  8. Survey of US Correctional Institutions for Routine HCV Testing

    PubMed Central

    Kurth, Ann E.; Bazerman, Lauri; Solomon, Liza; Patry, Emily; Rich, Josiah D.; Kuo, Irene

    2015-01-01

    To ascertain HCV testing practices among US prisons and jails, we conducted a survey study in 2012, consisting of medical directors of all US state prisons and 40 of the largest US jails, that demonstrated a minority of US prisons and jails conduct routine HCV testing. Routine voluntary HCV testing in correctional facilities is urgently needed to increase diagnosis, enable risk-reduction counseling and preventive health care, and facilitate evaluation for antiviral treatment. PMID:25393180

  9. Drivers and Barriers to Acceptance of Web-Based Aftercare of Patients in Inpatient Routine Care: A Cross-Sectional Survey

    PubMed Central

    Hennemann, Severin; Beutel, Manfred E

    2016-01-01

    Background Web-based aftercare can help to stabilize treatment effects and support transition after inpatient treatment, yet uptake by patients seems limited in routine care and little is known about the mechanisms of adoption and implementation. Objective The aim of this study was to (1) determine acceptance of Web-based aftercare and (2) explore its drivers and barriers in different subgroups of a mixed inpatient sample. Method In a cross-sectional design, 38.3% (374/977) of the inpatients from a broad spectrum of diagnostic groups (psychosomatic, cardiologic, orthopedic, pediatric, and substance-related disorders) filled out a self-administered questionnaire prior to discharge. Drivers and barriers to patients’ acceptance of Web-based aftercare were examined based on an extension to the “unified theory of acceptance and use of technology” (UTAUT). In total, 16.7% (59/353) of the participants indicated prior use of eHealth interventions. Results Acceptance (min 1, max 5) was low (mean 2.56, SD 1.22) and differed between diagnostic groups (Welch F4,133.10 =7.77, P<.001), with highest acceptance in adolescent patients (mean 3.46, SD 1.42). Acceptance was significantly predicted by 3 UTAUT predictors: social influence (beta=.39, P<.001), performance expectancy (beta=.31, P<.001), and effort expectancy (beta=.22, P<.001). Furthermore, stress due to permanent availability (beta=−.09, P=.01) was negatively associated with acceptance. Conclusion This study demonstrated a limited acceptance of Web-based aftercare in inpatients. Expectations, social environment’s attitude, and negative experience with permanent availability influence eHealth acceptance. Improving implementation, therefore, means increasing eHealth experience and literacy and facilitating positive attitudes in patients and health professionals through education and reduction of misconceptions about effectiveness or usability. PMID:28011445

  10. Oral anticoagulant therapy for stroke prevention in patients with atrial fibrillation undergoing ablation: results from the First European Snapshot Survey on Procedural Routines for Atrial Fibrillation Ablation (ESS-PRAFA).

    PubMed

    Potpara, Tatjana S; Larsen, Torben B; Deharo, Jean Claude; Rossvoll, Ole; Dagres, Nikolaos; Todd, Derick; Pison, Laurent; Proclemer, Alessandro; Purefellner, Helmut; Blomström-Lundqvist, Carina

    2015-06-01

    The European Snapshot Survey on Procedural Routines in Atrial Fibrillation Ablation (ESS-PRAFA) is a prospective, multicentre snapshot survey of patients undergoing atrial fibrillation (AF) ablation, conducted to collect patient-based data on current clinical practices in AF ablation in context of the latest AF Guidelines and contemporary oral anticoagulant therapies. The EP Research Network Centres were asked to prospectively enrol consecutive patients during a 6-week period (September/October 2014). Data were collected via the web-based case report form. We present the results pertinent to the use of antithrombotic therapies. Thirteen countries prospectively enrolled 455 eligible consecutive patients [mean age 59 ± 10.8 years, 131 (28.8%) females]. The mean CHA2DS2-VASc score was 1.12 ± 1.06 [137 patients (30.1%) had a score of ≥2]. Before ablation, 443 patients (97.4%) were on anticoagulant therapy [143 (31.4%) on non-vitamin K antagonist oral anticoagulants (NOACs) and 264 (58.0%) on vitamin K antagonists (VKAs)]. Of the latter, 79.7% underwent ablation without VKA interruption, whilst a variety of strategies were used in patients taking NOAC. After ablation, most patients (89.3%) continued the same anticoagulant as before, and 2 (0.4%) were not prescribed any anticoagulation. At discharge, 280 patients (62.2%) were advised oral anticoagulation for a limited period of mean 3.8 ± 2.2 months. On multivariate analysis, CHA2DS2-VASc, AF duration, prior VKA use, and estimated AF ablation success were significantly associated with the decision on short-term anticoagulation. Our results show the increasing use of NOAC in patients undergoing AF ablation and emphasize the need for more information to guide the periprocedural use of both NOACs and VKAs in real-world setting.

  11. Correlates of routine HIV testing practices: a survey of New York State primary care physicians, 2011.

    PubMed

    Zielinski, Mary; Leung, Shu-Yin J; Akkaya-Hocagil, Tugba; Rowe, Kirsten A; Ortega-Peluso, Christina; Smith, Lou C

    2015-01-01

    The New York State (NYS) HIV Testing Law of 2010 mandates that medical providers offer HIV testing to patients aged between 13 and 64 years during primary care, to increase the number of people aware of their infection status, and to ensure linkage to medical treatment. To assess physician practices related to this legislation, we conducted a study to identify the frequency and correlates of routine HIV testing behavior among primary care physicians approximately 15 months after the new law went into effect. During September 2011 to January 2012, we mailed self-administered surveys to a representative sample of NYS primary care physicians drawn from the AMA Masterfile of Physicians. Questions included physician practices, knowledge, attitudes, and beliefs related to routine HIV testing. Bivariate and multivariate analyses with a sample of 973 physicians were conducted to identify the most influential predictors of routine HIV testing behaviors. A minority of physicians reported "always" or "frequently" practicing behaviors consistent with routine HIV testing, with 41.7% [95% confidence interval (CI): 37.4 to 46.2] routinely offering tests to patients aged 13-64 years, 40.5% (95% CI: 36.3 to 44.8) to new patients, and 33.3% (95% CI: 29.4 to 37.6) to patients during routine physicals. Only 61.4% (95% CI: 57.4 to 65.6) said they had heard of the new law. In multivariate analyses, specialty, perceived barriers, familiarity with the law, and interaction terms representing familiarity by region and self-efficacy by region were significant predictors across the 3 scenarios of routine HIV testing behavior. Additional technical assistance and training is needed for physicians on adopting routine testing behaviors, minimizing barriers and enhancing skills.

  12. A survey of the value of routine intimate examination and related practices in subfertile couples.

    PubMed

    Desai, A K; Jaiyesimi, R A K

    2007-11-01

    The practice of undertaking routine intimate examinations in the management of subfertile couples varies among clinicians. An anonymous self-administered mailed questionnaire survey was carried out to determine the current practices followed by clinicians and the rationale supporting their practice. In the absence of large comparative studies, this survey provides expert opinion regarding this practice. The questionnaire was mailed to the Fellows and members of the Royal College of Obstetricians and Gynaecologists in the Northern, Yorkshire, West Midlands and Wales regions in the UK. A total of 802 questionnaires were posted, of which 516 were returned, giving an overall response rate of 64%. The responses and comments varied. Some 62% of respondents would routinely perform a pelvic examination on all women presenting with subfertility; 23% would do so only in selected cases and 63% of the clinicians would perform a routine transvaginal ultrasound. The male partners are examined by only 19% of the clinicians. A total of 83% of the respondents were of the opinion that the survey made them think about the role and justification of intimate examinations in greater detail. The practice of intimate examination of subfertile couples varies among clinicians in the survey group. There is a need for large prospective comparative studies to study the value of this examination and related practices in the management of subfertile couples. In the absence of comparative trials, this survey provides expert opinion. It may be suggested that an intimate examination should not be carried out routinely in all subfertile couples. It could be done when it has potential to add value to the management of the patient. A pragmatic approach should be adopted in every clinical situation.

  13. Routine functional assessment for hip fracture patients

    PubMed Central

    Pedersen, Tonny J; Lauritsen, Jens M

    2016-01-01

    Background and purpose Pre-fracture functional level has been shown to be a consistent predictor of rehabilitation outcomes in older hip fracture patients. We validated 4 overall pre-fracture functional level assessment instruments in patients aged 65 or more, used the prediction of outcome at 4 months post-fracture, and assessed cutoff values for decision making in treatment and rehabilitation. Patients and methods 165 consecutive patients with acute primary hip fracture were prospectively included in the study. Pre-fracture Barthel-20, Barthel-100, cumulated ambulation score, and new mobility score were scored immediately after admission. Outcome defined as mortality, residential status, and independent walking ability was assessed at 4 months. Results 3 of the assessment instruments, namely Barthel-20, Barthel-100, and new mobility score, correlated with outcome at 4 months post-fracture and were valid predictors. Thresholds were estimated. We found no evidence that Barthel-100, with its finer granularity, performs better than Barthel-20 as a predictor. Interpretation Our findings indicate that pre-fracture scores of Barthel-20 and new mobility score have predictive ability, and further investigation of usage for guidance of clinical and rehabilitation decisions concerning hip fracture patients is warranted. PMID:27329799

  14. Heart-sparing radiotherapy in patients with breast cancer: What are the techniques used in the clinical routine?: A pattern of practice survey in the German-speaking countries.

    PubMed

    Duma, Marciana-Nona; Münch, Stefan; Oechsner, Markus; Combs, Stephanie E

    2017-01-01

    The aim of this study was to understand the practice of care in German-speaking countries with regard to heart-sparing radiotherapy techniques. Between August 2015 and September 2015, an e-mail/fax-based survey was sent to radiation oncology departments in Germany, Austria, and the German-speaking Switzerland. The questionnaire was divided into 3 chapters: a general chapter on the department, a chapter specific for heart-sparing techniques in patients with breast cancer, and a third chapter on personal beliefs on the topic of heart sparing in patients with breast cancer. A total of 82 radiation oncology departments answered the questionnaire: 16 university clinics and 66 other departments. In general, heart-sparing techniques are being offered by 90.2% of departments for radiation oncology in the German-speaking countries. However, in the clinical routine, 87.7% of institutions use heart-sparing techniques in less than 50% of patients with breast cancer. Heart-sparing techniques are especially provided for patients with left-sided breast cancer (80%), patients after mastectomy (52.5%), and when the mammaria interna lymph drainage vessels are irradiated (41.3%). In 46.3% of departments, there are written internal guidelines for heart sparing in patients with breast cancer. Breathing-adapted radiotherapy is used as the most frequent heart-sparing technique in 64.7% of the institutions, followed by intensity-modulated radiation therapy, which is most frequently used by 22.1%. The only significant difference between university hospitals and other departments was seen for the offering of partial breast irradiation. The most commonly used heart-sparing technique is breathing-adapted radiotherapy, but there is no coherent approach for heart sparing in patients with breast cancer in the German-speaking countries. Overall, all options for cardiac protection/cardiac avoidance have their advantages and disadvantages, with deep inspiration breath-hold radiotherapyhaving the

  15. Seeking, Delaying and Avoiding Routine Health Care Services: Patient Perspectives

    PubMed Central

    Green, Carla A.; Johnson, Kim M.; Yarborough, Bobbi Jo H.

    2013-01-01

    Purpose To explore/identify patient perspectives regarding seeking, delaying, and avoiding health care services, particularly barriers and facilitators. Design Face-to-face interviews with health plan survey respondents. Setting An integrated health plan providing comprehensive care to 480,000 people in Oregon and Washington. Participants Willing respondents randomly selected to maximize heterogeneity within the following strata: gender, health care utilization, and self-reported alcohol consumption (indicator of health practices). Participants were 75 men and 75 women (150 total), 21–64 years old, with ≥12 months of health plan membership. Method Participants were recruited by letter (52.5% agreed). Data collection stopped when planned interviews were completed; saturation (the point at which additional interviews were not producing novel information) was achieved for key study questions. Semi-structured interviews were recorded, transcribed, and coded. Reviews of codes related to care seeking and feelings/attitudes about providers produced common themes. Results Facilitators of care seeking included welcoming staff, collaborative relationships with providers, and education about the value of preventive care. Barriers included costs, time needed for appointments, and cumbersome processes. Some participants delayed procedures, some avoided care until absolutely necessary, others framed care as routinely necessary. Conclusion Increasing comfort, improving appointment and visit-related processes, having positive patient-physician relationships, and enhancing communication and clinician-provided education may facilitate appropriate use of preventive services. Further research is needed with larger, representative, samples to evaluate findings. PMID:23971522

  16. Survey of contraindications in children's routine vaccination in Hangzhou, China.

    PubMed

    Liu, Shijun; Wang, Jun; Liu, Yan; Xu, Yuyang; Che, Xinren; Gu, Wenwen; Du, Jian; Zhang, Xiaoping; Xu, Erping

    2017-07-03

    Objective To describe the epidemiological characteristics of contraindications in children routine vaccination, to evaluate vaccination doctors' ability to determine contraindications. Method Using cross-section study, 34 urban and 15 suburb units were selected from 206 Community Health Center (CHC) in Hangzhou, China. Subjects were all children coming to CHCs for routine vaccination. All situations considered to be unsuitable for vaccination were recorded as contraindications. 3 experts were used to classify these abnormal records as true or false contraindications. Then, the multi-analysis was used to find factors related with the rate of false contraindications. Results There were 2801 children with 2969 contraindications in the present study. The prevalence of contraindications was 3.03‰ by dose of vaccines. Cough (24.78%), fever (21.86%) and medication (19.54%) were the most common contraindications in children routine vaccination. Measles-rubella vaccine (MR) (6.78‰), measles-mumps-rubella vaccine (MMR) (5.87‰) and hepatitis B vaccine (Hep B) (5.25‰) had higher prevalence of contraindications than other vaccines. According to the evaluation of 3 experts, about 13.53% of contraindications were misdiagnosed by vaccination doctor. The rate of misdiagnosed contraindications was correlated with the sex, age and educational background of vaccination doctor, total dose of vaccination of CHC. Conclusion A portion of children might miss the routine vaccination because of misdiagnosed contraindications. More investigations are needed to report the epidemiological distribution of contraindication in routine vaccination of children.

  17. Atrial Fibrillation Management Strategies in Routine Clinical Practice: Insights from the International RealiseAF Survey

    PubMed Central

    Chiang, Chern-En; Naditch-Brûlé, Lisa; Brette, Sandrine; Silva-Cardoso, José; Gamra, Habib; Murin, Jan; Zharinov, Oleg J.; Steg, Philippe Gabriel

    2016-01-01

    Background Atrial fibrillation (AF) can be managed with rhythm- or rate-control strategies. There are few data from routine clinical practice on the frequency with which each strategy is used and their correlates in terms of patients’ clinical characteristics, AF control, and symptom burden. Methods RealiseAF was an international, cross-sectional, observational survey of 11,198 patients with AF. The aim of this analysis was to describe patient profiles and symptoms according to the AF management strategy used. A multivariate logistic regression identified factors associated with AF management strategy at the end of the visit. Results Among 10,497 eligible patients, 53.7% used a rate-control strategy, compared with 34.5% who used a rhythm-control strategy. In 11.8% of patients, no clear strategy was stated. The proportion of patients with AF-related symptoms (EHRA Class > = II) was 78.1% (n = 4396/5630) for those using a rate-control strategy vs. 67.8% for those using a rhythm-control strategy (p<0.001). Multivariate logistic regression analysis revealed that age <75 years or the paroxysmal or persistent form of AF favored the choice of a rhythm-control strategy. A change in strategy was infrequent, even in patients with European Heart Rhythm Association (EHRA) Class > = II. Conclusions In the RealiseAF routine clinical practice survey, rate control was more commonly used than rhythm control, and a change in strategy was uncommon, even in symptomatic patients. In almost 12% of patients, no clear strategy was stated. Physician awareness regarding optimal management strategies for AF may be improved. PMID:26800084

  18. Physicians slow to e-mail routinely with patients.

    PubMed

    Boukus, Ellyn R; Grossman, Joy M; O'Malley, Ann S

    2010-10-01

    Some experts view e-mail between physicians and patients as a potential tool to improve physician-patient communication and, ultimately, patient care. Despite indications that many patients want to e-mail their physicians, physician adoption and use of e-mail with patients remains uncommon--only 6.7 percent of office-based physicians routinely e-mailed patients in 2008, according to a new national study from the Center for Studying Health System Change (HSC). Overall, about one-third of office-based physicians reported that information technology (IT) was available in their practice for e-mailing patients about clinical issues. Of those, fewer than one in five reported using e-mail with patients routinely; the remaining physicians were roughly evenly split between occasional users and non-users. Physicians in practices with access to electronic medical records and those working in health maintenance organizations (HMOs) or medical school settings were more likely to adopt and use e-mail to communicate with patients compared with other physicians. However, even among the highest users--physicians in group/staff-model HMOs--only 50.6 percent reported routinely e-mailing patients.

  19. Integrating the family into routine patient care: a qualitative study.

    PubMed

    Cole-Kelly, K; Yanoshik, M K; Campbell, J; Flynn, S P

    1998-12-01

    The field of family medicine has been enriched by a family-oriented approach and the inclusion of family systems concepts. Keeping the family as a central focus of care has been a fundamental commitment of family medicine. This research examines how exemplary physicians ("exemplars") integrate a family-oriented approach into the routine care of individual patients. Four family physician exemplars were observed. A total of 16 days was spent observing the physicians; 137 physician-patient encounters were audiotaped, transcribed, and analyzed. Grounded theory was used for analysis, and a model of a family-oriented approach was developed. Visits were classified by the reason for visit and the intensity of family-oriented talk and actions. There was modest variation among the physicians in terms of intensity and time spent with patients. Overall, 19% of patient encounters had a high intensity of family-orientedness; 34% were of low intensity. The average time spent with patients was 13 minutes, with visits ranging from 3 to 39 minutes in length. Our study demonstrated that physicians integrate family systems concepts into routine individual patient care. The findings identify characteristics of the family-oriented approach and those circumstances that promote and hinder it. Family physicians can adapt specific components of the family-oriented approach into their routine individual patient care.

  20. Latent Q fever endocarditis in patients undergoing routine valve surgery.

    PubMed

    Grisoli, Dominique; Million, Matthieu; Edouard, Sophie; Thuny, Franck; Lepidi, Hubert; Collart, Frédéric; Habib, Gilbert; Raoult, Didier

    2014-11-01

    Q fever is a worldwide zoonosis caused by a fastidious bacterium, Coxiella burnetii. A recent major outbreak of which in the Netherlands will most likely lead to the emergence of hundreds of cases of C. burnetii endocarditis during the next decade. Patients undergoing cardiac valve surgery may carry undiagnosed Q fever endocarditis with possible disastrous outcomes, and hence may benefit from a screening strategy. The study aim was to evaluate the frequency of unsuspected latent Q fever endocarditis in patients undergoing routine valve surgery. At the present authors' institution, all resected cardiac valves/prostheses are examined routinely histologically, microbiologically and on a molecular biological basis, in addition to serological testing for fastidious microorganisms. A retrospective review was conducted of data relating to all patients who had unsuspected Q fever endocarditis that had been diagnosed after routine valve/prosthesis replacement/repair between 2000 and 2013 at the authors' institution. Among 6,401 patients undergoing valve surgery, postoperative examinations of the explanted valves/prostheses led to an unexpected diagnosis of Q fever endocarditis in 14 cases (0.2%), who subsequently underwent appropriate medical treatments. Only two of the patients (14%) had intraoperative findings suggestive of endocarditis. On serological analysis of the blood samples, 11 patients (79%) presented an evocative Phase I IgG antibody titer > or =800. Valvular tissue-sample analyses yielded positive cultures and PCR in the same 13 patients (93%), whereas pathological and immunohistochemical examinations alone were suggestive of endocarditis in only seven Cases (50%). This screening strategy led to an unexpected diagnosis of Q fever endocarditis in 0.2% of patients undergoing routine valve surgery, who received subsequent appropriate antibiotic therapy. Systematic serological analysis should be mandatory before performing heart valve surgery in countries where C

  1. Dissociations in routine behaviour across patients and everyday tasks.

    PubMed

    Forde, Emer M E; Humphreys, Glyn W

    2002-01-01

    We present a single case study of a patient, FK, who was severely impaired on routine, everyday tasks, such as preparing a cup of tea. We used the action coding system developed by Schwartz et al. to provide quantitative and qualitative measures of his performance in a number of experimental manipulations. In section A, we established FK's baseline performance on a range of tasks with (a) task-congruent objects only and (b) task-congruent objects and semantic distracters. In section B, we aimed to facilitate FK's performance by (a) giving him a pictorial representation of the goal, (b) giving him a set of written commands to follow, (c) giving him one command at a time, (d) demonstrating how the task should be performed and (e) dividing the task into smaller subgoals. We compared FK's performance with another patient, HG, to establish if there are qualitative differences between patients with 'action disorganization syndrome'. In section C, we aimed to hinder FK's performance by interrupting his execution of routine tasks. By comparing the factors that facilitated and impaired FK's performance in sections B and C, we hoped to isolate the key cognitive processes required to generate and control routine behaviour. In section D, we investigated how task demands impact on our ability to complete different everyday activities. The results of these experiments have important clinical implications for rehabilitation programmes for patients with action disorganization syndrome and can also help to distinguish between contemporary theoretical accounts of routine behaviour. In particular, we propose that patients who can be classified under the umbrella term of 'action disorganization syndrome' do not all have a reduction to 'non-specific cognitive resources' but can have qualitatively different impairments to a specialized action production system.

  2. A Minority of Patients with Type 1 Diabetes Routinely Downloads and Retrospectively Reviews Device Data

    PubMed Central

    Neinstein, Aaron B.; Spindler, Matthew; Adi, Saleh

    2015-01-01

    Abstract Background: In type 1 diabetes (T1D), periodic review of blood glucose and insulin dosing should be performed, but it is not known how often patients review these data on their own. We describe the proportion of patients with T1D who routinely downloaded and reviewed their data at home. Materials and Methods: A cross-sectional survey of 155 adults and 185 caregivers of children with T1D at a single academic institution was performed. “Routine Downloaders” (downloaded four or more times in the past year) were also considered “Routine Reviewers” if they reviewed their data most of the time they downloaded from devices. Logistic regression was used to identify factors associated with being a Routine Reviewer. Results: Only 31% of adults and 56% of caregivers reported ever downloading data from one or more devices, whereas 20% and 40%, respectively, were considered Routine Downloaders. Only 12% of adults and 27% of caregivers were Routine Reviewers. Mean hemoglobin A1c was lower in Routine Reviewers compared with non-Routine Reviewers (7.2±1.0% vs. 8.1±1.6% [P=0.03] in adults and 7.8±1.4% vs. 8.6±1.7% [P=0.001] in children). In adjusted analysis of adults, the odds ratio of being a Routine Reviewer of one or more devices for every 10-year increase in age was 1.5 (95% confidence interval, 1.1, 2.1 [P=0.02]). For every 10 years since diabetes diagnosis, the odds ratio of being a Routine Reviewer was 1.7 (95% confidence interval, 1.2, 2.4 [P=0.01]). For caregivers, there were no statistically significant factors associated with being a Routine Reviewer. Conclusions: A minority of T1D patients routinely downloads and reviews data from their devices on their own. Further research is needed to understand obstacles, provide better education and tools for self-review, and determine if patient self-review is associated with improved glycemic control. PMID:26133226

  3. [Colposcopy and cervical biopsy in patients with routine Papanicolaou smear].

    PubMed

    Milla Villeda, R H; Alvarado Zaldívar, G; Sánchez Anguiano, L F; Barrera Tovar, M; Vázquez Arreola, I

    1997-06-01

    The objective of this report was to assess the sensitivity and specificity of Pap smear and to evaluate if routine colposcopy can improve cervical screening. One hundred and fifty patients undergoing routine cervical cytologic screening in our outpatient clinic were randomly selected. All patients were evaluated by colposcopy and cervical punch biopsy. Pap smears and biopsies specimens were interpreted independently. Colposcopy was performed and interpreted without knowledge of cytologic or histologic findings. The statistical analysis was carried out with a chi square (chi 2) test. A P value of less than 0.05 was considered significant. Twenty three patients (15.3%) who had biopsy proved to have cervical pathology. Pap smear identified only 4/23 (17%) of these patients. Colposcopy noted atypical transformation zones in 20/23 (97%), P < 0.001). Fifteen of 27 patients (55.5%) with negative Pap smears had colposcopic anormalities and histologically proved cervical intraepithelial neoplasia (CIN). We concluded that it is necessary to improve sensitivity and that colposcopy may enhance cervical screening particularly in women with otherwise negative Papapnicolaou smears.

  4. Routine Imaging after Operatively Repaired Distal Radius and Scaphoid Fractures: A Survey of Hand Surgeons

    PubMed Central

    Bohl, Daniel D.; Lese, Andrea B.; Patterson, Joseph T.; Grauer, Jonathan N.; Dodds, Seth D.

    2014-01-01

    Background There is currently no standard of care for imaging after hand and upper-extremity procedures, and current imaging practices have not been characterized. Questions/Purposes To characterize current imaging practices and to compare those practices to the best available evidence. Patients and Methods A survey was distributed to attending-level surgeons at a regional hand and upper-extremity surgery conference in the United States in 2013. 40 out of 75 surgeons completed the survey (53%). Results All results are presented for distal radius and scaphoid fractures, respectively. There was a high degree of variability between respondents in the number of radiographic series routinely ordered during follow-up of asymptomatic patients, with the number of series ranging from 1–6 and 1–6. On average, respondents did not order an excessive number of follow-up radiographs for asymptomatic patients, with means (± standard deviations) of 2.6 ± 1.0 and 3.3 ± 1.2 radiographic series. Radiographic series were taken at only 74% and 81% of postoperative visits with asymptomatic patients. Only 10% and 8% of respondents felt it was acceptable medical practice to save costs by ordering postoperative radiographs only when patients are symptomatic. Conclusions Among a sample of 40 fellowship-trained hand surgeons, these findings demonstrate a high degree of variability in number of radiographs obtained after operative repair of distal radius and scaphoid fractures. On average, respondents were relatively efficient with respect to total number of postoperative radiographs ordered. Level of Evidence Diagnostic study, level IV. PMID:25364636

  5. Pharmacy patrons 'awareness of pharmacists' education and routine patient care responsibilities.

    PubMed

    Oyelami-Adeleye, Ifemayowa; Abate, Marie A; Blommel, Mathew L

    2011-01-01

    To assess the similarities between pharmacists' and pharmacy patrons' views of pharmacists' roles and to explore the extent to which persons actually see pharmacists assuming certain roles. Cross-sectional survey was administered to pharmacists and patients who were filling prescriptions or seeking nonprescription medications in 9 community pharmacies in Morgantown, West Virginia. The survey assessed 11 routine patient care services. Main outcome measures include opinions of pharmacists and patients about responsibility for providing 11 routine care services and the extent to which these services are provided. Pharmacists and patients had similar opinions about services that pharmacists should provide for 7 of the 11 services evaluated. For the other 4 items for which opinions were divergent, the mean scores for the extent to which pharmacists provide these services indicated that pharmacists do not always provide these services. Pharmacy patrons might not attribute certain patient-related functions to pharmacists because pharmacists do not frequently perform these routine care-related services in actual practice. This article is open to POST-PUBLICATION REVIEW. Registered readers (see "For Readers") may comment by clicking on ABSTRACT on the issue's contents page.

  6. [Neuroimaging for patients with Alzheimer disease in routine practice].

    PubMed

    Matsuda, Hiroshi

    2010-07-01

    In routine practice neuroimaging has been applied as an adjunct technique for early and differential diagnosis of Alzheimer disease in routine practice. Of the several neuroimaging modalities, magnetic resonance imaging (MRI) and brain perfusion single-photon emission computed tomography (SPECT) have been commonly used in Japan; further software programs are used to aid statistical analysis of the imaging results. For example voxel-based specific regional analysis system for Alzheimer disease (VSRAD) for MRI and easy Z-score imaging system (eZIS) are used for the analysis of MRI and SPECT. In the early stage of Alzheimer disease, specific findings of regional atrophy and perfusion reduction are observed in some areas. In the posterior cingulate gyrus precuneus and parietal cortex, perfusion reduction was more frequently observed than atrophy. On the other hand, in the medial temporal structures, perfusion reduction was less frequently observed than atrophy. Perfusion reduction in the the posterior cingulate gyrus precuneus and in the parietal cortex was more prominent in the case of patients with early-onset Alzheimer disease than in the case of patients with late-onset Alzheimer disease. Further, atrophy in the medial temporal structures was more prominent in the case of patients with late-onset Alzheimer disease than in the case of those with early-onset Alzheimer disease. These findings are helpful for differentiating of Alzheimer disease from other diseases characterized by dementia.

  7. A survey of paediatricians' practice and training in routine infant eye examination

    PubMed Central

    Rahi, J.; Lynn, R.

    1998-01-01

    A survey of a sample of UK paediatricians was carried out to identify the practices and determine the training of those involved in routine surveillance examinations to detect ophthalmic disorders in infants. The findings indicate important variation in current practices and raise concerns about both undergraduate and postgraduate training in ophthalmic assessment of infants.

 PMID:9623402

  8. Routine screening for suicidal intention in patients with cancer.

    PubMed

    Leung, Yvonne W; Li, Madeline; Devins, Gerald; Zimmermann, Camilla; Rydall, Anne; Lo, Chris; Rodin, Gary

    2013-11-01

    Suicide rates are elevated in individuals with cancer, although suicidal intention is not typically assessed in cancer centers. We evaluated in a large comprehensive cancer center the utility of an electronic Distress Assessment and Response Tool (DART), in which suicidal intention is assessed with a single item. Patients attending cancer clinics completed DART as part of routine care. DART includes measures of physical symptoms, depression, anxiety, social difficulties, and practical concerns. Medical variables were obtained from the Princess Margaret Cancer Registry, the data warehouse of cancer patient statistics. A Generalized Estimating Equation (GEE) model was used to assess factors associated with suicidal intention. Between September 2009 and March 2012, 4822/5461 patients (88.3%) who completed DART consented to the use of their data for research. Amongst the latter, 280 (5.9%) of the 4775 patients who answered the question reported suicidal ideation, which was related to physical and psychological distress, and social difficulties (ps < 0.0001). Amongst those with ideation who responded to the intention question, 20/186 (10.8%) reported suicidal intention. Of respondents with more severe suicidal ideation, 12/49 (24.5%) reported suicidal intention. Using a GEE model, suicidal intention in those with ideation was significantly associated with male sex, difficulty making treatment decisions, and with everyday living concerns. Suicidal ideation is reported on an electronic distress screening tool (DART) by almost 6% of cancer patients, of whom almost 11% report suicidal intention and 33% decline to indicate intention. DART demonstrated utility in identifying patients who may be at highest risk of completed suicide and who require urgent clinical assessment. Copyright © 2013 John Wiley & Sons, Ltd.

  9. Different standards for healthy screenees than patients in routine clinics?

    PubMed Central

    Hoff, Geir

    2013-01-01

    Less than 5% of colorectal adenomas will become malignant, but we do not have sufficient knowledge about their natural course to target removal of these 5% only. Thus, 95% of polypectomies are a waste of time exposing patients to a small risk of complications. Recently, a new type of polyps, sessile serrated polyps, has attracted attention. Previously considered innocuous, they are now found to have molecular similarities to cancer and some guidelines recommend to have them removed. These lesions are often flat, covered by mucous, not easily seen and situated in the proximal colon where the bowel wall is thinner. Thus, polypectomy carries a higher risk of perforation than predominantly left-sided, stalked adenomas - and we do not know what is gained in terms of cancer prevention. Screening is a neat balance between harms and benefit for presumptively healthy participants not interested in risk exposure to obtain confirmation of being healthy. The situation is quite different for patient worried about symptom. Thus, the standards set for evidence-based practice may be higher for screening than for routine clinics - a mechanism which may benefit patients in the long run. PMID:24379569

  10. Different standards for healthy screenees than patients in routine clinics?

    PubMed

    Hoff, Geir

    2013-12-14

    Less than 5% of colorectal adenomas will become malignant, but we do not have sufficient knowledge about their natural course to target removal of these 5% only. Thus, 95% of polypectomies are a waste of time exposing patients to a small risk of complications. Recently, a new type of polyps, sessile serrated polyps, has attracted attention. Previously considered innocuous, they are now found to have molecular similarities to cancer and some guidelines recommend to have them removed. These lesions are often flat, covered by mucous, not easily seen and situated in the proximal colon where the bowel wall is thinner. Thus, polypectomy carries a higher risk of perforation than predominantly left-sided, stalked adenomas - and we do not know what is gained in terms of cancer prevention. Screening is a neat balance between harms and benefit for presumptively healthy participants not interested in risk exposure to obtain confirmation of being healthy. The situation is quite different for patient worried about symptom. Thus, the standards set for evidence-based practice may be higher for screening than for routine clinics - a mechanism which may benefit patients in the long run.

  11. Oblique Chest Views as a Routine Part of Skeletal Surveys Performed for Possible Physical Abuse--Is This Practice Worthwhile?

    ERIC Educational Resources Information Center

    Hansen, Karen Kirhofer; Prince, Jeffrey S.; Nixon, G. William

    2008-01-01

    Objective: To evaluate the utility of oblique chest views in the diagnosis of rib fractures when used as a routine part of the skeletal survey performed for possible physical abuse. Methods: Oblique chest views have been part of the routine skeletal survey protocol at Primary Children's Medical Center since October 2002. Dictated radiology reports…

  12. Oblique Chest Views as a Routine Part of Skeletal Surveys Performed for Possible Physical Abuse--Is This Practice Worthwhile?

    ERIC Educational Resources Information Center

    Hansen, Karen Kirhofer; Prince, Jeffrey S.; Nixon, G. William

    2008-01-01

    Objective: To evaluate the utility of oblique chest views in the diagnosis of rib fractures when used as a routine part of the skeletal survey performed for possible physical abuse. Methods: Oblique chest views have been part of the routine skeletal survey protocol at Primary Children's Medical Center since October 2002. Dictated radiology reports…

  13. The case for routine HIV screening before IVF treatment: a survey of UK IVF centre policies.

    PubMed

    Marcus, S F; Avery, S M; Abusheikha, N; Marcus, N K; Brinsden, P R

    2000-08-01

    The case for routine human immunodeficiency virus (HIV) screening of all couples seeking assisted reproductive treatment is so strong that it should be made obligatory for all couples entering IVF programmes to be given information about HIV transmission, and offered testing. In August 1999, questionnaires regarding routine HIV screening of couples seeking IVF treatment were sent to the medical directors of the 74 licensed assisted conception units in the UK. Of the 45 (60.8%) centres who responded, 19 (42.2%) routinely screen both partners for HIV antibodies, 25 (55.5%) do not screen and one centre selectively screens high-risk patients. There was no significant difference in the proportion of centres that routinely carried out screening with regards to the unit size: six out of 13 (46.2%) small units compared with 13/32 (40.6%) large units. In all, 17 centres (37.8%) rated HIV screening as essential, nine (20%) as desirable, 11 (24.4%) as not required, while eight (17. 8%) centres did not comment. Of the 19 centres that have a routine screening policy, 18 have management protocols in the event that the test is positive. Of these 18 centres, 12 adhere rigidly to the protocol, while five centres adhere to the protocol with few exceptions and the remaining one uses its protocol for guidance only. The main reasons for not employing routine HIV screening were: the lack of cost effectiveness, low prevalence of HIV infection in their population, necessity for and cost of counselling, uncertainty about the need for screening and potential delay to start of treatment.

  14. Daily life activity routine discovery in hemiparetic rehabilitation patients using topic models.

    PubMed

    Seiter, J; Derungs, A; Schuster-Amft, C; Amft, O; Tröster, G

    2015-01-01

    Monitoring natural behavior and activity routines of hemiparetic rehabilitation patients across the day can provide valuable progress information for therapists and patients and contribute to an optimized rehabilitation process. In particular, continuous patient monitoring could add type, frequency and duration of daily life activity routines and hence complement standard clinical scores that are assessed for particular tasks only. Machine learning methods have been applied to infer activity routines from sensor data. However, supervised methods require activity annotations to build recognition models and thus require extensive patient supervision. Discovery methods, including topic models could provide patient routine information and deal with variability in activity and movement performance across patients. Topic models have been used to discover characteristic activity routine patterns of healthy individuals using activity primitives recognized from supervised sensor data. Yet, the applicability of topic models for hemiparetic rehabilitation patients and techniques to derive activity primitives without supervision needs to be addressed. We investigate, 1) whether a topic model-based activity routine discovery framework can infer activity routines of rehabilitation patients from wearable motion sensor data. 2) We compare the performance of our topic model-based activity routine discovery using rule-based and clustering-based activity vocabulary. We analyze the activity routine discovery in a dataset recorded with 11 hemiparetic rehabilitation patients during up to ten full recording days per individual in an ambulatory daycare rehabilitation center using wearable motion sensors attached to both wrists and the non-affected thigh. We introduce and compare rule-based and clustering-based activity vocabulary to process statistical and frequency acceleration features to activity words. Activity words were used for activity routine pattern discovery using topic models

  15. Evidence of dose saving in routine CT practice using iterative reconstruction derived from a national diagnostic reference level survey

    PubMed Central

    Hayton, A; Beveridge, T; Marks, P; Wallace, A

    2015-01-01

    Objective: To assess the influence and significance of the use of iterative reconstruction (IR) algorithms on patient dose in CT in Australia. Methods: We examined survey data submitted to the Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) National Diagnostic Reference Level Service (NDRLS) during 2013 and 2014. We compared median survey dose metrics with categorization by scan region and use of IR. Results: The use of IR results in a reduction in volume CT dose index of between 17% and 44% and a reduction in dose–length product of between 14% and 34% depending on the specific scan region. The reduction was highly significant (p < 0.001, Wilcoxon rank-sum test) for all six scan regions included in the NDRLS. Overall, 69% (806/1167) of surveys included in the analysis used IR. Conclusion: The use of IR in CT is achieving dose savings of 20–30% in routine practice in Australia. IR appears to be widely used by participants in the ARPANSA NDRLS with approximately 70% of surveys submitted employing this technique. Advances in knowledge: This study examines the impact of the use of IR on patient dose in CT on a national scale. PMID:26133224

  16. Preliminary Survey of Icing Conditions Measured During Routine Transcontinental Airline Operation

    NASA Technical Reports Server (NTRS)

    Perkins, Porter J.

    1952-01-01

    Icing data collected on routine operations by four DC-4-type aircraft equipped with NACA pressure-type icing-rate meters are presented as preliminary information obtained from a statistical icing data program sponsored by the NACA with the cooperation of many airline companies and the United States Air Force. The program is continuing on a much greater scale to provide large quantities of data from many air routes in the United States and overseas. Areas not covered by established air routes are also being included in the survey. The four aircraft which collected the data presented in this report were operated by United Air Lines over a transcontinental route from January through May, 1951. An analysis of the pressure-type icing-rate meter was satisfactory for collecting statistical data during routine operations. Data obtained on routine flight icing encounters from.these four instrumented aircraft, although insufficient for a conclusive statistical analysis, provide a greater quantity and considerably more realistic information than that obtained from random research flights. A summary of statistical data will be published when the information obtained daring the 1951-52 icing season and that to be obtained during the 1952-53 season can be analyzed and assembled. The 1951-52 data already analyzed indicate that the quantity, quality, and range of icing information being provided by this expanded program should afford a sound basis for ice-protection-system design by defining the important meteorological parameters of the icing cloud.

  17. Routine data from hospital information systems can support patient recruitment for clinical studies.

    PubMed

    Dugas, Martin; Lange, Matthias; Müller-Tidow, Carsten; Kirchhof, Paulus; Prokosch, Hans-Ulrich

    2010-04-01

    Delayed patient recruitment is a common problem in clinical studies. Hospital information systems (HIS) contain data items relevant for inclusion or exclusion criteria of these studies. We developed and assessed a system to support patient recruitment using HIS data. We developed a workflow integrated in our HIS to notify study physicians about potential trial subjects. Automatic HIS database queries based on inclusion and exclusion criteria for each clinical study are performed regularly and generate e-mail notifications via a communication server. Study physicians can verify eligibility with a specific HIS study module. The system performance was assessed with a survey addressing utility, usability, stability, change in recruitment rate, and estimated time savings. During 10 months of operation, 1328 notifications were generated and 329 enrollments (25%) were documented for seven studies. Precision of alerts depends on availability of appropriate HIS items. Utility and usability were assessed as good, and stability as excellent. Users reported an increased patient recruitment rate for three studies. Three studies reported an estimated time saving of 10 min per recruited patient. The main perceived benefit was systematic identification of potentially eligible patients without time-consuming patient screening procedures in the different parts of the hospital. Notifications about potentially eligible patients depend on HIS data quality regarding inclusion/exclusion criteria, in particular, completeness, timeliness, and validity. Routine HIS data can support patient recruitment for clinical studies by means of an automated notification workflow and efficient access to clinical data.

  18. Harnessing Information Technology to Inform Patients Facing Routine Decisions: Cancer Screening as a Test Case.

    PubMed

    Krist, Alex H; Woolf, Steven H; Hochheimer, Camille; Sabo, Roy T; Kashiri, Paulette; Jones, Resa M; Lafata, Jennifer Elston; Etz, Rebecca S; Tu, Shin-Ping

    2017-05-01

    Technology could transform routine decision making by anticipating patients' information needs, assessing where patients are with decisions and preferences, personalizing educational experiences, facilitating patient-clinician information exchange, and supporting follow-up. This study evaluated whether patients and clinicians will use such a decision module and its impact on care, using 3 cancer screening decisions as test cases. Twelve practices with 55,453 patients using a patient portal participated in this prospective observational cohort study. Participation was open to patients who might face a cancer screening decision: women aged 40 to 49 who had not had a mammogram in 2 years, men aged 55 to 69 who had not had a prostate-specific antigen test in 2 years, and adults aged 50 to 74 overdue for colorectal cancer screening. Data sources included module responses, electronic health record data, and a postencounter survey. In 1 year, one-fifth of the portal users (11,458 patients) faced a potential cancer screening decision. Among these patients, 20.6% started and 7.9% completed the decision module. Fully 47.2% of module completers shared responses with their clinician. After their next office visit, 57.8% of those surveyed thought their clinician had seen their responses, and many reported the module made their appointment more productive (40.7%), helped engage them in the decision (47.7%), broadened their knowledge (48.1%), and improved communication (37.5%). Many patients face decisions that can be anticipated and proactively facilitated through technology. Although use of technology has the potential to make visits more efficient and effective, cultural, workflow, and technical changes are needed before it could be widely disseminated. © 2017 Annals of Family Medicine, Inc.

  19. Medical treatment choices for patients affected by advanced NSCLC in routine clinical practice: results from the Italian observational "SUN" (Survey on the lUng cancer maNagement) study.

    PubMed

    Gridelli, Cesare; Ardizzoni, Andrea; Barni, Sandro; Crinò, Lucio; Caprioli, Alberto; Piazza, Elena; Lorusso, Vito; Barbera, Santi; Zilembo, Nicoletta; Gebbia, Vittorio; Adamo, Vincenzo; Pela, Riccardo; Marangolo, Maurizio; Morena, Raffaella; Filippelli, Gianfranco; Buscarino, Calogero; Alabiso, Oscar; Maione, Paolo; Venturino, Paola; De Marinis, Filippo

    2011-12-01

    Lung cancer is the most common cancer in the world today, in terms of both incidence and mortality. Non-small cell lung cancer (NSCLC) accounts for about 85% of all lung cancers, and the majority of people diagnosed with NSCLC have locally advanced or metastatic disease. Treatment algorithms have rapidly changed in the last 10 years because of the introduction of new chemotherapeutic and targeted agents in clinical practice. SUN is a 1-year longitudinal observational multicenter study that has consecutively enrolled patients affected by stage IIIB or IV NSCLC with the aim to describe the pattern of care and evolving approaches in the treatment of advanced NSCLC. 987 consecutive NSCLC patients were enrolled between January 2007 and March 2008 at the 74 participating centers throughout Italy and a 12-month follow-up was performed. Cyto-histological diagnosis was performed mainly by broncoscopy with only 24% by CT-scan guided fine-needle aspiration biopsy. 91.4% of the patients received a first-line medical treatment and 8.6% supportive care only. Median age of patients receiving first-line treatment was 66 years. First-line chemotherapy consisted of a single agent in 20% of patients and combination chemotherapy in 80%. The most frequently used chemotherapy regimens were cisplatin plus gemcitabine and carboplatin plus gemcitabine. Median survival of patients receiving first-line chemotherapy was 9.1 months. 32% percent of patients received a second-line treatment that consisted of chemotherapy in 71% of cases and erlotinib in 29%. Overall third-line treatment was given to 7.3% of patients. These results showed a pattern of care for advanced NSCLC that reflects the current clinical practice in Italy at the study time with a high adherence to the International guidelines by the Italian Oncologists.

  20. Need to improve routine HIV testing of U.S. Veterans in care: results of an Internet survey.

    PubMed

    Valdiserri, Ronald O; Nazi, Kim; McInnes, D Keith; Ross, David; Kinsinger, Linda

    2010-06-01

    Late diagnosis of HIV infection contributes to poor medical outcomes and helps sustain continued transmission of virus. Published evidence suggests that despite current public health recommendations, patients receiving care in the Veterans Health Administration (VHA) system are not being routinely tested for HIV infection. Using a sample of computer-literate veterans, we conducted a survey of recent testing experiences. My HealtheVet (MHV) is a secure website allowing registered Veterans to access limited personal VHA health information. Using the American Customer Satisfaction Index (ACSI) Survey, an electronic questionnaire on "health screening" was conducted in late Fall/early winter 2008-2009. A random sample (4%) of MHV users were surveyed; approximately 17% completed the survey and responses ranged from 31,237 to 33,074. Only 9% of the respondents indicated that they had been offered a test for HIV in the last 12 months compared to 83% who had been offered cholesterol screening, 65% blood sugar screening and 19% who had been offered testing for Hepatitis C virus (HCV). Of those who had been offered HIV testing, 91% indicated that they'd had the test performed. Of note, the percentage of respondents who indicated that they would "very likely" accept a test, if offered, was similar for HIV (73%), HCV (79%), cholesterol (75%), and blood sugar (75%). Although these results cannot be generalized to all Veterans in care, they suggest that routine testing for HIV has not been taking place and support recent VHA policy changes to remove barriers to HIV testing.

  1. Cancer Patients? Willingness to Routinely Complete the EQ-5D Instrument at Clinic Visits.

    PubMed

    Naik, Hiten; Qiu, Xin; Brown, M Catherine; Mahler, Mary; Hon, Henrique; Tiessen, Kyoko; Thai, Henry; Ho, Valerie; Gonos, Christina; Charow, Rebecca; Pat, Vivien; Irwin, Margaret; Herzog, Lindsay; Ho, Anthea; Xu, Wei; Howell, Doris; Seung, Soo Jin; Liu, Geoffrey; Mittmann, Nicole

    2016-09-13

    Health utility (HU) scores play an essential role in pharmacoeconomic analyses. Routine clinical administration of the EuroQol-5 Dimensions (EQ-5D) can allow for HU and health related quality of life (HRQOL) assessments in the real-world setting. The primary goals of this study were to evaluate whether patients were willing to complete the EQ-5D instrument on a routine basis and which clinical or demographic factors influence this willingness. 618 adult cancer survivors across multiple cancer disease sites at the Princess Margaret Cancer Centre completed an acceptability survey after completing the EQ-5D instrument. The mean (SD) EQ-5D score was 0.81 (0.15). Among those surveyed, 88% reported that the EQ-5D was easy to complete. 91% took under 5 minutes and 88% were satisfied with its length. 85% were satisfied with the types of questions asked on the EQ-5D. Importantly, 92% reported that they would complete the EQ-5D, even if it were used solely for research purposes; 73% agreed with the notion of completing it regularly at their clinic visits. Patients with lower EQ-5D scores (p=0.0006), and non-Caucasians (p=0.0024; 60% willing) were less willing to complete the instrument on a regular basis. Curability of tumour, disease site, age, and gender did not influence willingness. The majority of cancer patients across disease sites are willing to complete the EQ-5D instrument regularly, even if it were solely for research purposes, but up to 39% declined participation in the first place.

  2. Review of systems, physical examination, and routine tests for case-finding in ambulatory patients.

    PubMed

    Boland, B J; Wollan, P C; Silverstein, M D

    1995-04-01

    The screening value of the comprehensive review of systems and the complete physical examination in detecting unsuspected diseases for which therapeutic interventions are initiated has not been formally studied in ambulatory patients. The medical records of 100 randomly selected adult patients who had an ambulatory general medical evaluation at the Mayo Clinic in 1990-1991 were surveyed to compare review of systems and physical examination with routine laboratory tests, chest radiography, and electrocardiography as case-finding maneuvers. The main outcome measure was the therapeutic yield of each case-finding maneuver, defined as the proportion of maneuvers leading to a new therapy for a new clinically important diagnosis. The utilization rate of routine tests in the 100 patients (mean age: 59 +/- 16 years; 58% women) was high, ranging from 77 to 98%. Overall, the case-finding maneuvers led to 36 unsuspected clinically important diagnoses and resulted in 25 new therapeutic interventions. Higher therapeutic yield was observed for review of systems (7%), physical examination (5%), and lipid screening (9.2%) than for chemistry group (2.2%), complete blood count (1.8%), thyroid tests (1.5%), urinalysis (1.1%), electrocardiography (0%), or chest radiography (0%). The number of therapeutic interventions was not associated with patient's age (P = 0.55), sex (P = 0.88), comorbidity (P = 0.30) or with the time interval since the last general medical evaluation (P = 0.12). Based on therapeutic yield, these data suggest that review of systems and physical examination are valuable case-finding maneuvers in the periodic medical evaluation of ambulatory patients.

  3. Children in day surgery: clinical practice and routines. The results from a nation-wide survey.

    PubMed

    Segerdahl, M; Warrén-Stomberg, M; Rawal, N; Brattwall, M; Jakobsson, J

    2008-07-01

    Day surgery is common in paediatric surgical practice. Safe routines including parental and child information in order to optimise care and reduce anxiety are important. Most day surgery units are not specialised in paediatric care, which is why specific paediatric expertise is often lacking. We studied the practice of paediatric day surgery in Sweden by a questionnaire survey sent to all hospitals, obtaining an 88% response rate. Three specific paediatric cases were enquired for in more detail. The proportion of paediatric day surgery vs. in-hospital procedures was 46%. Seventy-one out of 88 responding units performed paediatric day surgery. All units had anxiolytic pre-medication as a routine in 1-6-year-olds, and in 7-16-year-olds at 60% of the units. Most units performed circumcision and adenoidectomy, while 33% performed tonsillectomy. Anaesthesia induction was intravenous in older children, and also in 1-6-year-olds at 50% of the units. Parental presence at induction was mandatory. Post-operatively, 93% of units routinely assessed pain. Paracetamol and NSAIDs were the most common analgesics, as monotherapy or combined with rescue medication in the recovery as IV morphine. At 42% of units, take-home bags of analgesics were provided, covering 1-3 days of treatment. Pain was the most frequent complaint on follow-up. Micturition difficulties were common after circumcision, nausea after adenoidectomy and nutrition difficulties after tonsillectomy. In Sweden, most day surgery units perform paediatric surgery, most children receive pre-medication, anaesthesia is induced IV and take-home analgesics paracetamol and or NSAIDs are often provided. Still, pain is a common complaint after discharge.

  4. Routine feedback of test results to participants in clinic- and survey-based surveillance of HIV

    PubMed Central

    Johnson, Cheryl; Garcia Calleja, Jesus Maria; Sabin, Keith; Obermeyer, Carla; Taegtmeyer, Miriam; Zaba, Basia; El-Hayek, Carol; Singh, Jerome Amir

    2015-01-01

    Abstract Surveillance for human immunodeficiency virus (HIV) in low- and middle-income countries started in the 1980s. However, the questions of whether the results of HIV tests should be given to participants, and if so how, has still not been resolved. In the absence of effective treatment, it was considered acceptable to withhold results from HIV-positive participants. However, when antiretroviral treatment is available, some argue for beneficence – that it is the researcher’s duty to return the test results to all those who provide samples for surveillance. The corollary is that only participants who wish to receive their test results would be eligible to participate in surveys. Others argue for autonomy – that to obtain a more representative result for the general population, surveys should not exclude participants who do not wish to receive their test results. This round table discussion takes a closer look at those two arguments. We believe that the global community should work towards routine feedback of HIV surveillance while ensuring that participants receive and understand their test results. PMID:26229207

  5. Routine feedback of test results to participants in clinic- and survey-based surveillance of HIV.

    PubMed

    Baggaley, Rachel; Johnson, Cheryl; Garcia Calleja, Jesus Maria; Sabin, Keith; Obermeyer, Carla; Taegtmeyer, Miriam; Zaba, Basia; El-Hayek, Carol; Singh, Jerome Amir

    2015-05-01

    Surveillance for human immunodeficiency virus (HIV) in low- and middle-income countries started in the 1980s. However, the questions of whether the results of HIV tests should be given to participants, and if so how, has still not been resolved. In the absence of effective treatment, it was considered acceptable to withhold results from HIV-positive participants. However, when antiretroviral treatment is available, some argue for beneficence - that it is the researcher's duty to return the test results to all those who provide samples for surveillance. The corollary is that only participants who wish to receive their test results would be eligible to participate in surveys. Others argue for autonomy - that to obtain a more representative result for the general population, surveys should not exclude participants who do not wish to receive their test results. This round table discussion takes a closer look at those two arguments. We believe that the global community should work towards routine feedback of HIV surveillance while ensuring that participants receive and understand their test results.

  6. Relation of routine, periodic fasting to risk of diabetes mellitus, and coronary artery disease in patients undergoing coronary angiography.

    PubMed

    Horne, Benjamin D; Muhlestein, Joseph B; May, Heidi T; Carlquist, John F; Lappé, Donald L; Bair, Tami L; Anderson, Jeffrey L

    2012-06-01

    Previously we discovered that routine periodic fasting was associated with a lower prevalence of coronary artery disease (CAD). Other studies have shown that fasting increases longevity in animals. A hypothesis-generating analysis suggested that fasting may also associate with diabetes. This study prospectively tested whether routine periodic fasting is associated with diabetes mellitus (DM). Patients (n = 200) undergoing coronary angiography were surveyed for routine fasting behavior before their procedure. DM diagnosis was based on physician reports of current and historical clinical and medication data. Secondary end points included CAD (physician reported for ≥ 1 lesion of ≥ 70% stenosis), glucose, and body mass index (BMI). Meta-analyses were performed by evaluation of these patients and 448 patients from a previous study. DM was present in 10.3% of patients who fasted routinely and 22.0% of those who do not fast (odds ratio [OR] 0.41, 95% confidence interval [CI] 0.17 to 0.99, p = 0.042). CAD was found in 63.2% of fasting and 75.0% of nonfasting patients (OR 0.42, CI 0.21 to 0.84, p = 0.014), and in nondiabetics this CAD association was similar (OR 0.38, CI 0.16 to 0.89, p = 0.025). Meta-analysis showed modest differences for fasters versus nonfasters in glucose concentrations (108 ± 36 vs 115 ± 46 mg/dl, p = 0.047) and BMI (27.9 ± 5.3 vs 29.0 ± 5.8 kg/m(2), p = 0.044). In conclusion, prospective hypothesis testing showed that routine periodic fasting was associated with a lower prevalence of DM in patients undergoing coronary angiography. A reported fasting association with a lower CAD risk was also validated and fasting associations with lower glucose and BMI were found. Copyright © 2012 Elsevier Inc. All rights reserved.

  7. Routine biological tests in self-poisoning patients: results from an observational prospective multicenter study.

    PubMed

    Reydel, Thomas; Callahan, Jean-Christophe; Verley, Laurent; Teiten, Christelle; Andreotti, Christophe; Claessens, Yann Erick; Missud, David; L'Her, Erwan; Le Roux, Gael; Lerolle, Nicolas

    2016-08-01

    Routine biological tests are frequently ordered in self-poisoning patients, but their clinical relevance is poorly studied. This is a prospective multicentric observational study conducted in the emergency departments and intensive care units of 5 university and nonuniversity French hospitals. Adult self-poisoning patients without severely altered vital status on admission were prospectively included. Routine biological test (serum electrolytes and creatinine, liver enzymes, bilirubin, blood cell count, prothrombin time) ordering and results were analyzed. A total of 1027 patients were enrolled (age, 40.2 ± 14 years; women, 61.5%); no patient died during the hospital stay. Benzodiazepine was suspected in more than 70% of cases; 65% (range, 48%-80%) of patients had at least 1 routine biological test performed. At least 1 abnormal test was registered in 23% of these patients. Three factors were associated with abnormal test results: age older than 40 years, male sex, and poisoning with a drug known to alter routine tests (ie, acetaminophen, NSAIDs, metformine, lithium). Depending on these factors, abnormal results ranged from 14% to 48%. Unexpected severe life-threatening conditions were recorded in 6 patients. Only 3 patients were referred to the intensive care unit solely because of abnormal test results. Routine biological tests are commonly prescribed in nonsevere self-poisoning patients. Abnormal results are frequent but their relevance at bedside remains limited. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Limited utility of routine surveillance imaging for classical Hodgkin lymphoma patients in first complete remission.

    PubMed

    Pingali, Sai Ravi; Jewell, Sarah W; Havlat, Luiza; Bast, Martin A; Thompson, Jonathan R; Eastwood, Daniel C; Bartlett, Nancy L; Armitage, James O; Wagner-Johnston, Nina D; Vose, Julie M; Fenske, Timothy S

    2014-07-15

    The objective of this study was to compare the outcomes of patients with classical Hodgkin lymphoma (cHL) who achieved complete remission with frontline therapy and then underwent either clinical surveillance or routine surveillance imaging. In total, 241 patients who were newly diagnosed with cHL between January 2000 and December 2010 at 3 participating tertiary care centers and achieved complete remission after first-line therapy were retrospectively analyzed. Of these, there were 174 patients in the routine surveillance imaging group and 67 patients in the clinical surveillance group, based on the intended mode of surveillance. In the routine surveillance imaging group, the intended plan of surveillance included computed tomography and/or positron emission tomography scans; whereas, in the clinical surveillance group, the intended plan of surveillance was clinical examination and laboratory studies, and scans were obtained only to evaluate concerning signs or symptoms. Baseline patient characteristics, prognostic features, treatment records, and outcomes were collected. The primary objective was to compare overall survival for patients in both groups. For secondary objectives, we compared the success of second-line therapy and estimated the costs of imaging for each group. After 5 years of follow-up, the overall survival rate was 97% (95% confidence interval, 92%-99%) in the routine surveillance imaging group and 96% (95% confidence interval, 87%-99%) in the clinical surveillance group (P = .41). There were few relapses in each group, and all patients who relapsed in both groups achieved complete remission with second-line therapy. The charges associated with routine surveillance imaging were significantly higher than those for the clinical surveillance strategy, with no apparent clinical benefit. Clinical surveillance was not inferior to routine surveillance imaging in patients with cHL who achieved complete remission with frontline therapy. Routine

  9. The use of patient-reported outcomes becomes standard practice in the routine clinical care of lung–heart transplant patients

    PubMed Central

    Santana, Maria J; Feeny, David; Weinkauf, Justin; Nador, Roland; Kapasi, Ali; Jackson, Kathleen; Schafenacker, Marianne; Zuk, Dalyce; Lien, Dale

    2010-01-01

    Objective: To assess the use of patient-reported outcome (PROs) measures in the routine clinical care of lung–heart transplant patients. We assessed whether the addition of PROs in routine clinical care affected the duration of the consultation and patient’s and clinician’s views. Method: Consecutive lung–heart transplant patients visiting the outpatient clinic, University of Alberta Hospital, completed the Chronic Respiratory Questionnaire (CRQ) and the Health Utilities Index (HUI) on touchscreen computers. Information on the patient’s responses was made available to the members of the transplant team prior to the encounter with the patient. The duration of clinical encounters was noted. At the end of every visit, clinicians completed a questionnaire on the usefulness of having PRO information available. After 6 months patients completed a survey of their experiences. Results: The final patient sample consisted of 172 patients with a mean (SD) age of 52 (13.3) years old; 47% were female; 68% were organ recipients and 32% candidates. The transplant team, comprising four pulmunologists, two nurses, and one pharmacist had an average of 9 years of practical experience in pulmunology. The mean duration of patient–clinician encounters in minutes was 15.15 (4.52). Ninety-eight percent of patients indicated that they would be happy to complete the CRQ and HUI at every clinic visit. Ninety-one percent of the assessments completed by clinicians showed complete satisfaction with the use of PROs in routine practice. Further, the clinicians developed guidelines for the use of PRO information in clinical practice. Conclusions: The incorporation of PRO measures in the routine clinical care of lung–heart transplant patients resulted in a reduction of the duration of patient–clinician encounters. The experience was well accepted by patients and clinicians. We conclude that the routine use of PROs in lung–heart transplant patients has become standard practice

  10. Checklists and Other Cognitive Aids For Emergency And Routine Anesthesia Care-A Survey on the Perception of Anesthesia Providers From a Large Academic US Institution.

    PubMed

    Krombach, Jens W; Edwards, William A; Marks, James D; Radke, Oliver C

    2015-08-01

    The use of printed or electronic checklists and other cognitive aids has gained increasing interest from anesthesia providers and professional societies. While these aids are not currently considered standard of care, the perceptions of the clinician might have an impact on their adoption. We conducted a comprehensive survey to study the current opinions of anesthesia provider on the use of checklists and other cognitive aids. A questionnaire was developed by a departmental checklist focus group, which aimed to identify the perception of health care checklists in general as well as specific checklists for routine and crisis situations in anesthesia. Furthermore participants were asked regarding their perception of performing routine anesthesia and managing crisis situations without any cognitive aids. Using a web-based system, the survey was administered to all anesthesia providers at a single large United States academic medical center (University of California San Francisco). Demographic information included professional status (faculty, anesthesia resident, or nurse anesthetists [certified registered nurse anesthetists; CRNA]) and years of clinical experience. 69% of 312 providers responded. 98% of the survey takers consider the procedural time-out (the widely used pre-incision operating room checklist) as important or very important. We found that many anesthesia providers acknowledged limitations in their ability to perform clinical tasks without any lapses, and a majority would use checklists and other cognitive aids if available. Their acceptances are especially high for crisis situations (87 - 97%, depending on years of experience) and routine care that providers do not perform often (76 - 91%). Printed or electronic aids for patient-care transition and shift hand-offs were also valued (61% and 58%). To prepare for and perform routine anesthesia care, 40% of providers claimed interest in using checklists, however, the interest differed significantly with

  11. Routine issuance of clinical magnets to patients receiving implantable defibrillators: retention of information and appropriateness of use

    PubMed Central

    Thomas, Dewi E; Barry, James P; Churchouse, Wendy; Anderson, Mark H

    2015-01-01

    Background The application of a clinical magnet over an implantable cardioverter defibrillator (ICD) can be used to suspend tachycardia therapies in patients receiving recurrent or inappropriate shocks. In our institution, they have been routinely issued to patients undergoing ICD implantation during the past 5 years. The purpose of this survey was to investigate how well information concerning their use had been retained, and in what circumstances the magnets had been used. Methods We sent a questionnaire to 476 patients, and received a response from 343 (72%). Data was collated using ‘Microsoft Excel’, cross-referenced against our own pacing database, and analysed using basic statistical methods. Results 256 (74.6%) patients recalled being issued with a magnet. 48% of these were still in possession of their written information leaflet at the time of survey; 62% felt that they were able to remember when and how to use the magnet—with patients who had received written instructions and verbal reinforcement demonstrating the best recall. 8% of patients had used their magnets and the most common reason for use was multiple or inappropriate shocks. In addition, almost half of the patients who had suffered inappropriate shocks had been able to successfully use their magnets. No cases of harm related to magnet use were identified. Conclusions The results of our survey suggest that routinely issuing clinical magnets to ICD patients is a safe and effective practice, and a small but significant number of patients were able to utilise their magnets in clinically important situations. PMID:26019880

  12. Assessment of pain and other patient symptoms in routine clinical care as quantitative, standardised, "scientific" data.

    PubMed

    Chua, Jacquelin R; Castrejon, Isabel; Pincus, Theodore

    2017-01-01

    Pain is the most common basis for visits to a rheumatologist, and reduction of pain is a primary goal of clinical care. Pain is assessed optimally by the patient on a self-report questionnaire. In clinical trials and other clinical research concerning pain and pain relief, detailed questionnaires are generally completed by patients. However, in routine clinical care, pain is generally assessed only according to narrative descriptions by the physician, and only a minority of settings assess pain using a standard, quantitative measure. Accurate, standard, quantitative assessment of pain in routine care is easily assessed in all patients with all diagnoses on a 0-10 visual analogue scale (VAS), by asking each patient to complete a 2-page multidimensional health assessment questionnaire/routine assessment of patient index data 3 (MDHAQ/RAPID3) at all visits. The MDHAQ includes VAS for pain, patient global assessment, and fatigue, as well as a quantitative physical function scale, RAPID3, review of systems, and recent medical history. The questionnaire provides the doctor with a 10-15 second overview of medical history data that otherwise would require about 10-15 minutes of conversation, saving time for the doctor and patient to focus on the most prominent concerns for the visit. MDHAQ scores from patients with 10 different rheumatic diagnoses, and specific data indicating similarity of scores in patients with osteoarthritis versus rheumatoid arthritis on the same questionnaire, are presented to illustrate the value of the MDHAQ in routine care.

  13. Agreement of treatment effects for mortality from routinely collected data and subsequent randomized trials: meta-epidemiological survey

    PubMed Central

    Hemkens, Lars G; Contopoulos-Ioannidis, Despina G

    2016-01-01

    Objective To assess differences in estimated treatment effects for mortality between observational studies with routinely collected health data (RCD; that are published before trials are available) and subsequent evidence from randomized controlled trials on the same clinical question. Design Meta-epidemiological survey. Data sources PubMed searched up to November 2014. Methods Eligible RCD studies were published up to 2010 that used propensity scores to address confounding bias and reported comparative effects of interventions for mortality. The analysis included only RCD studies conducted before any trial was published on the same topic. The direction of treatment effects, confidence intervals, and effect sizes (odds ratios) were compared between RCD studies and randomized controlled trials. The relative odds ratio (that is, the summary odds ratio of trial(s) divided by the RCD study estimate) and the summary relative odds ratio were calculated across all pairs of RCD studies and trials. A summary relative odds ratio greater than one indicates that RCD studies gave more favorable mortality results. Results The evaluation included 16 eligible RCD studies, and 36 subsequent published randomized controlled trials investigating the same clinical questions (with 17 275 patients and 835 deaths). Trials were published a median of three years after the corresponding RCD study. For five (31%) of the 16 clinical questions, the direction of treatment effects differed between RCD studies and trials. Confidence intervals in nine (56%) RCD studies did not include the RCT effect estimate. Overall, RCD studies showed significantly more favorable mortality estimates by 31% than subsequent trials (summary relative odds ratio 1.31 (95% confidence interval 1.03 to 1.65; I2=0%)). Conclusions Studies of routinely collected health data could give different answers from subsequent randomized controlled trials on the same clinical questions, and may substantially overestimate

  14. Multipronged strategy to reduce routine-priority blood testing in intensive care unit patients.

    PubMed

    Merkeley, Hayley L; Hemmett, Juliya; Cessford, Tara A; Amiri, Neda; Geller, Georgia S; Baradaran, Nazli; Norena, Monica; Wong, Hubert; Ayas, Najib; Dodek, Peter M

    2016-02-01

    The purpose of the study is to reduce unnecessary ordering of routine-priority blood tests. In this before-after study, we studied all patients admitted to a 15-bed tertiary intensive care unit (ICU) from July 1, 2011, to June 27, 2013. Based on input from intensivists, acceptable indications for ordering routine-priority complete blood counts (CBCs) and electrolyte/renal panels were developed. Sequential interventions were (1) education sessions for ICU housestaff about the lack of evidence for routine-priority blood tests; (2) an item on the ICU rounds checklist to ask if routine-priority blood tests were indicated; (3) a rubber stamp, "routine bloodwork NOT indicated for tomorrow," was used in the chart; (4) a prompt in the electronic ordering system to allow only accepted indications; and (5) a second educational session for ICU housestaff. We measured numbers of tests done before and after these interventions. After introduction of interventions, there were 0.14 fewer routine-priority CBCs and 0.13 fewer routine-priority electrolyte/renal panels done per patient-day. Nonroutine CBCs and nonroutine electrolyte/renal panels increased by 0.03 and 0.02 tests per patient-day, respectively. This overall reduction in tests equates to an adjusted savings of $11,200.24 over 1 year in 1 ICU. There were no differences in demographics, severity of illness, length of stay, or number of red cell transfusions between the 2 periods. Sequential interventions to discourage the ordering of routine-priority blood tests in an ICU were associated with a significant decrease in the number of tests ordered. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. Uterine fibroids at routine second-trimester ultrasound survey and risk of sonographic short cervix.

    PubMed

    Blitz, Matthew J; Rochelson, Burton; Augustine, Stephanie; Greenberg, Meir; Sison, Cristina P; Vohra, Nidhi

    2016-11-01

    To determine whether women with sonographically identified uterine fibroids are at higher risk for a short cervix. This retrospective cohort study evaluated all women with singleton gestations who had a routine second-trimester ultrasound at 17-23 weeks gestational age from 2010 to 2013. When fibroids were noted, their presence, number, location and size were recorded. Exclusion criteria included a history of cervical conization or loop electrosurgical excision procedure (LEEP), uterine anomalies, maternal age greater than 40 years, and a previously placed cerclage. The primary variable of interest was short cervix (<25 mm). Secondary variables of interest included gestational age at delivery, mode of delivery, indication for cesarean, malpresentation, birth weight, and Apgar scores. A multivariable logistic regression analysis was performed. Fibroids were identified in 522/10 314 patients (5.1%). In the final multivariable logistic regression model, short cervix was increased in women with fibroids (OR 2.29, 95% CI: 1.40, 3.74). The number of fibroids did not affect the frequency of short cervix. Fibroids were significantly associated with preterm delivery (<37 weeks), primary cesarean, breech presentation, lower birth weight infants, and lower Apgar scores. Women with uterine fibroids may be at higher risk for a short cervix. Fibroids are also associated with several adverse obstetric and neonatal outcomes.

  16. Implementing rapid, robust, cost-effective, patient-centred, routine genetic testing in ovarian cancer patients

    PubMed Central

    George, Angela; Riddell, Daniel; Seal, Sheila; Talukdar, Sabrina; Mahamdallie, Shazia; Ruark, Elise; Cloke, Victoria; Slade, Ingrid; Kemp, Zoe; Gore, Martin; Strydom, Ann; Banerjee, Susana; Hanson, Helen; Rahman, Nazneen

    2016-01-01

    Advances in DNA sequencing have made genetic testing fast and affordable, but limitations of testing processes are impeding realisation of patient benefits. Ovarian cancer exemplifies the potential value of genetic testing and the shortcomings of current pathways to access testing. Approximately 15% of ovarian cancer patients have a germline BRCA1 or BRCA2 mutation which has substantial implications for their personal management and that of their relatives. Unfortunately, in most countries, routine implementation of BRCA testing for ovarian cancer patients has been inconsistent and largely unsuccessful. We developed a rapid, robust, mainstream genetic testing pathway in which testing is undertaken by the trained cancer team with cascade testing to relatives performed by the genetics team. 207 women with ovarian cancer were offered testing through the mainstream pathway. All accepted. 33 (16%) had a BRCA mutation. The result informed management of 79% (121/154) women with active disease. Patient and clinician feedback was very positive. The pathway offers a 4-fold reduction in time and 13-fold reduction in resource requirement compared to the conventional testing pathway. The mainstream genetic testing pathway we present is effective, efficient and patient-centred. It can deliver rapid, robust, large-scale, cost-effective genetic testing of BRCA1 and BRCA2 and may serve as an exemplar for other genes and other diseases. PMID:27406733

  17. Estimating progression-free survival in patients with glioblastoma using routinely collected data.

    PubMed

    Kelly, Charlotte; Majewska, Paulina; Ioannidis, Stefanos; Raza, Muhammad Hasan; Williams, Matt

    2017-09-27

    Glioblastoma (GBM) represents 80% of all primary malignant brain tumours in adults. Prognosis is poor, and there is a clear correlation between disease progression and deterioration in functional status. In this pilot study we assess whether we can estimate disease progression and progression free survival (PFS) from routinely collected electronic healthcare data. We identified fifty patients with glioblastoma who had chemo-radiotherapy. For each patient we manually collected a reference data set recording demographics, surgery, radiotherapy, chemotherapy, follow-up and death. We also obtained an electronic routine data set for each patient by combining local data on chemotherapy/radiotherapy and hospital admissions. We calculated overall survival (OS) and PFS using the reference data set, and estimated them using the routine data sets using two different methods, and compared the estimated measures with the reference measures. Overall survival was 68% at 1 year and median OS was 12.8 months. The routine data correctly identified progressive disease in 37 of 40 patients and stable disease in 7 of 10 patients. PFS was 7.4 months and the estimated PFS using routine data was 9.1 and 7.8 months with methods 1 and 2 respectively. There was acceptable agreement between reference and routine data in 49 of 50 patients for OS and 35 of 50 patients for PFS. The event of progression, subsequent treatment and OS are well estimated using our approach, but PFS estimation is less accurate. Our approach could refine our understanding of the disease course and allow us to report PFS, OS and treatment nationally.

  18. A comparison of patient questionnaires and composite indexes in routine care of rheumatoid arthritis patients.

    PubMed

    Leeb, Burkhard F; Sautner, Judith; Mai, Harsono T H; Haindl, Pia M; Deutsch, Christoph; Rintelen, Bernhard

    2009-12-01

    To evaluate the agreement between the Routine Assessment of Patient Index Data 3 (RAPID-3) and a modified version of the Rheumatoid Arthritis Disease Activity Index (RADAI-5), as well as the Disease Activity Score including a 28 joint count (DAS28-ESR) and the Clinical Disease Activity Index (CDAI) in daily routine. One hundred and twenty-eight rheumatoid arthritis (RA) out-patients completed the RADAI-5 and the RAPID-3. Simultaneously, the DAS28-ESR and the CDAI were applied. Cronbach's Alpha as a measure for reliability was calculated and factorial analysis was performed. For agreement analysis, Kendall's Tau was calculated. Time to score the questionnaires was 25seconds. The median RADAI-5 was 2.8 (0-9.2), the median RAPID-3 3.3 (0-8.6), the median DAS28-ESR 2.95 (0.43-6.24), and the median CDAI 5.6 (0-37.5). Cronbach's Alpha for the RADAI-5 was 0.906 and 0.871 for the RAPID-3, however, only 0.165 for the DAS28-ESR and 0.210 for the CDAI, respectively. Factorial analysis revealed that both questionnaires and the DAS28-ESR, but not the CDAI, constitute mono-dimensional instruments. Tau for the agreement between the RADAI-5 and the RAPID-3 appeared to be 0.587 (p<0.001), and to be 0.582 (p<0.001) between the DAS28-ESR and the CDAI, while it was lower for the relationship between the questionnaires and the composite indexes. Reliability of the RAPID-3 and RADAI-5 was significantly higher than of the indexes. The questionnaires as well as the indexes proved to be in highly moderate agreement, while agreement between the questionnaires and the indexes appeared to be lower.

  19. Impact of routine admission chest X-ray films on patient care

    SciTech Connect

    Hubbell, F.A.; Greenfield, S.; Tyler, J.L.; Chetty, K.; Wyle, F.A.

    1985-01-24

    The authors evaluated the impact of routine chest X-ray films, obtained on admission, on the treatment of patients on internal medicine wards of the Veterans Administration Medical Center, Long Beach, California - a population known to have a high prevalence of cardiopulmonary disease. The reasons for ordering chest films were determined prospectively, and three Department of Medicine faculty members reviewed the charts of admitted patients to determine the impact of chest-film results on patient care. Routine chest X-ray films were ordered for 294 (60 per cent) of the 491 patients studied. Abnormalities were noted in 106 (36 per cent) of these 294 patients. The findings were previously known, chronic, and stable in 86 patients; they were new in only 20. Treatment was changed because of chest-film results in only 12 (4 per cent) of the patients. In only one of these patients would appropriate treatment probably have been omitted if a chest film had not been obtained, and the patient's outcome was not improved by the treatment instituted. The authors conclude that the impact of routine admission chest X-ray films on patient care is very small, even in a population with a high prevalence of cardiopulmonary disease. They recommend that such films not be ordered solely because of admission. 16 references, 3 tables.

  20. Quality-assurance results for routine water analysis in US Geological Survey laboratories, water year 1991

    USGS Publications Warehouse

    Maloney, T.J.; Ludtke, A.S.; Krizman, T.L.

    1994-01-01

    The US. Geological Survey operates a quality- assurance program based on the analyses of reference samples for the National Water Quality Laboratory in Arvada, Colorado, and the Quality of Water Service Unit in Ocala, Florida. Reference samples containing selected inorganic, nutrient, and low ionic-strength constituents are prepared and disguised as routine samples. The program goal is to determine precision and bias for as many analytical methods offered by the participating laboratories as possible. The samples typically are submitted at a rate of approximately 5 percent of the annual environmental sample load for each constituent. The samples are distributed to the laboratories throughout the year. Analytical data for these reference samples reflect the quality of environmental sample data produced by the laboratories because the samples are processed in the same manner for all steps from sample login through data release. The results are stored permanently in the National Water Data Storage and Retrieval System. During water year 1991, 86 analytical procedures were evaluated at the National Water Quality Laboratory and 37 analytical procedures were evaluated at the Quality of Water Service Unit. An overall evaluation of the inorganic (major ion and trace metal) constituent data for water year 1991 indicated analytical imprecision in the National Water Quality Laboratory for 5 of 67 analytical procedures: aluminum (whole-water recoverable, atomic emission spectrometric, direct-current plasma); calcium (atomic emission spectrometric, direct); fluoride (ion-exchange chromatographic); iron (whole-water recoverable, atomic absorption spectrometric, direct); and sulfate (ion-exchange chromatographic). The results for 11 of 67 analytical procedures had positive or negative bias during water year 1991. Analytical imprecision was indicated in the determination of two of the five National Water Quality Laboratory nutrient constituents: orthophosphate as phosphorus and

  1. Contextualising renal patient routines: Everyday space-time contexts, health service access, and wellbeing.

    PubMed

    McQuoid, Julia; Jowsey, Tanisha; Talaulikar, Girish

    2017-06-01

    Stable routines are key to successful illness self-management for the growing number of people living with chronic illness around the world. Yet, the influence of chronically ill individuals' everyday contexts in supporting routines is poorly understood. This paper takes a space-time geographical approach to explore the everyday space-time contexts and routines of individuals with chronic kidney disease (CKD). We ask: what is the relationship between renal patients' space-time contexts and their ability to establish and maintain stable routines, and, what role does health service access play in this regard? We draw from a qualitative case study of 26 individuals with CKD in Australia. Data comprised self-reported two day participant diaries and semi-structured interviews. Thematic analysis of interview transcripts was guided by an inductive-deductive approach. We examined the embeddedness of routines within the space-time contexts of participants' everyday lives. We found that participants' everyday space-time contexts were highly complex, especially for those receiving dialysis and/or employed, making routines difficult to establish and vulnerable to disruption. Health service access helped shape participants' everyday space-time contexts, meaning that incidences of unpredictability in accessing health services set-off 'ripple effects' within participants' space-time contexts, disrupting routines and making everyday life negotiation more difficult. The ability to absorb ripple effects from unpredictable health services without disrupting routines varied by space-time context. Implications of these findings for the deployment of the concept of routine in health research, the framing of patient success in self-managing illness, and health services design are discussed. In conclusion, efforts to understand and support individuals in establishing and maintaining routines that support health and wellbeing can benefit from approaches that contextualise and de

  2. Patient benefits in the treatment of psoriasis: long-term outcomes in German routine care 2007-2014.

    PubMed

    Radtke, M A; Langenbruch, A; Jacobi, A; Schaarschmidt, M-L; Augustin, M

    2016-10-01

    Psoriasis is associated with significant patient burden. Few studies have specifically measured patient preferences and benefits. Outcomes assessment using the Patient Benefit Index (PBI) in nationwide psoriasis surveys comparing health care in 2007 and 2014. This was a non-interventional, cross-sectional survey conducted in 2007 and 2014 in randomly selected dermatological practices and clinics recording by a) physicians: comorbidity, clinical severity (PASI, GCA), and b) patients: quality of life (DLQI, EQ-5D), patient-relevant therapeutic benefits (PBI) and previous and curent treatments. In 2014, a total of n = 1265 patients (43.4% female, mean age 51.9 ± 14.3 years.; mean disease duration 21.6 ± 15.4 years.) were included. Overall PBI was 2.8 ± 1.1. A total of 91.6% of patients showed a more than minimum clinically relevant benefit (PBI>1). Patients treated with biologics and biologics combined with conventional systemics showed the highest benefit compared to patients with conventional systemic treatment and patients treated with topical steroids. In comparison with the 2007 survey (n = 2009), there was an increase in PBI from 2.5 ± 1.1 to 2.8 ± 1.1 and a gain of patients with high benefits (PBI ≥3) by 30% (38.5% vs. 49.4%). In German routine care, psoriasis patients have shown increased therapeutic benefits over time with highest benefits deriving from biologics combined with systemics. © 2016 European Academy of Dermatology and Venereology.

  3. Routine histologic examination of 728 mastectomy scars: did it benefit our patients?

    PubMed

    Woerdeman, Leonie A E; Kortmann, Jan B J; Hage, J Joris

    2006-11-01

    Routine histologic examination of secondarily excised mastectomy scars is considered good practice, even though the microscopic detection of a metastasis in clinically unsuspected mastectomy scars is rare. Because cost-effective use of histologic services is required, the occurrence rate of metastases in such scars needs to be established to assess the possible benefit of such routine examination. The histologic observations on 728 clinically unsuspected scars from prophylactic (n = 151) or curative (n = 395) mastectomy or breast-conservation treatment in 424 patients were traced and correlated to the indication of initial breast surgery, possible adjuvant therapy, and time lapse between initial surgery and scar examination. In none of the 728 scars was a scar metastasis or de novo tumor found. Routine histologic examination of clinically unsuspected scars excised at the time of breast reconstruction or scar correction after prophylactic or curative breast surgery did not benefit the authors' patients.

  4. How do family physicians measure blood pressure in routine clinical practice? National survey of Canadian family physicians.

    PubMed

    Kaczorowski, Janusz; Myers, Martin G; Gelfer, Mark; Dawes, Martin; Mang, Eric J; Berg, Angelique; Grande, Claudio Del; Kljujic, Dragan

    2017-03-01

    To describe the techniques currently used by family physicians in Canada to measure blood pressure (BP) for screening for, diagnosing, and treating hypertension. A Web-based cross-sectional survey distributed by e-mail. Stratified random sample of family physicians in Canada. Family physician members of the College of Family Physicians of Canada with valid e-mail addresses. Physicians' self-reported routine methods for recording BP in their practices to screen for, diagnose, and manage hypertension. A total of 774 valid responses were received, for a response rate of 16.2%. Respondents were similar to nonrespondents except for underrepresentation of male physicians. Of 769 respondents, 417 (54.2%) indicated that they used manual office BP measurement with a mercury or aneroid device and stethoscope as the routine method to screen patients for high BP, while 42.9% (330 of 769) reported using automated office BP (AOBP) measurement. The method most frequently used to make a diagnosis of hypertension was AOBP measurement (31.1%, 240 of 771), followed by home BP measurement (22.4%, 173 of 771) and manual office BP measurement (21.4%, 165 of 771). Ambulatory BP monitoring (ABPM) was used for diagnosis by 14.4% (111 of 771) of respondents. The most frequently reported method for ongoing management was home BP monitoring (68.7%, 528 of 769), followed by manual office BP measurement (63.6%, 489 of 769) and AOBP measurement (59.2%, 455 of 769). More than three-quarters (77.8%, 598 of 769) of respondents indicated that ABPM was readily available for their patients. Canadian family physicians exhibit overall high use of electronic devices for BP measurement, However, more efforts are needed to encourage practitioners to follow current Canadian guidelines, which advocate the use of AOBP measurement for hypertension screening, ABPM and home BP measurement for making a diagnosis, and both AOBP and home BP monitoring for ongoing management. Copyright© the College of Family

  5. The Utility of Routine Intensive Care Admission for Patients Undergoing Intracranial Neurosurgical Procedures: A Systematic Review.

    PubMed

    de Almeida, Cesar Cimonari; Boone, M Dustin; Laviv, Yosef; Kasper, Burkhard S; Chen, Clark C; Kasper, Ekkehard M

    2017-08-14

    Patients who have undergone intracranial neurosurgical procedures have traditionally been admitted to an intensive care unit (ICU) for close postoperative neurological observation. The purpose of this study was to systematically review the evidence for routine ICU admission in patients undergoing intracranial neurosurgical procedures and to evaluate the safety of alternative postoperative pathways. We were interested in identifying studies that examined selected patients who presented for elective, non-emergent intracranial surgery whose postoperative outcomes were compared as a function of ICU versus non-ICU admission. A systematic review was performed in July 2016 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist of the Medline database. The search strategy was created based on the following key words: "craniotomy," "neurosurgical procedure," and "intensive care unit." The nine articles that satisfied the inclusion criteria yielded a total of 2227 patients. Of these patients, 879 were observed in a non-ICU setting. The most frequent diagnoses were supratentorial brain tumors, followed by patients with cerebrovascular diseases and infratentorial brain tumors. Three percent (30/879) of the patients originally assigned to floor or intermediate care status were transferred to the ICU. The most frequently observed neurological complications leading to ICU transfer were delayed postoperative neurological recovery, seizures, worsening of neurological deficits, hemiparesis, and cranial nerves deficits. Our systematic review demonstrates that routine postoperative ICU admission may not benefit carefully selected patients who have undergone elective intracranial neurosurgical procedures. In addition, limiting routine ICU admission may result in significant cost savings.

  6. Development of quality indicators to evaluate the monitoring of SLE patients in routine clinical practice

    PubMed Central

    Mosca, M.; Tani, C.; Aringer, M.; Bombardieri, S.; Boumpas, D.; Cervera, R.; Doria, A.; Jayne, D.; Khamashta, M. A.; Kuhn, A.; Gordon, C.; Petri, M.; Schneider, M.; Shoenfeld, Y.; Smolen, J. S.; Talarico, R.; Tincani, A.; Ward, M. M.; Werth, V. P.; Carmona, L.

    2014-01-01

    The assessment of systemic lupus erythematosus (SLE) patients in routine clinical practice is mainly based on the experience of the treating physician. This carries the risk of unwanted variability. Variability may have an impact on the quality of care offered to SLE patients, thereby affecting outcomes. Recommendations represent systematically developed statements to help practitioners in reducing variability. However, major difficulties arise in the application of recommendations into clinical practice. In this respect, the use of quality indicators may raise the awareness among rheumatologists regarding potential deficiencies in services and improve the quality of health care. The aim of this study was to develop a set of quality indicators (QI) for SLE by translating into QIs the recently developed EULAR Recommendations for monitoring SLE patients in routine clinical practice and observational studies. Eleven QIs have been developed referring to the use of validated activity and damage indices in routine clinical practice, general evaluation of drug toxicity, evaluation of comorbidities, eye evaluation, laboratory assessment, evaluation of the presence of chronic viral infections, documentation of vaccination and of antibody testing at baseline. A disease specific set of quality assessment tools should help physicians deliver high quality of care across populations. Routine updates will be needed. PMID:21224016

  7. Agreement of treatment effects for mortality from routinely collected data and subsequent randomized trials: meta-epidemiological survey.

    PubMed

    Hemkens, Lars G; Contopoulos-Ioannidis, Despina G; Ioannidis, John P A

    2016-02-08

    To assess differences in estimated treatment effects for mortality between observational studies with routinely collected health data (RCD; that are published before trials are available) and subsequent evidence from randomized controlled trials on the same clinical question. Meta-epidemiological survey. PubMed searched up to November 2014. Eligible RCD studies were published up to 2010 that used propensity scores to address confounding bias and reported comparative effects of interventions for mortality. The analysis included only RCD studies conducted before any trial was published on the same topic. The direction of treatment effects, confidence intervals, and effect sizes (odds ratios) were compared between RCD studies and randomized controlled trials. The relative odds ratio (that is, the summary odds ratio of trial(s) divided by the RCD study estimate) and the summary relative odds ratio were calculated across all pairs of RCD studies and trials. A summary relative odds ratio greater than one indicates that RCD studies gave more favorable mortality results. The evaluation included 16 eligible RCD studies, and 36 subsequent published randomized controlled trials investigating the same clinical questions (with 17,275 patients and 835 deaths). Trials were published a median of three years after the corresponding RCD study. For five (31%) of the 16 clinical questions, the direction of treatment effects differed between RCD studies and trials. Confidence intervals in nine (56%) RCD studies did not include the RCT effect estimate. Overall, RCD studies showed significantly more favorable mortality estimates by 31% than subsequent trials (summary relative odds ratio 1.31 (95% confidence interval 1.03 to 1.65; I(2)=0%)). Studies of routinely collected health data could give different answers from subsequent randomized controlled trials on the same clinical questions, and may substantially overestimate treatment effects. Caution is needed to prevent misguided clinical

  8. Routine Vaccination Coverage in Northern Nigeria: Results from 40 District-Level Cluster Surveys, 2014-2015

    PubMed Central

    Ogbuanu, Ikechukwu U.; Adegoke, Oluwasegun J.; Scobie, Heather M.; Uba, Belinda V.; Wannemuehler, Kathleen A.; Ruiz, Alicia; Elmousaad, Hashim; Ohuabunwo, Chima J.; Mustafa, Mahmud; Nguku, Patrick; Waziri, Ndadilnasiya Endie; Vertefeuille, John F.

    2016-01-01

    Background Despite recent success towards controlling poliovirus transmission, Nigeria has struggled to achieve uniformly high routine vaccination coverage. A lack of reliable vaccination coverage data at the operational level makes it challenging to target program improvement. To reliably estimate vaccination coverage, we conducted district-level vaccine coverage surveys using a pre-existing infrastructure of polio technical staff in northern Nigeria. Methods Household-level cluster surveys were conducted in 40 polio high risk districts of Nigeria during 2014–2015. Global positioning system technology and intensive supervision by a pool of qualified technical staff were used to ensure high survey quality. Vaccination status of children aged 12–23 months was documented based on vaccination card or caretaker’s recall. District-level coverage estimates were calculated using survey methods. Results Data from 7,815 children across 40 districts were analyzed. District-level coverage with the third dose of diphtheria-pertussis-tetanus vaccine (DPT3) ranged widely from 1–63%, with all districts having DPT3 coverage below the target of 80%. Median coverage across all districts for each of eight vaccine doses (1 Bacille Calmette-Guérin dose, 3 DPT doses, 3 oral poliovirus vaccine doses, and 1 measles vaccine dose) was <50%. DPT3 coverage by survey was substantially lower (range: 28%–139%) than the 2013 administrative coverage reported among children aged <12 months. Common reported reasons for non-vaccination included lack of knowledge about vaccines and vaccination services (50%) and factors related to access to routine immunization services (15%). Conclusions Survey results highlighted vaccine coverage gaps that were systematically underestimated by administrative reporting across 40 polio high risk districts in northern Nigeria. Given the limitations of administrative coverage data, our approach to conducting quality district-level coverage surveys and

  9. Routine Vaccination Coverage in Northern Nigeria: Results from 40 District-Level Cluster Surveys, 2014-2015.

    PubMed

    Gunnala, Rajni; Ogbuanu, Ikechukwu U; Adegoke, Oluwasegun J; Scobie, Heather M; Uba, Belinda V; Wannemuehler, Kathleen A; Ruiz, Alicia; Elmousaad, Hashim; Ohuabunwo, Chima J; Mustafa, Mahmud; Nguku, Patrick; Waziri, Ndadilnasiya Endie; Vertefeuille, John F

    2016-01-01

    Despite recent success towards controlling poliovirus transmission, Nigeria has struggled to achieve uniformly high routine vaccination coverage. A lack of reliable vaccination coverage data at the operational level makes it challenging to target program improvement. To reliably estimate vaccination coverage, we conducted district-level vaccine coverage surveys using a pre-existing infrastructure of polio technical staff in northern Nigeria. Household-level cluster surveys were conducted in 40 polio high risk districts of Nigeria during 2014-2015. Global positioning system technology and intensive supervision by a pool of qualified technical staff were used to ensure high survey quality. Vaccination status of children aged 12-23 months was documented based on vaccination card or caretaker's recall. District-level coverage estimates were calculated using survey methods. Data from 7,815 children across 40 districts were analyzed. District-level coverage with the third dose of diphtheria-pertussis-tetanus vaccine (DPT3) ranged widely from 1-63%, with all districts having DPT3 coverage below the target of 80%. Median coverage across all districts for each of eight vaccine doses (1 Bacille Calmette-Guérin dose, 3 DPT doses, 3 oral poliovirus vaccine doses, and 1 measles vaccine dose) was <50%. DPT3 coverage by survey was substantially lower (range: 28%-139%) than the 2013 administrative coverage reported among children aged <12 months. Common reported reasons for non-vaccination included lack of knowledge about vaccines and vaccination services (50%) and factors related to access to routine immunization services (15%). Survey results highlighted vaccine coverage gaps that were systematically underestimated by administrative reporting across 40 polio high risk districts in northern Nigeria. Given the limitations of administrative coverage data, our approach to conducting quality district-level coverage surveys and providing data to assess and remediate issues

  10. Lack of hygiene routines among patients and family members at patient hotels--a possible route for transmitting puerperal fever.

    PubMed

    Starlander, Gustaf; Lytsy, Birgitta; Melhus, Asa

    2010-07-01

    The use of patient hotels for ambulatory care of women with uncomplicated deliveries has become a routine in Sweden. This report describes a minor outbreak of a group A Streptococcus strain in 2 newly delivered mothers and their newborn babies at a patient hotel.

  11. National survey of hospital patients.

    PubMed Central

    Bruster, S.; Jarman, B.; Bosanquet, N.; Weston, D.; Erens, R.; Delbanco, T. L.

    1994-01-01

    OBJECTIVE--To survey patients' opinions of their experiences in hospital in order to produce data that can help managers and doctors to identify and solve problems. DESIGN--Random sample of 36 NHS hospitals, stratified by size of hospital (number of beds), area (north, midlands, south east, south west), and type of hospital (teaching or non-teaching, trust or directly managed). From each hospital a random sample of, on average, 143 patients was interviewed at home or the place of discharge two to four weeks after discharge by means of a structured questionnaire about their treatment in hospital. SUBJECTS--5150 randomly chosen NHS patients recently discharged from acute hospitals in England. Subjects had been patients on medical and surgical wards apart from paediatric, maternity, psychiatric, and geriatric wards. MAIN OUTCOME MEASURES--Patients' responses to direct questions about preadmission procedures, admission, communication with staff, physical care, tests and operations, help from staff, pain management, and discharge planning. Patients' responses to general questions about their degree of satisfaction in hospitals. RESULTS--Problems were reported by patients, particularly with regard to communication with staff (56% (2824/5020) had not been given written or printed information); pain management (33% (1042/3162) of those suffering pain were in pain all or most of the time); and discharge planning (70% (3599/5124) had not been told about warning signs and 62% (3177/5119) had not been told when to resume normal activities). Hospitals failed to reach the standards of the Patient's Charter--for example, in explaining the treatment proposed and giving patients the option of not taking part in student training. Answers to questions about patient satisfaction were, however, highly positive but of little use to managers. CONCLUSIONS--This survey has highlighted several problems with treatment in NHS hospitals. Asking patients direct questions about what happened

  12. Ambulance personnel adherence to hygiene routines: still protecting ourselves but not the patient.

    PubMed

    Emanuelsson, Lena; Karlsson, Lena; Castrèn, Maaret; Lindström, Veronica

    2013-08-01

    It is well known that adherence to hygiene routines leads to increased quality of care and safety for patients and personnel in hospitals. However, there have been few studies describing hygiene in ambulances, despite the fact that many patients receive advanced medical care and treatment from ambulance services before arriving at an emergency department. Therefore, the purpose of this study was to describe the adherence of ambulance personnel to hygiene routines in the ambulances. A participant observation study in the County of Värmland (Sweden) was conducted over 1 day in November 2010. Seven hygiene-related variables were collected during the observations: disinfection of hands before and after patient contact; correct use of gloves, gowns and short-sleeved uniforms; no rings, watches, or bracelets; and short or tied back hair during patient care. A total of 68 observed ambulance assignments were analyzed in terms of the adherence of personnel to hygiene routines. In 34% of the observed cases, hand rub was used before patient care and, in 72% of the observed cases, the ambulance personnel used hand rub after patient care. Correct adherence to the rule requiring use of a short-sleeved uniform was found in 28% of the observations. Correct adherence to the rule regarding short or tied back hair was found in 91% of the observations. The ambulance personnel were found to have relatively good adherence to some hygiene routines, but not all. The adherence by ambulance personnel to all of the seven observed variables was correct in only 3% of the assignments.

  13. Implications of routinely measuring Ankle-Brachial Index (ABI) among patients attending at a Lipid Clinic.

    PubMed

    Sona, Alessandro; Comba, Monica; Brescianini, Alessia; Corsinovi, Laura; Zanocchi, Mauro; Fonte, Gianfranco; Bo, Mario

    2009-05-01

    Low (< or = 90) Ankle Brachial Index (ABI) values identify patients at high risk for cardiovascular (CV) disease and mortality. Implications for CV risk classification from routinely measuring ABI in the context of a Lipid Clinic have not been fully investigated. We aimed to evaluate whether and to what extent routine ABI determination on top of conventional risk prediction models may modify CV risk classification. Consecutive asymptomatic non-diabetic individuals free from previous CV events attending for a first visit at a Lipid Clinic underwent routine ABI determination and conventional CV risk classification according either to national CUORE model (including age, gender, smoking, total and high density lipoprotein cholesterol, systolic blood pressure and current use of blood pressure lowering drugs) and SCORE model for low risk countries. In the overall sample (320 subjects, mean age 64.8 years) 77 subjects (24.1%) were found to have low ABI value. Forty-two of 250 subjects (16.8%) and 47 of 215 individuals (21.3%) at low or moderate risk according to the CUORE and SCORE models, respectively, were found to have low ABI values, and should be reclassified at high risk. In a series of consecutive asymptomatic individuals in a Lipid Clinic, we observed a high prevalence of low ABI values among subjects deemed at low or moderate risk on conventional prediction models, leading to CV high-risk reclassification of roughly one fifth of patients. These findings reinforce recommendations for routine determination of ABI at least within referral primary prevention settings.

  14. Is there evidence to support the need for routine surgeon presence on trauma patient arrival?

    PubMed

    Green, Steven M

    2006-05-01

    The trauma center certification requirements of the American College of Surgeons include the expectation that, whenever possible, general surgeons be routinely present at the emergency department arrival of seriously injured patients. The 2 historical factors that originally prompted this requirement, frequent exploratory laparotomies and emergency physicians without trauma training, no longer exist in most modern trauma centers. Research from multiple centers and in multiple varying formats has not identified improvement in patient-oriented outcomes from early surgeon involvement. Surgeons are not routinely present during the resuscitative phase of Canadian and European trauma care, with no demonstrated or perceived decrease in the quality of care. American trauma surgeons themselves do not consistently believe that their use in this capacity is either necessary or an efficient distribution of resources. There is not compelling evidence to support the assumption that trauma outcomes are improved by the routine presence of surgeons on patient arrival. Research is necessary to clarify which trauma patients require either emergency or urgent unique expertise of a general surgeon during the initial phase of trauma management. Individual trauma centers should be permitted the flexibility necessary to perform such research and to use such findings to refine and focus their secondary triage criteria.

  15. Relationship of comorbid substance and alcohol use disorders to disability among patients in routine psychiatric practice.

    PubMed

    Wilk, Joshua; West, Joyce C; Rae, Donald S; Regier, Darrel A

    2006-01-01

    The primary aim of this study was to present data on the relationship of mental and comorbid substance use disorders to work disability and functioning in routine psychiatric practice in the United States. Data were used from the 1997 and 1999 American Psychiatric Institute for Research and Education's Practice Research Network Study of Psychiatric Patients and Treatments, totaling 754 psychiatrists and 3,088 patients. Results found patients with comorbid substance use disorders had significantly higher rates of work disability. These findings highlight the critical need to address the disturbing lack of substance use treatment and rehabilitation services for this population.

  16. Is Routine Thromboprophylaxis Needed in Korean Patients Undergoing Unicompartmental Knee Arthroplasty?

    PubMed

    Koh, In Jun; Kim, Ju Hwan; Kim, Man Soo; Jang, Sung Won; Kim, Chulkyu; In, Yong

    2016-03-01

    This study was undertaken to determine the prevalence and the natural course of venous thromboembolism (VTE) without thromboprophylaxis to ascertain whether routine thromboprophylaxis is necessary following unicompartmental knee arthroplasty (UKA) in Korean patients. The medical records and multidetector row computed tomography (MDCT) imaging of the consecutive 77 UKAs in 70 patients were reviewed. In all patients, MDCTs were undertaken preoperatively and at 1-week after surgery, and VTE symptoms were evaluated. At postoperative 6-months, follow-up MDCTs were undertaken in all patients in whom VTEs were newly detected after surgery. VTE lesions were newly detected in 18 (26%) of the 70 patients. However, none of the patients complained of VTE-related symptoms and MDCT demonstrated that all VTEs were small and involved limited portion without lower leg edema or pleuroparenchymal complication. At the 6-month follow up MDCT, all types of VTEs were shown to be completely resolved, regardless of their location. All of the VTE lesions maintained an asymptomatic status for 6-month after surgery. VTE following UKA in Korean patients who do not receive thromboprophylaxis seems to occur frequently, but all of the VTEs are clinically insignificant and all VTEs are spontaneously regressed. Routine thromboprophylaxis or thrombolytic treatment in Korean patients undergoing UKA may not be necessary.

  17. The role of routine spinal imaging and immobilisation in asymptomatic patients after gunshot wounds.

    PubMed

    DuBose, Joseph; Teixeira, Pedro G R; Hadjizacharia, Pantelis; Hannon, Matt; Inaba, Kenji; Green, D G; Plurad, David; Demetriades, Demetrios; Rhee, Peter

    2009-08-01

    The role of routine dedicated spinal imaging and immobilisation following gunshot wounds (GSW) to the head, neck or torso has been debated. The purpose of this study was to determine the incidence of spinal column injury requiring stabilisation in evaluable patients following gunshot injury. A retrospective study from of a Level I trauma centre from January 1995 to December 2004. All patients with GSW to the head, neck or torso and bony spinal column injury underwent medical record review to determine injury type, presentation, presence of concomitant spinal cord injury, treatment and outcome. A total of 4204 patients sustaining GSW to the head, neck or torso were identified. Complete medical records were available for the 327 (7.8%) patients with bony spinal column injury. Among these patients, 173 (52.9%) sustained spinal cord injury. Two patients (0.6%) with GSW to the torso and bony spinal column injury required operative spinal intervention. The indication for operative intervention in both cases was removal of a foreign body or bony fragment for decompression of the spinal canal. None of the 4204 patients sustaining GSW to the head, neck or torso demonstrated spinal instability requiring operative intervention, and only 2/327 (0.6%) required any form of operative intervention for decompression. Spinal instability following GSW with spine injury is very rare. Routine spinal imaging and immobilisation is unwarranted in examinable patients without symptoms consistent with spinal injury following GSW to the head, neck or torso.

  18. Catheter ablation for atrial fibrillation: results from the first European Snapshot Survey on Procedural Routines for Atrial Fibrillation Ablation (ESS-PRAFA) Part II.

    PubMed

    Chen, Jian; Dagres, Nikolaos; Hocini, Melece; Fauchier, Laurent; Bongiorni, Maria Grazia; Defaye, Pascal; Hernandez-Madrid, Antonio; Estner, Heidi; Sciaraffia, Elena; Blomström-Lundqvist, Carina

    2015-11-01

    The European Snapshot Survey on Procedural Routines in Atrial Fibrillation Ablation (ESS-PRAFA) is a prospective, multicentre snapshot survey collecting patient-based data on current clinical practices during atrial fibrillation (AF) ablation. The participating centres were asked to prospectively enrol consecutive patients during a 6-week period (from September to October 2014). A web-based case report form was employed to collect information of patients and data of procedures. A total of 455 eligible consecutive patients from 13 countries were enrolled (mean age 59 ± 10.8 years, 28.8% women). Distinct strategies and endpoints were collected for AF ablation procedures. Pulmonary vein isolation (PVI) was performed in 96.7% and served as the endpoint in 91.3% of procedures. A total of 52 (11.5%) patients underwent ablation as first-line therapy. The cryoballoon technique was employed in 31.4% of procedures. Procedure, ablation, and fluoroscopy times differed among various types of AF ablation. Divergences in patient selection and complications were observed among low-, medium-, and high-volume centres. Adverse events were observed in 4.6% of AF ablation procedures. In conclusion, PVI was still the main strategy for AF ablation. Procedure-related complications seemed not to have declined. The centre volume played an important role in patient selection, strategy choice, and had impact on the rate of periprocedural complication.

  19. The significance of routine laboratory parameters in patients with sudden sensorineural hearing loss.

    PubMed

    Yasan, Hasan; Tüz, Mustafa; Yariktaş, Murat; Aynali, Giray; Tomruk, Onder; Akkuş, Omer

    2013-12-01

    There are several factors (viral infections, metabolic and ototoxic disorders etc.) accused for the development of sudden sensorineural hearing loss. Some prognostic factors (late onset of treatment etc.) had been evaluated in the literature. There is no sufficient data on the effect of routine laboratory parameters on the development and/or prognosis of sudden sensorineural hearing loss. The aim of this study is to investigate the effects of routine blood chemistry and hematological parameters on the development and prognosis of disease in patients with idiopathic sudden sensorineural hearing loss. One hundred and forty-seven patients with the diagnosis of idiopathic sudden sensorineural hearing loss followed up during the periods of 2000-2010 years were included in this study. One hundred and three septoplasty patients with no otologic complaints were enrolled as control group. Following the clinical and demographic evaluations, patients with idiopathic sudden sensorineural hearing loss and control groups, and patients treated successfully and patients with poor outcome were compared with each other. Data were analyzed by T test. All hematological and biochemical parameters were compared. Hemoglobin, hematocrit, white blood cell count, total and direct bilirubin, fasting blood glucose level and aspartate aminotransferase were significantly different between idiopathic sudden sensorineural hearing loss and control groups. There was no significantly different parameter between patients treated successfully and patients with poor outcome. Hemoglobin, hematocrit, white blood cell count, total and direct bilirubin, fasting blood glucose level and AST all can be risk factors for SHL, or they can be the result of undetermined pathology, because these parameters have no effect on the prognosis. Other routine parameters seem to have no effect on the development and/or prognosis of idiopathic sudden sensorineural hearing loss.

  20. Usefulness of routine periodic fasting to lower risk of coronary artery disease in patients undergoing coronary angiography.

    PubMed

    Horne, Benjamin D; May, Heidi T; Anderson, Jeffrey L; Kfoury, Abdallah G; Bailey, Beau M; McClure, Brian S; Renlund, Dale G; Lappé, Donald L; Carlquist, John F; Fisher, Patrick W; Pearson, Robert R; Bair, Tami L; Adams, Ted D; Muhlestein, Joseph B

    2008-10-01

    Coronary artery disease (CAD) is common and multifactorial. Members of the Church of Jesus Christ of Latter-day Saints (LDS, or Mormons) in Utah may have lower cardiac mortality than other Utahns and the US population. Although the LDS proscription of smoking likely contributes to lower cardiac risk, it is unknown whether other shared behaviors also contribute. This study evaluated potential CAD-associated effects of fasting. Patients (n(1) = 4,629) enrolled in the Intermountain Heart Collaborative Study registry (1994 to 2002) were evaluated for the association of religious preference with CAD diagnosis (> or = 70% coronary stenosis using angiography) or no CAD (normal coronaries, <10% stenosis). Consequently, another set of patients (n(2) = 448) were surveyed (2004 to 2006) for the association of behavioral factors with CAD, with routine fasting (i.e., abstinence from food and drink) as the primary variable. Secondary survey measures included proscription of alcohol, tea, and coffee; social support; and religious worship patterns. In population 1 (initial), 61% of LDS and 66% of all others had CAD (adjusted [including for smoking] odds ratio [OR] 0.81, p = 0.009). In population 2 (survey), fasting was associated with lower risk of CAD (64% vs 76% CAD; OR 0.55, 95% confidence interval 0.35 to 0.87, p = 0.010), and this remained after adjustment for traditional risk factors (OR 0.46, 95% confidence interval 0.27 to 0.81, p = 0.007). Fasting was also associated with lower diabetes prevalence (p = 0.048). In regression models entering other secondary behavioral measures, fasting remained significant with a similar effect size. In conclusion, not only proscription of tobacco, but also routine periodic fasting was associated with lower risk of CAD.

  1. Usefulness of Routine Periodic Fasting to Lower Risk of Coronary Artery Disease among Patients Undergoing Coronary Angiography

    PubMed Central

    Horne, Benjamin D.; May, Heidi T.; Anderson, Jeffrey L.; Kfoury, Abdallah G.; Bailey, Beau M.; McClure, Brian S.; Renlund, Dale G.; Lappé, Donald L.; Carlquist, John F.; Fisher, Patrick W.; Pearson, Robert R.; Bair, Tami L.; Adams, Ted D.; Muhlestein, Joseph B.

    2008-01-01

    Coronary artery disease (CAD) is common and multi-factorial. Members of the Church of Jesus Christ of Latter-day Saints (LDS, or Mormons) in Utah may have lower cardiac mortality than other Utahns and the US population. While the LDS proscription of smoking likely contributes to lower cardiac risk, it is unknown whether other shared behaviors also contribute. This study evaluated potential CAD-associated effects of fasting. Patients (N1=4,629) enrolled in the Intermountain Heart Collaborative Study registry (1994-2002) were evaluated for association of religious preference with CAD diagnosis (≥70% coronary stenosis on angiography) or no CAD (normal coronaries, <10% stenosis). Consequently, another set of patients (N2=448) were surveyed (2004-2006) for association of behavioral factors with CAD, with the primary variable being routine fasting (i.e., abstinence from food and drink). Secondary survey measures included proscription of alcohol, tea, and coffee, social support, and religious worship patterns. In population 1 (initial), 61% of LDS and 66% of all others had CAD (adjusted [including for smoking]: odds ratio [OR]=0.81; p=0.009). In population 2 (survey), fasting was associated with lower risk of CAD (64% vs. 76% CAD; OR=0.55, CI=0.35, 0.87; p=0.010) and this remained after adjustment for traditional risk factors (OR=0.46, CI=0.27, 0.81; p=0.007). Fasting was also associated with lower diabetes prevalence (p=0.048). In regression models entering other secondary behavioral measures, fasting remained significant with similar effect size. In conclusion, not only proscription of tobacco, but also routine periodic fasting was associated with lower risk of CAD. PMID:18805103

  2. The significance of routine biochemical markers in patients with major depressive disorder

    PubMed Central

    Peng, You-Fan; Xiang, Yang; Wei, Ye-Sheng

    2016-01-01

    The aim of our study is to examine the levels of routine biochemical markers in patients with major depressive disorder (MDD), and combine multiple biochemical parameters to assess the discriminative power for patients with MDD. We used the Hamilton Depression (HAMD) score to evaluate the severity of depressive symptoms in 228 patients with MDD. The phase of depression severity was between moderate and severe in MDD patients. There were significant differences between MDD patients and healthy controls in alanine transaminase (ALT), urea nitrogen (UN), lactate dehydrogenase (LDH), uric acid (UA), total protein (TP), total bile acid (TBA), creatinine (Cr), total bilirubin (Tbil), direct bilirubin (Dbil) and indirect bilirubin (Ibil), high density lipoprotein-cholesterol (HDL-C), fasting blood-glucose (FBG) and fructosamine (SF). Multivariate analysis showed that UN, FBG, HDL-C, SF, TP, Cr and Tbil remained independently association with MDD. Further, a logit equation was established to identify patients with MDD. The composite markers exhibited an area under the curve of 0.810 with cut-off values of 0.410. Our results suggest the associations between UN, FBG, HDL-C, TP, Cr, Tbil, SF and MDD, use of these routine biochemical markers in combination may contribute to improve the complete management for patients with MDD. PMID:27683078

  3. An Effective Machine Learning Approach for Prognosis of Paraquat Poisoning Patients Using Blood Routine Indexes.

    PubMed

    Chen, Huiling; Hu, Lufeng; Li, Huaizhong; Hong, Guangliang; Zhang, Tao; Ma, Jianshe; Lu, Zhongqiu

    2017-01-01

    The early identification of toxic paraquat (PQ) poisoning in patients is critical to ensure timely and accurate prognosis. Although plasma PQ concentration has been reported as a clinical indicator of PQ poisoning, it is not commonly applied in practice due to the inconvenient necessary instruments and operation. In this study, we explored the use of blood routine indexes to identify the degree of PQ toxicity and/or diagnose PQ poisoning in patients via machine learning approach. Specifically, we developed a method based on support vector machine combined with the feature selection technique to accurately predict PQ poisoning risk status, then tested the method on 79 (42 male and 37 female; 41 living and 38 deceased) patients. The detection method was rigorously evaluated against a real-world data set to determine its accuracy, sensitivity and specificity. Feature selection was also applied to identify the factors correlated with risk status, and the results showed that there are significant differences in blood routine indexes between dead and living PQ-poisoned individuals (p-value < 0.01). Feature selection also showed that the most important correlated indexes are white blood cell and neutrophils. In conclusion, the toxicity or prognosis of PQ poisoning can be preliminarily ascertained by blood routine testing without PQ concentration data, representing an additional tool and innovative approach to assess the prognosis of PQ poisoning.

  4. Is social inequality related to different patient concerns in routine oral cancer follow-up clinics?

    PubMed

    Allen, Sarah; Lowe, Derek; Harris, Rebecca V; Brown, Steve; Rogers, Simon N

    2017-01-01

    Oral cancer has a higher incidence in the lower social strata, and these patients are less likely to engage in supportive interventions and report a poorer quality of life (QoL). The aim of this paper is to compare the Patient Concerns Inventory (PCI) responses across social groups attending routine oral cancer follow-up clinics with particular focus on the deprivation lower quartile. The PCI package is completed by patients as part of their routine review consultation with SNR. Patients were those diagnosed between 2008 and 2012. Deprivation was stratified using the IMD 2010 from postcode. Of the 106 eligible patients, 85 % used the PCI. Just over half (54 %) were living in the most deprived quartile, with two-thirds (68 %) of males in the most deprived quartile, compared with 35 % of females (p = 0.004). In regard to number and type of PCI items selected by patients at their first PCI clinic, there were no notable differences in respect of IMD classification. The two commonest concerns were fear of recurrence (43 %) and sore mouth (43 %). The most deprived quartile reported significant problems in regard to mood (p = 0.004) and recreation (p = 0.02), and a non-significant trend (36 vs 18 %, p = 0.09) in stating their overall QoL as being less than good. It is possible to identify the concerns of patients from lower socioeconomic strata as part of routine follow-up clinics. This allows for targeted multi-professional intervention and supports to improve the outcome in this hard to reach group.

  5. Cryptococcosis in HIV-infected hospitalized patients in Germany: Evidence for routine antigen testing.

    PubMed

    Katchanov, Juri; Jefferys, Laura; Tominski, Daniela; Wöstmann, Kai; Slevogt, Hortense; Arastéh, Keikawus; Stocker, Hartmut

    2015-07-01

    To investigate the diagnostic value of routine cryptococcal antigen (CRAG) testing in HIV-infected patients in a low prevalence setting. Retrospective single centre cohort study of a 10-year period (2005-2014). 5461 patients tested for CRAG were included. Cryptococcal antigenaemia was found in 1.6% and 1.1% of patients with CD4 counts of ≤100/μl and 101-200/μl, respectively. The positive predictive values for identifying clinically relevant cryptococcal disease was 96% and 100%, respectively. Half of the patients had a non-specific presentation and median time-to-diagnosis was high (5 days, range 1-44 days). The median time-to-diagnosis in direct admissions to our centre with routine CRAG testing was significantly shorter: 1 day (range: 1-17) vs. 7 days (range: 2-44), p = 0.003. Prevalence of cryptococcal antigenaemia was 2.8% in patients with pneumocystis pneumonia and median time-to-diagnosis of cryptococcosis was significantly longer in this subgroup (15 days; range: 1-44 vs. 3 days; range: 1-17; p = 0.008). CRAG titres ≥1:512 were associated with disseminated disease (OR 21.3, p = 0.0008, 95% CI 1.64-277), however, 10% of patients with disseminated cryptococcosis had CRAG titres <1:16. Our data support routine CRAG testing in hospitalized HIV-infected patients with CD4 counts ≤200/μl, and/or pneumocystis pneumonia. Copyright © 2015 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

  6. Need for routine delayed radionuclide hepatobiliary imaging in patients with intercurrent disease

    SciTech Connect

    Drane, W.E.; Nelp, W.B.; Rudd, T.G.

    1984-06-01

    A retrospective review was made of all radionuclide hepatobiliary studies performed in a major trauma center over a 27-month period and correlated with the patients' clinical course. In a population of 42 patients (27 of whom were on total parenteral nutrition (TPN)) who had severe intercurrent illness (primarily trauma), and an additional 18 patients who had hepatocellular dysfunction, hepatobiliary imaging confirmed a patent cystic duct in 43 of 60 patients (72%). Of 17 patients who had nonvisualization of the gallbladder, four had surgically proved acute cholecystitis. The presence of gallstones, wall thickening, or sludge on sonograms did not correlate with cystic duct patency, and was not specific for acute cholecystitis. Though gallbladder function is compromised in the population with severe intercurrent disease, radionuclide hepatobiliary imaging is still valuable; it can confirm a patent systic duct in at least 72% of patients if routine imaging is continued for up to 24 hours.

  7. Is routine ultrasound examination of the gallbladder justified in critical care patients?

    PubMed

    Myrianthefs, Pavlos; Evodia, Efimia; Vlachou, Ioanna; Petrocheilou, Glykeria; Gavala, Alexandra; Pappa, Maria; Baltopoulos, George; Karakitsos, Dimitrios

    2012-01-01

    Objective. We evaluated whether routine ultrasound examination may illustrate gallbladder abnormalities, including acute acalculous cholecystitis (AAC) in the intensive care unit (ICU). Patients and Methods. Ultrasound monitoring of the GB was performed by two blinded radiologists in mechanically ventilated patients irrespective of clinical and laboratory findings. We evaluated major (gallbladder wall thickening and edema, sonographic Murphy's sign, pericholecystic fluid) and minor (gallbladder distention and sludge) ultrasound criteria. Measurements and Results. We included 53 patients (42 males; mean age 57.6 ± 2.8 years; APACHE II score 21.3 ± 0.9; mean ICU stay 35.9 ± 4.8 days). Twenty-five patients (47.2%) exhibited at least one abnormal imaging finding, while only six out of them had hepatic dysfunction. No correlation existed between liver biochemistry and ultrasound results in the total population. Three male patients (5.7%), on the grounds of unexplained sepsis, were diagnosed with AAC as incited by ultrasound, and surgical intervention was lifesaving. Patients who exhibited ≥2 ultrasound findings (30.2%) were managed successfully under the guidance of evolving ultrasound, clinical, and laboratory findings. Conclusions. Ultrasound gallbladder monitoring guided lifesaving surgical treatment in 3 cases of AAC; however, its routine application is questionable and still entails high levels of clinical suspicion.

  8. Is routine pelvic surveillance imaging necessary in patients with Wilms tumor?

    PubMed

    Kaste, Sue C; Brady, Samuel L; Yee, Brian; McPherson, Valerie J; Kaufman, Robert A; Billups, Catherine A; Daw, Najat C; Pappo, Alberto S

    2013-01-01

    It is unclear whether routine pelvic imaging is needed in patients with Wilms tumor. Thus, the primary objective of the current study was to examine the role of routine pelvic computed tomography (CT) in a cohort of pediatric patients with Wilms tumor. With institutional review board approval, the authors retrospectively identified 110 patients who had Wilms tumor diagnosed between January 1999 and December 2009 with surveillance imaging that continued through March 2011. The authors estimated overall survival (OS), event-free survival (EFS), and dosimetry from dose length product (DLP) conversion to the effective dose (ED) for every CT in a subgroup of 80 patients who had CT studies obtained using contemporary scanners (2002-2011). Metal-oxide-semiconductor field-effect transistor (MOSFET) dosimeters were placed within organs of anthropomorphic phantoms to directly calculate the truncal ED. ED(DLP) was correlated with ED(MOSFET) to calculate potential pelvic dose savings. Eighty patients underwent 605 CT examinations that contained DLP information, including 352 CT scans of the chest, abdomen, and pelvis; 123 CT scans of the chest and abdomen; 102 CT scans of the chest only; 18 CT scans of the abdomen and pelvis; 9 CT scans of the abdomen only; and 1 CT that was limited to the pelvis. The respective 5-year OS and EFS estimates were 92.8% ± 3% and 2.6% ± 4.3%. Sixteen of 110 patients (15%) developed a relapse a median of 11.3 months (range, 5.0 months to 7.3 years) after diagnosis, and 4 patients died of disease recurrence. Three patients developed pelvic relapses, all 3 of which were symptomatic. The estimated ED savings from sex-neutral CT surveillance performed at a 120-kilovolt peak without pelvic imaging was calculated as 30.5% for the average patient aged 1 year, 30.4% for the average patient aged 5 years, 39.4% for the average patient aged 10 years, and 44.9% for the average patient aged 15 years. Omitting pelvic CT from the routine, off-therapy follow

  9. Barium swallow study in routine clinical practice: a prospective study in patients with chronic cough*,**

    PubMed Central

    Nin, Carlos Shuler; Marchiori, Edson; Irion, Klaus Loureiro; Paludo, Artur de Oliveira; Alves, Giordano Rafael Tronco; Hochhegger, Daniela Reis; Hochhegger, Bruno

    2013-01-01

    OBJECTIVE: To assess the routine use of barium swallow study in patients with chronic cough. METHODS: Between October of 2011 and March of 2012, 95 consecutive patients submitted to chest X-ray due to chronic cough (duration > 8 weeks) were included in the study. For study purposes, additional images were obtained immediately after the oral administration of 5 mL of a 5% barium sulfate suspension. Two radiologists systematically evaluated all of the images in order to identify any pathological changes. Fisher's exact test and the chi-square test for categorical data were used in the comparisons. RESULTS: The images taken immediately after barium swallow revealed significant pathological conditions that were potentially related to chronic cough in 12 (12.6%) of the 95 patients. These conditions, which included diaphragmatic hiatal hernia, esophageal neoplasm, achalasia, esophageal diverticulum, and abnormal esophageal dilatation, were not detected on the images taken without contrast. After appropriate treatment, the symptoms disappeared in 11 (91.6%) of the patients, whereas the treatment was ineffective in 1 (8.4%). We observed no complications related to barium swallow, such as contrast aspiration. CONCLUSIONS: Barium swallow improved the detection of significant radiographic findings related to chronic cough in 11.5% of patients. These initial findings suggest that the routine use of barium swallow can significantly increase the sensitivity of chest X-rays in the detection of chronic cough-related etiologies. PMID:24473762

  10. Improved quality of patient care through routine second review of histopathology specimens prior to multidisciplinary meetings.

    PubMed

    Kuijpers, Chantal C H J; Burger, Gerard; Al-Janabi, Shaimaa; Willems, Stefan M; van Diest, Paul J; Jiwa, Mehdi

    2016-10-01

    Double reading may be a valuable tool for improving quality of patient care by identifying diagnostic errors before final sign-out, but standard double reading would significantly increase costs of pathology. We assessed the added value of intradepartmental routine double reading of histopathology specimens prior to multidisciplinary meetings. Diagnoses, treatment plans and prognoses of patients are often discussed at multidisciplinary meetings. As part of the daily routine, all pathology specimens to be discussed at upcoming multidisciplinary meetings undergo prior intradepartmental double reading. We identified all histopathology specimens from 2013 that underwent such double reading and determined major and minor discordance rates based on clinical relevance between the initial and consensus sign-out diagnoses. We included 6796 histopathology specimens that underwent double reading, representing approximately 8% of all histopathology cases at our institution in 2013. Double reading diagnoses were concordant in 6566 specimens (96.6%). Major and minor discordances were observed in 60 (0.9%) and 170 (2.5%) specimens, respectively. Urology specimens had significantly more discordances than other tissues of origin, Gleason grading of prostate cancer biopsies being the most frequent diagnostic problem. Furthermore, premalignant and malignant cases showed significantly higher discordance rates than the rest. The vast majority (90%) of discordances represented changes within the same diagnostic category (eg, malignant to malignant). Routine double reading of histopathology specimens prior to multidisciplinary meetings prevents diagnostic errors. It resulted in about 1% discordant diagnoses of potential clinical significance, indicating that second review is worthwhile in terms of patient safety and quality of patient care. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  11. Perioperative management of antithrombotic treatment during implantation or revision of cardiac implantable electronic devices: the European Snapshot Survey on Procedural Routines for Electronic Device Implantation (ESS-PREDI).

    PubMed

    Deharo, Jean-Claude; Sciaraffia, Elena; Leclercq, Christophe; Amara, Walid; Doering, Michael; Bongiorni, Maria G; Chen, Jian; Dagres, Nicolaus; Estner, Heidi; Larsen, Torben B; Johansen, Jens B; Potpara, Tatjana S; Proclemer, Alessandro; Pison, Laurent; Brunet, Caroline; Blomström-Lundqvist, Carina

    2016-05-01

    The European Snapshot Survey on Procedural Routines for Electronic Device Implantation (ESS-PREDI) was a prospective European survey of consecutive adults who had undergone implantation/surgical revision of a cardiac implantable electronic device (CIED) on chronic antithrombotic therapy (enrolment March-June 2015). The aim of the survey was to investigate perioperative treatment with oral anticoagulants and antiplatelets in CIED implantation or surgical revision and to determine the incidence of complications, including clinically significant pocket haematomas. Information on antithrombotic therapy before and after surgery and bleeding and thromboembolic complications occurring after the intervention was collected at first follow-up. The study population comprised 723 patients (66.7% men, 76.9% aged ≥66 years). Antithrombotic treatment was continued during surgery in 489 (67.6%) patients; 6 (0.8%) had their treatment definitively stopped; 46 (6.4%) were switched to another antithrombotic therapy. Heparin bridging was used in 55 out of 154 (35.8%) patients when interrupting vitamin K antagonist (VKA) treatment. Non-vitamin K oral anticoagulant (NOAC) treatment was interrupted in 88.7% of patients, with heparin bridging in 25.6%, but accounted for only 25.3% of the oral anticoagulants used. A total of 108 complications were observed in 98 patients. No intracranial haemorrhage or embolic events were observed. Chronic NOAC treatment before surgery was associated with lower rates of minor pocket haematoma (1.4%; P= 0.042) vs. dual antiplatelet therapy (13.0%), VKA (11.4%), VKA + antiplatelet (9.2%), or NOAC + antiplatelet (7.7%). Similar results were observed for bleeding complications (P= 0.028). Perioperative management of patients undergoing CIED implantation/surgical revision while on chronic antithrombotic therapy varies, with evidence of a disparity between guideline recommendations and practice patterns in Europe. Haemorrhagic complications were significantly

  12. Routine Urine Culture at the Time of Percutaneous Urinary Drainage: Does Every Patient Need One?

    SciTech Connect

    Brody, L.A. Brown, K.T.; Covey, A.M.; Brown, A.E.; Getrajdman, G.I.

    2006-08-15

    Purpose. To determine the clinical variables associated with bacteriuria in patients undergoing primary percutaneous antegrade urinary drainage procedures in order to predict the utility of routinely obtaining urine cultures at the time of the procedure. Methods. Between October 1995 and March 1998 urine cultures were prospectively obtained in all patients undergoing a primary percutaneous antegrade urinary drainage procedure. One hundred and eighty-seven patients underwent 264 procedures. Results were available in 252 cases. Culture results were correlated with clinical, laboratory, and demographic variables. Anaerobic cultures were not uniformly performed. Results. Urine cultures were positive in 24 of 252 (9.5%) cases. An indwelling or recently removed ipsilateral device (catheter or stent) and a history of previous cystectomy with urinary diversion were significant predictors of a positive culture. Patients without either of these predictors, and without clinical or laboratory evidence of infection, were rarely found to have positive cultures. Conclusion. The likelihood of a positive urine culture can be predicted on the basis of the aforementioned clinical variables. In the absence of these clinical indicators routine urine cultures are neither useful nor cost-effective.

  13. [Cognitive remediation in clinical routine: a study on psychiatric patients' acceptance].

    PubMed

    Bossert, M; Weisbrod, M; Aschenbrenner, S

    2014-12-01

    Cognitive remediation represents an effective treatment for improving functional outcome of psychiatric diseases like schizophrenia or depression. However, in clinical routine the therapeutic approach has not been established continuously. This can be partly attributed to doubts about the reasonableness of cognitive remediation for psychiatric patients. Therefore the current study investigates psychiatric patients' acceptance of, motivation for, and exhaustion due to cognitive remediation compared to an established treatment programme. 21 psychiatric patients who simultaneously participated in occupational therapy and cognitive remediation rated the motivation, exhaustion, enjoyment, and effort on a visual analogue scale (VAS) over five weeks with regard to the respective therapy. The ratings of occupational therapy and cognitive remediation did not differ relating to motivation, exhaustion, and enjoyment. The subjective effort in cognitive remediation was higher than that in occupational therapy. Cognitive remediation is evaluated as being equivalent to an already established treatment programme by psychiatric patients concerning motivation, enjoyment, and exhaustion. Doubts about the acceptance and reasonableness of cognitive remediation could not be confirmed. In clinical routine cognitive remediation as an effective and accepted therapeutic approach should be integrated as a standard procedure for various disorders. © Georg Thieme Verlag KG Stuttgart · New York.

  14. Assessing barriers to adherence in routine clinical care for pediatric kidney transplant patients.

    PubMed

    Varnell, Charles D; Rich, Kristin L; Nichols, Melissa; Dahale, Devesh; Goebel, Jens W; Pai, Ahna L H; Hooper, David K; Modi, Avani C

    2017-08-01

    Patient-identified barriers to immunosuppressive medications are associated with poor adherence and negative clinical outcomes in transplant patients. Assessment of adherence barriers is not part of routine post-transplant care, and studies regarding implementing such a process in a reliable way are lacking. Using the Model for Improvement and PDSA cycles, we implemented a system to identify adherence barriers, including patient-centered design of a barriers assessment tool, identification of eligible patients, clear roles for clinic staff, and creating a culture of non-judgmental discussion around adherence. We performed time-series analysis of our process measure. Secondary analyses examined the endorsement and concordance of adherence barriers between patient-caregiver dyads. After three methods of testing, the most reliable delivery system was an EHR-integrated tablet that alerted staff of patient eligibility for assessment. Barriers were endorsed by 35% of caregivers (n=85) and 43% of patients (n=60). The most frequently patient-endorsed barriers were forgetting, poor taste, and side effects. Caregivers endorsed forgetting and side effects. Concordance between patient-caregiver dyads was fair (k=0.299). Standardized adherence barriers assessment is feasible in the clinical care of pediatric kidney transplant patients. Features necessary for success included automation, redundant systems with designated staff to identify and mitigate failures, aligned reporting structures, and reliable measurement approaches. Future studies will examine whether barriers predict clinical outcomes (eg, organ rejection, graft loss). © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  15. Is Routine Audiometric Evaluation Necessary in Gynaecologic Tumour Patients Undergoing Chemotherapy?

    PubMed Central

    Fasunla, Ayotunde J.; Harbeck, Nadia; Schmalfeld, Barbara; Berktold, Sabina; Böhner, Christina; Hundt, Walter; Wolf, Petra; Steinbach, Silke

    2013-01-01

    Summary Background Our objective was to assess the auditory function of gynaecological tumour patients who had received cytotoxic agents and to determine their associated risk of ototoxicity. Patients and Methods 87 patients who had undergone chemotherapy for gynaecological malignancies were investigated. Of these patients, 79% had breast cancer, and 14% ovarian cancer. All of the patients had a subjective assessment of their hearing function on a visual analogue scale. Audiometric tests were performed before and at 9 weeks, 18 weeks and 3 months after completion of chemotherapy. Results The age of the patients ranged from 32 to 71 years (mean age of 53.5 ± 10.5 years). The average subjective rating of the patients’ hearing function was 83.0 ± 17.2 before and 84.8 ± 16.9 3 months after completion of chemotherapy. No significant audiometric change at either the speech hearing frequency range (0.5–2 KHz) or high frequencies was observed in the patients after chemotherapy. There was also no significant difference in the hearing threshold of the patients who had received platinum analogue-based chemotherapy compared to non-platinum analogue-based chemotherapy. Conclusion Hearing loss is uncommon in patients treated with the typical gynaecological chemotherapy protocols. Hence, routine audiometric testing in these patients is not necessary. PMID:24415980

  16. Preliminary Astrometric Results from the PS1 Demo Month and Routine Survey Operations

    DTIC Science & Technology

    2010-09-01

    data.  The cadence optimizes sky coverage in  multiple survey colors ( SDSS  g­,r­,i­,z­,y‐bands) at the  expense of repeated visits to the same field...objects with other catalogs (USNO‐B1.0,  SDSS , Tycho‐2,  2MASS, etc.) so that unique star identification numbers can  be assigned across all catalogs. This

  17. Low-dose intranasal versus oral midazolam for routine body MRI of claustrophobic patients.

    PubMed

    Tschirch, Frank T C; Göpfert, Kerstin; Fröhlich, Johannes M; Brunner, Genevieve; Weishaupt, Dominik

    2007-06-01

    The purpose of this study was to assess prospectively the potential of low-dose intranasal midazolam compared to oral midazolam in claustrophobic patients undergoing routine body magnetic resonance imaging (MRI). Seventy-two adult claustrophobic patients referred for body MRI were randomly assigned to one of two treatment groups (TG1 and TG2). The 36 patients of TG1 received 7.5 mg midazolam orally 15 min before MRI, whereas the 36 patients of TG2 received one (or, if necessary, two) pumps of a midazolam nasal spray into each nostril immediately prior to MRI (in total, 1 or 2 mg). Patients' tolerance, anxiety and sedation were assessed using a questionnaire and a visual analogue scale immediately before and after MRI. Image quality was evaluated using a five-point-scale. In TG1, 18/36 MRI examinations (50%) had to be cancelled, the reduction of anxiety was insufficient in 12/18 remaining patients (67%). In TG2, 35/36 MRI examinations (97%) were completed successfully, without relevant adverse effects. MRI image quality was rated higher among patients of TG2 compared to TG1 (p<0.001). Low-dose intranasal midazolam is an effective and patient-friendly solution to overcome anxiety in claustrophobic patients in a broad spectrum of body MRI. Its anxiolytic effect is superior to that of the orally administrated form.

  18. How to routinely collect data on patient-reported outcome and experience measures in renal registries in Europe: an expert consensus meeting.

    PubMed

    Breckenridge, Kate; Bekker, Hillary L; Gibbons, Elizabeth; van der Veer, Sabine N; Abbott, Denise; Briançon, Serge; Cullen, Ron; Garneata, Liliana; Jager, Kitty J; Lønning, Kjersti; Metcalfe, Wendy; Morton, Rachael L; Murtagh, Fliss E M; Prutz, Karl; Robertson, Susan; Rychlik, Ivan; Schon, Steffan; Sharp, Linda; Speyer, Elodie; Tentori, Francesca; Caskey, Fergus J

    2015-10-01

    Despite the potential for patient-reported outcome measures (PROMs) and experience measures (PREMs) to enhance understanding of patient experiences and outcomes they have not, to date, been widely incorporated into renal registry datasets. This report summarizes the main points learned from an ERA-EDTA QUEST-funded consensus meeting on how to routinely collect PROMs and PREMs in renal registries in Europe. In preparation for the meeting, we surveyed all European renal registries to establish current or planned efforts to collect PROMs/PREMs. A systematic review of the literature was performed. Publications reporting barriers and/or facilitators to PROMs/PREMs collection by registries were identified and a narrative synthesis undertaken. A group of renal registry representatives, PROMs/PREMs experts and patient representatives then met to (i) share any experience renal registries in Europe have in this area; (ii) establish how patient-reported data might be collected by understanding how registries currently collect routine data and how patient-reported data is collected in other settings; (iii) harmonize the future collection of patient-reported data by renal registries in Europe by agreeing upon preferred instruments and (iv) to identify the barriers to routine collection of patient-reported data in renal registries in Europe. In total, 23 of the 45 European renal registries responded to the survey. Two reported experience in collecting PROMs and three stated that they were actively exploring ways to do so. The systematic review identified 157 potentially relevant articles of which 9 met the inclusion criteria and were analysed for barriers and facilitators to routine PROM/PREM collection. Thirteen themes were identified and mapped to a three-stage framework around establishing the need, setting up and maintaining the routine collection of PROMs/PREMs. At the consensus meeting some PROMs instruments were agreed for routine renal registry collection (the generic SF

  19. How to routinely collect data on patient-reported outcome and experience measures in renal registries in Europe: an expert consensus meeting

    PubMed Central

    Breckenridge, Kate; Bekker, Hillary L.; Gibbons, Elizabeth; van der Veer, Sabine N.; Abbott, Denise; Briançon, Serge; Cullen, Ron; Garneata, Liliana; Jager, Kitty J.; Lønning, Kjersti; Metcalfe, Wendy; Morton, Rachael L.; Murtagh, Fliss E.M.; Prutz, Karl; Robertson, Susan; Rychlik, Ivan; Schon, Steffan; Sharp, Linda; Speyer, Elodie; Tentori, Francesca; Caskey, Fergus J.

    2015-01-01

    Despite the potential for patient-reported outcome measures (PROMs) and experience measures (PREMs) to enhance understanding of patient experiences and outcomes they have not, to date, been widely incorporated into renal registry datasets. This report summarizes the main points learned from an ERA-EDTA QUEST-funded consensus meeting on how to routinely collect PROMs and PREMs in renal registries in Europe. In preparation for the meeting, we surveyed all European renal registries to establish current or planned efforts to collect PROMs/PREMs. A systematic review of the literature was performed. Publications reporting barriers and/or facilitators to PROMs/PREMs collection by registries were identified and a narrative synthesis undertaken. A group of renal registry representatives, PROMs/PREMs experts and patient representatives then met to (i) share any experience renal registries in Europe have in this area; (ii) establish how patient-reported data might be collected by understanding how registries currently collect routine data and how patient-reported data is collected in other settings; (iii) harmonize the future collection of patient-reported data by renal registries in Europe by agreeing upon preferred instruments and (iv) to identify the barriers to routine collection of patient-reported data in renal registries in Europe. In total, 23 of the 45 European renal registries responded to the survey. Two reported experience in collecting PROMs and three stated that they were actively exploring ways to do so. The systematic review identified 157 potentially relevant articles of which 9 met the inclusion criteria and were analysed for barriers and facilitators to routine PROM/PREM collection. Thirteen themes were identified and mapped to a three-stage framework around establishing the need, setting up and maintaining the routine collection of PROMs/PREMs. At the consensus meeting some PROMs instruments were agreed for routine renal registry collection (the generic SF

  20. Safety profile and patient satisfaction of the routine use of propofol in gastrointestinal endoscopy.

    PubMed

    Gurung, R B; Purbe, B; Malla, B; Dhungel, A; Yogol, S; Poudel, A; Kunwor, K; Byanju, S

    2014-01-01

    Routine use of sedation in upper gastrointestinal endoscopy is uncommon in Nepal. There is no study on use of propofol sedation in routine endoscopy examination in Nepal. This study was conducted in order to assess the patient satisfaction and safety profile in patient undergoing routine upper GI endoscopic examination on outpatients. To study safety profile and patient satisfaction of use of propofol in patients undergoing upper GI endoscopy. A prospective, observational study was conducted in the endoscopy unit of Dhulikhel hospital, Kathmandu University Hospital from July 2011 to 2012 July. Patients who were referred to upper GI endoscopy were offered to sedation under propofol. Informed consent was taken after explaining side effects, advantages and risk-benefit to the clients. The propofol was administered by the endoscopy nurse under guidance and supervision of the endoscopy performing physician. Data were collected and analyzed using SPSS version 16.0 with 0.05 level of significance. Total of 203 patients included in the study. Among 203 patients, 21.2% were males and 78.8% were females; 83.7% were of less than of 60 years age and 16.3% above 60 years of age. The mean total dose of propofol required was 136.08 ± 48.82 mg. Total of 29.1 % of cases required O2 administration during the procedure time due to transient drop in O2 saturation. Total of 4.4% of cases required fluid administration due to transient fall in blood pressure. Total of 68.0% of cases were completely sedated; 28.6% had minor restless and 3.4% showed agitation during induction period of propofol sedation. Total of 99.5% of patients reported pleasant experience while 0.5% reported unpleasant. Among 203 respondents, 98.5% responded they would prefer to do the procedure under propofol sedation in the future; 1.5% responded they did not want sedations in the future. Upper GI endoscopy can safely be performed under propofol sedation administered by registered trained nurse under the supervision

  1. Routine screening of hospital patients for secondhand tobacco smoke exposure: a feasibility study.

    PubMed

    Kruse, Gina Rae; Rigotti, Nancy A

    2014-12-01

    Secondhand tobacco smoke (SHS) exposure causes over 40,000 deaths per year, but healthcare systems rarely address this risk factor. In September 2012, Massachusetts General Hospital initiated routine inpatient screening for SHS exposure by adding a question to the nurses' computerized admission assessment form ("Is smoking allowed in your home or car?"). We measured the implementation of this screening question over 1year. Multivariable analysis of hospital records of adult and pediatric admissions (N=35,701) from September 1, 2012 to August 31, 2013, to assess screening question completion and identify characteristics of nonsmokers who may be exposed to SHS. Nurses entered "Yes" or "No" to the screening question for 91% of 34,295 adult admissions and 86% of 1406 pediatric admissions. Among nonsmokers, smoking in the home or car was allowed for 3% of adult admissions and 4% of pediatric admissions. Adults admitted for psychiatric diagnoses, children admitted for asthma, and patients with Medicaid insurance had higher odds of exposure to SHS in their home or car. Routine screening of SHS among hospitalized patients by nurses is feasible. Doing so offers hospitals an opportunity to intervene and to promote smoke-free policies in patients' homes and cars. Copyright © 2014 Elsevier Inc. All rights reserved.

  2. Should adjuvant radiotherapy to the supraclavicular fossa be routinely given in patients with breast conservative treatment?

    PubMed

    Wang, Chun-Wei; Kuo, Wen-Hong; Chang, King-Jen; Huang, Chiun-Sheng; Cheng, Jason Chia-Hsien

    2007-08-01

    To analyze the overall outcome, supraclavicular fossa (SCF) recurrence rate, and pattern of failure in breast cancer patients treated with conservative surgery and adjuvant radiotherapy excluding SCF treatment. A total of 143 patients were enrolled in the study. Ninety-two percent of patients were stages I and II, and 8% were stage III. The median age was 44 years, and 31% of patients were patients with involved axillary nodes (N) >/= 4, and 0.8% in patients with N < 4. The 5-year SCF-recurrence-free survival in patients with N >/= 4 and N < 4 was 80% and 99%, respectively (P < 0.001). N >/= 4 was the only independent predictor for locoregional control (P = 0.045), disease-free survival (P = 0.001), and overall survival (P = 0.008) in multivariate analysis. Women with N >/= 4 have a significantly higher risk of SCF recurrence and poorer survival. The SCF might be safely spared in patients with N < 4, but should be routinely included in the radiotherapy design for those with N >/= 4.

  3. The need for routine delayed radionuclide hepatobiliary imaging in patients with intercurrent disease

    SciTech Connect

    Drane, W.E.; Nelp, W.B.; Rudd, T.G.

    1984-06-01

    A retrospective review was made of all radionuclide hepatobiliary studies performed in a major trauma center over a 27-month period and correlated with the patients' clinical course. In a population of 42 patients (27 of whom were on total parenteral nutrition (TPN)) who had severe intercurrent illness (primarily trauma), and an additional 18 patients who had hepatocellular dysfunction, hepatobiliary imaging confirmed a patent cystic duct in 43 of 60 patients (72%). Fourteen of these 43 patients (33%) had gallbladder visualization at later than one hour after radiotracer administration, and seven of these 14 required imaging from four to 24 hours. Of 17 patients who had nonvisualization of the gallbladder, four had surgically proved acute cholecystitis. Images of nine of the remaining 13 patients with gallbladder nonvisualization were not obtained for 24 hours. The presence of gallstones, wall thickening, or sludge on sonograms did not correlate with cystic duct patency, and was not specific for acute cholecystitis. Though gallbladder function is compromised in the population with severe intercurrent disease, radionuclide hepatobiliary imaging is still valuable; it can confirm a patent cystic duct in at least 72% of patients if routine imaging is continued for up to 24 hours.

  4. Implementation of routine foot check in patients with diabetes on hemodialysis: associations with outcomes

    PubMed Central

    Marn Pernat, Andreja; Peršič, Vanja; Usvyat, Len; Saunders, Lynn; Rogus, John; Maddux, Franklin W; Lacson, Eduardo; Kotanko, Peter

    2016-01-01

    Objective Patients with diabetes are at increased risk of foot ulcers, which may result in limb amputations. While regular foot care prevents ulcerations and amputation in those patients with diabetes not on dialysis, evidence is limited in diabetic hemodialysis patients. We investigated the association between the implementation of a routine foot check program in diabetic incident hemodialysis patients, and major lower limb amputations. Methods In 1/2008, monthly intradialytic foot checks were implemented as part of standard clinic care in all Fresenius Medical Care North America hemodialysis facilities. Patients with diabetes who initiated hemodialysis between 1/2004 and 12/2007 constituted the preimplementation cohort, and patients starting hemodialysis between 1/2008 and 12/2011 comprised the postimplementation cohort. In addition, we conducted a sensitivity analysis where we excluded patients from the clinics with <10 patients in the postimplementation period and where percent difference in patient with diabetes number between postimplementation and preimplementation period was <20%. We compared lower limb amputation rates employing Poisson regression models with offset of exposure time in these two cohorts. Results We studied 35 513 patients in the preimplementation and 25 779 patients in the postimplementation cohort. In the postimplementation cohort, amputation rate decreased by 17% (p=0.0034). The major lower limb amputation rate was 1.30 per 100 patient years in preimplementation and 1.07 in postimplementation cohort. These beneficial results were corroborated in the multivariate analysis (p=0.0175) and were even more pronounced in the sensitivity analysis (p=0.0083). Conclusion Monthly foot checks are associated with reduction of major lower limb amputations in diabetic incident hemodialysis patients. PMID:26958348

  5. Variation in the definition of intrauterine growth restriction in routine antenatal care: a physician survey among gynecologists in Northwest Germany.

    PubMed

    Ernst, Sinja Alexandra; Brand, Tilman; Petersen, Knud; Zeeb, Hajo

    2017-07-04

    To assess how intrauterine growth restriction (IUGR) is defined by gynecologists in routine practice. We surveyed primary care gynecologists in Bremen and Lower Saxony, Northwest Germany, between January and July 2014. Descriptive statistics were used to analyze the data; consensus was considered as 90% agreement among the respondents. Multiple logistic regression models were performed for the associations between respondents' background characteristics and choice of the small for gestational age (SGA) cutoff values. Overall, 185 primary care gynecologists participated in the survey. Consensus was only observed in two items: (1) an accurate determination of gestational age (91%) and (2) repeated measurement of the abdominal circumference (91%). Umbilical artery Doppler (76%) and repeated ultrasonography (76%) were the most frequently used methods to confirm suspected IUGR diagnoses, but different responses prevailed. Notably, only 46% of the respondents opted for the 10th percentile of estimated fetal weight as a cutoff for SGA classification, which is the internationally recommended value. The results of this survey indicate considerable practice variation regarding detection and management of IUGR pregnancies. There is a need for better agreement in terminology and definition of core aspects of IUGR in antenatal care.

  6. Value of routine staging imaging studies for patients with stage III breast cancer.

    PubMed

    Piatek, Caroline I; Ji, Lingyun; Kaur, Chandan; Russell, Christy A; Tripathy, Debu; Church, Terry; Sposto, Richard; Sener, Stephen F; Garcia, Agustin A

    2016-12-01

    Routine staging imaging studies (RSIS) are optional in stage III breast cancer (BC). The impact of RSIS on treatment decisions and patient outcomes has not been extensively studied. The goal of this study was to determine whether RSIS in stage III BC affected treatment or patient outcomes. Stage III BC patients from 2000 to 2010 were retrospectively identified. RSIS results and treatment plan in response to RSIS results were recorded. Univariate and multivariate Cox proportional hazards regression models with time-dependent covariates were used to assess associations between RSIS use and recurrence-free survival (RFS). Of 420 patients, 362 (86.2%) received RSIS. RSIS were negative in 264 (72.9%), indeterminate in 77 (18.3%), and positive in 21 patients (5.0%) for metastatic disease. Treatment was altered in 21 (5.8%) patients based on RSIS results (20 with metastatic disease, 1 with indeterminate disease). There was no difference in RFS with RSIS use on multivariate analysis (hazard ratio 1.3; 95% confidence interval 0.73-2.5, P = 0.32). Most stage III BC patients underwent RSIS, but RSIS results infrequently affected treatment decisions. There was no significant difference in RFS with RSIS use. RSIS to identify metastatic disease for stage III BC has limited value. J. Surg. Oncol. 2016;114:917-921. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  7. Measuring social exclusion in routine public health surveys: construction of a multidimensional instrument.

    PubMed

    van Bergen, Addi P L; Hoff, Stella J M; van Ameijden, Erik J C; van Hemert, Albert M

    2014-01-01

    Social exclusion is considered a major factor in the causation and maintenance of health inequalities, but its measurement in health research is still in its infancy. In the Netherlands the Institute for Social Research (SCP) developed an instrument to measure the multidimensional concept of social exclusion in social and economic policy research. Here, we present a method to construct a similar measure of social exclusion using available data from public health surveys. Analyses were performed on data from the health questionnaires that were completed by 20,877 adults in the four largest cities in the Netherlands. From each of the four questionnaires we selected the items that corresponded to those of the SCP-instrument. These were entered into a nonlinear canonical correlation analysis. The measurement properties of the resulting indices and dimension scales were assessed and compared to the SCP-instrument. The internal consistency of the indices and most of the dimension scales were adequate and the internal structure of the indices was as expected. Both generalisabiliy and construct validity were good: in all datasets strong associations were found between the index and a number of known risk factors of social exclusion. A limitation of content validity was that the dimension "lack of normative integration" could not be measured, because no relevant items were available. Our findings indicate that a measure for social exclusion can be constructed with available health questionnaires. This provides opportunities for application in public health surveillance systems in the Netherlands and elsewhere in the world.

  8. Patients in palliative care-Development of a predictive model for anxiety using routine data.

    PubMed

    Hofmann, Sonja; Hess, Stephanie; Klein, Carsten; Lindena, Gabriele; Radbruch, Lukas; Ostgathe, Christoph

    2017-01-01

    Anxiety is one of the most common psychological symptoms in patients in a palliative care situation. This study aims to develop a predictive model for anxiety using data from the standard documentation routine. Data sets of palliative care patients collected by the German quality management benchmarking system called Hospice and Palliative Care Evaluation (HOPE) from 2007 to 2011 were randomly divided into a training set containing two-thirds of the data and a test set with the remaining one-third. We dichotomized anxiety levels, proxy rated by medical staff using the validated HOPE Symptom and Problem Checklist, into two groups with no or mild anxiety versus moderate or severe anxiety. Using the training set, a multivariable logistic regression model was developed by backward stepwise selection. Predictive accuracy was evaluated by the area under the receiver operating characteristic curve (AUC) based on the test set. An analysis of 9924 data sets suggests a predictive model for anxiety in patients receiving palliative care which contains gender, age, ECOG, living situation, pain, nausea, dyspnea, loss of appetite, tiredness, need for assistance with activities of daily living, problems with organization of care, medication with sedatives/anxiolytics, antidepressants, antihypertensive drugs, laxatives, and antibiotics. It results in a fair predictive value (AUC = 0.72). Routinely collected data providing individual-, disease- and therapy-related information contain valuable information that is useful for the prediction of anxiety risks in patients receiving palliative care. These findings could thus be advantageous for providing appropriate support for patients in palliative care settings and should receive special attention in future research.

  9. Symptom Monitoring With Patient-Reported Outcomes During Routine Cancer Treatment: A Randomized Controlled Trial

    PubMed Central

    Deal, Allison M.; Kris, Mark G.; Scher, Howard I.; Hudis, Clifford A.; Sabbatini, Paul; Rogak, Lauren; Bennett, Antonia V.; Dueck, Amylou C.; Atkinson, Thomas M.; Chou, Joanne F.; Dulko, Dorothy; Sit, Laura; Barz, Allison; Novotny, Paul; Fruscione, Michael; Sloan, Jeff A.; Schrag, Deborah

    2016-01-01

    Purpose There is growing interest to enhance symptom monitoring during routine cancer care using patient-reported outcomes, but evidence of impact on clinical outcomes is limited. Methods We randomly assigned patients receiving routine outpatient chemotherapy for advanced solid tumors at Memorial Sloan Kettering Cancer Center to report 12 common symptoms via tablet computers or to receive usual care consisting of symptom monitoring at the discretion of clinicians. Those with home computers received weekly e-mail prompts to report between visits. Treating physicians received symptom printouts at visits, and nurses received e-mail alerts when participants reported severe or worsening symptoms. The primary outcome was change in health-related quality of life (HRQL) at 6 months compared with baseline, measured by the EuroQol EQ-5D Index. Secondary endpoints included emergency room (ER) visits, hospitalizations, and survival. Results Among 766 patients allocated, HRQL improved among more participants in the intervention group than usual care (34% v 18%) and worsened among fewer (38% v 53%; P < .001). Overall, mean HRQL declined by less in the intervention group than usual care (1.4- v 7.1-point drop; P < .001). Patients receiving intervention were less frequently admitted to the ER (34% v 41%; P = .02) or hospitalized (45% v 49%; P = .08) and remained on chemotherapy longer (mean, 8.2 v 6.3 months; P = .002). Although 75% of the intervention group was alive at 1 year, 69% with usual care survived the year (P = .05), with differences also seen in quality-adjusted survival (mean of 8.7 v. 8.0 months; P = .004). Benefits were greater for participants lacking prior computer experience. Most patients receiving intervention (63%) reported severe symptoms during the study. Nurses frequently initiated clinical actions in response to e-mail alerts. Conclusion Clinical benefits were associated with symptom self-reporting during cancer care. PMID:26644527

  10. Symptom Monitoring With Patient-Reported Outcomes During Routine Cancer Treatment: A Randomized Controlled Trial.

    PubMed

    Basch, Ethan; Deal, Allison M; Kris, Mark G; Scher, Howard I; Hudis, Clifford A; Sabbatini, Paul; Rogak, Lauren; Bennett, Antonia V; Dueck, Amylou C; Atkinson, Thomas M; Chou, Joanne F; Dulko, Dorothy; Sit, Laura; Barz, Allison; Novotny, Paul; Fruscione, Michael; Sloan, Jeff A; Schrag, Deborah

    2016-02-20

    There is growing interest to enhance symptom monitoring during routine cancer care using patient-reported outcomes, but evidence of impact on clinical outcomes is limited. We randomly assigned patients receiving routine outpatient chemotherapy for advanced solid tumors at Memorial Sloan Kettering Cancer Center to report 12 common symptoms via tablet computers or to receive usual care consisting of symptom monitoring at the discretion of clinicians. Those with home computers received weekly e-mail prompts to report between visits. Treating physicians received symptom printouts at visits, and nurses received e-mail alerts when participants reported severe or worsening symptoms. The primary outcome was change in health-related quality of life (HRQL) at 6 months compared with baseline, measured by the EuroQol EQ-5D Index. Secondary endpoints included emergency room (ER) visits, hospitalizations, and survival. Among 766 patients allocated, HRQL improved among more participants in the intervention group than usual care (34% v 18%) and worsened among fewer (38% v 53%; P < .001). Overall, mean HRQL declined by less in the intervention group than usual care (1.4- v 7.1-point drop; P < .001). Patients receiving intervention were less frequently admitted to the ER (34% v 41%; P = .02) or hospitalized (45% v 49%; P = .08) and remained on chemotherapy longer (mean, 8.2 v 6.3 months; P = .002). Although 75% of the intervention group was alive at 1 year, 69% with usual care survived the year (P = .05), with differences also seen in quality-adjusted survival (mean of 8.7 v. 8.0 months; P = .004). Benefits were greater for participants lacking prior computer experience. Most patients receiving intervention (63%) reported severe symptoms during the study. Nurses frequently initiated clinical actions in response to e-mail alerts. Clinical benefits were associated with symptom self-reporting during cancer care. © 2015 by American Society of Clinical Oncology.

  11. Microbiology of wildfire victims differs significantly from routine burns patients: data from an Australian wildfire disaster.

    PubMed

    Sherry, Norelle L; Padiglione, Alexander A; Spelman, Denis W; Cleland, Heather

    2013-03-01

    The catastrophic wildfires of February 2009 in Victoria, Australia killed 173 people and hospitalised 18 adults with burns. We conducted a case-control study of wildfire victims (WFVs) compared to routine burns patients to assess early differences in bacteriology. Demographic, outcome and bacteriology data (for the first 72 h) were prospectively collected on all 18 WFVs, and compared to those of 36 RBPs matched 2:1 for age, gender, burns severity (total body surface area ≥20%) and ICU admission. We found that WFVs had more positive cultures overall (10/18 [56%] vs 7/36 [19%], p=0.04), and we cultured more Gram negative bacteria from wounds (11/13 [85%] vs 3/12 [25%], p=0.005). Although WFVs were more likely to culture Enterobacteriaceae (5/18 vs 2/36) and Aeromonas spp. (3/18 vs 1/36), and less likely to culture Staphylococcus aureus (2/18 vs 6/36), these differences were not statistically significant. Given the predominance of Gram negative organisms cultured from WFVs, our routine burn wound prophylaxis (intravenous cephazolin) would have been inadequate in the WFV group. We suggest that an alternative regimen of oxacillin/nafcillin/flucloxacillin plus gentamicin (or a fluoroquinolone if renal impairment present) may be more appropriate for burn wound prophylaxis in this complex group of patients.

  12. Measuring Social Exclusion in Routine Public Health Surveys: Construction of a Multidimensional Instrument

    PubMed Central

    van Bergen, Addi P. L.; Hoff, Stella J. M.; van Ameijden, Erik J. C.; van Hemert, Albert M.

    2014-01-01

    Introduction Social exclusion is considered a major factor in the causation and maintenance of health inequalities, but its measurement in health research is still in its infancy. In the Netherlands the Institute for Social Research (SCP) developed an instrument to measure the multidimensional concept of social exclusion in social and economic policy research. Here, we present a method to construct a similar measure of social exclusion using available data from public health surveys. Methods Analyses were performed on data from the health questionnaires that were completed by 20,877 adults in the four largest cities in the Netherlands. From each of the four questionnaires we selected the items that corresponded to those of the SCP-instrument. These were entered into a nonlinear canonical correlation analysis. The measurement properties of the resulting indices and dimension scales were assessed and compared to the SCP-instrument. Results The internal consistency of the indices and most of the dimension scales were adequate and the internal structure of the indices was as expected. Both generalisabiliy and construct validity were good: in all datasets strong associations were found between the index and a number of known risk factors of social exclusion. A limitation of content validity was that the dimension “lack of normative integration” could not be measured, because no relevant items were available. Conclusions Our findings indicate that a measure for social exclusion can be constructed with available health questionnaires. This provides opportunities for application in public health surveillance systems in the Netherlands and elsewhere in the world. PMID:24878842

  13. [Daily routine in orthopedics and traumatology - results of a nationwide survey of residents].

    PubMed

    Merschin, D; Münzberg, M; Stange, R; Schüttrumpf, J P; Perl, M; Mutschler, M

    2014-10-01

    The subject orthopedics and traumatology suffers by a loss of attractiveness which results in a lack of young blood. The aim of this study of the Youth Forum of the German Society of Orthopedics and Traumatology (DGOU) is to register the working conditions of residents in orthopedics. In the months September and October 2013 we performed a survey on members of the following German societies: German Society of Orthopedics and Traumatology (DGOU), German Society of Traumatology (DGU) and the German Society of Orthopedics and Orthopedic Surgery (DGOOC), (age < 40). Our questionnaire includes 15 questions. We achieved 28,9 % (n = 331) answered questionnaires. The mean working time per week is 55 hours. 73 % of all participants do more than 5 emergency services per month. 52 % are more than 3 times on duty for 24 hours. Only 13 % of all residents have well ordered working hours. Normally working time is divided into three parts: one third for bureaucracy, one for operation theatre and the last for other activities (e.g. ward round). 35,6 % do only one surgery per week, 12 % do not perform any surgeries. An annual report is performed only in 45 %. A structured concept of training only exists in 16 % of all hospitals. In addition to clinical work 45 % are involved in scientific projects, mostly in their spare-time. Finally 58 % of all surgeons would still recommend orthopedics and traumatology. In order to maintain orthopedics and traumatology as an attractive it is necessary to implement flexible working time models and to reorganize and improve training-concepts. Georg Thieme Verlag KG Stuttgart · New York.

  14. Safety and effectiveness of dabigatran and warfarin in routine care of patients with atrial fibrillation.

    PubMed

    Seeger, John D; Bykov, Katsiaryna; Bartels, Dorothee B; Huybrechts, Krista; Zint, Kristina; Schneeweiss, Sebastian

    2015-11-25

    The RE-LY study demonstrated the safety and efficacy of dabigatran relative to warfarin for stroke prevention in non-valvular atrial fibrillation. It is important to further evaluate safety and effectiveness of drugs in routine care. This study used a sequential cohort design with propensity score matching to compare dabigatran with warfarin among patients in two commercial health insurance databases. New users of these anticoagulants were followed from initiation until discontinuation, the end of the study, or the occurrence of a study outcome (primary study outcomes were stroke and major bleeding). Proportional hazards regression was conducted separately within each data source and results were pooled. Among 19,189 matched dabigatran and warfarin initiators (mean age: 68 years, 36 % female), as-treated follow-up (average of 5 months for dabigatran, 4 months for warfarin) identified 62 and 69 strokes, respectively (pooled HR = 0.77; 95 % CI = 0.54 to 1.09), and 354 and 395 major haemorrhages, respectively (HR = 0.75; 0.65 to 0.87). No meaningful heterogeneity was identified across subgroups, but numeric trends suggest more pronounced stroke prevention by dabigatran relative to warfarin among patients age 75+ (HR = 0.57; 0.33 to 0.97) or with < 6 months of use (HR = 0.51; 0.19 to 1.42). Major bleeds were reduced more by dabigatran among patients aged < 55 (HR = 0.51; 0.30 to 0.87) and with CHADS2 < 2 (HR = 0.58; 0.44 to 0.77). In conclusion, in routine care of patients with non-valvular atrial fibrillation, dabigatran treatment resulted in improved health outcomes compared with warfarin.

  15. Post-marketing surveillance study with iodixanol in 20 185 Chinese patients from routine clinical practices.

    PubMed

    Zhang, B-C; Hou, L; Lv, B; Xu, Y-W

    2014-02-01

    To determine the incidence of immediate and delayed adverse drug reactions (ADRs), and to assess patient discomfort following administration of iodixanol during imaging examinations in routine clinical practice. A total of 20 185 patients across 95 clinical centres were enrolled in a prospective post-marketing surveillance registry with iodixanol. Patients were monitored for occurrence of ADRs immediately following iodixanol administration and for up to 7 days after administration. The overall rate of ADRs was 1.52%, of which 0.58% was immediate and 0.97% was delayed onset. Two patients had non-fatal serious ADRs (0.01%). The ADRs were significantly more common in patients who underwent contrast-enhanced CT/coronary CT angiography vs others (p < 0.001), in those receiving pre-heated iodixanol vs non-heating (p < 0.001), in those aged 70 years or younger (p < 0.001), in those in whom a power injector was used for contrast delivery (p < 0.001) and in those with a history of an allergic reaction to contrast (p = 0.024). Multivariate analysis showed that female gender, intravenous route of contrast injection, body weight ≥ 80 kg, age less than 65 years, contrast flow rate ≥ 4 ml s⁻¹ and prior reaction to iodinated contrast medium were all significant and independent contributors to ADRs. Pre-treatment contrast volume and history of cardiac disease, gout, hypertension, diabetes mellitus or asthma did not affect the rate of ADRs. Discomfort was generally mild, with 94.8% of patients reporting a composite score of 0-3. The safety of iodixanol in routine clinical practice was shown to be similar to the published safety profiles of other non-ionic iodinated contrast agents. Patient discomfort during administration was mild or absent in most patients. The major strength of this study is that it included 20 185 patients enrolled in various types of imaging examinations. The safety profile of iodixanol was comparable to previously published work.

  16. A Clinical Evaluation of Routine Blood Sampling Practices in Patients With Diabetes

    PubMed Central

    Pineau, Mitchel; Pynes, Mary Kate; Katz, Laurence B.; Ginsberg, Barry

    2014-01-01

    Background: There is a perception that patients with diabetes struggle to produce sufficient blood to fill glucose test strips, including strips with 1-µL fill requirements. The purpose of this study was to determine the volume of blood expressed when these patients perform routine fingersticks using their own lancing device and sampling technique and to evaluate the relationship between blood volume and pain. Methods: Sixty-four patients (type 1 or type 2 diabetes) performed 8 fingersticks using their own lancing device and preferred depth setting and lancing technique. Eight different commercially available lancing systems were used (8 patients/system). Blood volume and perceived pain were recorded after each fingerstick. Results: The mean blood volume across all patients was 3.1 µL (512 fingersticks), with 97% of patients expressing a mean of ≥1.0 µL of blood. There was no correlation between pain response and the volume of blood expressed. Nearly all patients agreed that they could easily and comfortably obtain a 1-µL blood sample, and most patients actually preferred a larger drop size to ease sampling and avoid wasting strips. Conclusion: These results provide evidence across 8 lancing systems that challenge the current perceptions that patients with diabetes struggle to produce sufficient blood samples to fill most test strips, including those with 1-µL fill requirements, and that obtaining larger volumes of blood is more painful. These results are consistent with the previous literature suggesting that patients derive no real benefits from very low strip volumes and generally prefer a blood drop size that enables them to confidently fill their test strip. PMID:24876439

  17. Feeding patients with preoperative symptoms of gastric outlet obstruction after pancreatoduodenectomy: Early oral or routine nasojejunal tube feeding?

    PubMed

    Gerritsen, Arja; Wennink, Roos A W; Busch, Olivier R C; Borel Rinkes, Inne H M; Kazemier, Geert; Gouma, Dirk J; Molenaar, I Quintus; Besselink, Marc G H

    2015-01-01

    Early oral feeding is currently considered the optimal routine feeding strategy after pancreatoduodenectomy (PD). Some have suggested that patients with preoperative symptoms of gastric outlet obstruction (GOO) who undergo PD have such a high risk of developing delayed gastric emptying that these patients should rather receive routine postoperative tube feeding. The aim of this study was to determine whether clinical outcomes after PD in these patients differ between postoperative early oral feeding and routine tube feeding. We analyzed a consecutive multicenter cohort of patients with preoperative symptoms of GOO undergoing PD (2010-2013). Patients were categorized into two groups based on the applied postoperative feeding strategy (dependent on their center's routine strategy): early oral feeding or routine nasojejunal tube feeding. Of 497 patients undergoing PD, 83 (17%) suffered from preoperative symptoms of GOO. 49 patients received early oral feeding and 29 patients received routine tube feeding. Time to resumption of adequate oral intake (primary outcome; 14 vs. 12 days, p = 0.61) did not differ between these two feeding strategies. Furthermore, overall complications and length of stay were similar in both groups. Of the patients receiving early oral feeding, 24 (49%) ultimately required postoperative tube feeding. In patients with an uncomplicated postoperative course, early oral feeding was associated with shorter time to adequate oral intake (8 vs. 12 days, p = 0.008) and shorter hospital stay (9 vs. 13 days, p < 0.001). Also in patients with preoperative symptoms of GOO, early oral feeding can be considered the routine feeding strategy after PD. Copyright © 2015 IAP and EPC. Published by Elsevier B.V. All rights reserved.

  18. Monthly CERA treatment maintains stable hemoglobin levels in routine clinical practice of peritoneal dialysis patients.

    PubMed

    González, M Teresa; Ramos, Rosa; Vera, Manel; Barbosa, Francesc; Garcia, Carmen; Garcia, Isabel; González-Segura, Carlota; Cuxart, Marc; Teixidó, Josep; José de la Cruz, Juan

    2013-01-01

    Data on routine use of continuous erythropoietin receptor activator (CERA) in peritoneal dialysis patients are scarce. This study aimed to assess the efficacy of CERA administered once monthly in maintaining stable Hb levels in patients on peritoneal dialysis under routine medical practice. This was a 12-month, observational, prospective and multicenter study. A total of 83 patients with anemia secondary to chronic kidney disease (CKD) on peritoneal dialysis for more than 3 months, on once-monthly subcutaneous CERA treatment, were followed up over a period of 1 year. Efficacy evaluation included Hb levels, mean time in which the Hb level was maintained within target range, CERA doses and number of dose changes. Median Hb level (interquartile range [IQR]) remained stable during the evaluation period [11.8 ± 1.4 g/dL at baseline, 11.8 ± 1.4 g/dL at month 6 and 11.8 ± 1.5 g/dL at month 12 (p > 0.05)]. The median (IQR) time of Hb level maintained within target range (11-13 mg/dL) was 6 (4-10) months. Ferritin, transferrin saturation index, and Fe were also stable and well maintained during the 12 months (p > 0.05). CERA mean dose (SD) was [115.4 (56.2) μg baseline; 117.2 (58.5) μg 6 months; 126.0 (65.9) μg 12 months (p = 0.127)]. The mean number of CERA dose changes per patient during the study was 1.6 (SD 1.3). Serious adverse events were not related to CERA treatment. The results suggest that once-monthly CERA successfully corrects anemia and maintains stable Hb levels within the recommended target range on peritoneal dialysis under routine medical practice.

  19. Clinical Significance of Commensal Gram-Positive Rods Routinely Isolated from Patient Samples.

    PubMed

    Leal, Sixto M; Jones, Melissa; Gilligan, Peter H

    2016-12-01

    Commensal bacteria from the skin and mucosal surfaces are routinely isolated from patient samples and considered contaminants. The majority of these isolates are catalase-positive Gram-positive rods from multiple genera routinely classified as diphtheroids. These organisms can be seen upon Gram staining of clinical specimens or can be isolated as the predominant or pure species in culture, raising a priori suspicion of a possible involvement in infection. With the development and adoption of matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS), suspicious isolates are now routinely identified to the species level. In this study, we performed a retrospective data review (2012 to 2015) and utilized site-specific laboratory criteria and chart reviews to identify species within the diphtheroid classification representative of true infection versus contamination. Our data set included 762 isolates from 13 genera constituting 41 bacterial species. Only 18% represented true infection, and 82% were deemed contaminants. Clinically significant isolates were identified in anaerobic wounds (18%), aerobic wounds (30%), blood (5.5%), urine (22%), cerebrospinal fluid (24%), ophthalmologic cultures (8%), and sterile sites (20%). Organisms deemed clinically significant included multiple Actinomyces species in wounds, Propionibacterium species in joints and cerebrospinal fluid associated with central nervous system hardware, Corynebacterium kroppenstedtii (100%) in breast, and Corynebacterium striatum in multiple sites. Novel findings include clinically significant urinary tract infections by Actinomyces neuii (21%) and Corynebacterium aurimucosum (21%). Taken together, these findings indicate that species-level identification of diphtheroids isolated with a priori suspicion of infection is essential to accurately determine whether an isolate belongs to a species associated with specific types of infection.

  20. Electronic eRAPID3 (Routine Assessment of Patient Index Data): opportunities and complexities.

    PubMed

    Pincus, Theodore

    2016-01-01

    RAPID3 (routine assessment of patient index data) is an index found within a multi-dimensional health assessment questionnaire (MDHAQ) for routine clinical care, composed only of 3 self-report scores for physical function, pain, and patient global estimate, each scored 0-10, for a total of 0-30. RAPID3 is correlated significantly with DAS28 (Disease Activity Score) and CDAI (Clinical Disease Activity Index), and distinguishes active from control treatments as efficiently as these indices in clinical trials involving adalimumab, abatacept, certolizumab, infliximab, and rituximab. Many versions of an electronic RAPID3 (eRAPID3) have been developed, which are incompatible with one another, as seen for electronic medical records (EMR). Therefore, opportunities are lost to pool data from many sites for advancement of patient care and outcomes. Interfaces for linkage to EMRs and pooling of data are available as Health Level Seven (HL7) standards, FHIR (Fast Health Interoperability Resources), and innovative open platforms like SMART (Substitutable Medical Apps, Reusable Technology), but many eRAPID3 versions do not have this capacity. RAPID3 scores may be elevated in many patients due to damage or distress, rather than, or in addition to, inflammation, a problem that also affects DAS28, CDAI, and all RA indices which include a patient global estimate, even if they include a formal joint count. A full MDHAQ, of which RAPID3 is a component, provides clues to the presence of damage, and/or distress and adds much further information, with no more work for the health professional and little more time for the patient. A RheuMetric physician checklist of global scores for inflammation, damage, and distress is also useful to recognise damage and/or distress, but not available with most available eRAPID3 versions. Many eRAPID3 versions also are limited by the absence of flowsheets to monitor scores over time, the absence of strategies to convey data to health professionals to

  1. Cost-Effectiveness of Contralateral Prophylactic Mastectomy Versus Routine Surveillance in Patients With Unilateral Breast Cancer

    PubMed Central

    Zendejas, Benjamin; Moriarty, James P.; O'Byrne, Jamie; Degnim, Amy C.; Farley, David R.; Boughey, Judy C.

    2011-01-01

    Purpose Contralateral prophylactic mastectomy (CPM) rates in women with unilateral breast cancer are increasing despite controversy regarding survival advantage. Current scrutiny of the medical costs led us to evaluate the cost-effectiveness of CPM versus routine surveillance as an alternative contralateral breast cancer (CBC) risk management strategy. Methods Using a Markov model, we simulated patients with breast cancer from mastectomy to death. Model parameters were gathered from published literature or national databases. Base-case analysis focused on patients with average-risk breast cancer, 45 years of age at treatment. Outcomes were valued in quality-adjusted life-years (QALYs). Patients' age, risk level of breast cancer, and quality of life (QOL) were varied to assess their impact on results. Results Mean costs of treatment for women age 45 years are comparable: $36,594 for the CPM and $35,182 for surveillance. CPM provides 21.22 mean QALYs compared with 20.93 for surveillance, resulting in an incremental cost-effectiveness ratio (ICER) of $4,869/QALY gained for CPM. To prevent one CBC, six CPMs would be needed. CPM is no longer cost-effective for patients older than 70 years (ICER $62,750/QALY). For BRCA-positive patients, CPM is clearly cost-effective, providing more QALYs while being less costly. In non-BRCA patients, cost-effectiveness of CPM is highly dependent on assumptions regarding QOL for CPM versus surveillance strategy. Conclusion CPM is cost-effective compared with surveillance for patients with breast cancer who are younger than 70 years. Results are sensitive to BRCA-positive status and assumptions of QOL differences between CPM and surveillance patients. This highlights the importance of tailoring treatment for individual patients. PMID:21690472

  2. Routine Troponin Measurements Are Unnecessary to Exclude Asymptomatic Coronary Events in Acute Ischemic Stroke Patients.

    PubMed

    Ali, Farwa; Young, Jimmy; Rabinstein, Alejandro A; Flemming, Kelly D; Fugate, Jennifer E

    2016-05-01

    Obtaining serum troponin levels in every patient with acute stroke is recommended in recent stroke guidelines, but there is no evidence that these contribute positively to clinical care. We sought to determine the clinical significance of measuring troponin levels in acute ischemic stroke patients. We reviewed 398 consecutive patients with acute ischemic stroke at a large academic institution from 2010 to 2012. Troponin levels were measured as a result of protocol in place during part of the study period. The mean age was 70 years (standard deviation ±16 years) and 197 (49.5%) were men. Chronic kidney disease was present in 78 (19.6%), coronary artery disease in 107 (26.9%), and atrial fibrillation in 107 (26.9%). Serum troponin T was measured in 246 of 398 patients (61.8%). Troponin was elevated (>.01 ng/mL) at any point in 38 of 246 patients (15.5%) and was elevated in 28 patients at all 3 measurements (11.3% of those with troponin measured). Only 4 of 246 patients (1.6%) had a significant uptrend. Two were iatrogenic in the setting of hemodynamic augmentation using vasopressors to maintain cerebral perfusion. One case was attributed to stroke and chronic kidney disease and another case to heart failure from inflammatory fibrocalcific mitral valvular heart disease. Serum troponin elevation in patients with ischemic stroke is not usually caused by clinically significant acute myocardial ischemia unless iatrogenic in the setting of vasopressor administration. Serum troponin levels should be measured judicially, based on clinical context, rather than routinely in all stroke patients. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  3. Critical pitfall: varices in cancer patients mimicking lymphadenopathy; differentiation of varicose veins and enlarged lymph nodes in routine staging.

    PubMed

    Schubert, Tilman; Pansini, Michele; Bongartz, Georg; Niemann, Tilo

    2011-01-01

    Two patients, each with a history of multiple cancers, were referred to our institution for routine cancer staging. Contrast enhanced multislice-CT showed round and oval shaped inguinal and retroperitoneal masses in one patient and inguinal mass lesions in the other patient. The mass lesions were suspicious of lymphadenopathy related to cancer recurrence. Additional MR-Imaging, however, showed tortuous varicose veins as well as suspicious lymph nodes in one patient and solely venous convolutes in the other patient. Regarding the routine contrast enhanced CT-scan in the portovenous phase, varices showed no significant difference in radiodensity compared to enlarged lymph nodes.

  4. Critical Pitfall: Varices in Cancer Patients mimicking Lymphadenopathy; Differentiation of varicose veins and enlarged lymph nodes in routine staging

    PubMed Central

    Schubert, Tilman; Pansini, Michele; Bongartz, Georg; Niemann, Tilo

    2011-01-01

    Two patients, each with a history of multiple cancers, were referred to our institution for routine cancer staging. Contrast enhanced multislice-CT showed round and oval shaped inguinal and retroperitoneal masses in one patient and inguinal mass lesions in the other patient. The mass lesions were suspicious of lymphadenopathy related to cancer recurrence. Additional MR-Imaging, however, showed tortuous varicose veins as well as suspicious lymph nodes in one patient and solely venous convolutes in the other patient. Regarding the routine contrast enhanced CT-scan in the portovenous phase, varices showed no significant difference in radiodensity compared to enlarged lymph nodes. PMID:22470814

  5. Adherence with urate-lowering therapies among male patients with gout in a routine clinical setting.

    PubMed

    Lee, Sunggun; So, Min Wook

    2016-11-01

    To assess adherence (compliance and persistence) and factors that might contribute to nonadherence to urate-lowering therapies (ULT) in patients with gout in a routine clinical setting. This prospective observational cohort study was conducted in the rheumatology center of a local tertiary hospital. A total of 132 male adults aged 75 years or younger who were incidentally diagnosed with gout were included. Adherence to ULT was assessed by the clinic nurses through pill counts. Of the 132 patients, 94 (71.2%) was compliant and 81 (61.4%) was persistent with ULT. The logistic regression analysis revealed that the absence of chronic kidney disease (CKD) and the previous history of non-persistence with ULT are the independent factors associated with noncompliance and the absence of CKD is an independent factor associated with non-persistence. The average serum urate levels of the noncompliant (p = 0.001) and non-persistent (p = 0.002) patients were significantly higher than those of the compliant and persistent patients. The absence of CKD and the previous history of non-persistence of ULT that are correlated with poor adherence and easily assessed can be used to identify patients at a particular risk of poor adherence.

  6. [Molecular diagnosis of HFE mutations in routine laboratories. Results of a survey from reference laboratories in France].

    PubMed

    Jouanolle, Anne-Marie; Gérolami, Victoria; Ged, Cécile; Grandchamp, Bernard; Le Gac, Gérald; Pissard, Serge; Rochette, Jacques; Aguilar-Martinez, Patricia

    2012-01-01

    HFE-related hemochromatosis (HFE hemochromatosis) or type 1 hemochromatosis is an autosomal recessive disease characterized by progressive iron overload usually expressed in adulthood. The HFE gene, located on the short arm of chromosome 6 (6p21.3), encodes a protein that plays a crucial role in iron metabolism by modulating hepcidin synthesis in the liver. Homozygosity for the p.Cys282Tyr mutation accounts for nearly 80% of cases of hemochromatosis in France. Genetic testing is the key investigation to confirm the diagnosis of HFE hemochromatosis. A survey on routine practices was carried out among the eight reference laboratories of the French national network on genetic iron disorders. The main findings from this survey are as follows: 1) the p.Cys282Tyr mutation must be searched for as an initial step to establish the diagnosis of HFE hemochromatosis. This is in agreement with the recommendations of the French Health Authority (HAS) published in 2005. In these recommendations, homozygosity for the p.Cys282Tyr mutation with at least elevated transferrin saturation, is considered the only genotype that confirms of the diagnosis of HFE hemochromatosis; 2) in combination with the p.Cys282Tyr mutation (compound heterozygous genotypes), the p.Ser65Cys and the p.His63Asp variants may contribute to the occurrence of mild iron overload; 3) family screening is mandatory following the detection of homozygous individuals for the p.Cys282Tyr mutation.

  7. Evaluation of two different hand hygiene procedures during routine patient care.

    PubMed

    Eksi, F; Mehli, M; Akgun, S; Bayram, A; Balci, I; Aydin, N

    2010-01-01

    In this study, the antimicrobial efficacy of hand washing (HW) and hand washing plus rubbing with an alcohol-based solution (HWR) on numbers of total and transient flora colonies on the hands of healthcare workers (HCWs) during routine patient care was assessed. Samples were collected, using a standard bag broth technique, from the hands of 154 HCWs, before and immediately after carrying out a hand hygiene procedure. The numbers of total and transient flora colonies per plate were counted and transient pathogens were identified. A significant statistical difference between ward speciality was detected with respect to the isolation rate of transient flora. Transient hand flora were recovered from 25.3% of HCWs before carrying out the hand hygiene procedure. With respect to the disappearance and prevention of regrowth of transient flora after hand hygiene, the HWR technique was significantly more effective than HW. In conclusion, a disinfectant should be added to the hand washing process to achieve optimum protection against nosocomial infections in routine hospital practice.

  8. Using routine inpatient data to identify patients at risk of hospital readmission

    PubMed Central

    Howell, Stuart; Coory, Michael; Martin, Jennifer; Duckett, Stephen

    2009-01-01

    Background A relatively small percentage of patients with chronic medical conditions account for a much larger percentage of inpatient costs. There is some evidence that case-management can improve health and quality-of-life and reduce the number of times these patients are readmitted. To assess whether a statistical algorithm, based on routine inpatient data, can be used to identify patients at risk of readmission and who would therefore benefit from case-management. Methods Queensland database study of public-hospital patients, who had at least one emergency admission for a chronic medical condition (e.g., congestive heart failure, chronic obstructive pulmonary disease, diabetes or dementia) during 2005/2006. Multivariate logistic regression was used to develop an algorithm to predict readmission within 12 months. The performance of the algorithm was tested against recorded readmissions using sensitivity, specificity, and Likelihood Ratios (positive and negative). Results Several factors were identified that predicted readmission (i.e., age, co-morbidities, economic disadvantage, number of previous admissions). The discriminatory power of the model was modest as determined by area under the receiver operating characteristic (ROC) curve (c = 0.65). At a risk score threshold of 50, the algorithm identified only 44.7% (95% CI: 42.5%, 46.9%) of patients admitted with a reference condition who had an admission in the next 12 months; 37.5% (95% CI: 35.0%, 40.0%) of patients were flagged incorrectly (they did not have a subsequent admission). Conclusion A statistical algorithm based on Queensland hospital inpatient data, performed only moderately in identifying patients at risk of readmission. The main problem is that there are too many false negatives, which means that many patients who might benefit would not be offered case-management. PMID:19505342

  9. Are daily routine chest radiographs necessary after pulmonary surgery in adult patients?

    PubMed Central

    Reeb, Jeremie; Falcoz, Pierre-Emmanuel; Olland, Anne; Massard, Gilbert

    2013-01-01

    A best evidence topic was constructed according to a structured protocol. The question addressed was whether daily routine (DR) chest radiographs (CXRs) are necessary after pulmonary surgery in adult patients. Of the 66 papers found using a report search, seven presented the best evidence to answer the clinical question. Four of these seven studies specifically addressed post-cardiothoracic adult patients. Three of these seven studies addressed intensive care unit (ICU) patients and included post-cardiothoracic adult patients in well-designed studies. Six of these seven studies compared the DR CXRs strategy to the clinically indicated, on-demand (OD) CXRs strategy. Another study analysed the clinical impact of ceasing to perform the DR, postoperative, post-chest tubes removal CXRs. The authors, journal, date and country of publication, study type, group studied, relevant outcomes and results of these papers are given. We conclude that, on the whole, the seven studies are unanimously in favour of forgoing DR CXRs after lung resection and advocate OD CXRs. One study suggested that hypoxic patients could benefit from a DR CXRs strategy, while other studies failed to identify any subgroup for whom performing DR CXRs was beneficial. Indeed, DR CXRs, commonly taken after thoracic surgery, have poor diagnostic and therapeutic value. Eliminating them for adult patients having undergone thoracic surgery significantly decreases the number of CXRs per patient without increasing mortality rates, length of hospital stays (LOSs), readmission rates and adverse events. Hence, current evidence shows that DR CXRs could be forgone after lung resection because OD CXRs, recommended by clinical monitoring, have a better impact on management and have not been proved to negatively affect patient outcomes. Moreover, an OD CXRs strategy lowers the cost of care. Nevertheless, an OD CXRs strategy requires close clinical monitoring by experienced surgeons and dedicated intensivists. However

  10. Accuracy of routine diagnostic tests used in paracoccidioidomycosis patients at a university hospital.

    PubMed

    Moreto, T C; Marques, M E A; de Oliveira, M L S C; Moris, D V; de Carvalho, L R; Mendes, R P

    2011-08-01

    The identification of appropriate laboratory measures to confirm clinical hypotheses is important in routine paracoccidioidomycosis medical care. The clinical records and laboratory reports of 401 paracoccidioidomycosis patients attended at the Tropical Diseases Area, Faculdade de Medicina de Botucatu, from 1974 to 2008 were reviewed. Direct mycological (DM), cell block (CB), histopathological (HP), and double immunodiffusion (DID) tests were evaluated before treatment. Typical Paracoccidioides brasiliensis yeast forms were observed in clinical specimens of 86% of the patients, but 14% were detected only by serological test. DM of 51 different tissue specimens produced 74.5% sensitivity, and 62.5% sensitivity was observed in 112 sputum samples. CB in 483 sputum samples generated 55.3% sensitivity. HP performed in 239 samples from different tissues revealed 96.7% sensitivity. Serology carried out in 351 patients and 200 healthy controls provided 90.0% sensitivity, 100.0% specificity, 100.0% positive predictive value, 85.1% negative predictive value and 93.6% accuracy. Comparisons of laboratory measurements performed in the same patient showed that sensitivity decreases from HP to DID to CB and DM, with the last two assays providing similar sensitivities. This study demonstrated that P. brasiliensis identification by HP, CB, and/or DM associated with DID is sufficient to establish the laboratorial diagnosis of paracoccidioidomycosis in practically all cases. Copyright © 2011 Royal Society of Tropical Medicine and Hygiene. Published by Elsevier Ltd. All rights reserved.

  11. A simple and inexpensive method to routinely produce customized neck supports for patient immobilization during radiotherapy.

    PubMed

    McKernan, B; Bydder, S; Ebert, M; Waterhouse, D; Joseph, D

    2008-12-01

    Accurate and reproducible patient positioning is fundamental to the success of fractionated radiotherapy. Poor patient positioning could result in geographic misses. We have recently reported on an improved method of customized face mask production using laser surface scanning. In this report, we sought to identify and develop a method to routinely make customized neck supports for patients prescribed radiotherapy to the brain or head and neck regions. We identified a potentially suitable product--sealed packs containing two liquids that produce expanding polyurethane foam when mixed--and developed a method for their use. The neck supports are inexpensive and simple to produce (taking less than 5 min of radiation therapist labour). We assessed the customized neck supports in several ways. The effect on setup accuracy was assessed by comparing two consecutive cohorts of patients. Statistically significant differences favouring the customized neck supports included a reduced total displacement error (mean 3.4 vs. 2.1 mm) and a reduced left-right setup error (mean 1.8 vs. 1.1 mm). This is consistent with the greater support provided by the customized neck supports. This method could easily be undertaken by other departments.

  12. Does routine ultrasound change management in the follow-up of patients with vesicoureteral reflux?

    PubMed

    Rudzinski, Jan K; Weber, Bryce; Wildgoose, Petra; Lorenzo, Armando; Bagli, Darius; Farhat, Walid; Harvey, Elizabeth; Salle, Joao Luiz Pippi

    2013-01-01

    Children with vesicoureteral reflux (VUR) usually need a renal ultrasound (RUS). There is little data on the role of follow-up RUS in VUR. We evaluated the impact of follow-up RUS on the change in clinical management in patients with VUR. We prospectively analyzed children with a previous diagnosis of VUR seen in the outpatient clinic with a routine follow-up RUS within 4 months. Variables collected included: demographic data, VUR history, dysfunctional voiding symptoms and concurrent ultrasound findings. Change in management was defined as addition of new medication, nurse counselling, surgery or further investigations. The study included 114 consecutive patients. The mean patient age was 4.5 years old, mean age of VUR diagnosis was 1.7 years, with average follow-up of 2.8 years. A change in management with stable RUS occurred in 14 patients, in which the change included ordering a DMSA in 9, nurse counselling for dysfunctional voiding in 3, and booking surgery in 2 patients. Change on RUS was seen in 4 patients. Multivariable analysis showed that history of urinary tract infection (UTI) since the last follow-up visit was more significant than RUS findings. The RUS findings in most patients followed for VUR remain stable or with minimal changes. The variable showing a significant effect on change in management in our study was history of UTI since the last follow-up visit rather than RUS findings. The value of follow-up RUS for children with VUR may need to be revisited.

  13. Rapid learning in practice: A lung cancer survival decision support system in routine patient care data

    PubMed Central

    Dekker, Andre; Vinod, Shalini; Holloway, Lois; Oberije, Cary; George, Armia; Goozee, Gary; Delaney, Geoff P.; Lambin, Philippe; Thwaites, David

    2016-01-01

    Background and purpose A rapid learning approach has been proposed to extract and apply knowledge from routine care data rather than solely relying on clinical trial evidence. To validate this in practice we deployed a previously developed decision support system (DSS) in a typical, busy clinic for non-small cell lung cancer (NSCLC) patients. Material and methods Gender, age, performance status, lung function, lymph node status, tumor volume and survival were extracted without review from clinical data sources for lung cancer patients. With these data the DSS was tested to predict overall survival. Results 3919 lung cancer patients were identified with 159 eligible for inclusion, due to ineligible histology or stage, non-radical dose, missing tumor volume or survival. The DSS successfully identified a good prognosis group and a medium/poor prognosis group (2 year OS 69% vs. 27/30%, p < 0.001). Stage was less discriminatory (2 year OS 47% for stage I–II vs. 36% for stage IIIA–IIIB, p = 0.12) with most good prognosis patients having higher stage disease. The DSS predicted a large absolute overall survival benefit (~40%) for a radical dose compared to a non-radical dose in patients with a good prognosis, while no survival benefit of radical radiotherapy was predicted for patients with a poor prognosis. Conclusions A rapid learning environment is possible with the quality of clinical data sufficient to validate a DSS. It uses patient and tumor features to identify prognostic groups in whom therapy can be individualized based on predicted outcomes. Especially the survival benefit of a radical versus non-radical dose predicted by the DSS for various prognostic groups has clinical relevance, but needs to be prospectively validated. PMID:25241994

  14. Brain measures of nociception using near-infrared spectroscopy in patients undergoing routine screening colonoscopy.

    PubMed

    Becerra, Lino; Aasted, Christopher M; Boas, David A; George, Edward; Yücel, Meryem A; Kussman, Barry D; Kelsey, Peter; Borsook, David

    2016-04-01

    Colonoscopy is an invaluable tool for the screening and diagnosis of many colonic diseases. For most colonoscopies, moderate sedation is used during the procedure. However, insufflation of the colon produces a nociceptive stimulus that is usually accompanied by facial grimacing/groaning while under sedation. The objective of this study was to evaluate whether a nociceptive signal elicited by colonic insufflation could be measured from the brain. Seventeen otherwise healthy patients (age 54.8 ± 9.1; 6 female) undergoing routine colonoscopy (ie, no history of significant medical conditions) were monitored using near-infrared spectroscopy (NIRS). Moderate sedation was produced using standard clinical protocols for midazolam and meperidine, titrated to effect. Near-infrared spectroscopy data captured during the procedure was analyzed offline to evaluate the brains' responses to nociceptive stimuli evoked by the insufflation events (defined by physician or observing patients' facial responses). Analysis of NIRS data revealed a specific, reproducible prefrontal cortex activity corresponding to times when patients grimaced. The pattern of the activation is similar to that previously observed during nociceptive stimuli in awake healthy individuals, suggesting that this approach may be used to evaluate brain activity evoked by nociceptive stimuli under sedation, when there is incomplete analgesia. Although some patients report recollection of procedural pain after the procedure, the effects of repeated nociceptive stimuli in surgical patients may contribute to postoperative changes including chronic pain. The results from this study indicate that NIRS may be a suitable technology for continuous nociceptive afferent monitoring in patients undergoing sedation and could have applications under sedation or anesthesia.

  15. Automatic detection of paroxysmal atrial fibrillation in patients with ischaemic stroke: better than routine diagnostic workup?

    PubMed

    Uphaus, T; Grings, A; Gröschel, S; Müller, A; Weber-Krüger, M; Wachter, R; Gröschel, K

    2017-07-01

    Prolonged electrocardiogram (ECG) monitoring after ischaemic stroke increases the diagnostic yield of paroxysmal atrial fibrillation (pAF). In order to facilitate the additional workload involved in ECG analysis due to prolonged monitoring times, we investigated the effectiveness of pAF detection with an automated software algorithm (SA) in comparison to the routine staff-based analysis (RA) during standard stroke-unit care. Therefore, patients with acute ischaemic stroke or transitory ischaemic attack presenting with sinus rhythmus on the admission ECG and no history of atrial fibrillation were prospectively included. A 24-h Holter ECG assessment was performed using either RA based on a computer-aided evaluation and subsequent review by a cardiologist or a commercially available automated SA. In the case of discordant results concerning the occurrence of pAF between the two methods, the data underwent an independent external rating. Of 809 prospectively enrolled patients, 580 patients fulfilled the inclusion criteria. pAF was ultimately diagnosed in 3.3% of the cohort (19 patients). SA and RA correctly diagnosed pAF in 17 patients resulting in a comparable diagnostic effectiveness of the analysis methods (sensitivity: SA 89.5% vs. RA 89.5%; specificity: SA 99.3% vs. RA 99.1%; κ, 0.686; P < 0.001; 95% confidence interval, 0.525-0.847). RA revealed clinically relevant ECG abnormalities in an additional seven patients. Although it should not completely replace RA, SA-based evaluation of Holter ECG reaches a high diagnostic effectiveness for the detection of pAF and can be used for a rapid and resource-saving analysis of ECG data to deal with prolonged monitoring times. © 2017 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.

  16. Estimating the costs associated with the management of patients with chronic wounds using linked routine data.

    PubMed

    Phillips, Ceri J; Humphreys, Ioan; Fletcher, Jacqui; Harding, Keith; Chamberlain, George; Macey, Steven

    2016-12-01

    Chronic wounds are known to represent a significant burden to patients and National Health Service (NHS) alike. However, previous attempts to estimate the costs associated with the management of chronic wounds have been based on literature studies or broad estimates derived from incidence rates and extrapolations from relatively small-scale studies. The aim of this study is therefore to determine the extent of resource utilisation by patients classed as having chronic wounds within Wales using linked routine data - available through the Secure Anonymised Information Linkage (SAIL) database - to estimate the costs associated with the management of these patients by the NHS in Wales. The SAIL database brings together, and anonymously links, a wide range of person-based data from general practitioner (GP) practices within Wales, which includes primary and secondary care consultations to create an encrypted anonymised linking field for each individual. This linkage allows the patient pathway to be tracked through the NHS system both retrospectively and prospectively from a specific reference date. The estimated costs were derived by extrapolating to an all-Wales level from the results gleaned from the SAIL database using the respective READ codes to capture relevant patients with chronic wounds. The number of patients identified as having chronic wounds within the SAIL database was 78 090, which equates to 190 463 across Wales as a whole and a prevalence of 6% of the Welsh population. The total cost of managing patients with chronic wounds in Wales amounted to £328·8 million - an average cost of £1727 per patient and 5·5% of total expenditure on the health service in Wales. A relatively few READ codes represented a significant proportion of expenditure, with diabetic foot ulcers, leg ulcers, foot ulcers, varicose eczema, bed sores and postoperative wound care constituting 93% of total expenditure. When a more conservative perspective was used in relation to

  17. Dysport (botulinum toxin type A) in routine therapeutic usage: a telephone needs assessment survey of European physicians to evaluate current awareness and adherence to product labeling changes.

    PubMed

    Hubble, Jean; Schwab, Joseph; Hubert, Catherine; Abbott, Chandra Coleman

    2013-01-01

    Botulinum neurotoxin type A is a well-established treatment for a number of conditions involving muscle hyperactivity. Dysport (Ipsen Ltd, Wrexham, United Kingdom) is a botulinum neurotoxin type A preparation that has been available for a number of therapeutic uses for over 20 years in the European Union (EU). This survey was part of the EU botulinum toxin risk management plan to identify potential educational needs of injectors by collecting data on their routine practice administration of Dysport and their awareness of potential adverse events (AEs) that are included in the current product labeling. Dysport-experienced injectors in 5 EU countries were surveyed via telephone about their experience of Dysport in patients with cervical dystonia, adult upper and lower limb spasticity, pediatric cerebral palsy, and blepharospasm/hemifacial spasm. The reconstitution dilution volume most often used was 2.5 mL per 500 U for all indications. The mean total dose ranged from 387 to 530 U for cervical dystonia, 508 to 773 U for upper limb spasticity, 600 to 832 U for lower limb spasticity, 375 to 700 U for pediatric cerebral palsy, and 54 to 213 U for blepharospasm/hemifacial spasm. The potential AEs most commonly mentioned by surveyed physicians were dysphagia for cervical dystonia, arm muscle weakness for upper limb spasticity, leg muscle weakness for lower limb spasticity, and pediatric cerebral palsy and ptosis for blepharospasm/hemifacial spasm. The results indicate that product-labeling recommendations are generally applied in clinical practice and that there is a good familiarity with potential AEs based on clinical condition. Nevertheless, the survey shows that experienced injectors do sometimes deviate from the manufacturers labeling recommendations, highlighting the importance of ongoing education.

  18. [Comparison of thromboelastography and routine coagulation tests for evaluation of blood coagulation function in patients].

    PubMed

    Chen, Guan-Yi; Ou Yang, Xi-Lin; Wu, Jing-Hui; Wang, Li-Hua; Yang, Jin-Hua; Gu, Li-Nan; Lu, Zhu-Jie; Zhao, Xiao-Zi

    2015-04-01

    To investigate the correlation and consistency between thromboelastography(TEG) and routine coagulation tests, and to evaluate the value of the two methods in determining the blood coagulation of patients. The TEG, routine coagulation tests and platelet counts of 182 patients from the Intensive Care Unit(ICU) and Department of Gastroenterology in our hospital from January to September 2014 were performed and analyzed retrospectively for their correlation, Kappa identity test analysis and chi-square test, and the diagnostic sensitivity and specificity of both methods in the patients with bleeding were evaluated. The TEG R time and PT, R time and APTT showed a linear dependence (P<0.01). The relationship between the TEG K value, α-Angle, MA and Fibrinogen showed a linear dependence (P<0.001). And the relationship between the TEG K value, α-Angle, MA and the platelet count were in a linear dependent way (P<0.001). The Kappa values of the TEG R time with PT and APTT were 0.038 (P>0.05) and 0.061 (P>0.05), respectively. The chi-square test values of the TEG R time with PT and APTT were 35.309 (P<0.001) and 15.848 (P<0.001), respectively. The Fibrinogen and the TEG K value, α-Angle, MA value had statistical significance (P<0.001), with a Kappa value of 0.323, 0.288 and 0.427, respectively. The chi-square test values between Fibrinogen and the TEG K value, α-Angle, MA value were not statistically significant, with X2=1.091 (P=0.296), X2=1.361 (P=0.243), X2=0.108 (P=0.742). The Kappa values of the platelet count and the TEG K value, α-Angle, MA value were 0.379, 0.208 and 0.352, respectively, which were also statistically significant difference (P<0.001). The chi-square test values between the platelet count and the TEG K value, α-Angle, MA value showed a statistically significant difference (P<0.001), with X2=37.5, X2=37.23, X2=26.630. The diagnostic sensitivity of the two methods for the patients with bleeding was less than 50%. There was a significant correlation

  19. Patient dose considerations for routine megavoltage cone-beam CT imaging

    SciTech Connect

    Morin, Olivier; Gillis, Amy; Descovich, Martina; Chen, Josephine; Aubin, Michele; Aubry, Jean-Francois; Chen Hong; Gottschalk, Alexander R.; Xia Ping; Pouliot, Jean

    2007-05-15

    Megavoltage cone-beam CT (MVCBCT), the recent addition to the family of in-room CT imaging systems for image-guided radiation therapy (IGRT), uses a conventional treatment unit equipped with a flat panel detector to obtain a three-dimensional representation of the patient in treatment position. MVCBCT has been used for more than two years in our clinic for anatomy verification and to improve patient alignment prior to dose delivery. The objective of this research is to evaluate the image acquisition dose delivered to patients for MVCBCT and to develop a simple method to reduce the additional dose resulting from routine MVCBCT imaging. Conventional CT scans of phantoms and patients were imported into a commercial treatment planning system (TPS: Phillips, Pinnacle) and an arc treatment mimicking the MVCBCT acquisition process was generated to compute the delivered acquisition dose. To validate the dose obtained from the TPS, a simple water-equivalent cylindrical phantom with spaces for MOSFETs and an ion chamber was used to measure the MVCBCT image acquisition dose. Absolute dose distributions were obtained by simulating MVCBCTs of 9 and 5 monitor units (MU) on pelvis and head and neck patients, respectively. A compensation factor was introduced to generate composite plans of treatment and MVCBCT imaging dose. The article provides a simple equation to compute the compensation factor. The developed imaging compensation method was tested on routinely used clinical plans for prostate and head and neck patients. The quantitative comparison between the calculated dose by the TPS and measurement points on the cylindrical phantom were all within 3%. The dose percentage difference for the ion chamber placed in the center of the phantom was only 0.2%. For a typical MVCBCT, the dose delivered to patients forms a small anterior-posterior gradient ranging from 0.6 to 1.2 cGy per MVCBCT MU. MVCBCT acquisitions in the pelvis and head and neck areas deliver slightly more dose than

  20. Routine 24-Hour Computed Tomography Brain Scan is not useful in stable patients Post Intravenous Tissue Plasminogen Activator.

    PubMed

    Guhwe, Mary; Utley-Smith, Queen; Blessing, Robert; Goldstein, Larry B

    2016-03-01

    Obtaining a routine computed tomography (CT) brain scan 24 hours after treatment with intravenous tissue plasminogen activator (IV-tPA) is included in the American Heart Association/American Stroke Association acute stroke guidelines. The usefulness of the test in stable patients is not known. We hypothesized that the results of routine, 24-hour post-treatment neuroimaging (CT or magnetic resonance imaging [MRI] brain scans) would not alter the management of clinically stable patients. Patients treated with IV-tPA between January 2011 and December 2013 were identified from a single hospital's stroke registry. All patients were closely monitored for changes in stroke severity. Demographics, changes in neurological status, neuroimaging results, and changes in therapy were abstracted from the patients' medical records. Patients having a neuroimaging study because of neurological deterioration were excluded. Of 136 patients treated with IV-tPA, 131 met criteria for inclusion. Of these, 86.7% had moderate to severe neurological deficits (i.e., initial National Institutes of Health Stroke Scale score > 5 points; median 8 points). All patients had routine imaging ~24 hours after treatment (CT brain 62.6%, MRI brain 12.4%, both CT and MRI brain 25%). Asymptomatic hemorrhagic transformation occurred in 6.7% and potentially changed management in a single patient (target systolic blood pressure was lowered from 185 to 180 mmHg). Over a 3-year period, routine neuroimaging ~24-hours after IV-tPA in clinically stable patients was associated with a change in therapy in only 1 (.95%) patient. If confirmed in other cohorts, these results suggest that routine neuroimaging after IV-tPA may be safely avoided in clinically stable patients, eliminating unnecessary radiation exposure in those having CT brain and reducing costs. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  1. Routine Clinical-Pathologic Correlation of Pigmented Skin Tumors Can Influence Patient Management

    PubMed Central

    Longo, Caterina; Piana, Simonetta; Lallas, Aimilios; Moscarella, Elvira; Lombardi, Mara; Raucci, Margherita; Pellacani, Giovanni; Argenziano, Giuseppe

    2015-01-01

    Background Several studies have demonstrated the benefit of integrating clinical with pathologic information, to obtain a confident diagnosis for melanocytic tumors. However, all those studies were conducted retrospectively and no data are currently available about the role of a clinical-pathologic correlation approach on a daily basis in clinical practice. Aim of the Study In our study, we evaluated the impact of a routine clinical-pathologic correlation approach for difficult skin tumors seen over 3 years in a tertiary referral center. Results Interestingly, a re-appraisal was requested for 158 out of 2015 (7.7%) excised lesions because clinical-pathologic correlation was missing. Of note, in 0.6% of them (13 out of 2045) the first histologic diagnosis was revised in the light of clinical information that assisted the Pathologist to re-evaluate the histopathologic findings that might be bland or inconspicuous per se. Conclusion In conclusion, our study demonstrated that an integrated approach involving clinicians and pathologists allows improving management of selected patients by shifting from a simply disease-focused management (melanoma versus nevus) to a patient-centered approach. PMID:26325678

  2. Bayesian estimation of cyclosporin exposure for routine therapeutic drug monitoring in kidney transplant patients

    PubMed Central

    Bourgoin, Hélène; Paintaud, Gilles; Büchler, Matthias; Lebranchu, Yvon; Autret-Leca, Elisabeth; Mentré, France; Guellec, Chantal Le

    2005-01-01

    Aims AUC-based monitoring of cyclosporin A (CsA) is useful to optimize dose adaptation in difficult cases. We developed a population pharmacokinetic model to describe dose-exposure relationships for CsA in renal transplant patients and applied it to the Bayesian estimation of AUCs using three blood concentrations. Methods A total of 84 renal graft recipients treated with CsA microemulsion were included in this study. Population pharmacokinetic analysis was conducted using NONMEM. A two-compartment model with zero-order absorption and a lag time best described the data. Bayesian estimation was based on CsA blood concentrations measured before dosing and 1 h and 2 h post dose. Predictive performance was evaluated using a cross-validation approach. Estimated AUCs were compared with AUCs calculated by the trapezoidal method. The Bayesian approach was also applied to an independent group of eight patients exhibiting unusual pharmacokinetic profiles. Results Mean population pharmacokinetic parameters were apparent clearance 30 l h−1, apparent volume of distribution 79.8 l, duration of absorption 52 min, absorption lag time 7 min. No significant relationships were found between any of the pharmacokinetic parameters and individual characteristics. A good correlation was obtained between Bayesian-estimated and experimental AUCs, with a mean prediction error of 2.8% (95% CI [−0.6, 6.2]) and an accuracy of 13.1% (95% CI [7.5, 17.2]). A good correlation was also obtained in the eight patients with unusual pharmacokinetic profiles (r2 = 0.96, P < 0.01). Conclusions Our Bayesian approach enabled a good estimation of CsA exposure in a population of patients with variable pharmacokinetic profiles, showing its usefulness for routine AUC-based therapeutic drug monitoring. PMID:15606436

  3. Yield of yearly routine physical examination in HIV-1 infected patients is limited: A retrospective cohort study in the Netherlands

    PubMed Central

    van Amsterdam, Marleen A.; van Assen, Sander; Sprenger, Herman G.; Wilting, Kasper R.; Stienstra, Ymkje

    2017-01-01

    Background Routine physical examinations might be of value in HIV-infected patients, but the yield is unknown. We determined the diagnoses that would have been missed without performing annual routine physical examinations in HIV-infected patients with stable disease. Methods Data were collected from the medical records of 299 HIV-1-infected patients with CD4 count >350 cells/mm3 if not using combination antiretroviral therapy (cART), or CD4 count >100 cells/mm3 and undetectable viral load if using cART. We defined the diagnoses that would have been missed without performing routine physical examinations on annual check-ups in 2010. Exclusion criteria were hepatitis B/C co-infection, start/ switch of cART < 24 weeks, pregnancy, and transgenderism. Results 215 patients (72%) had positive findings: lipodystrophy (30%), lymphadenopathy (16%) and hypertension (8.4%) were the most common. Two-thirds of all findings were not new or were based on complaints indicating a physical examination even if not routinely scheduled. For 24 patients (8.0%) the routine physical examination led to the finding of a new diagnosis: six—all men who have sex with men (MSM)—had a concurrent sexually transmitted infection, eight had hypertension, and ten others had a large variety of diagnoses. A total atrioventricular block with bradycardia was the most clinically relevant finding. Conclusions Annual physical examinations of HIV-infected patients with stable disease brought few new diagnoses that would have been missed without performing a routine examination. Our results suggest that standard assessments could be restricted to six-monthly measuring blood pressure in all patients and annually performing anogenital and digital rectal examination on MSM. PMID:28636651

  4. Yield of yearly routine physical examination in HIV-1 infected patients is limited: A retrospective cohort study in the Netherlands.

    PubMed

    van Amsterdam, Marleen A; van Assen, Sander; Sprenger, Herman G; Wilting, Kasper R; Stienstra, Ymkje; Bierman, Wouter F W

    2017-01-01

    Routine physical examinations might be of value in HIV-infected patients, but the yield is unknown. We determined the diagnoses that would have been missed without performing annual routine physical examinations in HIV-infected patients with stable disease. Data were collected from the medical records of 299 HIV-1-infected patients with CD4 count >350 cells/mm3 if not using combination antiretroviral therapy (cART), or CD4 count >100 cells/mm3 and undetectable viral load if using cART. We defined the diagnoses that would have been missed without performing routine physical examinations on annual check-ups in 2010. Exclusion criteria were hepatitis B/C co-infection, start/ switch of cART < 24 weeks, pregnancy, and transgenderism. 215 patients (72%) had positive findings: lipodystrophy (30%), lymphadenopathy (16%) and hypertension (8.4%) were the most common. Two-thirds of all findings were not new or were based on complaints indicating a physical examination even if not routinely scheduled. For 24 patients (8.0%) the routine physical examination led to the finding of a new diagnosis: six-all men who have sex with men (MSM)-had a concurrent sexually transmitted infection, eight had hypertension, and ten others had a large variety of diagnoses. A total atrioventricular block with bradycardia was the most clinically relevant finding. Annual physical examinations of HIV-infected patients with stable disease brought few new diagnoses that would have been missed without performing a routine examination. Our results suggest that standard assessments could be restricted to six-monthly measuring blood pressure in all patients and annually performing anogenital and digital rectal examination on MSM.

  5. Can routine clinical data identify older patients at risk of poor healthcare outcomes on admission to hospital?

    PubMed

    Ibrahim, Kinda; Owen, Charlotte; Patel, Harnish P; May, Carl; Baxter, Mark; Sayer, Avan A; Roberts, Helen C

    2017-08-10

    Older patients who are at risk of poor healthcare outcomes should be recognised early during hospital admission to allow appropriate interventions. It is unclear whether routinely collected data can identify high-risk patients. The aim of this study was to define current practice with regard to the identification of older patients at high risk of poor healthcare outcomes on admission to hospital. Interviews/focus groups were conducted to establish the views of 22 healthcare staff across five acute medicine for older people wards in one hospital including seven nurses, four dieticians, seven doctors, and four therapists. In addition, a random sample of 60 patients' clinical records were reviewed to characterise the older patients, identify risk assessments performed routinely on admission, and describe usual care. We found that staff relied on their clinical judgment to identify high risk patients which was influenced by a number of factors such as reasons for admission, staff familiarity with patients, patients' general condition, visible frailty, and patients' ability to manage at home. "Therapy assessment" and patients' engagement with therapy were also reported to be important in recognising high-risk patients. However, staff recognised that making clinical judgments was often difficult and that it might occur several days after admission potentially delaying specific interventions. Routine risk assessments carried out on admission to identify single healthcare needs included risk of malnutrition (completed for 85% patients), falls risk (95%), moving and handling assessments (85%), and pressure ulcer risk assessments (88%). These were not used collectively to highlight patients at risk of poor healthcare outcomes. Thus, patients at risk of poor healthcare outcomes were not explicitly identified on admission using routinely collected data. There is a need for an early identification of these patients using a valid measure alongside staff clinical judgment to

  6. Integrating patient safety standards into the accreditation program: a qualitative study to assess the readiness of Lebanese hospitals to implement into routine practice.

    PubMed

    El-Jardali, Fadi; Jaafar, Maha; Jamal, Diana; Rabbaa, Sally

    2012-09-01

    Concerns about quality of care have led to the integration of patient safety standards and goals in national and international accreditation programs. Since 2005, two national hospital accreditation surveys have been conducted in Lebanon. In 2010, the Ministry of Health integrated patient safety standards into the current program. This study is one of the first efforts in Lebanon and the region to assess hospitals' readiness to integrate patient safety standards into routine practice. This cross-sectional study sampled 6807 respondents from 68 hospitals in Lebanon. This paper will detail results from the qualitative thematic analysis of the responses on 5 open-ended questions added to the Hospital Survey on Patient Safety Culture. The emerging themes were compared across regions, accreditation status, and hospital size. Lebanese hospitals have made progress by recognizing patient safety as a major strategic goal and priority, but gaps still exist in implementation. Very few hospitals are ready for effective implementation of these standards. Staff education and training are needed. Public awareness about patient safety and integrating these concepts into health educational curricula were cited as important strategies among others for creating a culture of patient safety. Variations in responses across regions, accreditation status, and hospital size were discussed. Integrating patient safety initiatives into routine practices requires a cultural shift in health-care organizations. Before assessing whether hospitals comply with patient safety standards, it is important to provide them with sufficient training and education on how to successfully implement these standards. Study findings provide valuable lessons for Lebanon and other countries, which are in the process or currently mandating the implementation of patient safety standards and/or accreditation programs.

  7. Extraspinal Incidental Findings on Routine MRI of Lumbar Spine: Prevalence and Reporting Rates in 1278 Patients.

    PubMed

    Tuncel, Sedat Alpaslan; Çaglı, Bekir; Tekataş, Aslan; Kırıcı, Mehmet Yadigar; Ünlü, Ercüment; Gençhellaç, Hakan

    2015-01-01

    The aim of the present study was to determine the prevalence and reporting rate of incidental findings (IF) in adult outpatients undergoing lumbar magnetic resonance imaging (MRI). Re-evaluation of a total of 1278 lumbar MRI images (collected from patients with a mean age of 50.5 years, range 16-91 years) captured between August 2010-August 2011 was done by a neuroradiologist and a musculoskeletal radiologist. IFs were classified according to organ or system (liver, gallbladder, kidney, bladder, uterus, ovary, lymph node, intestine and aorta). The rate of reporting of a range of IF was examined. The outcome of each patient's treatment was evaluated based on review of hospital records and by telephone interviews. A total of 253 IFs were found in 241 patients (18.8% of 1278). Among these, clinically significant IFs (n = 34) included: 2 renal masses (0.15%), 2 aortic aneurysms (0.15%), 2 cases of hydronephrosis (0.15%), 11 adrenal masses (0.86%), 7 lymphadenopathies (0.55%), 6 cases of endometrial or cervical thickening (0.47%), 1 liver hemangioma (0.08%), 1 pelvic fluid (0.08%) and 2 ovarian dermoid cysts (0.15%). Overall, 28% (71/253) of IFs were included in the clinical reports, while clinically significant findings were reported in 41% (14/34) of cases. Extraspinal IFs are commonly detected during a routine lumbar MRI, and many of these findings are not clinically significant. However, IFs including clinically important findings are occasionally omitted from formal radiological reports.

  8. Vitamin D Deficiency and Associated Factors in Patients with Mental Disorders Treated in Routine Practice.

    PubMed

    Ristic, Svetlana; Zivanovic, Sandra; Milovanovic, Dragan R; Janjic, Vladimir; Djokovic, Danijela; Jovicevic, Ana; Pirkovic, Marijana Stanojevic; Kocic, Sanja

    2017-01-01

    This research aimed to investigate factors associated with vitamin D deficiency and to provide data about its prevalence in patients suffering from different psychiatric illnesses. The study had a cross-sectional design and it included 220 patients of both genders, aged from 19-81 y, with a wide range of mental disorders (F00-F89), and treated in routine ambulatory and hospital practice. The researchers collected data from three sources: medical records, a study questionnaire and biochemical analysis of patients' serum samples (concentration of vitamin D measured as 25(OH)D, calcium, phosphorus, magnesium, sodium and potassium). Data were analyzed using descriptive statistics, methods for hypothesis testing and binary logistic regression, at the p≤0.05 level. A total of 140 patients (64%) had a deficiency of vitamin D (<12 ng/mL), and 45 (20%) had inadequate vitamin D serum levels (12-20 ng/mL), while 35 (16%) had sufficient vitamin D serum concentrations (>20 ng/mL). Among variables related to demographics, life style habits, mental illness, comorbid disorders and drugs, two of them, female gender (odds ratio (OR)=2.5, 95% confidence interval (CI)=1.3-4.9, p=0.006) and using clozapine (OR=15.6, 95% CI 1.7-144.7, p=0.02), were significantly associated with vitamin D deficiency. Physical activity (OR= 0.4, 95% CI 0.2-0.9, p=0.02), exercising (OR=0.2, 95% CI <0.1-0.7, p=0.02) and offal in the diet (OR=0.5, 95% CI 0.3-0.9, p=0.03) significantly aggregated in the patients who had a 25(OH)D serum concentration above the deficiency cut-off level. Patients with mental disorders are at high risk for vitamin D deficiency, particularly females and clozapine users as well as those having no adequate physical activity or dietary habits.

  9. The necessity of routine post-thoracostomy tube chest radiographs in post-operative thoracic surgery patients.

    PubMed

    Whitehouse, M R; Patel, A; Morgan, J A

    2009-04-01

    Chest radiographs are routinely performed post-operatively in thoracic surgery patients, in particular after the removal of thoracostomy tubes. From observation of our practice, we hypothesised that chest radiographs did not need to be performed routinely post-operatively and after removal of thoracostomy tubes. To determine whether routine chest radiographs post-operatively and post-thoracostomy tube removal directly influenced patient management. A five month prospective study was carried out to analyse our current practice at the Thoracic Surgery Unit, Bristol Royal Infirmary, Bristol, U.K. Demographic and clinico-pathological data were collected during admission. In the cohort of 74 patients, 66 (89%) patients had post-operative chest radiographs. Only three (5%) patients who had a chest radiograph had change in their management. Twenty-five (34%) patients had a chest radiograph post-thoracostomy tube removal. Only one (4%) patient in this group who had a chest radiograph after thoracostomy tube removal had a change of management. Interestingly, the decision to change patient management was not made on the basis of the chest radiographs alone; the clinical situation was the main determinant. Patients that did not have a chest radiograph postoperatively (eight patients, 11%) and post-thoracostomy tube removal (49 patients, 66%) did not suffer any adverse sequelae. We feel our data support the hypothesis that it is not necessary to perform routine chest radiographs in thoracic surgery patients post-operatively and after post-operative thoracostomy tube removal. It would be better to monitor these patients clinically and only request chest radiographs on the basis of deterioration in recorded observations or clinical findings.

  10. [Promoting recovery of schizophrenic patients: discrepancy between routine practice and evidence. The SIEP-DIRECT'S Project].

    PubMed

    Semisa, Domenico; Casacchia, Massimo; Di Munzio, Walter; Neri, Giovanni; Buscaglia, Giacinto; Burti, Lorenzo; Pucci, Cristina; Corlito, Giuseppe; Bacigalupi, Maurizio; Parravani, Roberto; Roncone, Rita; Cristofalo, Doriana; Lora, Antonio; Ruggeri, Mirella

    2008-01-01

    The aim of this work is to present the main discrepancies, as evidenced by the SIEP-DIRECT'S Project, between the evidence-based NICE guidelines for schizophrenia and the usual practices of the Italian mental health services in order to promote the recovery of patients with schizophrenia. Starting from the main NICE recommendations on recovery promotion, 41 indicators were developed. These were experimented in 19 participating Italian Mental Health Departments (MHD) or Psychiatric Services through self-evaluation of the activities carried out to promote patient recovery with the aim of assessing the level of adherence to the recommendations. The data required by most of the indicators were obtained from the psychiatric informative system or from the Direction of the MHD. Moreover, specific research was carried out on the clinical records and on representative patient samples. Furthermore, for 14 indicators, there was requested an assessment by the part of "multidisciplinary" or "specialistic" focus groups who then attributed a score according to a defined "ad hoc" scale. According to the data obtained, although the mental health services seem to care about the physical condition of their patients, they do not routinely examine principle parameters such as blood pressure, glycaemia etc., and collaboration with general practitioners is often complex or not uniformly practiced. Most psychiatrists and psychologists possess the basic communication skills but not enough competences in cognitive-behavioural treatments; such treatments, and every other form of structured individual psychotherapy, are seldom carried out and seem to have become marginal activities within the Services. Also family psycho-educational interventions are under-used. The Services are very active in the care of multi-problem schizophrenia patients, who make up a large percentage (almost a quarter, on average) of the patients in their care. These patients are offered specific and integrated

  11. Impact of transitioning from HIV clinical trials to routine medical care on clinical outcomes and patient perceptions.

    PubMed

    Yehia, Baligh R; Long, Judith A; Stearns, Cordelia R; French, Benjamin; Tebas, Pablo; Frank, Ian

    2012-01-01

    Participation in antiretroviral therapy clinical trials (ART-RCTs) offers many advantages including access to new drugs, close monitoring, and cost savings. These same benefits may pose a risk to patients ending ART-RCTs and returning to routine care; as they may experience changes to their drug regimen, decreased monitoring, and new out-of-pocket costs. We aimed to evaluate this transition and determine its effects on viral outcomes and patient perceptions. A retrospective cohort was assembled from participants of naïve ART-RCTs at the University of Pennsylvania between 1 January 2000 and 31 December 2009. Data were collected in the 12 months prior to and after trial completion. Multivariable logistic regression was used to evaluate viral failure rates and to identify factors associated with viral failure. Qualitative interviews were held with a subset of patients. Content analysis was used to identify thematic differences between patients with viral failure and those with viral suppression. In total, 116 patients enrolled in 5 ART-RCTs from 2000 to 2009. Viral failure was observed in 39 patients (34%). Nonwhites, high enrollment CD4 count, and trial completion in 1999-2002 were risk factors for failure. Patients transitioning from ART-RCTs to routine care had a 20% increased odds of failure (Adjusted Odds Ratio 1.20 (95% CI [0.37, 3.88])). Nine patients with viral suppression and three with viral failure in the year after trail completion were interviewed. Suppressed patients were more eager to continue trial participation, nervous about leaving the trial, and felt prepared to return to routine care. In contrast, those with viral failure were less concerned about the transition. These findings suggest that the posttrial period may be a vulnerable time for patients. Patients without a healthy fear of transitioning from ART-RCTs to routine care may be at increased risk of viral failure. Focus should be given to assisting patients during this transition.

  12. Routine perioperative ketorolac administration is not associated with hemorrhage in pediatric neurosurgery patients.

    PubMed

    Richardson, Marlin Dustin; Palmeri, Nicholas O; Williams, Sarah A; Torok, Michelle R; O'Neill, Brent R; Handler, Michael H; Hankinson, Todd C

    2016-01-01

    OBJECT NSAIDs are effective perioperative analgesics. Many surgeons are reluctant to use NSAIDs perioperatively because of a theoretical increase in the risk for bleeding events. The authors assessed the effect of routine perioperative ketorolac use on intracranial hemorrhage in children undergoing a wide range of neurosurgical procedures. METHODS A retrospective single-institution analysis of 1451 neurosurgical cases was performed. Data included demographics, type of surgery, and perioperative ketorolac use. Outcomes included bleeding events requiring return to the operating room, bleeding seen on postoperative imaging, and the development of renal failure or gastrointestinal tract injury. Variables associated with both the exposure and outcomes (p < 0.20) were evaluated as potential confounders for bleeding on postoperative imaging, and multivariable logistic regression was performed. Bivariable analysis was performed for bleeding events. Odds ratios and 95% CIs were estimated. RESULTS Of the 1451 patients, 955 received ketorolac. Multivariate regression analysis demonstrated no significant association between clinically significant bleeding events (OR 0.69; 95% CI 0.15-3.1) or radiographic hemorrhage (OR 0.81; 95% CI 0.43-1.51) and the perioperative administration of ketorolac. Treatment with a medication that creates a known bleeding risk (OR 3.11; 95% CI 1.01-9.57), surgical procedure (OR 2.35; 95% CI 1.11-4.94), and craniotomy/craniectomy (OR 2.43; 95% CI 1.19-4.94) were associated with a significantly elevated risk for radiographically identified hemorrhage. CONCLUSIONS Short-term ketorolac therapy does not appear to be associated with a statistically significant increase in the risk of bleeding documented on postoperative imaging in pediatric neurosurgical patients and may be considered as part of a perioperative analgesic regimen. Although no association was found between ketorolac and clinically significant bleeding events, a larger study needs to be

  13. Brand-to-generic levetiracetam switch in patients with epilepsy in a routine clinical setting.

    PubMed

    Markoula, Sofia; Chatzistefanidis, Dimitrios; Gatzonis, Stylianos; Siatouni, Anna; Siarava, Eleftheria; Verentzioti, Anastasia; Kyritsis, Athanassios P; Patsalos, Philip N

    2017-05-01

    The therapeutic equivalence of generic and brand antiepileptic drugs, based on studies performed on healthy volunteers, has been questioned. We compare, in a routine clinical setting, brand versus generic levetiracetam (LEV) bioequivalence in patients with epilepsy and also the clinical efficacy and tolerability of the substitution. A prospective, open-label, non-randomized, steady-state, multiple-dose, bioequivalence study was conducted in 12 patients with epilepsy (5 females), with a mean age of 38.4±16.2 years. Patients treated with the brand LEV (Keppra; UCB Pharma) were closely followed for a four-week period and subsequently switched to a generic LEV (Pharmaten) and followed for another four-week period. Blood samples were collected at the end of each 4-week period, during a dose interval for each formulation, for LEV concentration measurements by liquid chromatography mass spectrometry. Steady-state area under the curve (AUC) and peak plasma concentration (Cmax) data were subjected to conventional average bioequivalence analysis. Secondary clinical outcomes, including seizure frequency and adverse events, were recorded. Patients had epilepsy for a mean period of 14.1±10.6years and the mean daily LEV dose was 2583.3±763.7mg. The mean AUC±SD and Cmax±SD was 288.4±86.3(mg/L)h and 37.8±10.4mg/L respectively for brand LEV and 319.2±104.7(mg/L)h and 41.6±12.3mg/L respectively for the generic LEV. Statistic analysis showed no statistical significant difference in bioequivalence. Also, no change in seizures frequency and/or adverse events was recorded. In our clinical setting, generic LEV was determined to be bioequivalent to brand LEV. Furthermore, seizures frequency or/and adverse events were not affected upon switching from brand to generic LEV. Copyright © 2017 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  14. Association of survival time with transthoracic echocardiography in stable patients with heart failure: Is routine follow-up ever appropriate?

    PubMed

    Fonseca, Ricardo; Otahal, Petr; Galligan, John; Neilson, Samuel; Huynh, Quan; Saito, Makoto; Negishi, Kazuaki; Marwick, Thomas H

    2017-03-01

    The appropriateness of repeat transthoracic echocardiography (TTE) for stable heart failure (HF) is based on timing of the follow-up examination, but this lacks scientific support. We sought the association of routine follow-up TTE on survival and readmission in stable HF. Patients with HF were selected from consecutive HF admissions from 2008 to 2012. Groups were divided into: no follow-up TTE; routine <1year with no change in status ("rarely appropriate"), ≥1year follow-up with no change in status ("maybe appropriate") and TTE due to change in clinical status ("appropriate"). Survival analysis was performed for the combined endpoint of HF readmission and death, and a separate analysis was performed for HF readmission, with death as a competing risk. Of 550 HF patients, 141 had a follow-up TTE, including 41 (29%) within 1year. The event-free time in years was similar between no TTE (1.10years [95%CI: 0.69, 1.49], routine TTE <1year (2.61years [95% CI: 1.08, 3.04], routine >1year (2.45years [95% CI: 1.37, 5.78]); all were greater than symptomatic patients (0.09years [95% CI: 0.02, 1.80]). HF readmission was independently associated with statins, renal disease, coronary angiography and NYHA class, but not follow-up TTE timing. There were no differences in the cumulative incidence for death between groups. There were no differences in change in management in routine TTE <1year and ≥1year. The distinction of appropriateness of routine repeat TTE in stable HF patients, based on testing <1 or ≥1year after index admission appears unjustified. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  15. Personality disorders in heart failure patients requiring psychiatric management: comorbidity detections from a routine depression and anxiety screening protocol.

    PubMed

    Tully, Phillip J; Selkow, Terina

    2014-12-30

    Several international guidelines recommend routine depression screening in cardiac disease populations. No previous study has determined the prevalence and comorbidities of personality disorders in patients presenting for psychiatric treatment after these screening initiatives. In the first stage 404 heart failure (HF) patients were routinely screened and 73 underwent structured interview when either of the following criteria were met: (a) Patient Health Questionnaire ≥10; (b) Generalized Anxiety Disorder Questionnaire ≥7); (c) Response to one item panic-screener. Or (d) Suicidality. Patients with personality disorders were compared to the positive-screen patients on psychiatric comorbidities. The most common personality disorders were avoidant (8.2%), borderline (6.8%) and obsessive compulsive (4.1%), other personality disorders were prevalent in less than <3% of patients. Personality disorder patients had significantly greater risk of major depression (risk ratio (RR) 1.2; 95% confidence interval (CI) 1.2-13.3), generalized anxiety disorder (RR 3.2; 95% CI 1.0-10.0), social phobia (RR 3.8; 95% CI 1.3-11.5) and alcohol abuse/dependence (RR 3.2; 95% 1.0-9.5). The findings that HF patients with personality disorders presented with complex psychiatric comorbidity suggest that pathways facilitating the integration of psychiatric services into cardiology settings are warranted when routine depression screening is in place. Crown Copyright © 2014. Published by Elsevier Ireland Ltd. All rights reserved.

  16. Use of deep sequencing data for routine analysis of HIV resistance in newly diagnosed patients

    PubMed Central

    Fernández-Caballero, Jose-Angel; Chueca, Natalia; Alvarez, Marta; Gonzalez, Dimitri; García, Federico

    2014-01-01

    Introduction Use of deep sequencing is becoming a critical tool in clinical virology, with an important impact in the HIV field for routine diagnostic purposes. Here, we present the comparison of deep and Sanger sequencing in newly diagnosed HIV patients, and the use of DeepChek v1.3 & VisibleChek for their interpretation and integration with virological and clinical data. Patients and Methods Plasma samples from 88 newly diagnosed HIV-1-infected patients were included in the study. Median age (IQR) was 37 (27–47), median CD4 count (IQR) was 387 (220–554), and 85% were males. Median Viral Load (Log, IQR) was 5.03 (4.51–5.53). Deep sequencing was obtained using a GS-Junior (Roche). Sequences were preprocessed with the 454 AVA software; aligned reads were uploaded into the DeepChek v1.3 system (ABL SA). Sanger sequences (Trugene), were uploaded in parallel. Stanford algorithm (version 7.0) resistance interpretation to first line drugs and all the mutations (score≥5) were analyzed. For deep sequencing, 1%, 5% and 10% thresholds were chosen for resistance interpretation. Results Using VisibleChek for analysis, we were able to describe the detection of any mutation using Sanger in 37/88 patients, with a total number of 50 Stanford ≥5 mutations, K103N and E138A being the most prevalent (n=4). Using UDS-1%, we found 72/88 patients with at least one mutation (total of 206 Stanford ≥5 mutations). Using Sanger data, 9/88 patients (10.22%) showed any resistance to NNRTIs, while none showed resistance to NRTIs or PIs. Using UDS-10% increased resistance to NRTIs [3/88 (3.40%)], to NNRTIs 12/88 (13.63%), and to a lesser extent to PIs [1/88 (1.13%)]. Using UDS-5% increased resistance to NRTIs [4/88 (4.54%)] and to NNRTIs [12/88 (13.63%)], but not to PIs. Using UDS-1% increased resistance to all classes: NRTIs [14/88 (15.90%)], NNRTIs [26/88 (30.68%)], and PIs [6/88 (6.81]. Conclusions DeepChek and VisibleChek allow for an easy, reliable and rapid analysis of UDS data

  17. Revenue, relationships and routines: the social organization of acute myocardial infarction patient transfers in the United States.

    PubMed

    Veinot, Tiffany C; Bosk, Emily A; Unnikrishnan, K P; Iwashyna, Theodore J

    2012-11-01

    Heart attack, or acute myocardial infarction (AMI), is a leading cause of death in the United States (U.S.). The most effective therapy for AMI is rapid revascularization: the mechanical opening of the clogged artery in the heart. Forty-four percent of patients with AMI who are admitted to a non-revascularization hospital in the U.S. are transferred to a hospital with that capacity. Yet, we know little about the process by which community hospitals complete these transfers, and why publicly available hospital quality data plays a small role in community hospitals' choice of transfer destinations. Therefore, we investigated how community hospital staff implement patient transfers and select destinations. We conducted a mixed methods study involving: interviews with staff at three community hospitals (n = 25) in a Midwestern state and analysis of U.S. national Medicare records for 1996-2006. Community hospitals in the U.S., including our field sites, typically had longstanding relationships with one key receiving hospital. Community hospitals addressed the need for rapid AMI patient transfers by routinizing the collective, interhospital work process. Routinization reduced staff uncertainty, coordinated their efforts and conserved their cognitive resources for patient care. While destination selection was nominally a physician role, the decision was routinized, such that staff immediately contacted a "usual" transfer destination upon AMI diagnosis. Transfer destination selection was primarily driven at an institutional level by organizational concerns and bed supply, rather than physician choice or patient preference. Transfer routinization emerged as a form of social order that invoked tradeoffs between process speed and efficiency and patient-centered, quality-driven decision making. We consider the implications of routinization and institutional imperatives for health policy, quality improvement and health informatics interventions. Copyright © 2012 Elsevier Ltd

  18. Revenue, relationships and routines: The social organization of acute myocardial infarction patient transfers in the United States

    PubMed Central

    Veinot, Tiffany C.; Bosk, Emily A.; Unnikrishnan, K.P.; Iwashyna, Theodore J.

    2013-01-01

    Heart attack, or acute myocardial infarction (AMI), is a leading cause of death in the United States (US). The most effective therapy for AMI is rapid revascularization: the mechanical opening of the clogged artery in the heart. Forty-four percent of patients with AMI who are admitted to a non-revascularization hospital in the US are transferred to a hospital with that capacity. Yet, we know little about the process by which community hospitals complete these transfers, and why publicly available hospital quality data plays a small role in community hospitals’ choice of transfer destinations. Therefore, we investigated how community hospital staff implement patient transfers and select destinations. We conducted a mixed methods study involving: interviews with staff at three community hospitals (n = 25) in a Midwestern state and analysis of US national Medicare records for 1996–2006. Community hospitals in the US, including our field sites, typically had longstanding relationships with one key receiving hospital. Community hospitals addressed the need for rapid AMI patient transfers by routinizing the collective, interhospital work process. Routinization reduced staff uncertainty, coordinated their efforts and conserved their cognitive resources for patient care. While destination selection was nominally a physician role, the decision was routinized, such that staff immediately contacted a “usual” transfer destination upon AMI diagnosis. Transfer destination selection was primarily driven at an institutional level by organizational concerns and bed supply, rather than physician choice or patient preference. Transfer routinization emerged as a form of social order that invoked tradeoffs between process speed and efficiency and patient-centered, quality-driven decision making. We consider the implications of routinization and institutional imperatives for health policy, quality improvement and health informatics interventions. PMID:22884942

  19. Use of deep sequencing data for routine analysis of HIV resistance in newly diagnosed patients.

    PubMed

    Fernández-Caballero, Jose-Angel; Chueca, Natalia; Alvarez, Marta; Gonzalez, Dimitri; García, Federico

    2014-01-01

    Use of deep sequencing is becoming a critical tool in clinical virology, with an important impact in the HIV field for routine diagnostic purposes. Here, we present the comparison of deep and Sanger sequencing in newly diagnosed HIV patients, and the use of DeepChek v1.3 & VisibleChek for their interpretation and integration with virological and clinical data. Plasma samples from 88 newly diagnosed HIV-1-infected patients were included in the study. Median age (IQR) was 37 (27-47), median CD4 count (IQR) was 387 (220-554), and 85% were males. Median Viral Load (Log, IQR) was 5.03 (4.51-5.53). Deep sequencing was obtained using a GS-Junior (Roche). Sequences were preprocessed with the 454 AVA software; aligned reads were uploaded into the DeepChek v1.3 system (ABL SA). Sanger sequences (Trugene), were uploaded in parallel. Stanford algorithm (version 7.0) resistance interpretation to first line drugs and all the mutations (score≥5) were analyzed. For deep sequencing, 1%, 5% and 10% thresholds were chosen for resistance interpretation. Using VisibleChek for analysis, we were able to describe the detection of any mutation using Sanger in 37/88 patients, with a total number of 50 Stanford ≥5 mutations, K103N and E138A being the most prevalent (n=4). Using UDS-1%, we found 72/88 patients with at least one mutation (total of 206 Stanford ≥5 mutations). Using Sanger data, 9/88 patients (10.22%) showed any resistance to NNRTIs, while none showed resistance to NRTIs or PIs. Using UDS-10% increased resistance to NRTIs [3/88 (3.40%)], to NNRTIs 12/88 (13.63%), and to a lesser extent to PIs [1/88 (1.13%)]. Using UDS-5% increased resistance to NRTIs [4/88 (4.54%)] and to NNRTIs [12/88 (13.63%)], but not to PIs. Using UDS-1% increased resistance to all classes: NRTIs [14/88 (15.90%)], NNRTIs [26/88 (30.68%)], and PIs [6/88 (6.81]. DeepChek and VisibleChek allow for an easy, reliable and rapid analysis of UDS data from HIV-1. Compared to Sanger data, UDS detected a higher

  20. Quality-assurance results for routine water analyses in U.S. Geological Survey laboratories, water year 1998

    USGS Publications Warehouse

    Ludtke, Amy S.; Woodworth, Mark T.; Marsh, Philip S.

    2000-01-01

    The U.S. Geological Survey operates a quality-assurance program based on the analyses of reference samples for two laboratories: the National Water Quality Laboratory and the Quality of Water Service Unit. Reference samples that contain selected inorganic, nutrient, and low-level constituents are prepared and submitted to the laboratory as disguised routine samples. The program goal is to estimate precision and bias for as many analytical methods offered by the participating laboratories as possible. Blind reference samples typically are submitted at a rate of 2 to 5 percent of the annual environmental-sample load for each constituent. The samples are distributed to the laboratories throughout the year. The reference samples are subject to the identical laboratory handling, processing, and analytical procedures as those applied to environmental samples and, therefore, have been used as an independent source to verify bias and precision of laboratory analytical methods and ambient water-quality measurements. The results are stored permanently in the National Water Information System and the Blind Sample Project's data base. During water year 1998, 95 analytical procedures were evaluated at the National Water Quality Laboratory and 63 analytical procedures were evaluated at the Quality of Water Service Unit. An overall evaluation of the inorganic and low-level constituent data for water year 1998 indicated 77 of 78 analytical procedures at the National Water Quality Laboratory met the criteria for precision. Silver (dissolved, inductively coupled plasma-mass spectrometry) was determined to be imprecise. Five of 78 analytical procedures showed bias throughout the range of reference samples: chromium (dissolved, inductively coupled plasma-atomic emission spectrometry), dissolved solids (dissolved, gravimetric), lithium (dissolved, inductively coupled plasma-atomic emission spectrometry), silver (dissolved, inductively coupled plasma-mass spectrometry), and zinc

  1. Measuring routine nursing service efficiency: a comparison of cost per patient day and data envelopment analysis models.

    PubMed Central

    Nunamaker, T R

    1983-01-01

    This article provides an illustrative application of Data Envelopment Analysis (DEA) methodology to the measurement of routine nursing service efficiency at a group of Wisconsin hospitals. The DEA efficiency ratings and cost savings estimates are then compared to those resulting from application of Medicare's routine cost limitation to the sample data. DEA is also used to determine if any changes in the potential for efficient operations occurred during the 1978-1979 period. Empirical results were representative of the fundamental differences existing between the DEA and cost per patient day approaches. No evidence was found to support the notion that the overall potential for efficient delivery of routine services by the sample institutions was greater in one year than another. PMID:6874357

  2. The incidence of ocular candidiasis and evaluation of routine opthalmic examination in critically ill patients with candidaemia.

    PubMed

    Gluck, S; Headdon, W G; Tang, Dws; Bastian, I B; Goggin, M J; Deane, A M

    2015-11-01

    Despite a paucity of data regarding both the incidence of ocular candidiasis and the utility of ophthalmic examination in critically ill patients, routine ophthalmic examination is recommended for critically ill patients with candidaemia. The objectives were to estimate the incidence of ocular candidiasis and evaluate whether ophthalmic examination influenced subsequent management of these patients. We conducted a ten-year retrospective observational study. Data were extracted for all ICU patients who were blood culture positive for fungal infection. Risk factors for candidaemia and eye involvement were quantified and details regarding ophthalmic examination were reviewed. Candida species were cultured in 93 patients. Risk factors for ocular candidiasis were present in 57% of patients. Forty-one percent of patients died prior to ophthalmology examination and 2% of patients were discharged before candidaemia was identified. During examination, signs of ocular candidiasis were only present in one (2.9%) patient, who had a risk factor for ocular candidiasis. Based on these findings, the duration of antifungal treatment for this patient was increased. Ocular candidiasis occurs rarely in critically ill patients with candidaemia, but because treatment regimens may be altered when diagnosed, routine ophthalmic examination is still indicated.

  3. Yield of routine provocative cardiac testing among patients in an emergency department-based chest pain unit.

    PubMed

    Hermann, Luke K; Newman, David H; Pleasant, W Andrew; Rojanasarntikul, Dhanadol; Lakoff, Daniel; Goldberg, Scott A; Duvall, W Lane; Henzlova, Milena J

    2013-06-24

    The American Heart Association recommends routine provocative cardiac testing in accelerated diagnostic protocols for coronary ischemia. The diagnostic and therapeutic yield of this approach are unknown. To assess the yield of routine provocative cardiac testing in an emergency department-based chest pain unit. We examined a prospectively collected database of patients evaluated for possible acute coronary syndrome between March 4, 2004, and May 15, 2010, in the emergency department-based chest pain unit of an urban academic tertiary care center. Patients with signs or symptoms of possible acute coronary syndrome and without an ischemic electrocardiography result or a positive biomarker were enrolled in the database. All patients were evaluated by exercise stress testing or myocardial perfusion imaging. Demographic and clinical features, results of routine provocative cardiac testing and angiography, and therapeutic interventions were recorded. Diagnostic yield (true-positive rate) was calculated, and the potential therapeutic yield of invasive therapy was assessed through blinded, structured medical record review using American Heart Association designations (class I, IIa, IIb, or lower) for the potential benefit from percutaneous intervention. In total, 4181 patients were enrolled in the study. Chest pain was initially reported in 93.5%, most (73.2%) were at intermediate risk for coronary artery disease, and 37.6% were male. Routine provocative cardiac testing was positive for coronary ischemia in 470 (11.2%), of whom 123 underwent coronary angiography. Obstructive disease was confirmed in 63 of 123 (51.2% true positive), and 28 (0.7% overall) had findings consistent with the potential benefit from revascularization (American Heart Association class I or IIa). In an emergency department-based chest pain unit, routine provocative cardiac testing generated a small therapeutic yield, new diagnoses of coronary artery disease were uncommon, and false-positive results

  4. Routine contrast esophagram has minimal impact on the postoperative management of patients undergoing esophagectomy for esophageal cancer.

    PubMed

    Cools-Lartigue, Jonathan; Andalib, Amin; Abo-Alsaud, Ali; Gowing, Stephen; Nguyen, Maxime; Mulder, David; Ferri, Lorenzo

    2014-08-01

    Routine contrast esophagram is frequently performed after esophagectomy in order to detect occult anastomotic leak (AL). This modality has a low sensitivity, and its routine use has been called into question. Accordingly, we sought to demonstrate the clinical impact of routine contrast esophagography in the management of patients undergoing esophagectomy for malignant disease. All patients undergoing esophagectomy from 2005 to 2011 for malignancy at a North American University hospital were identified from a prospectively collected database. Barium esophagram (BE) was performed within the first week postoperatively. Patients were dichotomized according to whether they had an AL, and the sensitivity and specificity of BE was determined. The clinical impact of the BE result, defined as cessation of enteral feeding, additional interventions, or delay in discharge, was determined. Overall, 221 patients underwent esophagectomy. Thirty (13.6 %) developed an AL, of which 10 (30 %) had a positive BE, 12 (40 %) had a negative BE, and 8 (26.7 %) had no BE and were diagnosed clinically (1/8), by computed tomography (CT) (3/8), endoscopically (3/8), or at reoperation (1/7). AL in patients with a negative BE was confirmed clinically (4/12), by CT (6/12), endoscopically (1/12), or at reoperation (1/12). The sensitivity and specificity of BE was 45.5 and 97.8 %, respectively. BE altered postoperative management in 8/221 (3.6 %) patients, with 5/221 (2.3 %) undergoing therapeutic intervention. Conversely, 3/221 (1.4 %) patients demonstrated clinically insignificant AL, delaying discharge and feeding without intervention. Contrast esophagram is not an effective screening modality for AL when employed routinely following esophagectomy.

  5. [Detection of lupus anticoagulants in the routine blood coagulation laboratory exemplified by 36 patients with systemic lupus erythematosus].

    PubMed

    Halbmayer, W M; Haushofer, A; Schratzberger, W; Petera, P; Duschet, P; Fischer, M

    1993-07-15

    36 patients suffering from systemic lupus erythematosus (SLE) were subjected to various screening and confirmation tests for the presence of lupus anticoagulants (LA) which are a risk for thrombosis. In five out of the 36 patients (14%) lupus anticoagulants could be found. Five out of the 36 patients (14%) showed increased antiphospholipid antibody (APA) levels whereby only two of these patients were at the same time LA-positive. The specificity, sensitivity and effectiveness of various tests in respect of LA-demonstrability have been assessed and the results taken as the basis for proposal of a largely automated stepwise diagnostic procedure for LA-determination within the routine coagulation laboratory.

  6. Value of routine transition zone biopsies in patients undergoing ultrasound-guided sextant biopsies for the first time.

    PubMed

    Morote, J; López, M; Encabo, G; de Torres, I

    1999-04-01

    To analyze the efficacy of routine transition zone biopsies in patients undergoing ultrasound-guided sextant biopsies for the first time because of a suspicious digital rectal examination (DRE) or an elevated serum prostate-specific antigen (PSA) level. During sextant prostatic biopsy two additional transition zone biopsies were performed in 164 consecutive patients: in 98 because of a serum PSA of >4.0 ng/ml, and in 66 because of a suspicious DRE. The overall cancer detection rate was 46.9% (77/164). In 28 patients (36.4%) cancer was only detected in the peripheral zone, in 2 (2.6%) only in the transition zone and in 47 (61%) in both zones. Routine transition zone biopsies performed at the time of a first sextant biopsy seem to have low efficacy.

  7. Clinical value of stool culture in paediatric oncology patients: hospital evaluation and UK survey of practice.

    PubMed

    O'Connor, O; Cooke, R P D; Cunliffe, N A; Pizer, B

    2017-01-01

    Diarrhoea is a frequently occurring symptom in paediatric oncology patients. The role of routine testing for enteric bacteria in hospitalized patients with diarrhoea is considered limited, but the diagnostic value of testing in children with oncological conditions has not been reported. Therefore, we conducted a five-year retrospective service evaluation in our tertiary paediatric oncology unit together with a national survey of 21 centres to estimate the utility of stool cultures in oncology patients with diarrhoea and the national approach to testing. Our local survey demonstrated very low diagnostic yield using routine enteric stool cultures with only one sample out of 842 (0.1%) testing positive. The national survey demonstrated considerable variation in practice. There is little evidence to support the use of conventional stool culture for enteric bacteria in children with cancer in our centre. These findings should inform national testing policies.

  8. Underuse of long-term routine hospital follow-up care in patients with a history of breast cancer?

    PubMed Central

    2011-01-01

    Background After primary treatment for breast cancer, patients are recommended to use hospital follow-up care routinely. Long-term data on the utilization of this follow-up care are relatively rare. Methods Information regarding the utilization of routine hospital follow-up care was retrieved from hospital documents of 662 patients treated for breast cancer. Utilization of hospital follow-up care was defined as the use of follow-up care according to the guidelines in that period of time. Determinants of hospital follow up care were evaluated with multivariate analysis by generalized estimating equations (GEE). Results The median follow-up time was 9.0 (0.3-18.1) years. At fifth and tenth year after diagnosis, 16.1% and 33.5% of the patients had less follow-up visits than recommended in the national guideline, and 33.1% and 40.4% had less frequent mammography than recommended. Less frequent mammography was found in older patients (age > 70; OR: 2.10; 95%CI: 1.62-2.74), patients with comorbidity (OR: 1.26; 95%CI: 1.05-1.52) and patients using hormonal therapy (OR: 1.51; 95%CI: 1.01-2.25). Conclusions Most patients with a history of breast cancer use hospital follow-up care according to the guidelines. In older patients, patients with comorbidity and patients receiving hormonal therapy yearly mammography is performed much less than recommended. PMID:21708039

  9. Diagnostic Yield of Routine Stress Testing in Low and Intermediate Risk Chest Pain Patients Under 40 Years: A Systematic Review.

    PubMed

    Skoien, Wade

    2016-09-01

    Chest pain is one of the most frequent causes for presentation to emergency departments (EDs). The majority of patients will undergo diagnostic workup including stress testing to rule out an acute coronary syndrome, but very few patients will be diagnosed with a cardiac cause for their pain. Patients under 40 years represent a lower risk group in which routine stress testing may be of little benefit. This systematic review sought to determine the diagnostic yield of routine stress testing in low- and intermediate-risk chest pain patients under 40 years. Electronic databases were searched for relevant studies. The quality of the included primary studies was assessed using the National Health and Medical Research Council evidence hierarchy and the McMaster Critical Appraisal Tool for Quantitative Studies. Descriptive statistics summarized the findings. Five primary studies were included in the review (all level III-3 evidence); 7 additional sources of relevant data were also included. Diagnostic yield of routine stress testing in low- and intermediate-risk patients under 40 years is reported between 0% and 1.1%. Combined data from included primary studies demonstrated just 4 out of 1683 true positive stress tests (0.24%), only one of which was definitively confirmed by coronary angiogram; additional data sources identified just 1 out of 310 true positive stress tests (0.32%). Diagnostic yield of routine stress testing in low- and intermediate-risk chest pain patients under 40 years is low. However, better quality studies are required to be able to draw definitive conclusions.

  10. Does routine pin re-torquing of patients wearing a halo-thoracic orthosis reduce the need for pin replacement?

    PubMed

    Fraser, Sue; Coffey, John P

    2015-08-01

    The halo orthosis is a treatment option currently used in Australia for cervical spine immobilisation following trauma, fracture and post surgical stabilisation. In a previous study, the authors reported halo pin replacement to be a common complication. The aim of this study was to investigate the potential correlation between routine halo pin re-torquing and the incidence of pin replacement. A retrospective case series study was undertaken. A total of 258 charts were reviewed, with 170 patients included in the study. Patients were fitted with a Bremer HALO System with the initial application torque maintained by routine re-torquing throughout the duration of wear. A total of 680 pins (4 per patient) were inserted during the initial application of the halo orthoses, with only six pins replaced (0.88%) throughout the duration of the study. The findings from this study demonstrate a potential correlation between routinely re-torquing halo pins and decreasing the incidence of pin replacement. This case series study has identified a potential improvement in clinical management of patients wearing a halo-thoracic orthosis. © The International Society for Prosthetics and Orthotics 2014.

  11. Disease management programs for patients with COPD in Germany: a longitudinal evaluation of routinely collected patient records.

    PubMed

    Mehring, Michael; Donnachie, Ewan; Fexer, Johannes; Hofmann, Frank; Schneider, Antonius

    2014-07-01

    The primary aim of the disease management program (DMP) for patients with COPD is to improve health outcomes and thereby to reduce overall costs. Six years after its introduction in Germany, no consensus has yet been reached as to whether the DMP has been effective in reaching these goals. The objective of the study was an evaluation of the DMP for COPD in Bavaria using routinely collected subject medical records. A longitudinal population-based study, comparing the total DMP population of up to 86,560 patients with a stable cohort of 17,549 subjects over a period of 5 years. The effect of subject dropout in the cohort is further estimated by means of inverse probability weighting. The proportion of subjects in the total population who were prescribed and received treatment with oral corticosteroids declined at a constant rate of 1.0% per year (P < .001). The proportion of subjects who were given a prescription for theophylline decreased at a constant rate of 2.0% per year (P < .001). By 2012, 15.6% of the total population and 26% of the cohort had undergone self-management education. While the proportion of smokers in the total population remained constant because of the effect of newly enrolled subjects, the proportion of smokers decreased significantly even after dropout adjustment, from 29% to 21%. The occurrence of exacerbations decreased steadily at a rate of 0.9% (total population) or 0.7% (cohort) per year. While the occurrence of emergency hospital admissions decreased in the total population, an increase was observed within the cohort. Summarizing all results leads to the suggestion that the German DMP for COPD has been effective in enhancing the quality of care in regard to an improved adherence to guidelines, pharmacotherapy, exacerbations, and self-management education. However, the DMP was not able to prevent an increase in emergency hospital admissions for the stable population in the cohort. Copyright © 2014 by Daedalus Enterprises.

  12. Comprehensive self management and routine monitoring in chronic obstructive pulmonary disease patients in general practice: randomised controlled trial.

    PubMed

    Bischoff, Erik W M A; Akkermans, Reinier; Bourbeau, Jean; van Weel, Chris; Vercoulen, Jan H; Schermer, Tjard R J

    2012-11-28

    To assess the long term effects of two different modes of disease management (comprehensive self management and routine monitoring) on quality of life (primary objective), frequency and patients' management of exacerbations, and self efficacy (secondary objectives) in patients with chronic obstructive pulmonary disease (COPD) in general practice. 24 month, multicentre, investigator blinded, three arm, pragmatic, randomised controlled trial. 15 general practices in the eastern part of the Netherlands. Patients with COPD confirmed by spirometry and treated in general practice. Patients with very severe COPD or treated by a respiratory physician were excluded. A comprehensive self management programme as an adjunct to usual care, consisting of four tailored sessions with ongoing telephone support by a practice nurse; routine monitoring as an adjunct to usual care, consisting of 2-4 structured consultations a year with a practice nurse; or usual care alone (contacts with the general practitioner at the patients' own initiative). The primary outcome was the change in COPD specific quality of life at 24 months as measured with the chronic respiratory questionnaire total score. Secondary outcomes were chronic respiratory questionnaire domain scores, frequency and patients' management of exacerbations measured with the Nijmegen telephonic exacerbation assessment system, and self efficacy measured with the COPD self-efficacy scale. 165 patients were allocated to self management (n=55), routine monitoring (n=55), or usual care alone (n=55). At 24 months, adjusted treatment differences between the three groups in mean chronic respiratory questionnaire total score were not significant. Secondary outcomes did not differ, except for exacerbation management. Compared with usual care, more exacerbations in the self management group were managed with bronchodilators (odds ratio 2.81, 95% confidence interval 1.16 to 6.82) and with prednisolone, antibiotics, or both (3.98, 1.10 to 15

  13. The adequacy of gross pathological examination of routine tonsils and adenoids in patients 21 years old and younger.

    PubMed

    Williams, Michelle D; Brown, Heather M

    2003-10-01

    Most hospitals microscopically examine all routine tonsil and adenoid specimens from healthy pediatric patients with recurrent infections or obstructive sleep apnea. Concern over missing the rare unsuspected, significant diagnosis propagates this practice. Careful gross examination for asymmetry and clinical findings should obviate the need for routine microscopic examination of tonsil and adenoid specimens in patients age 21 years and younger. A retrospective study was conducted using the SNOMED database of 4070 patients age 21 years or younger who underwent tonsillectomy and/or adenoidectomy between 1970 and July 2001 at the University of Florida. The age distribution of the study group was 0 to 5 years (52%), 6 to 12 years (37%), and 13 to 21 years (11%). Specimens consisted of tonsils only (15%), tonsils and adenoids (40%), and adenoids only (45%). Clinically significant diagnoses were diagnoses that impacted the care of patients and included malignancies and some infections. Non-clinically significant diagnoses included normal, acute or chronic tonsillitis, and tonsillar hyperplasia. Clinically significant pathological processes were seen in the tonsil or adenoid specimens of 3 of the 4070 patients. These 3 cases included a 2-year-old male with Burkitt's lymphoma, a 19-year-old male with non-Hodgkin's lymphoma (small noncleaved cell, non-Burkitt's type), and an 11-year-old male with a probable viral process but in whom a lymphoma could not be absolutely excluded. All 3 of these patients had signs and symptoms, including significant cervical lymphadenopathy, meriting microscopic analysis of the specimens. In conclusion, microscopic examination of all routine tonsils and adenoids for individuals 21 years or younger is not indicated. Gross examination is still recommended. Clinical suspicion and specimen asymmetry should be used to determine when thorough histological examination is merited.

  14. CYCLE pilot: a protocol for a pilot randomised study of early cycle ergometry versus routine physiotherapy in mechanically ventilated patients

    PubMed Central

    Molloy, Alexander J; Clarke, France; Herridge, Margaret S; Koo, Karen K Y; Rudkowski, Jill; Seely, Andrew J E; Pellizzari, Joseph R; Tarride, Jean-Eric; Mourtzakis, Marina; Karachi, Timothy; Cook, Deborah J

    2016-01-01

    Introduction Early exercise with in-bed cycling as part of an intensive care unit (ICU) rehabilitation programme has the potential to improve physical and functional outcomes following critical illness. The objective of this study is to determine the feasibility of enrolling adults in a multicentre pilot randomised clinical trial (RCT) of early in-bed cycling versus routine physiotherapy to inform a larger RCT. Methods and analysis 60-patient parallel group pilot RCT in 7 Canadian medical-surgical ICUs. We will include all previously ambulatory adult patients within the first 0–4 days of mechanical ventilation, without exclusion criteria. After informed consent, patients will be randomised using a web-based, centralised electronic system, to 30 min of in-bed leg cycling in addition to routine physiotherapy, 5 days per week, for the duration of their ICU stay (28 days maximum) or routine physiotherapy alone. We will measure patients' muscle strength (Medical Research Council Sum Score, quadriceps force) and function (Physical Function in ICU Test (scored), 30 s sit-to-stand, 2 min walk test) at ICU awakening, ICU discharge and hospital discharge. Our 4 feasibility outcomes are: (1) patient accrual of 1–2 patients per month per centre, (2) protocol violation rate <20%, (3) outcome measure ascertainment >80% at the 3 time points and (4) blinded outcomes ascertainment >80% at hospital discharge. Hospital outcome assessors are blinded to group assignment, whereas participants, ICU physiotherapists, ICU caregivers, research coordinators and ICU outcome assessors are not blinded to group assignment. We will analyse feasibility outcomes with descriptive statistics. Ethics and dissemination Each participating centre will obtain local ethics approval, and results of the study will be published to inform the design and conduct of a future multicentre RCT of in-bed cycling to improve physical outcomes in ICU survivors. Trial registration number NCT02377830; Pre

  15. Implementing specific oral tolerance induction to milk into routine clinical practice: experience from first 50 patients

    PubMed Central

    Luyt, David; Bravin, Kristian; Luyt, Jessica

    2014-01-01

    Background Although the natural history of cow’s milk allergy is to resolve during childhood or adolescence, a small but significant proportion of children will remain allergic. Specific oral tolerance induction to cow’s milk (CM-SOTI) provides a treatment option in these children with continuing allergy with high success rates. However current sentiment limits widespread availability as existing reports advise that it is too soon to translate CM-SOTI into routine clinical practice. Methods In January 2007 we implemented a slow up-dosing CM-SOTI program. Eligible subjects were identified at routine visits to our children’s allergy clinic. Persisting cow’s milk allergy was confirmed from recent contact symptoms or a positive baked milk challenge. As allergic symptoms are common during CM-SOTI, families were provided with ready dietetic access for advice on dosing and symptom treatment. Subjects were continuously monitored at subsequent clinic visits or telephonically, where no longer followed, for a median of 49 months. Results The first 50 subjects (35 males) treated ranged in age from 5.1 to 15.8 years (median 10.3 years). Full tolerance (250 mL) was achieved in 23 subjects, 9 without any symptoms, and a further 9 achieved partial tolerance with continued ingestion. Eighteen children failed to achieve any regular milk ingestion; 11 because of persistent or significant symptoms whilst 8 withdrew against medical advice. Allergic symptoms were predominantly mild to moderate in severity, although 2 cases needed treatment with inhaled salbutamol and a further 2 required intramuscular adrenaline. Clinical tolerance, both full and partial, persists beyond 5 years. Conclusion We have demonstrated that a CM-SOTI program can be successfully and safely implemented as routine clinical practice with acceptable compliance during prolonged home up-dosing, despite frequent allergic symptoms, and for up to 4 years after starting treatment. CM-SOTI can thus be put into

  16. Value of routine measurement of serum calcitonin concentrations in patients with nodular thyroid disease: A multicenter study.

    PubMed

    Papi, G; Corsello, S M; Cioni, K; Pizzini, A M; Corrado, S; Carapezzi, C; Fadda, G; Baldini, A; Carani, C; Pontecorvi, A; Roti, E

    2006-05-01

    The routine measurement of serum calcitonin (CT) has been proposed for patients with nodular thyroid disease (NTD), to detect unsuspected medullary thyroid carcinoma (MTC) before surgery. To assess the prevalence of hypercalcitoninemia and MTC in NTD patients; to compare the ability of CT measurement and fine needle aspiration cytology (FNAC) to predict MTC; to identify age groups of NTD patients who should be better candidates than others to undergo routine measurement of CT. 1425 consecutive patients, referred from April 1, 2003, through March 31, 2004, to four Italian endocrine centers due to NTD, were grouped depending on age, and underwent basal and, in some cases, pentagastrin (Pg)-stimulated CT measurement, FNAC and, when indicated, surgery. Serum CT concentrations were measured by an immunoluminometric assay (ILMA). Hypercalcitoninemia was found in 23 out of 1425 patients. MTC was discovered in 9 patients, all >40 yr old and showing high CT levels. Sensitivity of basal and Pg-stimulated CT to predict MTC before surgery was 100% for both tests, whereas specificity was 95 and 93%, respectively. CT specificity reached 100% when a cutoff value of 20 pg/ml was taken. FNAC showed an overall 86% sensitivity. When >10 mm MTC nodules were considered, FNAC sensitivity approached 100%. On the contrary, a correct cytological diagnosis was obtained in only one out of five patients with <10 mm MTC nodules (microMTC); in one patient with histologically proved microMTC, FNAC even demonstrated a benign lesion. Hypercalcitoninemia or MTC were associated with chronic thyroiditis in 30 or 33% of cases, respectively. C-cell hyperplasia was found in 57% of hypercalcitoninemic patients without MTC. Basal CT measurement detects elevated CT values in 1.6% of NTD patients. Although CT is not a specific marker of MTC, its routine measurement represents a useful tool in the pre-operative evaluation of NTD patients, particularly those >40 yr old presenting with nodules <10 mm, even

  17. Reappraisal of routine oral care with chlorhexidine gluconate for patients receiving mechanical ventilation: systematic review and meta-analysis.

    PubMed

    Klompas, Michael; Speck, Kathleen; Howell, Michael D; Greene, Linda R; Berenholtz, Sean M

    2014-05-01

    Regular oral care with chlorhexidine gluconate is standard of care for patients receiving mechanical ventilation in most hospitals. This policy is predicated on meta-analyses suggesting decreased risk of ventilator-associated pneumonia, but these meta-analyses may be misleading because of lack of distinction between cardiac surgery and non-cardiac surgery studies, conflation of open-label vs double-blind investigations, and insufficient emphasis on patient-centered outcomes such as duration of mechanical ventilation, length of stay, and mortality. To evaluate the impact of routine oral care with chlorhexidine on patient-centered outcomes in patients receiving mechanical ventilation. PubMed, Embase, CINAHL, and Web of Science from inception until July 2013 without limits on date or language. Randomized clinical trials comparing chlorhexidine vs placebo in adults receiving mechanical ventilation. Of 171 unique citations, 16 studies including 3630 patients met inclusion criteria. Eligible trials were independently identified, evaluated for risk of bias, and extracted by 2 investigators. Differences were resolved by consensus. We stratified studies into cardiac surgery vs non-cardiac surgery and open-label vs double-blind investigations. Eligible studies were pooled using random-effects meta-analysis. Ventilator-associated pneumonia, mortality, duration of mechanical ventilation, intensive care unit and hospital length of stay, antibiotic prescribing. There were fewer lower respiratory tract infections in cardiac surgery patients randomized to chlorhexidine (relative risk [RR], 0.56 [95% CI, 0.41-0.77]) but no significant difference in ventilator-associated pneumonia risk in double-blind studies of non-cardiac surgery patients (RR, 0.88 [95% CI, 0.66-1.16]). There was no significant mortality difference between chlorhexidine and placebo in cardiac surgery studies (RR, 0.88 [95% CI, 0.25-2.14]) and nonsignificantly increased mortality in non-cardiac surgery studies (RR

  18. Does routine colonoscopy help diagnose familial adenomatous polyposis in patients presenting with desmoid tumors but no gastrointestinal symptoms?

    PubMed

    Shin, Rumi; Cho, Hwan-Seong; Kim, Duck-Woo; Ahn, So Yeon; Ihn, Myong Hoon; Park, Hyo Jin; Oh, Heung-Kwon; Kang, Sung-Bum

    2017-01-01

    Desmoid tumor (DT) is a rare myofibroblastic proliferative neoplasm, but can occur in up to 26% of patients with familial adenomatous polyposis (FAP). Therefore, DT may be an extraintestinal manifestation of FAP that precedes the development of advanced malignancies. The aim of this study was to identify the incidence of polyps in DT patients and investigate value of colonoscopy for diagnosis of FAP in DT patients without gastrointestinal symptoms. The records of patients diagnosed with DT were retrospectively reviewed using the clinical data warehouse (CDW) system. Clinical data, including location of tumor, type(s) of treatment, and colonoscopic findings, were collected. Sixty-five patients were diagnosed with DT during the study period; 10 patients received colonoscopies before diagnosis of DT, and 20 patients received colonoscopies after diagnosis of DT. The mean age at diagnosis of DT was 41.9 ± 16.7 years old (range 17-74). Most tumors were extra-abdominal (n = 24, 80.0%), and fewer were intra-abdominal (n = 4, 13.3%) or in an abdominal wall (n = 2, 6.7%). The colonoscopy results revealed one or two tubular adenomas in 11 patients (36.6%), although none of the patients had colorectal polyposis or colorectal cancer. None of the patients in our study population had colorectal polyposis. Routine colonoscopy of DT patients without gastrointestinal symptoms seems to have low diagnostic yield for detection of FAP.

  19. Implementing routine screening for distress, the sixth vital sign, for patients with head and neck and neurologic cancers.

    PubMed

    Bultz, Barry D; Waller, Amy; Cullum, Jodi; Jones, Paula; Halland, Johan; Groff, Shannon L; Leckie, Catriona; Shirt, Lisa; Blanchard, Scott; Lau, Harold; Easaw, Jacob; Fassbender, Konrad; Carlson, Linda E

    2013-10-01

    This study examined the benefits of incorporating screening for distress as a routine part of care for patients with head and neck and neurologic cancers in a tertiary cancer center. Using a comparative 2-cohort pre-post implementation sequential design, consecutive outpatients with head and neck and neurologic cancers were recruited into 2 separate cohorts. Cohort 1 included patients attending clinics during April 2010, before the implementation of the screening program. The program was then implemented and patients completed the Screening for Distress Minimum Dataset (the Edmonton Symptom Assessment System [ESAS] and the Canadian Problem Checklist [CPC]) at each clinic visit. Cohort 2 included patients attending clinics during March 2011. Consenting patients completed screening and outcome measures (ESAS, CPC, and either the Functional Assessment of Cancer Therapy-Brain or the Functional Assessment of Cancer Therapy-Head and Neck). A total of 146 patients (78 head and neck and 68 neurologic) provided data for Cohort 1, and 143 (81 head and neck and 62 neurologic) provided data for Cohort 2. Compared with Cohort 1, patients with neurologic cancers in Cohort 2 reported significantly higher scores on the Functional Assessment of Cancer Therapy: General total and emotional quality of life subscale; fewer high scores (≥ 4) on the ESAS breathlessness item; and fewer problems with fears/worries, frustration/anger, finding meaning in life, and worry about friends/family. Head and neck patients in Cohort 2 reported significantly higher emotional quality of life and fewer problems with eating and weight than those in Cohort 1. Although no definitive causal attributions can be made, patients exposed to routine screening for distress reported better well-being and fewer emotional, physical, and practical problems than historical controls.

  20. Comprehensive self management and routine monitoring in chronic obstructive pulmonary disease patients in general practice: randomised controlled trial

    PubMed Central

    Akkermans, Reinier; Bourbeau, Jean; van Weel, Chris; Vercoulen, Jan H; Schermer, Tjard R J

    2012-01-01

    Objective To assess the long term effects of two different modes of disease management (comprehensive self management and routine monitoring) on quality of life (primary objective), frequency and patients’ management of exacerbations, and self efficacy (secondary objectives) in patients with chronic obstructive pulmonary disease (COPD) in general practice. Design 24 month, multicentre, investigator blinded, three arm, pragmatic, randomised controlled trial. Setting 15 general practices in the eastern part of the Netherlands. Participants Patients with COPD confirmed by spirometry and treated in general practice. Patients with very severe COPD or treated by a respiratory physician were excluded. Interventions A comprehensive self management programme as an adjunct to usual care, consisting of four tailored sessions with ongoing telephone support by a practice nurse; routine monitoring as an adjunct to usual care, consisting of 2-4 structured consultations a year with a practice nurse; or usual care alone (contacts with the general practitioner at the patients’ own initiative). Outcome measures The primary outcome was the change in COPD specific quality of life at 24 months as measured with the chronic respiratory questionnaire total score. Secondary outcomes were chronic respiratory questionnaire domain scores, frequency and patients’ management of exacerbations measured with the Nijmegen telephonic exacerbation assessment system, and self efficacy measured with the COPD self-efficacy scale. Results 165 patients were allocated to self management (n=55), routine monitoring (n=55), or usual care alone (n=55). At 24 months, adjusted treatment differences between the three groups in mean chronic respiratory questionnaire total score were not significant. Secondary outcomes did not differ, except for exacerbation management. Compared with usual care, more exacerbations in the self management group were managed with bronchodilators (odds ratio 2.81, 95% confidence

  1. Comparison of point-of-care hemostatic assays, routine coagulation tests, and outcome scores in critically ill patients.

    PubMed

    Larsson, A; Tynngård, N; Kander, T; Bonnevier, J; Schött, U

    2015-10-01

    The purposes of the study are to compare point-of-care (POC) hemostatic devices in critically ill patients with routine laboratory tests and intensive care unit (ICU) outcome scoring assessments and to describe the time course of these variables in relation to mortality rate. Patients admitted to the ICU with a prognosis of more than 3 days of stay were included. The POC devices, Multiplate platelet aggregometry, rotational thromboelastometry, and ReoRox viscoelastic tests, were used. All variables were compared between survivors and nonsurvivors. Point-of-care results were compared to prothrombin time, activated partial thromboplastin time, platelet count, fibrinogen concentration, and Sequential Organ Failure Assessment score and Simplified Acute Physiology Score 3. Blood was sampled on days 0 to 1, 2 to 3, and 4 to 10 from 114 patients with mixed diagnoses during 237 sampling events. Nonsurvivors showed POC and laboratory signs of hypocoagulation and decreased fibrinolysis over time compared to survivors. ReoRox detected differences between survivors and nonsurvivors better than ROTEM and Multiplate. All POC and routine laboratory tests showed a hypocoagulative response in nonsurvivors compared to survivors. ReoRox was better than ROTEM and Multiplate at detecting differences between surviving and nonsurviving ICU patients. However, Simplified Acute Physiology Score 3 showed the best association to mortality outcome. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Testing survey methodology to measure patients' experiences and views of the emergency and urgent care system: telephone versus postal survey

    PubMed Central

    2010-01-01

    Background To address three methodological challenges when attempting to measure patients' experiences and views of a system of inter-related health services rather than a single service: the feasibility of a population survey for identifying system users, the optimal recall period for system use, and the mode of administration which is most feasible and representative in the context of routine measurement of system performance. Methods Postal survey of a random sample of 900 members of the general population and market research telephone survey of quota sample of 1000 members of the general population. Results Response rates to the postal and market research telephone population surveys were 51% (457 out of 893 receiving the questionnaire) and 9% (1014 out of 11924 contactable telephone numbers) respectively. Both surveys were able to identify users of the system in the previous three months: 22% (99/457) of postal and 15% (151/1000) of telephone survey respondents. For both surveys, recall of event occurrence reduced by a half after four weeks. The telephone survey more accurately estimated use of individual services within the system than the postal survey. Experiences and views of events remained reasonably stable over the three month recall time period for both modes of administration. Even though the response rate was lower, the telephone survey was more representative of the population, was faster and cheaper to undertake, and had fewer missing values. Conclusions It is possible to identify users of a health care system using a population survey. A recall period of three months can be used to estimate experiences and views but one month is more accurate for estimating use of the system. A quota sample market research telephone survey gives a low response rate yet is more representative and accurate than a postal survey of a random sample of the population. PMID:20534151

  3. Nutritional status in patients with active inflammatory bowel disease: prevalence of malnutrition and methods for routine nutritional assessment.

    PubMed

    Mijac, Dragana D; Janković, Goran L J; Jorga, Jagoda; Krstić, Miodrag N

    2010-08-01

    Malnutrition is a common feature of inflammatory bowel disease (IBD). There are numerous methods for the assessment of nutritional status, but the gold standard has not yet been established. The aims of the study were to estimate the prevalence of undernutrition and to evaluate methods for routine nutritional assessment of active IBD patients. Twenty-three patients with active Crohn disease, 53 patients with active ulcerative colitis and 30 controls were included in the study. The nutritional status was assessed by extensive anthropometric measurements, percentage of weight loss in the past 1-6 months and biochemical markers of nutrition. All investigated nutritional parameters were significantly different in IBD patients compared to control subjects, except MCV, tryglicerides and serum total protein level. Serum albumin level and body mass index (BMI) were the most predictive parameters of malnutrition. According to different assessment methods the prevalence of undernutrition and severe undernutrition in patients with active IBD were 25.0%-69.7% and 1.3%-31.6%, respectively, while in the control subjects no abnormalities have been detected. There was no statistically significant difference of nutritional parameters between UC and CD patients except lower mid-arm muscle circumference in UC group. Malnutrition is common in IBD patients. BMI and serum albumin are simple and convenient methods for the assessment of the nutritional status in IBD patients. Further studies with larger group of patients are necessary to elucidate the prevalence of malnutrition and the most accurate assessment methods in IBD patients.

  4. Challenging patient safety culture: survey results.

    PubMed

    Hellings, Johan; Schrooten, Ward; Klazinga, Niek; Vleugels, Arthur

    2007-01-01

    The purpose of this paper is to measure patient safety culture in five Belgian general hospitals. Safety culture plays an important role in the approach towards greater patient safety in hospitals. The Patient Safety Culture Hospital questionnaire was distributed hospital-wide in five general hospitals. It evaluates ten patient safety culture dimensions and two outcomes. The scores were expressed as the percentage of positive answers towards patient safety for each dimension. The survey was conducted from March through November 2005. In total, 3,940 individuals responded (overall response rate = 77 per cent), including 2,813 nurses and assistants, 462 physicians, 397 physiotherapists, laboratory and radiology assistants, social workers and 64 pharmacists and pharmacy assistants. The dimensional positive scores were found to be low to average in all the hospitals. The lowest scores were "hospital management support for patient safety" (35 per cent), "non-punitive response to error" (36 per cent), "hospital transfers and transitions" (36 per cent), "staffing" (38 per cent), and "teamwork across hospital units" (40 per cent). The dimension "teamwork within hospital units" generated the highest score (70 per cent). Although the same dimensions were considered problematic in the different hospitals, important variations between the five hospitals were observed. A comprehensive and tailor-made plan to improve patient safety culture in these hospitals can now be developed. Results indicate that important aspects of the patient safety culture in these hospitals need improvement. This is an important challenge to all stakeholders wishing to improve patient safety.

  5. Hodgkin lymphoma patients in first remission: routine positron emission tomography/computerized tomography imaging is not superior to clinical follow-up for patients with no residual mass.

    PubMed

    Dann, Eldad J; Berkahn, Leanne; Mashiach, Tatiana; Frumer, Michael; Agur, Ariel; McDiarmid, Bridgett; Bar-Shalom, Rachel; Paltiel, Ora; Goldschmidt, Neta

    2014-03-01

    There is no consensus regarding optimal follow-up mode for Hodgkin lymphoma (HL) patients that achieve complete remission following chemotherapy or combined chemo- and radiation therapy. Several studies demonstrated high sensitivity of positron emission tomography/computerized tomography (PET/CT) in detecting disease progression; however, these techniques are currently not recommended for routine follow-up. This retrospective study conducted in two Israeli (N = 291) and one New Zealand academic centres (N = 77), compared a group of HL patients, followed-up with routine imaging every 6 months during the first 2 years after achieving remission, once in the third year, with additional dedicated studies performed due to symptoms or physical findings (Group I) to a group of patients without residual masses who underwent clinically-based surveillance with dedicated imaging upon relapse suspicion (Group II). Five-year overall survival (OS) was 94% and median time to relapse was 8·6 months for both modes. Relapse rates in Groups I and II were 13% and 9%, respectively. During the first 3 years of follow-up, 47·5 and 4·7 studies were performed per detected relapse in Groups I and II, respectively. The current study demonstrated no benefit in either progression-free survival (PFS) or OS in HL patients followed by routine imaging versus clinical follow-up. The cost was 10 times higher for routine imaging. © 2013 John Wiley & Sons Ltd.

  6. The lack of effect of routine magnesium administration on respiratory function in mechanically ventilated patients.

    PubMed

    Johnson, D; Gallagher, C; Cavanaugh, M; Yip, R; Mayers, I

    1993-08-01

    We wished to determine if magnesium infusion would improve respiratory muscle function in long-term ventilated patients even in the absence of hypomagnesemia. Prospective study of mechanically ventilated patients using a double-blind crossover design. A combined medical-surgical ICU of a university teaching hospital. Twenty-one separate admissions to the ICU in 20 patients were studied. Patients who were selected had been intubated and mechanically ventilated for at least 6 days with the admitting diagnosis of respiratory failure. Twelve patients received 6 g MgSO4 intravenous (i.v.) infusion over 16 h on day 1 followed by placebo infusion on day 2. Nine patients received placebo on day 1 followed by MgSO4 (6 g i.v.) on day 2. We measured vital capacity (VC), maximal inspiratory pressure (Pmax) and maximal expiratory pressure (Pemax) in all patients. There were no significant differences in Pimax (37 +/- 14 vs 42 +/- 20 cm H2O), Pemax (59 +/- 32 vs 61 +/- 38 cm H2O), and VC (850 +/- 460 vs 960 +/- 490 ml) comparing values before and after magnesium infusion. We could not find a subgroup of patients with a marked improvement in Pimax or Pemax. In patients requiring mechanical ventilation for respiratory failure, magnesium infusion is not associated with increased respiratory muscle strength. Although a trial of MgSO4 administration may be considered for patients with difficulty weaning from mechanical ventilation, it is unlikely to result in clinical improvement.

  7. Do patients undergoing MitraClip implantation require routine ICU admission?

    PubMed

    Di Prima, Ambra L; Covello, Daniel R; Franco, Annalisa; Gerli, Chiara; Lembo, Rosalba; Denti, Paolo; Godino, Cosmo; Taramasso, Maurizio; Maisano, Francesco; Pappalardo, Federico

    2014-12-01

    Because of its reduced invasiveness, MitraClip (Abbott Vascular, Menlo Park, CA) therapy usually is reserved for patients with extreme left ventricular dysfunction or severe comorbidity contraindicating surgery. The appropriate post-procedural care in this high-risk population is yet to be defined. In this study, the postoperative course of such patients is reported, focusing on early complications and need for intensive care unit (ICU) management. A retrospective analysis of patients with severe mitral regurgitation undergoing transcatheter mitral valve repair with the MitraClip system in the authors institution was performed. One hundred thirty patients underwent MitraClip implantation between 2008 and 2012. At the end of the procedure, all patients were admitted to the ICU. Median ICU stay was 0.98 (0.82-1.87) days. Median mechanical ventilation time was 9.5 (6.8-14.1) hours. One hundred one patients (78%) required inotropic support and 13 patients (10%) suffered cardiogenic shock and required intra-aortic balloon pump support. No patient died during the procedure, but 3 patients died in the ICU. Three postoperative course profiles were identified: Fast-track, overnight stay, and critical illness. Twenty-four patients (18.5%) had an uneventful postoperative course, 89 patients (68.5%) suffered minor complications, and 17 patients (13.1%) required intensive care management and organ support. Preoperative serum creatinine (odds ratio [OR] 1.8; p = 0.014), cardiogenic shock (OR 34,8; p = 0.002), ventricular tachycardia (OR 2.8; p = 0.03), and intra procedural inotropes (OR 4; p = 0.001) were correlated with a complicated postoperative course. A large number of patients undergoing MitraClip could be managed with a fast-track ICU course; however, it still is difficult to predict the postoperative course based on preoperative characteristics. Copyright © 2014 Elsevier Inc. All rights reserved.

  8. Current use of routinely collected health data to complement randomized controlled trials: a meta-epidemiological survey

    PubMed Central

    Hemkens, Lars G.; Contopoulos-Ioannidis, Despina G.; Ioannidis, John P.A.

    2016-01-01

    Background: Studies that use routinely collected health data (RCD studies) are advocated to complement evidence from randomized controlled trials (RCTs) for comparative effectiveness research and to inform health care decisions when RCTs would be unfeasible. We aimed to evaluate the current use of routinely collected health data to complement RCT evidence. Methods: We searched PubMed for RCD studies published to 2010 that evaluated the comparative effectiveness of medical treatments on mortality using propensity scores. We identified RCTs of the same treatment comparisons and evaluated how frequently the RCD studies analyzed treatments that had not been compared previously in randomized trials. When RCTs did exist, we noted the claimed motivations for each RCD study. We also analyzed the citation impact of the RCD studies. Results: Of 337 eligible RCD studies identified, 231 (68.5%) analyzed treatments that had already been compared in RCTs. The study investigators rarely claimed that it would be unethical (6/337) or difficult (18/337) to perform RCTs on the same question. Evidence from RCTs was mentioned or cited by authors of 213 RCD studies. The most common motivations for conducting the RCD studies were alleged limited generalizability of trial results to the "real world" (37.6%), evaluation of specific outcomes (31.9%) or specific populations (23.5%), and inconclusive or inconsistent evidence from randomized trials (25.8%). Studies evaluating "real world" effects had the lowest citation impact. Interpretation: Most of the RCD studies we identified explored comparative treatment effects that had already been investigated in RCTs. The objective of such studies needs to shift more toward answering pivotal questions that are not supported by trial evidence or for which RCTs would be unfeasible. PMID:27398355

  9. Current use of routinely collected health data to complement randomized controlled trials: a meta-epidemiological survey.

    PubMed

    Hemkens, Lars G; Contopoulos-Ioannidis, Despina G; Ioannidis, John P A

    2016-01-01

    Studies that use routinely collected health data (RCD studies) are advocated to complement evidence from randomized controlled trials (RCTs) for comparative effectiveness research and to inform health care decisions when RCTs would be unfeasible. We aimed to evaluate the current use of routinely collected health data to complement RCT evidence. We searched PubMed for RCD studies published to 2010 that evaluated the comparative effectiveness of medical treatments on mortality using propensity scores. We identified RCTs of the same treatment comparisons and evaluated how frequently the RCD studies analyzed treatments that had not been compared previously in randomized trials. When RCTs did exist, we noted the claimed motivations for each RCD study. We also analyzed the citation impact of the RCD studies. Of 337 eligible RCD studies identified, 231 (68.5%) analyzed treatments that had already been compared in RCTs. The study investigators rarely claimed that it would be unethical (6/337) or difficult (18/337) to perform RCTs on the same question. Evidence from RCTs was mentioned or cited by authors of 213 RCD studies. The most common motivations for conducting the RCD studies were alleged limited generalizability of trial results to the "real world" (37.6%), evaluation of specific outcomes (31.9%) or specific populations (23.5%), and inconclusive or inconsistent evidence from randomized trials (25.8%). Studies evaluating "real world" effects had the lowest citation impact. Most of the RCD studies we identified explored comparative treatment effects that had already been investigated in RCTs. The objective of such studies needs to shift more toward answering pivotal questions that are not supported by trial evidence or for which RCTs would be unfeasible.

  10. The effect of routine rounding by nursing staff on patient satisfaction on a cardiac telemetry unit.

    PubMed

    Sobaski, Tanya; Abraham, Merline; Fillmore, Rhonda; McFall, Dawn E; Davidhizar, Ruth

    2008-01-01

    Patients' perception of their care is affected by the attention they receive while hospitalized. It has become a popular metric for improving the quality of care delivered. Rounding is believed to be the key to patients' perception of the care they receive. In this study, nursing administration wanted to increase patient's perception of how well their needs were being met. Regular scheduled rounding provided an opportunity for nursing to interact with patients on a regular schedule. All nursing care categories measured exceeded the goal of 90% in the first month after implementation, with the largest increase of averaged percentages being "attention to special or personal needs.

  11. Comparison of Reconstruction Intervals in Routine ECG-Pulsed 64-Row-MSCT Coronary Angiography in Frequency Controlled Patients

    SciTech Connect

    Frydrychowicz, Alex Pache, Gregor; Saueressig, Ulrich; Foell, Daniela; Kotter, Elmar; Langer, Mathias; Bley, Thorsten A.

    2007-02-15

    Purpose. In light of the increasing use and acceptance of multislice computed tomography (MSCT) coronary angiography it was the purpose of this study to compare reconstruction intervals used in a routine ECG-pulsed MSCT coronary artery angiography setting with frequency controlled patients. Methods. Examinations were performed on a Siemens Somatom Sensation 64 scanner with a total of 110 ml of contrast agent and ECG pulsing (interval from 40% to 70%) after oral application of a {beta}-blocker if the heart rate was higher than 65 bpm. All human subjects were referred for the evaluation of suspected coronary artery disease. Coronary artery segments were evaluated by two experienced radiologists in a consensus reading. A ranking of diagnostic image quality (from 1 (no evaluation possible) to 5 (excellent image quality)) was statistically evaluated by Wilcoxon Signed Rank Test. Results. In 45 patients (30 male, 15 female, age 63.8 {+-} 12.1 years) we detected a significant advantage of the 60% reconstruction interval over 40%, 50%, and 70% (for each p < 0.05). In cases of sudden arrhythmia or movement during the scan, additional reconstruction intervals within the ECG-pulsed reconstruction intervals remained necessary for diagnosis. Conclusion. In a routine diagnostic setting with frequency controlled patients and ECG pulsing the 60% reconstruction interval can be considered superior for the initial diagnosis in 64-row multislice computed tomography coronary angiography. However, further information can be derived from various reconstruction intervals such as 40% and 70%.

  12. Feasibility and diagnostic accuracy of the Patient-Reported Outcomes Measurement Information System (PROMIS) item banks for routine surveillance of sleep and fatigue problems in ambulatory cancer care.

    PubMed

    Leung, Yvonne W; Brown, Catherine; Cosio, Andrea Perez; Dobriyal, Aditi; Malik, Noor; Pat, Vivien; Irwin, Margaret; Tomasini, Pascale; Liu, Geoffrey; Howell, Doris

    2016-09-15

    Routine screening for problematic symptoms is emerging as a best practice in cancer systems globally. The objective of this observational study was to assess the feasibility and diagnostic accuracy of Patient-Reported Outcomes Measurement Information System (PROMIS) computerized adaptive testing (CAT) for fatigue and sleep-disturbance items compared with legacy measures in routine ambulatory cancer care. Patients who attended outpatient clinics at the Princess Margaret Cancer Center completed PROMIS CAT item banks and legacy measures (the Functional Assessment of Chronic Illness Therapy [FACIT]-Fatigue scale and the Insomnia Severity Index [ISI]) using tablet computers during clinic visits. The completion rates, patient acceptability, and diagnostic accuracy of PROMIS CAT were evaluated against legacy measures using receiver operating characteristic (ROC) curve analysis. Participants consisted of 336 patients (mean age ± standard deviation, 57.4 ± 15.7 years; 55% females; 75% Caucasian). Over 98% of patients did not find symptom screening was burdensome, although only 65% were willing to complete the survey at every visit. PROMIS CAT scores were significantly correlated with both FACIT-Fatigue scores (r = -0.83) and ISI scores (r = -0.57; p < 0.0001 for all). Areas under the curve (AUC) by ROC analysis for fatigue were 0.946 using the FACIT-Fatigue cutoff ≤30, 0.910 for sleep disturbance, and 0.922 for sleep impairment using the ISI cutoff ≥15. The recommended T-score cut-off for PROMIS CAT Fatigue was 57, Sleep Disturbance was 57, and Sleep Impairment was 57. The current results support the feasibility and accuracy of PROMIS CAT and its potential for use in routine ambulatory cancer care. Future research will assess feedback of these data to clinicians and evaluate effects on earlier identification of and intervention for these problems. Cancer 2016. © 2016 American Cancer Society. Cancer 2016;122:2906-2917. © 2016 American Cancer

  13. Vascular calcification and atherosclerosis in hemodialysis patients: what can we learn from the routine clinical practice?

    PubMed

    Gelev, Saso; Spasovski, Goce; Dzikova, Sonja; Trajkovski, Zoran; Damjanovski, Goge; Amitov, Vili; Sikole, Aleksandar

    2008-01-01

    Hemodialysis (HD) patients are at increased risk for arterial intimal (AIC) and medial calcification (AMC). In a cross-sectional study on 153 HD patients we evaluated the presence of AIC and AMC using plain radiography of the pelvis and the presence of atherosclerotic lesions using high-resolution B-mode ultrasonography of the common carotid arteries (CCA). The radiography of the pelvis confirmed the frequent presence of AIC (35.3%) and AMC (35.9%) in our HD patients. Arterial calcification was absent (non calcified-NC) in a minority of patients (28.8%). Patients with AIC had significantly higher prevalence of atherosclerotic plaques on CCA (78.6%) compared with both other groups and a higher number of documented atherosclerotic complications, such as cardiovascular (85.2%), cerebrovascular (33.3%) and peripheral arterial disease (38.9%) in comparison with the NC patients. According to the 1-year calculated data from patient records, there were no significant differences in the specific HD risks, such as the dose of prescribed calcium carbonate and vitamin D3, serum levels of calcium, phosphate, calcium-phosphate product and intact parathyroid hormone. All four bone metabolism markers within the range proposed by K/DOQI guidelines were achieved in 9.3%, 14.5% and 20.4% in the AIC, AMC and NC group, respectively. Patients with AIC and AMC are frequently found in the HD population. Screening for arterial calcifications in chronic kidney disease patients is suggested even in the early pre-dialysis period. The highest proportion of patients within the guidelines proposed range for bone and mineral metabolism markers was observed in the NC group. A longer period of data analysis is required in order to evaluate the possible role of some traditional and HD-specific risk factors for the development of arterial calcifications. The achievement of the K/DOQI guidelines is an important issue in the prevention of those conditions.

  14. Feasibility of Long-Term Patient Self-Reporting of Toxicities From Home via the Internet During Routine Chemotherapy

    PubMed Central

    Judson, Timothy J.; Bennett, Antonia V.; Rogak, Lauren J.; Sit, Laura; Barz, Allison; Kris, Mark G.; Hudis, CliffordA.; Scher, Howard I.; Sabattini, Paul; Schrag, Deborah; Basch, Ethan

    2013-01-01

    Purpose Patient-reported outcomes are increasingly used in routine outpatient cancer care to guide clinical decisions and enhance communication. Prior evidence suggests good patient compliance with reporting at scheduled clinic visits, but there is limited evidence about compliance with long-term longitudinal reporting between visits. Patients and Methods Patients receiving chemotherapy for lung, gynecologic, genitourinary, or breast cancer at a tertiary cancer center, with access to a home computer and prior e-mail experience, were asked to self-report seven symptomatic toxicities via the Web between visits. E-mail reminders were sent to participants weekly; patient-reported high-grade toxicities triggered e-mail alerts to nurses; printed reports were provided to oncologists at visits. A priori threshold criteria were set to determine if this data collection approach merited further development based on monthly (≥ 75% participants reporting at least once per month on average) and weekly compliance rates (60% at least once per week). Results Between September 2006 and November 2010, 286 patients were enrolled (64% were women; 88% were white; median age, 58 years). Mean follow-up was 34 weeks (range, 2 to 214). On average, monthly compliance was 83%, and weekly compliance was 62%, without attrition until the month before death. Greater compliance was associated with older age and higher education but not with performance status. Compliance was greatest during the initial 12 weeks. Symptomatic illness and technical problems were rarely barriers to compliance. Conclusion Monthly compliance with home Web reporting was high, but weekly compliance was lower, warranting strategies to enhance compliance in routine care settings. PMID:23733753

  15. Costs of cancer care for use in economic evaluation: a UK analysis of patient-level routine health system data.

    PubMed

    Hall, P S; Hamilton, P; Hulme, C T; Meads, D M; Jones, H; Newsham, A; Marti, J; Smith, A F; Mason, H; Velikova, G; Ashley, L; Wright, P

    2015-03-03

    The rising financial burden of cancer on health-care systems worldwide has led to the increased demand for evidence-based research on which to base reimbursement decisions. Economic evaluations are an integral component of this necessary research. Ascertainment of reliable health-care cost and quality-of-life estimates to inform such studies has historically been challenging, but recent advances in informatics in the United Kingdom provide new opportunities. The costs of hospital care for breast, colorectal and prostate cancer disease-free survivors were calculated over 15 months from initial diagnosis of cancer using routinely collected data within a UK National Health Service (NHS) Hospital Trust. Costs were linked at patient level to patient-reported outcomes and registry-derived sociodemographic factors. Predictors of cost and the relationship between costs and patient-reported utility were examined. The study population included 223 breast cancer patients, 145 colorectal and 104 prostate cancer patients. The mean 15-month cumulative health-care costs were £12 595 (95% CI £11 517-£13 722), £12 643 (£11 282-£14 102) and £3722 (£3263-£4208), per-patient respectively. The majority of costs occurred within the first 6 months from diagnosis. Clinical stage was the most important predictor of costs for all cancer types. EQ-5D score was predictive of costs in colorectal cancer but not in breast or prostate cancer. It is now possible to evaluate health-care cost using routine NHS data sets. Such methods can be utilised in future retrospective and prospective studies to efficiently collect economic data.

  16. Should All Congestive Heart Failure Patients Have a Routine Sleep Apnea Screening? Pro.

    PubMed

    Sériès, Frédéric

    2015-07-01

    Sleep-disordered breathing (SDB) is highly prevalent in heart failure (HF) patients. These breathing disturbances are independent predictors of increased morbidity and comorbid conditions that improve with SDB treatment. Considering the overlap between SDB-related and HF clinical symptoms reported by patients, objective tests need to be conducted for a diagnosis to be firmly established and to determine the type and severity of SDB that will dictate treatment alternatives. Considering the high success rate and diagnostic value of ambulatory monitoring techniques, they represent a practical, cost-effective, and accurate alternative to diagnosing SDB in HF patients.

  17. Routine Histopathologic Examination of Appendectomy Specimens: Retrospective Analysis of 1255 Patients

    PubMed Central

    Emre, Arif; Akbulut, Sami; Bozdag, Zehra; Yilmaz, Mehmet; Kanlioz, Murat; Emre, Rabia; Sahin, Nurhan

    2013-01-01

    The objective of this study was to analyze the clinical benefit of histopathologic analysis of appendectomy specimens from patients with an initial diagnosis of acute appendicitis. We retrospectively analyzed the demographic and histopathologic data of 1255 patients (712 males, 543 females; age range, 17–85 years) who underwent appendectomy to treat an initial diagnosis of acute appendicitis. Patients who underwent incidental appendectomy during other surgeries were excluded from the study. Histopathologic findings of the appendectomy specimens were used to confirm the initial diagnosis. Ninety-four percent of the appendectomy specimens were positive for appendicitis. Of those, 880 were phlegmonous appendicitis, 148 were gangrenous appendicitis with perforation, and the remaining 88 showed unusual histopathologic findings. In the 88 specimens with unusual pathology, fibrous obliteration was observed in 57 specimens, carcinoid tumor in 11, Encheliophis vermicularis parasite infection in 8, granulatomous inflammation in 6, appendiceal endometriosis in 2, and 1 specimen each showed mucocele, eosinophilic infiltration, Taenia saginata parasite infection, and appendicular diverticulitis. All carcinoid tumors were located in the distal appendix. Six of the 11 carcinoid tumors were defined by histopathology as involving tubular cells, and the other 5 as involving enterochromaffin cells. Six patients had muscularis propria invasion, 2 patients had submucosa invasion, 2 patients had mesoappendix invasion, and 1 patient had serosal invasion. All patients with tumors remained disease free during the follow-up (range, 1–27 months). We conclude that when the ratio of unusual pathologic findings for appendectomy specimens is considered, it is evident that all surgical specimens should be subjected to careful histologic examination. PMID:24229023

  18. Routine clinical evaluation of cerebrovascular reserve capacity using carbogen in patients with intracranial stenosis.

    PubMed

    Donahue, Manus J; Dethrage, Lindsey M; Faraco, Carlos C; Jordan, Lori C; Clemmons, Paul; Singer, Robert; Mocco, J; Shyr, Yu; Desai, Aditi; O'Duffy, Anne; Riebau, Derek; Hermann, Lisa; Connors, John; Kirshner, Howard; Strother, Megan K

    2014-08-01

    A promising method for identifying hemodynamic impairment that may serve as a biomarker for stroke risk in patients with intracranial stenosis is cerebrovascular reactivity (CVR) mapping using noninvasive MRI. Here, abilities to measure CVR safely in the clinic using hypercarbic hyperoxic (carbogen) gas challenges, which increase oxygen delivery to tissue, are investigated. In sequence with structural and angiographic imaging, blood oxygenation level-dependent carbogen-induced CVR scans were performed in patients with symptomatic intracranial stenosis (n=92) and control (n=10) volunteers, with a subgroup of patients (n=57) undergoing cerebral blood flow-weighted pseudocontinuous arterial spin labeling CVR. Subjects were stratified for 4 substudies to evaluate relationships between (1) carbogen and hypercarbic normoxic CVR in healthy tissue (n=10), (2) carbogen cerebral blood flow CVR and blood oxygenation level-dependent CVR in intracranial stenosis patients (n=57), (3) carbogen CVR and clinical measures of disease in patients with asymmetrical intracranial atherosclerotic (n=31) and moyamoya (n=29) disease, and (4) the CVR scan and immediate and longer-term complications (n=92). Noninvasive blood oxygenation level-dependent carbogen-induced CVR values correlate with (1) lobar hypercarbic normoxic gas stimuli in healthy tissue (R=0.92; P<0.001), (2) carbogen-induced cerebral blood flow CVR in patients with intracranial stenosis (R=0.30-0.33; P<0.012), and (3) angiographic measures of disease severity both in atherosclerotic and moyamoya patients after appropriate processing. No immediate stroke-related complications were reported in response to carbogen administration; longer-term neurological events fell within the range for expected events in this patient population. Carbogen-induced CVR elicited no added adverse events and provided a surrogate marker of cerebrovascular reserve consistent with intracranial vasculopathy. © 2014 American Heart Association, Inc.

  19. Routine clinical evaluation of cerebrovascular reserve capacity using carbogen in patients with intracranial stenosis

    PubMed Central

    Donahue, Manus J.; Dethrage, Lindsey; Faraco, Carlos C.; Jordan, Lori C.; Clemmons, Paul; Singer, Robert; Mocco, J; Shyr, Yu; Desai, Aditi; O’Duffy, Anne; Riebau, Derek; Hermann, Lisa; Connors, John; Kirshner, Howard; Strother, Megan K.

    2014-01-01

    Background and Purpose A promising method for identifying hemodynamic impairment that may serve as a biomarker for stroke risk in patients with intracranial (IC) stenosis is cerebrovascular reactivity (CVR) mapping using non-invasive MRI. Here, abilities to measure CVR safely in the clinic using hypercarbic hyperoxic (carbogen) gas challenges, which increase oxygen delivery to tissue, are investigated. Methods In sequence with structural and angiographic imaging, blood-oxygenation-level-dependent (BOLD) carbogen-induced CVR scans were performed in patients with symptomatic IC stenosis (n=92) and control (n=10) volunteers, with a subgroup of patients (n=57) undergoing cerebral blood flow-weighted (CBFw) pseudo-continuous arterial spin labeling (pCASL) CVR. Subjects were stratified for four sub-studies: to evaluate relationships between (i) carbogen and hyercarbic normoxic (HN) CVR in healthy tissue (n=10), (ii) carbogen CBF CVR and BOLD CVR in IC stenosis patients (n=57), (iii) carbogen CVR and clinical measures of disease in patients with asymmetric IC atherosclerotic (n=31) and moyamoya (n=29) disease, and (iv) the CVR scan and immediate and longer-term complications (n=92). Results Non-invasive BOLD carbogen-induced CVR values correlate with (i) lobar HN gas stimuli in healthy tissue (R=0.92; P<0.001), (ii) carbogen-induced CBF CVR in IC stenosis patients (R=0.30–0.33; P<0.012), and (iii) angiographic measures of disease severity both in atherosclerotic and moyamoya patients after appropriate processing. No immediate stroke-related complications were reported in response to carbogen administration; longer-term neurological events fell within the range for expected events in this patient population. Conclusions Carbogen-induced CVR elicited no added adverse events and provided a surrogate marker of cerebrovascular reserve consistent with IC vasculopathy. PMID:24938845

  20. Routine pre-operative focused ultrasonography by anesthesiologists in patients undergoing urgent surgical procedures.

    PubMed

    Bøtker, M T; Vang, M L; Grøfte, T; Sloth, E; Frederiksen, C A

    2014-08-01

    Unexpected cardiopulmonary complications are well described during surgery and anesthesia. Pre-operative evaluation by focused cardiopulmonary ultrasonography may prevent such mishaps. The aim of this study was to determine the frequency of unexpected cardiopulmonary pathology with focused ultrasonography in patients undergoing urgent surgical procedures. We performed pre-operative focused cardiopulmonary ultrasonography in patients aged 18 years or above undergoing urgent surgical procedures at pre-defined study days. Known and unexpected cardiopulmonary pathology was recorded, and subsequent changes in the anesthesia technique or supportive actions were registered. A total of 112 patients scheduled for urgent surgical procedures were included. Their mean age (standard deviation) was 62 (21) years. Of these patients, 24% were American Society of Anesthesiologists (ASA) class 1, 39% were ASA class 2, 32% were ASA class 3, and 4% were ASA class 4. Unexpected cardiopulmonary pathology was disclosed in 27% [95% confidence interval (CI) 19-36] of the patients and led to a change in anesthesia technique or supportive actions in 43% (95% CI 25-63) of these. Unexpected pathology leading to changes in anesthesia technique or supportive actions was only disclosed in a group of patients above the age of 60 years and/or in ASA class ≥ 3. Focused cardiopulmonary ultrasonography disclosed unexpected pathology in patients undergoing urgent surgical procedures and induced changes in the anesthesia technique or supportive actions. Pre-operative focused ultrasonography seems feasible in patients above 60 year and/or with physical limitations but not in young, healthy individuals. © 2014 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  1. Clinical outcomes and cost effectiveness of accelerated diagnostic protocol in a chest pain center compared with routine care of patients with chest pain.

    PubMed

    Asher, Elad; Reuveni, Haim; Shlomo, Nir; Gerber, Yariv; Beigel, Roy; Narodetski, Michael; Eldar, Michael; Or, Jacob; Hod, Hanoch; Shamiss, Arie; Matetzky, Shlomi

    2015-01-01

    The aim of this study was to compare in patients presenting with acute chest pain the clinical outcomes and cost-effectiveness of an accelerated diagnostic protocol utilizing contemporary technology in a chest pain unit versus routine care in an internal medicine department. Hospital and 90-day course were prospectively studied in 585 consecutive low-moderate risk acute chest pain patients, of whom 304 were investigated in a designated chest pain center using a pre-specified accelerated diagnostic protocol, while 281 underwent routine care in an internal medicine ward. Hospitalization was longer in the routine care compared with the accelerated diagnostic protocol group (p<0.001). During hospitalization, 298 accelerated diagnostic protocol patients (98%) vs. 57 (20%) routine care patients underwent non-invasive testing, (p<0.001). Throughout the 90-day follow-up, diagnostic imaging testing was performed in 125 (44%) and 26 (9%) patients in the routine care and accelerated diagnostic protocol patients, respectively (p<0.001). Ultimately, most patients in both groups had non-invasive imaging testing. Accelerated diagnostic protocol patients compared with those receiving routine care was associated with a lower incidence of readmissions for chest pain [8 (3%) vs. 24 (9%), p<0.01], and acute coronary syndromes [1 (0.3%) vs. 9 (3.2%), p<0.01], during the follow-up period. The accelerated diagnostic protocol remained a predictor of lower acute coronary syndromes and readmissions after propensity score analysis [OR = 0.28 (CI 95% 0.14-0.59)]. Cost per patient was similar in both groups [($2510 vs. $2703 for the accelerated diagnostic protocol and routine care group, respectively, (p = 0.9)]. An accelerated diagnostic protocol is clinically superior and as cost effective as routine in acute chest pain patients, and may save time and resources.

  2. [The peripheral vestibular disorders encountered in the routine out-patient practical work].

    PubMed

    Zamergrad, M V; Parfenov, V A; Morozova, S V; Mel'nikov, O A; Antonenko, L M

    2017-01-01

    The objective of the present study was to elucidate the frequency of causes underlying the development of dizziness and vertigo in the patients seeking advice and care at an outpatient healthcare facility. A total of 590 patients with complaints of dizziness and vertigo were examined. It was found out that the peripheral disorders of the vestibular analyzer were the most frequent causes of dizziness and vertigo in the majority of the examined patients. These conditions were documented to occur in more than 65% of the patients. The most common forms of peripheral vestibular disorders were benign paroxysmal positional vertigo, Meniere's disease, and vestibular neuronitis. The central vestibular disorders occurred considerably less frequently than peripheral ones and were diagnosed only in 10.9% of the patients. The results of the study provided a basis for the development of the algorithm forthe bedside examination of the patients presenting with vertigo and dizziness associated with peripheral vestibular disorders. It is emphasized that such examination should include, besides the standard neurological studies, the neuro-otological tests making it possible to detect the most common forms of peripheral vestibular disorders.

  3. Body dysmorphic disorder in patients undergoing septorhinoplasty surgery: should we be performing routine screening?

    PubMed

    Joseph, J; Randhawa, P; Hannan, S A; Long, J; Goh, S; O'Shea, N; Saleh, H; Hansen, E; Veale, D; Andrews, P

    2017-06-01

    Body dysmorphic disorder (BDD) is defined as having a preoccupation with a perceived flaw in one's appearance, which appears slight to others and significantly interferes with a person's functioning. When undetected in septorhinoplasty patients, it will often lead to poor outcomes. We performed a prospective cohort study to determine the prevalence of BDD in our patients and whether surgical correction could be considered. We recruited 34 patients being considered for septorhinoplasty in a tertiary referral rhinology clinic and a control group of 50 from the otology clinic giving a total of 84. Participants completed the Body Dysmorphic Disorder Questionnaire (BDDQ), the sino-nasal outcome test-23 (SNOT-23) and underwent nasal inspiratory peak flow (NIPF). Those found to be at high risk for BDD were referred to a clinical psychologist. Of the septorhinoplasty patients, 11 (32%) were high risk for BDD. Following psychological assessment, 7 (63%) patients were felt to be unsuitable for surgery and were offered psychological therapy. SNOT-23 scores were significantly higher in the BDD group indicating a negative impact on quality of life. NIPF readings were not significantly different in the BDD group compared to the control group. The BDDQ is a valid tool for identifying patients at risk of BDD. A close working relationship with clinical psychology has been advantageous to help the selection process of candidates for surgery when there is a high risk of BDD. © 2016 John Wiley & Sons Ltd.

  4. Feasibility of long-term patient self-reporting of toxicities from home via the Internet during routine chemotherapy.

    PubMed

    Judson, Timothy J; Bennett, Antonia V; Rogak, Lauren J; Sit, Laura; Barz, Allison; Kris, Mark G; Hudis, Clifford A; Scher, Howard I; Sabattini, Paul; Schrag, Deborah; Basch, Ethan

    2013-07-10

    Patient-reported outcomes are increasingly used in routine outpatient cancer care to guide clinical decisions and enhance communication. Prior evidence suggests good patient compliance with reporting at scheduled clinic visits, but there is limited evidence about compliance with long-term longitudinal reporting between visits. Patients receiving chemotherapy for lung, gynecologic, genitourinary, or breast cancer at a tertiary cancer center, with access to a home computer and prior e-mail experience, were asked to self-report seven symptomatic toxicities via the Web between visits. E-mail reminders were sent to participants weekly; patient-reported high-grade toxicities triggered e-mail alerts to nurses; printed reports were provided to oncologists at visits. A priori threshold criteria were set to determine if this data collection approach merited further development based on monthly (≥ 75% participants reporting at least once per month on average) and weekly compliance rates (60% at least once per week). Between September 2006 and November 2010, 286 patients were enrolled (64% were women; 88% were white; median age, 58 years). Mean follow-up was 34 weeks (range, 2 to 214). On average, monthly compliance was 83%, and weekly compliance was 62%, without attrition until the month before death. Greater compliance was associated with older age and higher education but not with performance status. Compliance was greatest during the initial 12 weeks. Symptomatic illness and technical problems were rarely barriers to compliance. Monthly compliance with home Web reporting was high, but weekly compliance was lower, warranting strategies to enhance compliance in routine care settings.

  5. Are Mortality and Acute Morbidity in Patients Presenting With Nonspecific Complaints Predictable Using Routine Variables?

    PubMed

    Jenny, Mirjam A; Hertwig, Ralph; Ackermann, Selina; Messmer, Anna S; Karakoumis, Julia; Nickel, Christian H; Bingisser, Roland

    2015-10-01

    Patients presenting to the emergency department (ED) with nonspecific complaints are difficult to accurately triage, risk stratify, and diagnose. This can delay appropriate treatment. The extent to which key medical outcomes are at all predictable in these patients, and which (if any) predictors are useful, has previously been unclear. To investigate these questions, we tested an array of statistical and machine learning models in a large group of patients and estimated the predictability of mortality (which occurred in 6.6% of our sample of patients), acute morbidity (58%), and presence of acute infectious disease (28.2%). To investigate whether the best available tools can predict the three key outcomes, we fed data from a sample of 1,278 ED patients with nonspecific complaints into 17 state-of-the-art statistical and machine learning models. The patient sample stems from a diagnostic multicenter study with prospective 30-day follow-up conducted in Switzerland. Predictability of the three key medical outcomes was quantified by computing the area under the receiver operating characteristic curve (AUC) for each model. The models performed at different levels but, on average, the predictability of the target outcomes ranged between 0.71 and 0.82. The better models clearly outperformed physicians' intuitive judgments of how ill patients looked (AUC = 0.67 for mortality, 0.65 for morbidity, and 0.60 for infectious disease). Modeling techniques can be used to derive formalized models that, on average, predict the outcomes of mortality, acute morbidity, and acute infectious disease in patients with nonspecific complaints with a level of accuracy far beyond chance. The models also predicted these outcomes more accurately than did physicians' intuitive judgments of how ill the patients look; however, the latter was among the small set of best predictors for mortality and acute morbidity. These results lay the groundwork for further refining triage and risk stratification

  6. Use of routinely available clinical, nutritional, and functional criteria to classify cachexia in advanced cancer patients.

    PubMed

    Vigano, Antonio A L; Morais, José A; Ciutto, Lorella; Rosenthall, Leonard; di Tomasso, Jonathan; Khan, Sarah; Olders, Henry; Borod, Manuel; Kilgour, Robert D

    2017-10-01

    Cachexia is a highly prevalent syndrome in cancer and chronic diseases. However, due to the heterogeneous features of cancer cachexia, its identification and classification challenge clinical practitioners. To determine the clinical relevance of a cancer cachexia classification system in advanced cancer patients. Beginning with the four-stage classification system proposed for cachexia [non-cachexia (NCa), pre-cachexia (PCa), cachexia (Ca) and refractory cachexia (RCa)], we assigned patients to these cachexia stages according to five classification criteria available in clinical practice: 1) biochemistry (high C-reactive protein or leukocytes, or hypoalbuminemia, or anemia), 2) food intake (normal/decreased), weight loss: 3) moderate (≤5%) or 4) significant (>5%/past six months) and 5) performance status (Eastern Cooperative Oncology Group Performance Status ≥ 3). We then determined if symptom severity, body composition changes, functional levels, hospitalizations and survival rates varied significantly across cachexia stages. Two-hundred and ninety-seven advanced cancer patients with primary gastrointestinal and lung tumors were included. Patients were classified into Ca (36%), PCa and RCa (21%, respectively) and NCa (15%). Significant (p < 0.05) differences were observed among cachexia stages for most of the outcome measures (symptoms, body composition, handgrip strength, emergency room visits and length of hospital stays) according to cachexia severity. Survival also differed between cachexia stages (except between PCa and Ca). Five clinical criteria can be used to stage cancer cachexia patients and predict important clinical, nutritional and functional outcomes. The lack of statistical difference between PCa and Ca in almost all clinical outcomes examined suggests either that the PCa group includes patients already affected by early cachexia or that more precise criteria are needed to differentiate PCa from Ca patients. More studies are required to

  7. Routes to diagnosis for cancer – determining the patient journey using multiple routine data sets

    PubMed Central

    Elliss-Brookes, L; McPhail, S; Ives, A; Greenslade, M; Shelton, J; Hiom, S; Richards, M

    2012-01-01

    Background: Cancer survival in England is lower than the European average, which has been at least partly attributed to later stage at diagnosis in English patients. There are substantial regional and demographic variations in cancer survival across England. The majority of patients are diagnosed following symptomatic or incidental presentation. This study defines a methodology by which the route the patient follows to the point of diagnosis can be categorised to examine demographic, organisational, service and personal reasons for delayed diagnosis. Methods: Administrative Hospital Episode Statistics data are linked with Cancer Waiting Times data, data from the cancer screening programmes and cancer registration data. Using these data sets, every case of cancer registered in England, which was diagnosed in 2006–2008, is categorised into one of eight ‘Routes to Diagnosis'. Results: Different cancer types show substantial differences between the proportion of cases that present by each route, in reasonable agreement with previous clinical studies. Patients presenting via Emergency routes have substantially lower 1-year relative survival. Conclusion: Linked cancer registration and administrative data can be used to robustly categorise the route to a cancer diagnosis for all patients. These categories can be used to enhance understanding of and explore possible reasons for delayed diagnosis. PMID:22996611

  8. Routine use of punch biopsy to diagnose small fiber neuropathy in fibromyalgia patients.

    PubMed

    Levine, Todd D; Saperstein, David S

    2015-03-01

    Fibromyalgia is a clinical syndrome that currently does not have any specific pathological finding to aid in diagnosis. Therefore, fibromyalgia is most likely a heterogeneous group of diseases with similar symptoms. Identifying and understanding the pathological basis of fibromyalgia will allow physicians to better categorize patients, increasing prospective treatment options, and improving potential therapeutic endeavors. Recent work has demonstrated that approximately 50% of patients diagnosed with fibromyalgia have damage to their small unmyelinated nerve fibers. A skin punch biopsy is a sensitive and specific diagnostic test for this damage as a reduction in nerve fiber density allows for the diagnosis of small fiber neuropathy. Small fiber neuropathy is a disease with symptoms similar to fibromyalgia, but it often has a definable etiology. Identifying small fiber neuropathy and its underlying cause in fibromyalgia patients provides them with a succinct diagnosis, increases treatment options, and facilitates more specific studies for future therapeutics.

  9. Prognosis of Binet stage A chronic lymphocytic leukemia patients: the strength of routine parameters.

    PubMed

    Letestu, Rémi; Lévy, Vincent; Eclache, Virginie; Baran-Marszak, Fanny; Vaur, Dominique; Naguib, Dina; Schischmanoff, Olivier; Katsahian, Sandrine; Nguyen-Khac, Florence; Davi, Frédéric; Merle-Béral, Hélène; Troussard, Xavier; Ajchenbaum-Cymbalista, Florence

    2010-11-25

    Recent developments in the management of chronic lymphocytic leukemia (CLL) patients have made necessary the availability of dependable prognostic factors. We have developed a prognostic index derived from the multivariate analysis of 339 stage A patients at diagnosis, exhaustively studied for classical and recent predictive markers. Only 4 biologic parameters were found to be independent predictors of progression-free survival (PFS): serum thymidine kinase (sTK), lymphocytosis, β2-microglobulin, and CD38 expression. Two groups were distinguishable: cases with no or 1 risk factor (among whom 85% did not progress after 7 years), and cases with 2 or more factors showing a median PFS of 20 months. Finally, we propose an easy, fast, cost-effective strategy for a trustworthy prognostication in stage A patients, who currently represent more than 80% of the CLL population, allowing physicians to adapt follow-up individually.

  10. Cardiovascular involvement in patients with diabetic macular oedema treated with intravitreal ranibizumab in routine clinical practice.

    PubMed

    Díaz-Rodríguez, R; Abreu-González, R; Dolz-Marco, R; Gallego-Pinazo, R

    2017-07-01

    To determine the cardiovascular events in naïve patients with diabetic macular oedema, before and after being treated with intravitreal ranibizumab. A retrospective and descriptive study was conducted on patients with diabetic macular oedema and foveal involvement, who started treatment with intravitreal ranibizumab in 2014 in the Hospital Universitario Nuestra Señora de Candelaria and the Hospital Universitario y Politécnico La Fe. During the follow-up until August 2015, a record was made of parameters, including the prevalence and incidence of stroke and myocardial infarction. Among the 1,324 intravitreal ranibizumab injections administered in 2014, only 159 of them corresponded to treatment initiation in 99 patients, with more than half requiring treatment of both eyes. The study patients included 58.4% males, in the 6th decade of life (Mean=65.93±11.24 years), non-smokers (86.7%), type 2 diabetes (91.9%), hypertension (70.7%), and with dyslipidaemia (65.7%). Prior to treatment initiation, it was found that 6 patients (6.1%) suffered from an acute myocardial infarction, and 8 (8.1%) from stroke, and only one (1%) with post-stroke (P=.039). In our experience it seems that the intravitreal ranibizumab in diabetic macular oedema could be a safe alternative in patients with a history of stroke and myocardial infarction. Copyright © 2016 Sociedad Española de Oftalmología. Publicado por Elsevier España, S.L.U. All rights reserved.

  11. Prevalence and routine assessment of unhealthy alcohol use in hospitalized patients.

    PubMed

    Rosón, Beatriz; Monte, Rafael; Gamallo, Rocío; Puerta, Ruben; Zapatero, Antonio; Fernández-Solá, Joaquín; Pastor, Isabel; Girón, José A; Laso, Javier

    2010-10-01

    To determine the prevalence of alcohol misuse among medical inpatients and the methods used by medical staff to evaluate alcohol consumption. Multicenter, prospective, observational, cross-sectional study performed at 21 hospitals in Spain. All adult patients hospitalized in internal medicine wards on 12 March 2008 were eligible for study. Alcohol consumption was evaluated with the Alcohol Use Disorders Identification Test (AUDIT-C and AUDIT) and the Systematic Inventory of Alcohol Consumption questionnaire. Drinking patterns were determined according to clinical evaluation using ICD-10 criteria. Medical records were reviewed to gather information on the recording of alcohol use. We assessed 1039 inpatients, of whom 123 (12%) had unhealthy alcohol drinking patterns. Alcohol misuse was more frequent among males (odds ratio 5.20), younger patients (odds ratio, 14.17), median age patients (odds ratio, 2.99), and South Region (odds ratio, 1.77). Alcohol use during hospitalization was recorded in 603 inpatients (59%); quantitative records were performed in 28% of hazardous and harmful drinkers and in 41% of dependent patients. Lack of alcohol use recording was more frequent among females (odds ratio 1.73), median and older age groups (odds ratios 1.44 and 1.73, respectively), Northwest Regions (odds ratios 3.46). Patients from the East Region (odds ratio 0.47) had more frequently assessed the question in their medical records. Prevalence of alcohol misuse was higher in hospitalized patients than in the general population. Adequate quantitative recording was infrequent. We stress the need to implement measures to increase and improve the detection and recording of alcohol use. Copyright (c) 2010 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  12. Vitamin B12 deficiency among patients with diabetes mellitus: is routine screening and supplementation justified?

    PubMed Central

    2013-01-01

    Vitamin B12 is an essential micronutrient required for optimal hemopoetic, neuro-cognitive and cardiovascular function. Biochemical and clinical vitamin B12 deficiency has been demonstrated to be highly prevalent among patients with type 1 and type 2 diabetes mellitus. It presents with diverse clinical manifestations ranging from impaired memory, dementia, delirium, peripheral neuropathy, sub acute combined degeneration of the spinal cord, megaloblastic anemia and pancytopenia. This review article offers a current perspective on the physiological roles of vitamin B12, proposed pathophysiological mechanisms of vitamin B12 deficiency, screening for vitamin B12 deficiency and vitamin B12 supplementation among patients with diabetes mellitus. PMID:23651730

  13. Can patient safety be measured by surveys of patient experiences?

    PubMed

    Solberg, Leif I; Asche, Stephen E; Averbeck, Beth M; Hayek, Anita M; Schmitt, Kay G; Lindquist, Tim C; Carlson, Richard R

    2008-05-01

    A study was conducted to test whether patient reports of medical errors via surveys could produce sufficiently accurate information to be used as a measure of patient safety. A survey mailed regularly by a large multispecialty medical group to recent patients to assess their satisfaction and error experiences was expanded to collect more details about the patient-perceived errors. Following an initial mailing to 3,109 patients and parents of child patients soon after they had office visits in June 2005, usable mailed or phone follow-up responses were obtained from 1,998 respondents (65.1% adjusted). Responses were reviewed through a two-stage process that included chart audits and implicit physician reviewer judgments. The analysis categorized the review results and compared patient-reported errors with satisfaction. Of the 1,998 respondents, 219 (11.0%) reported 247 separate incidents, for a rate of 12.4 errors per 100 patients. After complete review, only 5 (2.0%) of these incidents were judged to be real clinician errors. Most appeared to represent misunderstandings or behavior/communication problems, but 15.4% lacked sufficient information to categorize. Women, Hispanics, and those aged 41-60 years were most likely to report errors. Those respondents making error reports were much more likely to report visit dissatisfaction than those not reporting them (odds ratio [OR] = 13.8, p < .001). Although patient reports of perceived errors might be useful to improve the patient experience of care, they cannot be used to measure technical medical errors and patient safety reliably without added evaluation. This study's findings need to be replicated elsewhere before generalizing from one metropolitan region and a patient population that is about two-thirds members of one health plan.

  14. Learning from Homeschooling Routines

    ERIC Educational Resources Information Center

    Thomas, Jesse

    2016-01-01

    This study provides a rare opportunity to look inside the homeschool and to observe the routines of homeschooling families from across the United States. With more than 1000 survey participants, and nine parents selected for interviews, the compiled data were analyzed through open coding techniques. Meaningful aspects that arose from the routines…

  15. Learning from Homeschooling Routines

    ERIC Educational Resources Information Center

    Thomas, Jesse

    2016-01-01

    This study provides a rare opportunity to look inside the homeschool and to observe the routines of homeschooling families from across the United States. With more than 1000 survey participants, and nine parents selected for interviews, the compiled data were analyzed through open coding techniques. Meaningful aspects that arose from the routines…

  16. The role of routine pre-operative bedside echocardiography in detecting aortic stenosis in patients with a hip fracture.

    PubMed

    Loxdale, S J; Sneyd, J R; Donovan, A; Werrett, G; Viira, D J

    2012-01-01

    The prevalence and severity of aortic stenosis in unselected patients admitted with a hip fracture is unknown. Derriford Hospital operates a routine weekday, pre-operative, targeted bedside echocardiography examination on all patients admitted with a hip fracture. We carried out a prospective service evaluation for 13 months from October 2007 on all 501 admissions, of which 374 (75%) underwent pre-operative echocardiography. Of those patients investigated, 8 (2%) had severe, 24 (6%) moderate and 113 (30%) had mild aortic stenosis or aortic sclerosis. Eighty-seven of 278 (31%) patients with no murmur detected clinically on admission had aortic stenosis on echocardiography and of the 96 patients in whom a murmur was heard pre-operatively, 30 (31%) had a normal echocardiogram. Detection of a murmur does not necessarily reflect the presence of underling aortic valve disease. However, if a murmur is heard then the likelihood of the lesion's being moderate or severe aortic stenosis is increased (OR 8.5; 95% CI 3.8-19.5). Forty-four (12%) of our unselected patients with fractured femur had either moderate or severe aortic stenosis (with or without moderate or severe left ventricular failure), or mild stenosis with moderately or severely impaired left ventricular function.

  17. Integrating palliative care into routine care of patients with heart failure: models for clinical collaboration.

    PubMed

    Lewin, Warren H; Schaefer, Kristen G

    2017-02-13

    Heart failure (HF) affects nearly 5.7 million Americans and is described as a chronic incurable illness carrying a poor prognosis. Patients living with HF experience significant symptoms including dyspnea, pain, anxiety, fatigue, and depression. As the illness advances into later stages, symptoms become more intense and refractory to standard treatments, leading to recurrent acute-care utilization and contributing to poor quality of life. Advanced HF symptoms have been described to be as burdensome, if not more than, those in cancer populations. Yet access to and provision of palliative care (PC) for this population has been described as suboptimal. The Institute of Medicine recently called for better access to PC for seriously ill patients. Despite guidelines recommending the inclusion of PC into the multidisciplinary HF care team, there is little data offering guidance on how to best operationalize PC skills in caring for this population. This paper describes the emerging literature describing models of PC integration for HF patients and aims to identify key attributes of these care models that may help guide future multi-site clinical trials to define best practices for the successful delivery of PC for patients living with advanced HF.

  18. Routine surveillance for bloodstream infections in a pediatric hematopoietic stem cell transplant cohort: Do patients benefit?

    PubMed Central

    Rigby, Heather; Fernandez, Conrad V; Langley, Joanne; Mailman, Tim; Crooks, Bruce; Higgins, Ann

    2007-01-01

    BACKGROUND: Hematopoietic stem cell transplant (HSCT) recipients are at a high risk for late bloodstream infection (BSI). Controversy exists regarding the benefit of surveillance blood cultures in this immunosuppressed population. Despite the common use of this practice, the practical value is not well established in non-neutropenic children following HSCT. METHODS: At the IWK Health Centre (Halifax, Nova Scotia), weekly surveillance blood cultures from central lines are drawn from children following HSCT until the line is removed. A retrospective chart review was performed to determine the utility and cost of this practice. Eligible participants were non-neutropenic HSCT recipients with central venous access lines. The cost of laboratory investigations, nursing time, hospital stay and interventions for positive surveillance cultures was calculated. RESULTS: Forty-three HSCTs were performed in 41 children. Donors were allogenic in 33 cases (77%) and autologous in 10 cases (23%). There were 316 patient contacts for surveillance cultures (mean seven per patient) and 577 central line lumens sampled. Three of 43 patients (7%) had clinically significant positive surveillance blood cultures. Bacteria isolated were Klebsiella pneumoniae (n=2) and Corynebacterium jeikeium (n=1). All follow-up cultures before initiation of antimicrobial therapy were sterile. All three patients were admitted for antimicrobial therapy if they were not already hospitalized and/or had an uncomplicated course. The estimated total cost of BSI surveillance and management of asymptomatic infection over six years was $27,989. CONCLUSION: The present study suggests that BSI surveillance in children following HSCT engraftment has a very low yield and significant cost. It is unclear whether it contributes to improved patient outcomes. PMID:18923737

  19. (18)FDG PET/CT in Routine Surveillance of Asymptomatic Patients following Treatment of Sinonasal Neoplasms.

    PubMed

    Workman, Alan D; Glicksman, Jordan T; Parasher, Arjun K; Carey, Ryan M; Brooks, Steven G; Kennedy, David W; Nabavizadeh, Seyed A; Learned, Kim O; Palmer, James N; Adappa, Nithin D

    2017-08-01

    Objective Sinonasal neoplasms have a high rate of recurrence following treatment, and current guidelines support the use of a variety of surveillance techniques. Recent work demonstrates that performance parameters of surveillance modalities may differ with sinonasal tumors in particular when compared with head and neck tumors overall. This study aims to characterize the value of (18)fluorodeoxyglucose ((18)FDG) positron emission tomography/computed tomography (PET/CT) as a screening tool in asymptomatic patients. Study Design Retrospective cohort study. Setting Hospital of the University of Pennsylvania and Pennsylvania hospital. Methods Records of asymptomatic patients without suspicious endoscopy or suspicious imaging other than PET during the first 3 years following definitive treatment for sinonasal malignancy were screened and analyzed for inclusion in the cohort. Disease recurrence was determined by biopsy following suspicious PET evaluation. Results PET/CT scans (n = 111) were performed for 45 disease-free asymptomatic patients with no evidence of disease on endoscopy, and 6.3% were suspicious and prompted biopsy during this period, revealing 3 cases of disease recurrence. Overall specificity for PET/CT alone was 96.3% (95% CI, 90.7%-99.0%), with a negative predictive value of 99% (95% CI, 94.8%-100%). All recurrences were detected between 7 and 12 months, and all patients with true recurrence diagnosed by PET/CT had extrasinonasal involvement of tumor at the time of surgery. Conclusion We examined performance parameters of (18)FDG PET/CT in asymptomatic patients with no evidence of disease on endoscopy during the posttreatment period for sinonasal malignancy. The ability of PET/CT to detect recurrences that may be missed by structural imaging or endoscopy makes it a valuable tool for clinicians.

  20. Predictors of psychological outcome in patients with eating disorders: A routine outcome monitoring study.

    PubMed

    Dingemans, Alexandra E; van Son, Gabriëlle E; Aardoom, Jiska J; Bruidegom, Kiki; Slof-Op 't Landt, Margarita C T; van Furth, Eric F

    2016-09-01

    Identifying predictors of psychological outcome for patients with eating disorders may improve the effectiveness of treatment. Patients with different pre-treatment characteristics and symptoms may benefit from different therapies. This study aimed to identify potential predictors of treatment outcome in a large naturalistic cohort of patients with an eating disorder. The study sample included patients (N = 1153) with all types of eating disorders who were receiving residential, day, or outpatient treatment. Remission was defined by means of four different indicators based on the Eating Disorder Examination-Questionnaire global score: 1. achieving reliable change; 2. showing a 50% reduction in baseline symptom severity; 3. reaching the clinical significance cut-off point; and 4. a combination of indicators 2 and 3. Potential predictor variables were investigated in univariate and multivariate Cox regression models. Different predictors were found for the four outcome criteria. Patients with high levels of interpersonal distrust at baseline were less likely to have achieved reliable change in eating disorder psychopathology. Higher self-esteem and less body dissatisfaction at baseline was independently associated with a symptom reduction of more than 50% and/or reaching the clinical significance cut-off point. Contrary to our expectations, no differences in outcome were found between the eating disorder subtypes. Clinically, it is important to reduce the risk of poor outcome and to achieve a rapid response in treatment using an intervention designed for this purpose, such as shared decision making or an intervention directed at self-esteem or body image, which may act as a catalyst for change. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2016; 49:863-873). © 2016 Wiley Periodicals, Inc.

  1. Can routine information from electronic patient records predict a future diagnosis of alcohol use disorder?

    PubMed Central

    Lid, Torgeir Gilje; Eide, Geir Egil; Dalen, Ingvild; Meland, Eivind

    2016-01-01

    Objective To explore whether information regarding potentially alcohol-related health incidents recorded in electronic patient records might aid in earlier identification of alcohol use disorders. Design We extracted potentially alcohol-related information in electronic patient records and tested if alcohol-related diagnoses, prescriptions of codeine, tramadol, ethylmorphine, and benzodiazepines; elevated levels of gamma-glutamyl-transferase (GGT), and mean cell volume (MCV); and new sick leave certificates predicted specific alcohol use disorder. Setting Nine general practitioner surgeries with varying size and stability. Subjects Totally 20,764 patients with active electronic patient record until data gathering and with a history of at least four years without a specific alcohol use disorder after turning 18 years of age. Methods The Cox proportional hazard analysis with time-dependent covariates of potential accumulated risks over the previous four years. Main outcome measures Time from inclusion until the first specific alcohol use disorder, defined by either an alcohol specific diagnostic code or a text fragment documenting an alcohol problem. Results In the unadjusted and adjusted Cox-regression with time-dependent covariates all variables were highly significant with adjusted hazard ratios ranging from 1.25 to 3.50. Addictive drugs, sick leaves, GGT, MCV and International Classification for Primary Care version 2 (ICPC-2), and International Classification of Diseases version 10 (ICD-10) diagnoses were analyzed. Elevated GGT and MCV, ICD-10-diagnoses, and gender demonstrated the highest hazard ratios. Conclusions Many frequent health problems are potential predictors of an increased risk or vulnerability for alcohol use disorders. However, due to the modest hazard ratios, we were unable to establish a clinically useful tool. Key Points Alcohol is potentially relevant for many health problems, but current strategies for identification and intervention in

  2. Factors Associated With Smoking Status among HIV-Positive Patients in Routine Clinical Care

    PubMed Central

    Zyambo, Cosmas M; Willig, James H; Cropsey, Karen L; Carson, April P; Wilson, Craig; Tamhane, Ashutosh R; Westfall, Andrew O; Burkholder, Greer A

    2015-01-01

    Background Treatment-related reductions in morbidity and mortality among human immunodeficiency virus (HIV)-positive patients have been attenuated by cigarette smoking, which increases risk of cardiovascular, respiratory, and neoplastic diseases. This study investigated factors associated with smoking status among HIV-positive patients. Methods This cross-sectional study included 2,464 HIV-positive patients attending the HIV Clinic at the University of Alabama at Birmingham between April 2008 and December 2013. Smoking status (current, former, never), psychosocial factors, and clinical characteristics were assessed. Multinomial logistic regression was used to obtain unadjusted and adjusted odds ratios (OR) and 95% confidence intervals (CI) for the association of the various factors with smoking status. Results Among HIV-positive patients (mean age 45 years, 75% male, 55% African-American), the majority reported a history of smoking (39% current and 22% former smokers). In adjusted models, patient characteristics associated with increased odds of current smoking were male gender (OR for heterosexual men, 1.8 [95% CI: 1.3–2.6]; for men who have sex with men, 1.5 [1.1–1.9]), history of respiratory diseases (1.5 [1.2–1.9]), unsuppressed HIV viral load (>50 copies/mL) (1.5 [1.1–1.9]), depression (1.6 [1.3–2.0]), anxiety (1.6 [1.2–2.1]), and prior and current substance abuse (4.7 [3.6–6.1] and 8.3 [5.3–13.3] respectively). Male gender, anxiety, and substance abuse were also associated with being a former smoker. Conclusions Smoking was common among HIV-positive patients, with several psychosocial factors associated with current and former smoking. This suggests smoking cessation programs in HIV clinic settings may achieve greater impact by integrating interventions that also address illicit substance abuse and mental health. PMID:26767146

  3. Impact of Direct-to-Consumer Predictive Genomic Testing on Risk Perception and Worry Among Patients Receiving Routine Care in a Preventive Health Clinic

    PubMed Central

    James, Katherine M.; Cowl, Clayton T.; Tilburt, Jon C.; Sinicrope, Pamela S.; Robinson, Marguerite E.; Frimannsdottir, Katrin R.; Tiedje, Kristina; Koenig, Barbara A.

    2011-01-01

    OBJECTIVE: To assess the impact of direct-to-consumer (DTC) predictive genomic risk information on perceived risk and worry in the context of routine clinical care. PATIENTS AND METHODS: Patients attending a preventive medicine clinic between June 1 and December 18, 2009, were randomly assigned to receive either genomic risk information from a DTC product plus usual care (n=74) or usual care alone (n=76). At intervals of 1 week and 1 year after their clinic visit, participants completed surveys containing validated measures of risk perception and levels of worry associated with the 12 conditions assessed by the DTC product. RESULTS: Of 345 patients approached, 150 (43%) agreed to participate, 64 (19%) refused, and 131 (38%) did not respond. Compared with those receiving usual care, participants who received genomic risk information initially rated their risk as higher for 4 conditions (abdominal aneurysm [P=.001], Graves disease [P=.04], obesity [P=.01], and osteoarthritis [P=.04]) and lower for one (prostate cancer [P=.02]). Although differences were not significant, they also reported higher levels of worry for 7 conditions and lower levels for 5 others. At 1 year, there were no significant differences between groups. CONCLUSION: Predictive genomic risk information modestly influences risk perception and worry. The extent and direction of this influence may depend on the condition being tested and its baseline prominence in preventive health care and may attenuate with time. Trial Registration: clinicaltrials.gov identifier: NCT00782366 PMID:21964170

  4. Radiation exposure to patients receiving routine scoliosis radiography measured at depth in an anthropomorphic phantom

    SciTech Connect

    Dutkowsky, J.P.; Shearer, D.; Schepps, B.; Orton, C.; Scola, F. )

    1990-07-01

    Concern about the amount of radiation received during scoliosis evaluation and treatment led us to measure radiation exposure in an anthropomorphic phantom to determine the increased risk of breast cancer in young women with scoliosis. Assuming that 22 radiographic examinations were performed over the course of scoliosis treatment, the increased relative risk of breast cancer was determined to be 0.22% in these patients.

  5. Patient-reported outcome measures after routine periodontal and implant surgical procedures.

    PubMed

    Tan, Wah Ching; Krishnaswamy, Gita; Ong, Marianne M A; Lang, Niklaus P

    2014-06-01

    To compare patient-reported outcome measures (PROMs) after different dental surgical procedures over a 1-week post-surgical period and in relation to duration of the surgery, and periosteal releasing incisions. To evaluate the prevalence of post-surgical complications. Four hundred and sixty-eight healthy dental patients requiring surgeries, such as crown lengthening (CL), open flap debridement (OFD) and implant installation (IMP) in the National Dental Centre, Singapore (2009-2011), were consecutively recruited. PROMs on bleeding, swelling, pain and bruising were obtained using Visual Analogue Scales (VAS) on days 0, 3, 5 and 7 post-operatively. On the day of surgery, the IMP procedure gave the lowest median VAS for all four PROM parameters. After a week, OFD still had a significantly higher VAS for swelling, pain and bruising. Patients who underwent procedures lasting more than 60 min. had higher VAS for all parameters except bleeding. After considering other important confounders, type of surgery procedure was no longer associated with the VAS score for any of the parameters. Time after surgery, male gender and shorter surgery duration reduced post-operative VAS for one or more of the parameters. Longer surgeon experience helps reduce VAS scores only for bleeding. Prevalence for tenderness to palpation was 11.6%, 8.9% and 12.2% for IMP, CL and OFD, respectively, 1-week post-operatively. Swelling and suppuration occurred rarely. The median VAS scores for all PROM parameters were generally low and reduced to near zero over a week following all three surgical procedures tested. Time after surgery and shorter surgery duration were associated with lower VAS scores in all the PROM parameters in this cohort of patients. Surgery type was not associated significantly with VAS after adjustment with other important confounders. Low prevalences of post-surgical complications were reported. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  6. Colorectal cancer in aged patients. Toward the routine treatment through laparoscopic surgical approach

    PubMed Central

    VECCHIO, R.; MARCHESE, S.; FAMOSO, F.; LA CORTE, F.; MARLETTA, S.; LEANZA, G.; ZANGHÌ, G.; LEANZA, V.; INTAGLIATA, E.

    2015-01-01

    Aim Colorectal cancer is one of the most common malignancies in general population. The incidence seems to be higher in older age. Surgery remains the treatment of choice and laparoscopic approach offers numerous benefits. We report our personal experience in elderly patients operated on for colorectal cancer with laparoscopic resection. Patients and methods From January 2003 to September 2013, out of 160 patients aged 65 years or older and operated with minimally invasive techniques, 30 cases affected by colorectal cancer and operated on with laparoscopic approach were analyzed in this study. Results Male/female ratio was 1.35 and mean age 72 years. Constipation, weight loss, anemia and rectal bleeding were the most commonly reported symptoms. Lesions involved descending-sigmoid colon in 53% of cases, rectum in 37% and ascending colon in 10%. Among laparoscopic colorectal operations laparoscopic left colectomy was the most frequently performed, followed by right colectomy, abdominoperineal resection and Hartmann procedure. Operative times ranged from 3 to 5 hours depending on surgical procedure performed. Mean hospital stay was 6 days (range 4–9). Conversion to open approach occurred only in a case of laparoscopic right colectomy (3%) for uncontrolled bleeding. A single case of mortality was reported. In two cases (7%) anastomotic leakage was observed, conservatively treated in one patient and requiring reoperation in the other one. Conclusions Laparoscopic colorectal surgery is feasible and effective for malignancies in elderly population offering several advantages including immunologic and oncologic ones. However an experienced surgical team is essential in reducing risks and complications. PMID:25827663

  7. Routine Chromosomal Microarray Analysis is Necessary in Korean Patients With Unexplained Developmental Delay/Mental Retardation/Autism Spectrum Disorder

    PubMed Central

    Shin, Saeam; Yu, Nae; Choi, Jong Rak; Jeong, Seri

    2015-01-01

    Background All over the world, chromosomal microarray (CMA) is now the first tier diagnostic assay for genetic testing to evaluate developmental delay (DD), mental retardation (MR), and autism spectrum disorder (ASD) with unknown etiology. The average diagnostic yield of the CMA test is known to be about 12.2%, while that of conventional G-banding karyotype is below 3%. This study aimed to assess the usefulness of CMA for the purpose of clinical diagnostic testing in the Korean population. Methods We performed CMA and multiplex ligation-dependent probe amplification (MLPA) tests in 96 patients with normal karyotype and unexplained DD, MR, or ASD. The CMA was conducted with CytoScan 750K array (Affymetrix, USA) with an average resolution of 100 kb. Results Pathogenic copy number variations (CNVs) were detected in 15 patients by CMA and in two patients by MLPA for four known microdeletion syndromes (Prader-Willi/Angelman syndrome, DiGeorge syndrome, Miller-Dieker syndrome and Williams syndrome) designated by National Health Insurance system in Korea. The diagnostic yield was 15.6% and 2.1%, respectively. Thirteen (13.5%) patients (excluding cases with pathogenic CNVs) had variants of uncertain clinical significance. There was one patient with a 17.1-megabase (Mb) region of homozygosity on chromosome 4q. Conclusions Our findings suggest the necessity of CMA as a routine diagnostic test for unexplained DD, MR, and ASD in Korea. PMID:26206688

  8. Detecting re-infection in patients after an initial diagnosis of gonorrhoea: is routine recall for re-screening useful?

    PubMed

    Fernando, K A; Fowler, T; Harding, J; Flew, S; Caley, M; Phattey, J; Ross, Jdc

    2015-08-01

    To assess the outcome of routine sexually transmitted infection re-screening after a three-month interval in unselected patients diagnosed with gonorrhoea, we sought to assess whether this active approach would result in an increase in the number of people attending clinic and subsequently diagnosed with gonorrhoea re-infection, compared with normal re-presentation rates. A recall group of patients were invited for re-screening three months after their initial diagnosis of gonorrhoea. Permission was sought to send a reminder two weeks prior to their scheduled recall appointment. Comparisons were made with a historical control group of patients with gonorrhoea in the absence of any formal recall. Of the 242 patients in the intervention arm, 96 (40%) re-attended within six months, and 15 (6%) tested gonorrhoea positive. Two hundred and two patients were assessed in the control group, of whom 45 (22%) re-attended within six months, and 13 (6%) tested gonorrhoea positive. Women were more likely than men to re-attend following active recall, but they were not at higher risk of re-attending while re-infected with gonorrhoea. Active recall following a gonorrhoea diagnosis significantly increases re-attendance rates for repeat screening but did not result in an increased number of subsequent gonorrhoea diagnoses.

  9. Retrograde air embolization during routine radial artery catheter flushing in adult cardiac surgical patients: an ultrasound study.

    PubMed

    Murphy, Glenn S; Szokol, Joseph W; Marymont, Jesse H; Avram, Michael J; Vender, Jeffery S

    2004-09-01

    Rapid flushing of radial artery catheters may result in retrograde embolization of air into the cerebral circulation. This study examined the incidence of central air embolization during and after flushing of an arterial pressure monitoring system. One hundred adult patients undergoing cardiac surgical procedures were enrolled in this study. Ten ml of saline and blood were withdrawn into a syringe in the arterial flushing-sampling pressure system and then readministered to the patient through a 20-gauge radial artery catheter over 3-12 s. The right carotid artery, left carotid artery, and aortic arch were visualized using ultrasound imaging techniques during three manual flushes of the system. The left and right common carotid arteries were examined for the presence of macrobubbles or microbubbles using a linear array ultrasound transducer. The aortic arch was imaged using transesophageal echocardiography to detect retrograde air emboli. The severity of air embolization was quantified using a modification of an established grading system. A total of 298 ultrasound studies in 100 patients were recorded and analyzed after radial artery catheter flushing. Two aortic arch images were not obtained because of an inability to place the probe. Most clinicians (54%) returned flush solution to patients at near-maximal injection rates (2-3 ml per second). No air emboli (macrobubbles or microbubbles) were detected in the carotid arteries or aortic arch of any subject. Retrograde air embolization is a rare event after routine radial artery catheter flushing in adult patients with stable hemodynamic conditions.

  10. Should routine contrast study be a norm before stoma reversal? A retrospective study of patients with temporary ileostomy.

    PubMed

    Saini, Pradeep; Gupta, Praanjal; Sharma, Ashish; Agarwal, Nitin; Kaur, Navneet; Gupta, Arun

    2013-04-01

    In the developed nations, temporary ileostomies are usually made in order to protect a distal anastomosis after cancer surgery. However, in India and the neighbouring countries ileal perforation is the most common indication for creating a temporary ileostomy after emergency laparotomy. It seems logical to perform a contrast study when a stoma that was made to protect a bowel anastomosis is being reversed in order to check for anastomosis healing, leak or stenosis. Although we do not know precisely when and why we started this practice, it is customary at our institute to do a contrast study before reversal of a temporary ileostomy. At some institutes a routine contrast study is never done. The utility of this practice has not previously been studied at our institute. This study tries to correlate the surgeon's clinical and operative findings with the contrast study report in order to see if it may be reasonable to reverse the stoma without a routine contrast study in selected patients where the surgeon has clearly documented absence of any gross disease in the distal bowel and who have had an uneventful post-operative period. To our knowledge this appears to be the first such attempt from our country.

  11. Using routine health data and intermittent community surveys to assess the impact of maternal and neonatal health interventions in low-income countries: A systematic review.

    PubMed

    Dossa, Nissou I; Philibert, Aline; Dumont, Alexandre

    2016-11-01

    There is a need to provide increased evidence on effective interventions to reduce maternal and neonatal mortality in low- and middle-income countries (LMICs). To summarize the breadth of knowledge on using routine data (Routine Health Information Systems [RHIS] and Intermittent Community Surveys [ICS]) for well-designed maternal and neonatal health evaluations in LMICs. We searched reports and articles published in Embase, Medline, and Google scholar. Selection criteria Studies were considered for inclusion if they were carried out in LMICs, using RHIS or ICS data with experimental or quasi-experimental design. A form was used to collect information on indicators used for interventions' impact assessment. Descriptive statistics and multiple correspondence analyses were then performed. Of the 1201 publications identified, 46 studies met the inclusion criteria. Most of these were using RHIS data (n=40), mainly extracted from health facility registers (n=34), and non-controlled before and after design (n=30). The indicators, which were mostly reported, were related to the use of healthcare services (n=36) and maternal/neonatal health outcomes (n=31). Few studies used ICS data (n=6) or indicators of severity (n=2). RHIS and ICS data should be increasingly used for impact studies on maternal and neonatal health in LMICs. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  12. Barriers, facilitators, and benefits of implementation of dialectical behavior therapy in routine care: results from a national program evaluation survey in the Veterans Health Administration.

    PubMed

    Landes, Sara J; Rodriguez, Allison L; Smith, Brandy N; Matthieu, Monica M; Trent, Lindsay R; Kemp, Janet; Thompson, Caitlin

    2017-02-06

    National implementation of evidence-based psychotherapies (EBPs) in the Veterans Health Administration (VHA) provides important lessons on the barriers and facilitators to implementation in a large healthcare system. Little is known about barriers and facilitators to the implementation of a complex EBP for emotional and behavioral dysregulation-dialectical behavioral therapy (DBT). The purpose of this study was to understand VHA clinicians' experiences with barriers, facilitators, and benefits from implementing DBT into routine care. This national program evaluation survey measured site characteristics of VHA sites (N = 59) that had implemented DBT. DBT was most often implemented in general mental health outpatient clinics. While 42% of sites offered all four modes of DBT, skills group was the most frequently implemented mode. Fifty-nine percent of sites offered phone coaching in any form, yet only 11% of those offered it all the time. Providers were often provided little to no time to support implementation of DBT. Barriers that were difficult to overcome were related to phone coaching outside of business hours. Facilitators to implementation included staff interest and expertise. Perceived benefits included increased hope and functioning for clients, greater self-efficacy and compassion for providers, and ability to treat unique symptoms for clinics. There was considerable variability in the capacity to address implementation barriers among sites implementing DBT in VHA routine care. Mental health policy makers should note the barriers and facilitators reported here, with specific attention to phone coaching barriers.

  13. National survey of patients' bill of rights statutes.

    PubMed

    Paasche-Orlow, Michael K; Jacob, Dan M; Hochhauser, Mark; Parker, Ruth M

    2009-04-01

    Despite vigorous national debate between 1999-2001 the federal patients' bill of rights (PBOR) was not enacted. However, states have enacted legislation and the Joint Commission defined an accreditation standard to present patients with their rights. Because such initiatives can be undermined by overly complex language, we surveyed the readability of hospital PBOR documents as well as texts mandated by state law. State Web sites and codes were searched to identify PBOR statutes for general patient populations. The rights addressed were compared with the 12 themes presented in the American Hospital Association's (AHA) PBOR text of 2002. In addition, we obtained PBOR texts from a sample of hospitals in each state. Readability was evaluated using Prose, a software program which reports an average of eight readability formulas. Of 23 states with a PBOR statute for the general public, all establish a grievance policy, four protect a private right of action, and one stipulates fines for violations. These laws address an average of 7.4 of the 12 AHA themes. Nine states' statutes specify PBOR text for distribution to patients. These documents have an average readability of 15th grade (range, 11.6, New York, to 17.0, Minnesota). PBOR documents from 240 US hospitals have an average readability of 14th grade (range, 8.2 to 17.0). While the average U.S. adult reads at an 8th grade reading level, an advanced college reading level is routinely required to read PBOR documents. Patients are not likely to learn about their rights from documents they cannot read.

  14. Therapeutic benefits of cannabis: a patient survey.

    PubMed

    Webb, Charles W; Webb, Sandra M

    2014-04-01

    Clinical research regarding the therapeutic benefits of cannabis ("marijuana") has been almost non-existent in the United States since cannabis was given Schedule I status in the Controlled Substances Act of 1970. In order to discover the benefits and adverse effects perceived by medical cannabis patients, especially with regards to chronic pain, we hand-delivered surveys to one hundred consecutive patients who were returning for yearly re-certification for medical cannabis use in Hawai'i. The response rate was 94%. Mean and median ages were 49.3 and 51 years respectively. Ninety-seven per cent of respondents used cannabis primarily for chronic pain. Average pain improvement on a 0-10 pain scale was 5.0 (from 7.8 to 2.8), which translates to a 64% relative decrease in average pain. Half of all respondents also noted relief from stress/anxiety, and nearly half (45%) reported relief from insomnia. Most patients (71%) reported no adverse effects, while 6% reported a cough or throat irritation and 5% feared arrest even though medical cannabis is legal in Hawai'i. No serious adverse effects were reported. These results suggest that Cannabis is an extremely safe and effective medication for many chronic pain patients. Cannabis appears to alleviate pain, insomnia, and may be helpful in relieving anxiety. Cannabis has shown extreme promise in the treatment of numerous medical problems and deserves to be released from the current Schedule I federal prohibition against research and prescription.

  15. Circulating Cell Free Tumor DNA Detection as a Routine Tool for Lung Cancer Patient Management

    PubMed Central

    Vendrell, Julie A.; Mau-Them, Frédéric Tran; Béganton, Benoît; Godreuil, Sylvain; Coopman, Peter; Solassol, Jérôme

    2017-01-01

    Circulating tumoral DNA (ctDNA), commonly named “liquid biopsy”, has emerged as a new promising noninvasive tool to detect biomarker in several cancers including lung cancer. Applications involving molecular analysis of ctDNA in lung cancer have increased and encompass diagnosis, response to treatment, acquired resistance and prognosis prediction, while bypassing the problem of tumor heterogeneity. ctDNA may then help perform dynamic genetic surveillance in the era of precision medicine through indirect tumoral genomic information determination. The aims of this review were to examine the recent technical developments that allowed the detection of genetic alterations of ctDNA in lung cancer. Furthermore, we explored clinical applications in patients with lung cancer including treatment efficiency monitoring, acquired therapy resistance mechanisms and prognosis value. PMID:28146051

  16. Implementing Routine Health Literacy Assessment in Hospital and Primary Care Patients

    PubMed Central

    Cawthon, Courtney; Mion, Lorraine C.; Willens, David E.; Roumie, Christianne L.; Kripalani, Sunil

    2014-01-01

    Background Patients with inadequate health literacy often have poorer health outcomes and increased utilization and costs, compared to those with adequate health literacy skills. The Institute of Medicine has recommended that health literacy assessment be incorporated into health care information systems, which would facilitate large-scale studies of the effects of health literacy, as well as evaluation of system interventions to improve care by addressing health literacy. As part of the Health Literacy Screening (HEALS) study, a brief health literacy screen (BHLS) was incorporated into the electronic health record (EHR) at a large academic medical center. Methods Changes were implemented to the nursing intake documentation across all adult hospital units, the emergency department, and three primary care practices. The change involved replacing previous education screening items with the BHLS. Implementation was based on a quality improvement framework, with a focus on acceptability, adoption, appropriateness, feasibility, fidelity and sustainability. Support was gained from nursing leadership, education and training was provided, a documentation change was rolled out, feedback was obtained, and uptake of the new health literacy screening items was monitored. Results Between November 2010 and April 2012, there were 55,611 adult inpatient admissions, and from November 2010 to September 2011, 23,186 adult patients made 39,595 clinic visits to the three primary care practices. The completion (uptake) rate in the hospital for November 2010 through April 2012 was 91.8%. For outpatient clinics, the completion rate between November 2010 and October 2011 was 66.6%. Conclusions Although challenges exist, it is feasible to incorporate health literacy screening into clinical assessment and EHR documentation. Next steps are to evaluate the association of health literacy with processes and outcomes of care across inpatient and outpatient populations. PMID:24716329

  17. Routine HIV Testing among Hospitalized Patients in Argentina. Is It Time for a Policy Change?

    PubMed Central

    Socías, María Eugenia; Hermida, Laura; Singman, Mariana; Kulgis, Gisela; Díaz Armas, Andrés; Cando, Osvaldo; Sued, Omar; Pérez, Héctor; Hermes, Ricardo; Presas, José Luis; Cahn, Pedro

    2013-01-01

    Introduction The Argentinean AIDS Program estimates that 110,000 persons are living with HIV/AIDS in Argentina. Of those, approximately 40% are unaware of their status, and 30% are diagnosed in advanced stages of immunosuppression. Though studies show that universal HIV screening is cost-effective in settings with HIV prevalence greater than 0.1%, in Argentina, with the exception of antenatal care, HIV testing is always client-initiated. Objective We performed a pilot study to assess the acceptability of a universal HIV screening program among inpatients of an urban public hospital in Buenos Aires. Methods Over a six-month period, all eligible adult patients admitted to the internal medicine ward were offered HIV testing. Demographics, uptake rates, reasons for refusal and new HIV diagnoses were analyzed. Results Of the 350 admissions during this period, 249 were eligible and subsequently enrolled. The enrolled population was relatively old compared to the general population, was balanced on gender, and did not report traditional high risk factors for HIV infection. Only 88 (39%) reported prior HIV testing. One hundred and ninety (76%) patients accepted HIV testing. In multivariable analysis only younger age (OR 1.02; 95%CI 1.003-1.05) was independently associated with test uptake. Three new HIV diagnoses were made (undiagnosed HIV prevalence: 1.58%); none belonged to a most-at-risk population. Conclusions Our findings suggest that universal HIV screening in this setting is acceptable and potentially effective in identifying undiagnosed HIV-infected individuals. If confirmed in a larger study, our findings may inform changes in the Argentinean HIV testing policy. PMID:23936034

  18. Routine HIV testing among hospitalized patients in Argentina. is it time for a policy change?

    PubMed

    Socías, María Eugenia; Hermida, Laura; Singman, Mariana; Kulgis, Gisela; Díaz Armas, Andrés; Cando, Osvaldo; Sued, Omar; Pérez, Héctor; Hermes, Ricardo; Presas, José Luis; Cahn, Pedro

    2013-01-01

    The Argentinean AIDS Program estimates that 110,000 persons are living with HIV/AIDS in Argentina. Of those, approximately 40% are unaware of their status, and 30% are diagnosed in advanced stages of immunosuppression. Though studies show that universal HIV screening is cost-effective in settings with HIV prevalence greater than 0.1%, in Argentina, with the exception of antenatal care, HIV testing is always client-initiated. We performed a pilot study to assess the acceptability of a universal HIV screening program among inpatients of an urban public hospital in Buenos Aires. Over a six-month period, all eligible adult patients admitted to the internal medicine ward were offered HIV testing. Demographics, uptake rates, reasons for refusal and new HIV diagnoses were analyzed. Of the 350 admissions during this period, 249 were eligible and subsequently enrolled. The enrolled population was relatively old compared to the general population, was balanced on gender, and did not report traditional high risk factors for HIV infection. Only 88 (39%) reported prior HIV testing. One hundred and ninety (76%) patients accepted HIV testing. In multivariable analysis only younger age (OR 1.02; 95%CI 1.003-1.05) was independently associated with test uptake. Three new HIV diagnoses were made (undiagnosed HIV prevalence: 1.58%); none belonged to a most-at-risk population. Our findings suggest that universal HIV screening in this setting is acceptable and potentially effective in identifying undiagnosed HIV-infected individuals. If confirmed in a larger study, our findings may inform changes in the Argentinean HIV testing policy.

  19. Routine Screening for CYP2C19 Polymorphisms for Patients being Treated with Clopidogrel is not Recommended

    PubMed Central

    Hong, Robert A; Khan, Zia R; Valentin, Mona R; Badawi, Ramy A

    2015-01-01

    Recent efforts directed at potential litigation in Hawai‘i have resulted in a renewed interest for genetic screening for cytochrome P450 2C19 (CYP2C19) polymorphisms in patients treated with clopidogrel. Clopidogrel is an antiplatelet agent, frequently used in combination with aspirin, for the prevention of thrombotic complications with acute coronary syndrome and in patients undergoing percutaneous coronary interventions. Cytochrome P-450 (CYP) 2C19 is an enzyme involved in the bioactivation of clopidogrel from a pro-drug to an active inhibitor of platelet action. Patients of Asian and Pacific Island background have been reported to have an increase in CYP2C19 polymorphisms associated with loss-of-function of this enzyme when compared to other ethnicities. This has created an interest in genetic testing for CYP2C19 polymorphisms in Hawai‘i. Based upon our review of the current literature, we do not feel that there is support for the routine screening for CYP2C19 polymorphisms in patients being treated with clopidogrel; furthermore, the results of genetic testing may not be helpful in guiding therapeutic decisions. We recommend that decisions on the type of antiplatelet treatment be made based upon clinical evidence of potential differential outcomes associated with the use of these agents rather than on the basis of genetic testing. PMID:25628978

  20. Effectiveness of betahistine (48 mg/day) in patients with vestibular vertigo during routine practice: The VIRTUOSO study.

    PubMed

    Parfenov, Vladimir A; Golyk, Volodymyr A; Matsnev, Eduard I; Morozova, Svetlana V; Melnikov, Oleg A; Antonenko, Ludmila M; Sigaleva, Elena E; Situkho, Maksym I; Asaulenko, Olena I; Popovych, Vasyl I; Zamergrad, Maxim V

    2017-01-01

    Vestibular vertigo is associated with substantially reduced quality of life. Betahistine is effective in improving vertigo-associated symptoms, with longer treatment periods leading to greater improvements; however, it is not known whether these effects persist after treatment cessation. VIRTUOSO was a prospective, multinational, non-comparative, post-marketing observational programme investigating the effectiveness of betahistine (48 mg/day) and the course of vertigo after the discontinuation of treatment. Patients with vestibular vertigo who were prescribed 48 mg/day betahistine were enrolled in Russia and Ukraine. Treatment duration was up to 2 months, and patients were followed up for 2 months after discontinuation of betahistine. Efficacy endpoints included clinical response (assessed by change in vertigo severity), monthly attack frequency, and physician and patient grading of overall clinical response and improvement of vertigo-associated symptoms. Overall, 309 patients were enrolled and 305 completed the study. Clinical response was rated as good, very good or excellent in 74.1% of patients at end of treatment, with vertigo severity significantly decreased from baseline (p < 0.001). Monthly vertigo attack frequency decreased significantly during the 2 months of treatment (p < 0.001 from baseline) and further decreased during the 2-month follow-up (p < 0.001 from end of treatment). Overall, clinical response was graded as good or excellent by 94.4% of physicians and 95.4% of patients. Clinical improvement was considered either good or excellent by 82.6-90.5% of physicians and patients for nausea, vomiting and faintness. Only one adverse event was reported, with no serious adverse events. Our findings suggest that betahistine (48 mg/day) therapy is effective in treating vertigo in routine clinical settings. The observed effects persisted for 2 months after treatment cessation, suggesting that betahistine may facilitate lasting vestibular compensation.

  1. Effectiveness of betahistine (48 mg/day) in patients with vestibular vertigo during routine practice: The VIRTUOSO study

    PubMed Central

    Parfenov, Vladimir A.; Golyk, Volodymyr A.; Matsnev, Eduard I.; Morozova, Svetlana V.; Melnikov, Oleg A.; Antonenko, Ludmila M.; Sigaleva, Elena E.; Situkho, Maksym I.; Asaulenko, Olena I.; Popovych, Vasyl I.; Zamergrad, Maxim V.

    2017-01-01

    Background Vestibular vertigo is associated with substantially reduced quality of life. Betahistine is effective in improving vertigo-associated symptoms, with longer treatment periods leading to greater improvements; however, it is not known whether these effects persist after treatment cessation. Methods VIRTUOSO was a prospective, multinational, non-comparative, post-marketing observational programme investigating the effectiveness of betahistine (48 mg/day) and the course of vertigo after the discontinuation of treatment. Patients with vestibular vertigo who were prescribed 48 mg/day betahistine were enrolled in Russia and Ukraine. Treatment duration was up to 2 months, and patients were followed up for 2 months after discontinuation of betahistine. Efficacy endpoints included clinical response (assessed by change in vertigo severity), monthly attack frequency, and physician and patient grading of overall clinical response and improvement of vertigo-associated symptoms. Results Overall, 309 patients were enrolled and 305 completed the study. Clinical response was rated as good, very good or excellent in 74.1% of patients at end of treatment, with vertigo severity significantly decreased from baseline (p < 0.001). Monthly vertigo attack frequency decreased significantly during the 2 months of treatment (p < 0.001 from baseline) and further decreased during the 2-month follow-up (p < 0.001 from end of treatment). Overall, clinical response was graded as good or excellent by 94.4% of physicians and 95.4% of patients. Clinical improvement was considered either good or excellent by 82.6–90.5% of physicians and patients for nausea, vomiting and faintness. Only one adverse event was reported, with no serious adverse events. Conclusion Our findings suggest that betahistine (48 mg/day) therapy is effective in treating vertigo in routine clinical settings. The observed effects persisted for 2 months after treatment cessation, suggesting that betahistine may facilitate

  2. Balneological outpatient treatment for patients with knee osteoarthritis; an effective non-drug therapy option in daily routine?

    NASA Astrophysics Data System (ADS)

    Özkuk, Kaǧan; Gürdal, Hatice; Karagülle, Mine; Barut, Yasemin; Eröksüz, Rıza; Karagülle, Müfit Zeki

    2016-10-01

    This study aims to compare the effects of balneological treatments applied at consecutive and intermittent sessions without interfering with their daily routine in patients with knee osteoarthritis. This is a randomized, controlled, single-blind clinical trial. Fifty patients diagnosed with knee osteoarthritis were included. The patients were divided into two groups. All patients were given a total of ten sessions of balneological treatment consisting of hydrotherapy and mud pack therapy. Group 1 received consecutive treatment for 2 weeks, while group 2 received intermittent treatment for 5 weeks. Local peloid packs at 45 °C were applied for 20 min, after a tap water (38 °C) bath. Evaluations were conducted before, after treatment, and at 12th week of post-treatment by Pain (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Short Form-36 (SF-36). Both balneological treatment regimens of knee osteoarthritis had statistically significant clinical effects as well as effects on the quality of life. Patients' well-being continued at 3 months, except for joint stiffness (WOMAC), role-emotional (SF-36), and vitality (SF-36) in group 1 and for mental health (SF-36) in both groups. Both patient groups had improved compared to baseline. However, at 3 months after the treatment, the well-being of group 2 was unable to be maintained in terms of role-physical (SF-36) parameter, while the well-being of group 1 was unable to be maintained in terms of pain, WOMAC (pain, physical functions, total), and SF-36 (physical functioning, role-physical, pain, role-emotional, and mental health) variables, compared to data obtained immediately after treatment. Our study suggests that traditional and intermittent balneological therapies have similar efficacy in patients with knee osteoarthritis.

  3. Routine invasive strategy in acute coronary syndrome patients with renal dysfunction. Results of the ARIAM-SEMICYUC registry.

    PubMed

    Latour-Pérez, J; Gómez-Tello, V; de-Miguel-Balsa, E; Llamas-Álvarez, A; Carrillo-López, A; Sánchez-Román, J A; Ruíz-Ruíz, J; Martín-Rodríguez, M C; Fernández-González, C J; Fernández-Lozano, J A; Picazos Vicente, C

    2016-01-01

    To evaluate the use and effectiveness of a routine invasive strategy (RIS) in patients with acute coronary syndrome without persistent ST-segment elevation with renal dysfunction in the real world scenario. A retrospective cohort study based on the ARIAM-SEMICYUC Registry (2011-2014) was carried out. Renal dysfunction was defined as GFR (Cockroft-Gault)<60ml/min (moderate dysfunction) or<30ml/min (severe dysfunction). Patients in which early angiography (<72h) was performed due to cardiogenic shock or recurrent myocardial ischemia were excluded. The primary endpoint was hospital mortality. Confounding factors were controlled using propensity score analysis. A total of 4,279 patients were analyzed, of which 26% had moderate renal dysfunction and 5% severe dysfunction. Patients with renal dysfunction had greater severity and comorbidity, higher hospital mortality (8.6 vs. 1.8%), and lesser use of the RIS (40 vs. 52%). The adjusted OR for mortality in patients without/with renal dysfunction were 0.38 (95% confidence interval [95%CI] 0.17 to 0.81) and 0.52 (95%CI 0.32 to 0.87), respectively (interaction P-value=.4779). The impact (adjusted risk difference) of RIS was higher in the group with renal dysfunction (-5.1%, 95%CI -8.1 to -2.1 vs. -1.6%, 95%CI -2.6 to -0.6; interaction P-value=.0335). No significant interaction was detected for the other endpoints considered (ICU mortality, 30-day mortality, myocardial infarction, acute renal failure or moderate/severe bleeding). The results suggest that the effectiveness of IRS is similar in patients with normal or abnormal renal function, and alert to the under-utilization of this strategy in such patients. Copyright © 2015 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  4. Balneological outpatient treatment for patients with knee osteoarthritis; an effective non-drug therapy option in daily routine?

    PubMed

    Özkuk, Kağan; Gürdal, Hatice; Karagülle, Mine; Barut, Yasemin; Eröksüz, Rıza; Karagülle, Müfit Zeki

    2017-04-01

    This study aims to compare the effects of balneological treatments applied at consecutive and intermittent sessions without interfering with their daily routine in patients with knee osteoarthritis. This is a randomized, controlled, single-blind clinical trial. Fifty patients diagnosed with knee osteoarthritis were included. The patients were divided into two groups. All patients were given a total of ten sessions of balneological treatment consisting of hydrotherapy and mud pack therapy. Group 1 received consecutive treatment for 2 weeks, while group 2 received intermittent treatment for 5 weeks. Local peloid packs at 45 °C were applied for 20 min, after a tap water (38 °C) bath. Evaluations were conducted before, after treatment, and at 12th week of post-treatment by Pain (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Short Form-36 (SF-36). Both balneological treatment regimens of knee osteoarthritis had statistically significant clinical effects as well as effects on the quality of life. Patients' well-being continued at 3 months, except for joint stiffness (WOMAC), role-emotional (SF-36), and vitality (SF-36) in group 1 and for mental health (SF-36) in both groups. Both patient groups had improved compared to baseline. However, at 3 months after the treatment, the well-being of group 2 was unable to be maintained in terms of role-physical (SF-36) parameter, while the well-being of group 1 was unable to be maintained in terms of pain, WOMAC (pain, physical functions, total), and SF-36 (physical functioning, role-physical, pain, role-emotional, and mental health) variables, compared to data obtained immediately after treatment. Our study suggests that traditional and intermittent balneological therapies have similar efficacy in patients with knee osteoarthritis.

  5. Effect and safety of duodenal levodopa infusion in advanced Parkinson's disease: a retrospective multicenter outcome assessment in patient routine care.

    PubMed

    Antonini, A; Odin, P; Opiano, L; Tomantschger, V; Pacchetti, C; Pickut, B; Gasser, U E; Calandrella, D; Mancini, F; Zibetti, M; Minafra, B; Bertaina, I; De Deyn, P; Cras, C; Wolf, E; Spielberger, S; Poewe, W

    2013-11-01

    Duodenal levodopa infusion represents an effective strategy to manage motor and non-motor complications in patients with advanced Parkinson's disease (PD). However, most published clinical series regard small numbers of patients and do not exceed 1 year follow-up. In this multi-national observational cohort study conducted in seven specialised PD clinics and university hospitals we assessed long-term safety and outcome of chronic treatment with intra-duodenal levodopa infusions in a large population of patients with advanced PD. The starting population consisted of 98 treated patients (safety population). We report clinical outcomes of 73 patients with subsequent efficacy assessment(s) (efficacy population) over a follow-up period up to 2 years. Follow-up periods and collection of clinical observations varied based on individual routine care program. At last follow-up there was a significant (p ≤ 0.05) reduction in duration of "Off" periods as well as dyskinesia duration and severity that was associated with an improvement of quality of life. Twenty three patients (25.3 % of the safety population) withdraw, due to adverse drug reaction (5), procedure and device related events (7), compliance (3) and lack of efficacy (8). The mean duration for last value reported after baseline (LV) was 608 ± 292 days (median: 697 days). Our results demonstrate significant and sustained benefit over a long observation period in motor complications and in quality of life following a change from oral pulsatile to continuous levodopa delivery. The relatively large number of withdrawals reflects the current use of duodenal levodopa infusion in very advanced PD patients.

  6. Balneological outpatient treatment for patients with knee osteoarthritis; an effective non-drug therapy option in daily routine?

    NASA Astrophysics Data System (ADS)

    Özkuk, Kağan; Gürdal, Hatice; Karagülle, Mine; Barut, Yasemin; Eröksüz, Rıza; Karagülle, Müfit Zeki

    2017-04-01

    This study aims to compare the effects of balneological treatments applied at consecutive and intermittent sessions without interfering with their daily routine in patients with knee osteoarthritis. This is a randomized, controlled, single-blind clinical trial. Fifty patients diagnosed with knee osteoarthritis were included. The patients were divided into two groups. All patients were given a total of ten sessions of balneological treatment consisting of hydrotherapy and mud pack therapy. Group 1 received consecutive treatment for 2 weeks, while group 2 received intermittent treatment for 5 weeks. Local peloid packs at 45 °C were applied for 20 min, after a tap water (38 °C) bath. Evaluations were conducted before, after treatment, and at 12th week of post-treatment by Pain (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Short Form-36 (SF-36). Both balneological treatment regimens of knee osteoarthritis had statistically significant clinical effects as well as effects on the quality of life. Patients' well-being continued at 3 months, except for joint stiffness (WOMAC), role-emotional (SF-36), and vitality (SF-36) in group 1 and for mental health (SF-36) in both groups. Both patient groups had improved compared to baseline. However, at 3 months after the treatment, the well-being of group 2 was unable to be maintained in terms of role-physical (SF-36) parameter, while the well-being of group 1 was unable to be maintained in terms of pain, WOMAC (pain, physical functions, total), and SF-36 (physical functioning, role-physical, pain, role-emotional, and mental health) variables, compared to data obtained immediately after treatment. Our study suggests that traditional and intermittent balneological therapies have similar efficacy in patients with knee osteoarthritis.

  7. Evaluation of Subcutaneous Glucose Monitoring Systems under Routine Environmental Conditions in Patients with Type 1 Diabetes.

    PubMed

    Aberer, Felix; Hajnsek, Martin; Rumpler, Markus; Zenz, Sabine; Baumann, Petra; Elsayed, Hesham; Puffing, Adelheid; Treiber, Gerlies; Pieber, Thomas R; Sourij, Harald; Mader, Julia K

    2017-02-16

    Continuous and flash glucose monitoring (GM) systems have been established in diabetes care. We compared sensor performance of three commercially available GM systems. 12 patients with type 1 diabetes were included in a single-centre, open-label study where sensor performance of Abbott FreeStyle libre (Abbott), Dexcom G4 Platinum (Dexcom) and Medtronic MiniMed 640G (Medtronic) over 12 hours was compared during mimicked real-life conditions (meals, exercise, hypo- and hyperglycaemia). Sensor performance was determined by fulfilment of ISO 15197:2013 criteria, calculating mean absolute relative difference (MARD) as well as illustrated by Parkes Error grid and Bland-Altman plot. Sensor performance during changes of metabolic parameters (lactate, betahydroxybutyrate, glucagon, non-esterified-fatty-acids) was determined by Spearman`s rank correlation coefficient testing. The systems fulfilled ISO 15197:2013 criteria by 73.2% (Abbott), 56.1% (Dexcom) and 52.0% (Medtronic). MARD in the entire glycaemic range was 13.2% ± 10.9% (Abbott), 16.8% ± 12.3% (Dexcom) and 21.4% ± 17.6% (Medtronic), respectively. All sensors performed less accurately during hypoglycaemia and best during hyperglycaemia. We could not observe an influence of metabolic parameters on sensor performance.

  8. Quality-assurance data for routine water analysis in the National Water-Quality Laboratory of the US Geological Survey for water year 1988

    USGS Publications Warehouse

    Lucey, K.J.

    1989-01-01

    The US Geological Survey maintains a quality assurance program based on the analysis of reference samples for its National Water Quality Laboratory located in Denver, Colorado. Reference samples containing selected inorganic, nutrient, and precipitation (low-level concentration) constituents are prepared at the Survey 's Water Quality Services Unit in Ocala, Florida, disguised as routine samples, and sent daily or weekly, as appropriate, to the laboratory through other Survey offices. The results are stored permanently in the National Water Data Storage and Retrieval System (WATSTORE), the Survey 's database for all water data. These data are analyzed statistically for precision and bias. An overall evaluation of the inorganic major ion and trace metal constituent data for water year 1988 indicated a lack of precision in the National Water Quality Laboratory for the determination of 8 out of 58 constituents: calcium (inductively coupled plasma emission spectrometry), fluoride, iron (atomic absorption spectrometry), iron (total recoverable), magnesium (atomic absorption spectrometry), manganese (total recoverable), potassium, and sodium (inductively coupled plasma emission spectrometry). The results for 31 constituents had positive or negative bias during water year 1988. A lack of precision was indicated in the determination of three of the six nutrient constituents: nitrate plus nitrite nitrogen as nitrogen, nitrite nitrogen as nitrogen, and orthophosphate as phosphorus. A biased condition was indicated in the determination of ammonia nitrogen as nitrogen, ammonia plus organic nitrogen as nitrogen, and nitrate plus nitrite nitrogen as nitrogen. There was acceptable precision in the determination of all 10 constituents contained in precipitation samples. Results for ammonia nitrogen as nitrogen, sodium, and fluoride indicated a biased condition. (Author 's abstract)

  9. Hepatitis B virus reactivation among hepatitis C patients treated with direct-acting antiviral therapies in routine clinical practice.

    PubMed

    Loggi, Elisabetta; Gitto, Stefano; Galli, Silvia; Minichiello, Mario; Conti, Fabio; Grandini, Elena; Scuteri, Alessandra; Vitale, Giovanni; Di Donato, Roberto; Cursaro, Carmela; Furlini, Giuliano; Andreone, Pietro

    2017-08-01

    Hepatitis B (HBV) reactivation in chronic hepatitis C (CHC) patients treated with IFN-free direct acting antiviral (DAA) therapies has recently emerged as a potential risk. Given the potential burden of this issue, further data are needed to establish its actual clinical impact. The aim of the present study was to analyze the occurrence of HBV reactivation in a cohort of CHC patient treated with DAAs in routine clinical practice. Consecutive CHC patients with different genotypes, treated with DAA between January 2015 and January 2016 were included in the study. Subjects had been tested for HBsAg and anti-HBc antibodies before antiviral therapy. HBV-DNA levels were examined in anti-HBc positive patients at baseline and 24 weeks after the end of treatment. Post-treatment HBsAg determination was performed in case of HBV-DNA positivity. Serum anti-HBs kinetics was analysed in anti-HBs and anti-HBc positive subjects. A cohort of 137 consecutive HCV patients treated with IFN-free regimens in routine clinical practice was evaluated. From this cohort, plasma samples of 44 subjects with positive serology for HBV (anti-HBc positive) were tested for HBV-DNA levels at baseline and 24 weeks after the end of treatment. Two of them were HBsAg-positive, while the others had signs of a past HBV exposure (HBsAg-negative±HBsAb-positive). No reactivation was found in HBcAb-positive and HBsAg-negative subjects. In the two HBsAg-positive, one experienced an increase in HBV-DNA levels of ≥2 log10 IU/mL during treatment. However, the reactivation was without clinical impact and, most important, was followed by HBsAg loss. Based on our experience, a past HBV infection seems not to be a condition predisposing to HBV reactivation. On the contrary, in HBsAg-positive subjects not in suppressive treatment with nucleos(t)ide analogs, regular monitoring of HBV-DNA during and after DAA treatment should be considered. Copyright © 2017 Elsevier B.V. All rights reserved.

  10. Integrating Patient-Reported Outcome Measures into Routine Cancer Care: Cancer Patients’ and Clinicians’ Perceptions of Acceptability and Value

    PubMed Central

    Stover, Angela; Irwin, Debra E.; Chen, Ronald C.; Chera, Bhishamjit S.; Mayer, Deborah K.; Muss, Hyman B.; Rosenstein, Donald L.; Shea, Thomas C.; Wood, William A.; Lyons, Jessica C.; Reeve, Bryce B.

    2015-01-01

    Introduction: Despite growing interest in integrating patient-reported outcome (PRO) measures of symptoms and functional status into routine cancer care, little attention has been paid to patients’ and clinicians’ perceptions of acceptability and value. Methods: A two-phase qualitative study was conducted to develop a web-based PRO screening system with 21 items assessing symptoms (e.g., nausea) and functional status. Phase 1 involved cognitive interviews with 35 cancer outpatients (n=9 breast chemotherapy, radiation for prostate (n=8) or head and neck cancer (n=10), and n=8 bone marrow transplant [BMT]). In Phase 2, we evaluated the acceptability and perceived value of reviewing a PRO measure during real-time clinical encounters with 39 additional outpatients (n=10 breast, n=9 head and neck, n=10 prostate, n=10 BMT) and 12 clinicians (n=3 breast, n=2 head and neck, n=4 prostate, n=3 BMT). At least 20% of patients were ≥60 years, African American, or ≤ high school. Results: Patients felt that their PRO summary of symptoms and functional status was helpful in discussing health issues with clinicians (92%), wanted to review their results with clinicians during future visits (82%), and would recommend it to other patients (87%). Clinicians found the PRO summary to be easy to interpret (83%), most helpful for documenting the Review of Symptoms (92%), and would recommend it to future patients (92%). Over 90% of clinicians reported that consultation time did not increase. Conclusion: Both cancer patients and clinicians reported that discussing a PRO summary of symptoms and functional status during an outpatient visit was useful, acceptable, and feasible. PMID:26557724

  11. The role of patient experience surveys in quality assurance and improvement: a focus group study in English general practice.

    PubMed

    Boiko, Olga; Campbell, John L; Elmore, Natasha; Davey, Antoinette F; Roland, Martin; Burt, Jenni

    2015-12-01

    Despite widespread adoption of patient feedback surveys in international health-care systems, including the English NHS, evidence of a demonstrable impact of surveys on service improvement is sparse. To explore the views of primary care practice staff regarding the utility of patient experience surveys. Qualitative focus groups. Staff from 14 English general practices. Whilst participants engaged with feedback from patient experience surveys, they routinely questioned its validity and reliability. Participants identified surveys as having a number of useful functions: for patients, as a potentially therapeutic way of getting their voice heard; for practice staff, as a way of identifying areas of improvement; and for GPs, as a source of evidence for professional development and appraisal. Areas of potential change stimulated by survey feedback included redesigning front-line services, managing patient expectations and managing the performance of GPs. Despite this, practice staff struggled to identify and action changes based on survey feedback alone. Whilst surveys may be used to endorse existing high-quality service delivery, their use in informing changes in service delivery is more challenging for practice staff. Drawing on the Utility Index framework, we identified concerns relating to reliability and validity, cost and feasibility acceptability and educational impact, which combine to limit the utility of patient survey feedback. Feedback from patient experience surveys has great potential. However, without a specific and renewed focus on how to translate feedback into action, this potential will remain incompletely realized. © 2014 The Authors Health Expectations Published by John Wiley & Sons Ltd.

  12. Routine invasive management early after fibrinolysis: relationship between baseline risk and treatment effects in a pooled patient-level analysis of 7 randomized controlled trials.

    PubMed

    Bagai, Akshay; Tan, Mary; Di Mario, Carlo; Halvorsen, Sigrun; Cantor, Warren J; Le May, Michel R; Fernandez-Aviles, Francisco; Scheller, Bruno; Armstrong, Paul W; Borgia, Francesco; Piscione, Federico; Sánchez, Pedro L; Westerhout, Cynthia M; Goodman, Shaun G; Yan, Andrew T

    2014-11-01

    The efficacy of a routine invasive strategy early after fibrinolysis in relation to baseline risk status is unclear. We sought to characterize the interaction between patient risk and treatment with routine invasive strategy early after fibrinolysis for ST-segment elevation myocardial infarction. We pooled 2,974 patients from 7 randomized trials of fibrinolysis-treated patients with ST-segment elevation myocardial infarction comparing a routine early invasive strategy with a standard approach of percutaneous coronary intervention (PCI) guided by recurrent ischemia or need for rescue. Cox proportional hazards regression was used to examine the interaction between baseline patient risk classified by Thrombolysis in Myocardial Infarction risk score (low/intermediate: ≤ 5 [n = 2,697] vs high: > 5 [n = 277]) and treatment with routine early invasive strategy. Time to PCI after fibrinolysis was longer among patients randomized to standard treatment compared with routine early invasive strategy in the low/intermediate-risk strata (median 11.4 vs 3.5 hours), but was only marginally different between the 2 groups in the high-risk strata (median 4.1 vs 3.5 hours). There was a significant interaction between treatment assignment and risk status for the composite of 30-day death or reinfarction (P = .01). Compared with standard treatment, routine early invasive strategy was associated with lower 30-day death/reinfarction in the low/intermediate-risk stratum (7.5% vs 4.0%, P < .001), but not in the high-risk stratum (14.9% vs 19.6%, P = .45). Although clearly beneficial among the larger subgroup of patients at low/intermediate risk, the benefit of a routine early invasive strategy was not evident in the smaller subgroup of higher-risk patients in the context of an increased requirement for urgent PCI in the comparative standard treatment arm. Copyright © 2014 Elsevier Inc. All rights reserved.

  13. Microcytic hypochromic anemia: should high performance liquid chromatography be used routinely for screening anemic and antenatal patients?

    PubMed

    Philip, Joseph; Sarkar, Ravi Shankar; Kushwaha, Neerja

    2013-01-01

    Hemoglobinopathies are the most common inherited red cell disorders worldwide. Identification of these disorders is immensely important epidemiologically and for improved management protocols. Our aim was to determine the prevalence of hemoglobinopathies in patients with microcytic hypochromic anemia and to assess the suitability of using high performance liquid chromatography (HPLC) routinely for screening antenatal cases and patients with anemia. A total of 4335 cases received from Mar 2007 to Nov 2011 were studied for various hemoglobinopathies and variants on BIO RAD 'VARIANT' analyzer. Of the 4335 cases studied, 2119 were antenatal cases, 1710 patients with other disorders and 506 family studies. Of these, 688 cases displayed abnormal hemoglobin fractions on HPLC of which 140 were antenatal women. There were 455 cases of β thalassemia trait, 24 β thalassemia major, 20 thalassemia inter-media, 54 sickle cell trait, fivesickle cell disease, 21 double heterozygous β thalassemia-sickle cell trait, nineand 4 Hb D- Punjab heterozygous and homozygous respectively, three Hb D β Thalassemia trait, 20 and 37 Hb E homozygous and heterozygous respectively, three Hb E β Thalassemia trait and four cases of Hb Q India. Twenty nine adults had isolated HbF elevation. Our study found a high prevalence (15.8%) of hemoglobinopathies amongst microcytic hypochromic anemia and antenatal cases. An accurate diagnosis helps in preventing unnecessary iron loading. Screening all antenatal cases with anemia helps in timely antenatal counseling, thus preventing the psychological trauma of bearing a transfusion dependent child for life.

  14. A mixed-method investigation of patient monitoring and enhanced feedback in routine practice: Barriers and facilitators

    PubMed Central

    Lucock, Mike; Halstead, Jeremy; Leach, Chris; Barkham, Michael; Tucker, Samantha; Randal, Chloe; Middleton, Joanne; Khan, Wajid; Catlow, Hannah; Waters, Emma; Saxon, David

    2015-01-01

    Abstract Objective: To investigate the barriers and facilitators of an effective implementation of an outcome monitoring and feedback system in a UK National Health Service psychological therapy service. Method: An outcome monitoring system was introduced in two services. Enhanced feedback was given to therapists after session 4. Qualitative and quantitative methods were used, including questionnaires for therapists and patients. Thematic analysis was carried out on written and verbal feedback from therapists. Analysis of patient outcomes for 202 episodes of therapy was compared with benchmark data of 136 episodes of therapy for which feedback was not given to therapists. Results: Themes influencing the feasibility and acceptability of the feedback system were the extent to which therapists integrated the measures and feedback into the therapy, availability of administrative support, information technology, and complexity of the service. There were low levels of therapist actions resulting from the feedback, including discussing the feedback in supervision and with patients. Conclusions: The findings support the feasibility and acceptability of setting up a routine system in a complex service, but a number of challenges and barriers have to be overcome and therapist differences are apparent. More research on implementation and effectiveness is needed in diverse clinical settings. PMID:26436605

  15. Should excretory urography be used as a routine diagnostic procedure in patients with acute ureteric colic: a single center study.

    PubMed

    Samara, Osama A; Haroun, Dina A; Ashour, Do'a Z; Tarawneh, Emad S; Haroun, Azmi A

    2011-05-01

    The aim of this study was to find an accurate, easily available and safe imaging modality as an alternative to intravenous urography for the diagnosis of acute urinary obstruction. This retrospective study included 332 patients, who underwent both excretory urography (EU) preceeded by plain radiograph as well as ultrasonography for evaluation of acute flank pain. There were 198 male and 134 female patients. The presence or absence of urinary stones, level of obstruction, excretion delay on EU and dilated excretory system on either or both techniques were recorded. The sensitivity, specificity, predictive values, and accuracy for plain radiograph, ultrasonography, and for both modalities together were measured considering EU as a standard reference. The sensitivity and specificity of combined plain radiograph and ultrasound were 97% and 67%, respectively, with positive and negative predictive values and accuracy rates of 92%, 99%, and 97%, respectively. Our study suggests that the combination of plain radiograph and ultrasonography yields a high sensitivity, negative predictive value, and accuracy in depiction of urinary stones. Thus, EU need not be used as a routine diagnostic procedure in patients with acute obstructive uropathy.

  16. Longitudinal lactate levels from routine point-of-care monitoring in adult Malawian antiretroviral therapy patients: associations with stavudine toxicities.

    PubMed

    Chagoma, Newton; Mallewa, Jane; Kaunda, Symon; Njalale, Yasin; Kampira, Elizabeth; Mukaka, Mavuto; Heyderman, Robert S; van Oosterhout, Joep J

    2013-10-01

    Stavudine is still widely used in under-resourced settings such as Malawi due to its low price. It frequently causes peripheral neuropathy and lipodystrophy and increases the risk of lactic acidosis and other high lactate syndromes. We studied the association of longitudinal lactate levels, obtained by routine, 3-monthly point-of-care monitoring, with peripheral neuropathy, lipodystrophy and high lactate syndromes in adult Malawians who were in the second year of stavudine containing antiretroviral therapy (ART). Point-of-care lactate measurements were feasible in a busy urban ART clinic. Of 1170 lactate levels collected from 253 patients over the course of one year, 487 (41.8%) were elevated (>2.2mg/dl), 58 (5.0%) were highly elevated (>3.5mg/dl). At least one elevated lactate level occurred in 210 (83.0%) of patients and sustained hyperlactatemia in 65 (26.4%). In random effects analyses lipodystrophy and peripheral neuropathy were associated with higher lactate levels. Only five patients developed high lactate syndromes (one lactic acidosis) of whom no preceding lactate measurements were available because events had started before enrolment. Lactate levels significantly decreased over time and no high lactate syndromes were observed after the 15th month on ART. Lipodystrophy and peripheral neuropathy were associated with higher lactate levels. Lactate levels decreased over time, coinciding with absence of new high lactate syndromes after the 15th month on ART.

  17. Routine Drug Screening for Patients in the Emergency Department of a State Psychiatric Hospital: A Naturalistic Cohort Study.

    PubMed

    Margolis, Anatoly; Rosca, Paola; Kurs, Rena; Sznitman, Sharon R; Grinshpoon, Alexander

    2016-01-01

    This study investigates the proportion of drug users among patients with mental disorders who attended the emergency department of one major psychiatric hospital in Northern Israel, the most frequent psychiatric diagnoses associated with drug use, and the impact of confirmed drug use on hospital admission. We hypothesized that the proportion of individuals with positive urine drug test results presenting at the psychiatric emergency department during the study period would be 20% to 30%. An unselected cohort of 2,019 adult patients who visited the emergency department of Sha'ar Menashe Mental Health Center, a university-affiliated government facility, was evaluated and underwent routine urine drug testing between April 2012 and February 2014. Clinical, demographic, and urine drug test data were collected from medical records and statistically analyzed, comparing diagnostic evaluation at admission and after discharge from either the emergency department or the hospital. Univariate and logistic regression analyses were used to identify the possible variables associated with drug use in this sample. Urine drug test results showed that 194 of the 2,019 subjects (9.6%) had used a psychoactive substance before attending the emergency department. Among patients with positive urine drug test results, the majority (77.8%) used cannabis, 25.8% used opiates, 24.7% used ecstasy, and 5.2% used cocaine. Differences in the prevalence of positive urine drug test results between admitted and nonadmitted patients did not reach a statistically significant level. The frequency of positive urine drug test results across lifetime International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) diagnoses was 27.2% for substance-related disorders, 4.8% for psychotic disorders, 4.2% for mood disorders, 11.0% for personality disorders, and 11.5% for nonpsychotic disorders. Both univariate and logistic regression analyses revealed that younger age (18

  18. A systematic review of the impact of routine collection of patient reported outcome measures on patients, providers and health organisations in an oncologic setting

    PubMed Central

    2013-01-01

    Background Despite growing interest and urges by leading experts for the routine collection of patient reported outcome (PRO) measures in all general care patients, and in particular cancer patients, there has not been an updated comprehensive review of the evidence regarding the impact of adopting such a strategy on patients, service providers and organisations in an oncologic setting. Methods Based on a critical analysis of the three most recent systematic reviews, the current systematic review developed a six-method strategy in searching and reviewing the most relevant quantitative studies between January 2000 and October 2011 using a set of pre-determined inclusion criteria and theory-based outcome indicators. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system was used to rate the quality and importance of the identified publications, and the synthesis of the evidence was conducted. Results The 27 identified studies showed strong evidence that the well-implemented PROs improved patient-provider communication and patient satisfaction. There was also growing evidence that it improved the monitoring of treatment response and the detection of unrecognised problems. However, there was a weak or non-existent evidence-base regarding the impact on changes to patient management and improved health outcomes, changes to patient health behaviour, the effectiveness of quality improvement of organisations, and on transparency, accountability, public reporting activities, and performance of the health care system. Conclusions Despite the existence of significant gaps in the evidence-base, there is growing evidence in support of routine PRO collection in enabling better and patient-centred care in cancer settings. PMID:23758898

  19. [New routines in orthopedics department yielded more efficient care and more satisfied patients. Physiotherapist and team make the first assessment in new visits to the spine surgeon].

    PubMed

    Knutsson, Björn; Torstensson, Thomas

    2015-09-11

    There is a shortage of spine surgeons in Sweden. To guarantee the legal right to healthcare, many counties must hire doctors, with increasing costs. In our new out-patient department routine, the majority of the patients are examined by a physiotherapist at their first visit. History taking and clinical and radiographic examinations are discussed in a team conference, and possible candidates for spine surgery are selected for an appointment with a spine surgeon. Furthermore, the patients were more satisfied with the new routine and management plan.

  20. A modified Two-BUN method for routine urea modeling: clinical validation in 120 patients on a free diet.

    PubMed

    Casino, F G; Lomonte, C; Russo, R; Di Iorio, B; Chiarulli, G; Manno, C; Lopez, T

    1995-09-01

    Recently, a modified algorithm of the Two-BUN method (MA2p), avoiding dialyzer clearance measurement, was presented for routine assessment of Kt/V and NPCR. To validate MA2p in patients on a free diet (FDP), we studied 120 stable dialysis FDP by measuring Kt/V and NPCR with both MA2p and a modified version of the standard Three-BUN method (MA3p), for the 3 weekly sessions. The NPCR values (g/kg/day), calculated by MA3p for the 3 interdialyses were: 1.286 +/- 0.274, 1.256 +/- 0.276, and 1.116 +/- 0.230, respectively. The correlation coefficient (r) for averaged Kt/V values obtained by the two methods was 0.999 and the percent error (Error%) for MA2p vs. MA3p results ranged from -1.5 to +0.78%. The respective results for NPCR were: r = 0.967, Error% range from -11.7 to +13.9%. In conclusion, MA2p can be safely used in patients on a free diet. The lowest NPCR values were observed during the long interdialysis.

  1. The Bactec FX Blood Culture System Detects Brucella melitensis Bacteremia in Adult Patients within the Routine 1-Week Incubation Period.

    PubMed

    Sagi, Moshe; Nesher, Lior; Yagupsky, Pablo

    2017-03-01

    The performance of the Bactec FX blood culture system for detecting Brucella bacteremia within the routine 1-week incubation period was assessed in a prospective study conducted in an area in southern Israel in which Brucella melitensis is endemic. Aerobic vials (BD Bactec Plus Aerobic/F medium) inoculated with blood specimens obtained from adult patients with positive Rose-Bengal screening test results were monitored for 4 consecutive weeks, and blind subcultures of negative vials were performed on solid media on days 7 and 28. During a 16-month period, a total of 31 (35.2%) of 88 cultures, obtained from 19 (38.0%) of 50 patients, were positive for Brucella melitensis The blood culture instrument identified 30 (96.8%) of 31 positive vials within 7 days of incubation; the single positive vial that was missed by the automated readings was detected only by the blind subculture performed on day 28. It is concluded that the Bactec FX system is able to detect the vast majority of episodes of Brucella bacteremia within the 1-week incubation protocol instituted in most clinical microbiology laboratories and without the need to perform blind subcultures of negative vials, enabling early diagnosis and saving labor and incubation time and space.

  2. Randomized Trial Comparing a Web-Mediated Follow-up With Routine Surveillance in Lung Cancer Patients.

    PubMed

    Denis, Fabrice; Lethrosne, Claire; Pourel, Nicolas; Molinier, Olivier; Pointreau, Yoann; Domont, Julien; Bourgeois, Hugues; Senellart, Hélène; Trémolières, Pierre; Lizée, Thibaut; Bennouna, Jaafar; Urban, Thierry; El Khouri, Claude; Charron, Alexandre; Septans, Anne-Lise; Balavoine, Magali; Landry, Sébastien; Solal-Céligny, Philippe; Letellier, Christophe

    2017-09-01

    The use of web-based monitoring for lung cancer patients is growing in interest because of promising recent results suggesting improvement in cancer and resource utilization outcomes. It remains an open question whether the overall survival (OS) in these patients could be improved by using a web-mediated follow-up rather than classical scheduled follow-up and imaging. Advanced-stage lung cancer patients without evidence of disease progression after or during initial treatment were randomly assigned in a multicenter phase III trial to compare a web-mediated follow-up algorithm (experimental arm), based on weekly self-scored patient symptoms, with routine follow-up with CT scans scheduled every three to six months according to the disease stage (control arm). In the experimental arm, an alert email was automatically sent to the oncologist when self-scored symptoms matched predefined criteria. The primary outcome was OS. From June 2014 to January 2016, 133 patients were enrolled and 121 were retained in the intent-to-treat analysis; 12 deemed ineligible after random assignment were not subsequently followed. Most of the patients (95.1%) had stage III or IV disease. The median follow-up was nine months. The median OS was 19.0 months (95% confidence interval [CI] = 12.5 to noncalculable) in the experimental and 12.0 months (95% CI = 8.6 to 16.4) in the control arm (one-sided P = .001) (hazard ratio = 0.32, 95% CI = 0.15 to 0.67, one-sided P = .002). The performance status at first detected relapse was 0 to 1 for 75.9% of the patients in the experimental arm and for 32.5% of those in the control arm (two-sided P < .001). Optimal treatment was initiated in 72.4% of the patients in the experimental arm and in 32.5% of those in the control arm (two-sided P < .001). A web-mediated follow-up algorithm based on self-reported symptoms improved OS due to early relapse detection and better performance status at relapse.

  3. The PRONE score: an algorithm for predicting doctors’ risks of formal patient complaints using routinely collected administrative data

    PubMed Central

    Spittal, Matthew J; Bismark, Marie M; Studdert, David M

    2015-01-01

    Background Medicolegal agencies—such as malpractice insurers, medical boards and complaints bodies—are mostly passive regulators; they react to episodes of substandard care, rather than intervening to prevent them. At least part of the explanation for this reactive role lies in the widely recognised difficulty of making robust predictions about medicolegal risk at the individual clinician level. We aimed to develop a simple, reliable scoring system for predicting Australian doctors’ risks of becoming the subject of repeated patient complaints. Methods Using routinely collected administrative data, we constructed a national sample of 13 849 formal complaints against 8424 doctors. The complaints were lodged by patients with state health service commissions in Australia over a 12-year period. We used multivariate logistic regression analysis to identify predictors of subsequent complaints, defined as another complaint occurring within 2 years of an index complaint. Model estimates were then used to derive a simple predictive algorithm, designed for application at the doctor level. Results The PRONE (Predicted Risk Of New Event) score is a 22-point scoring system that indicates a doctor's future complaint risk based on four variables: a doctor's specialty and sex, the number of previous complaints and the time since the last complaint. The PRONE score performed well in predicting subsequent complaints, exhibiting strong validity and reliability and reasonable goodness of fit (c-statistic=0.70). Conclusions The PRONE score appears to be a valid method for assessing individual doctors’ risks of attracting recurrent complaints. Regulators could harness such information to target quality improvement interventions, and prevent substandard care and patient dissatisfaction. The approach we describe should be replicable in other agencies that handle large numbers of patient complaints or malpractice claims. PMID:25855664

  4. "Sorry Can You Speak It in English with Me?" Managing Routines in Lingua Franca Doctor--Patient Consultations in a Diabetes Clinic

    ERIC Educational Resources Information Center

    Martin, Gillian S.

    2015-01-01

    Research on the routines of doctor-patient consultations has been conducted in language and culture concordant dyads and in dyads where either doctor or patient uses a foreign language; yet there is an absence of scholarly engagement with consultations where both participants are using a foreign language. In seeking to address this gap, this…

  5. "Sorry Can You Speak It in English with Me?" Managing Routines in Lingua Franca Doctor--Patient Consultations in a Diabetes Clinic

    ERIC Educational Resources Information Center

    Martin, Gillian S.

    2015-01-01

    Research on the routines of doctor-patient consultations has been conducted in language and culture concordant dyads and in dyads where either doctor or patient uses a foreign language; yet there is an absence of scholarly engagement with consultations where both participants are using a foreign language. In seeking to address this gap, this…

  6. Outcomes of Hepatic Resection in Intrahepatic Cholangiocarcinoma Patients with Diabetes, Hypertension, and Dyslipidemia: Significance of Routine Follow-Up

    PubMed Central

    Nishioka, Takayoshi; Kubo, Shoji; Tanaka, Shogo; Wakasa, Kenichi; Takemura, Shigekazu; Kinoshita, Masahiko; Hamano, Genya; Kuwae, Yuko; Shibata, Toshihiko; Suehiro, Shigefumi

    2016-01-01

    Background The outcomes of hepatic resection in intrahepatic cholangiocarcinoma (ICC) patients with diabetes mellitus (DM), hypertension (HT), and dyslipidemia (DL) (metabolic components) remain unclear. Methods The outcomes of 43 ICC patients without known risk factors for ICC who underwent hepatic resection were retrospectively reviewed. These patients were divided into three groups: those followed-up for metabolic components at least every 6 months (follow-up group, n=16), those not followed-up for metabolic components (no follow-up group, n=14), and those without metabolic components (control group, n=13). Results In the follow-up group, 13 (81%) patients were further examined for ICC during follow-up because of abnormal screening results, such as elevated serum gamma-glutamyl transpeptidase and carbohydrate antigen 19-9 (CA19-9) concentrations or detection of hepatic tumor on ultrasonography and/or computed tomography, whereas most patients in the other two groups exhibited ICC-related symptoms. No patient in the follow-up group exhibited lymph node metastasis, whereas 43% of those in the no follow-up group and 46% in the control group had lymph node metastasis (p=0.005 and 0.004 vs. the follow-up group, respectively). All 16 patients in the follow-up group were diagnosed as International Union Against Cancer pathologic stage I or II (early stage). There were no significant differences in the incidence of postoperative recurrence between the three groups; however, the incidence of extrahepatic recurrence was lower in the follow-up group than in the no follow-up group and the control group (13% vs. 78% vs. 63%, p=0.0232). The 1-, 3-, and 5-year overall survivalrates in the follow-up group were better than those in the no follow-up and control groups (93/93/66% vs. 77/34/34% and 85/24/0%, p=0.034 and 0.001, respectively). Conclusions Routine measurement of serum gamma-glutamyl transpeptidase and/or CA19-9 levels and imaging examinations every 12 months (or 6

  7. Predicting frequent asthma exacerbations using blood eosinophil count and other patient data routinely available in clinical practice

    PubMed Central

    Price, David; Wilson, Andrew M; Chisholm, Alison; Rigazio, Anna; Burden, Anne; Thomas, Michael; King, Christine

    2016-01-01

    .50, 4.01]; P<0.001), and three or more courses increased the odds by >25-fold (OR: 25.7 [95% CI: 23.9, 27.6]; P<0.001). Conclusion Blood eosinophil count and several other variables routinely available in patient records may be used to predict frequent asthma exacerbations. PMID:26793004

  8. Routine follow-up cranial computed tomography for deeply sedated, intubated, and ventilated multiple trauma patients with suspected severe head injury.

    PubMed

    Wurmb, Thomas Erik; Schlereth, Stefan; Kredel, Markus; Muellenbach, Ralf M; Wunder, Christian; Brederlau, Jörg; Roewer, Norbert; Kenn, Werner; Kunze, Ekkehard

    2014-01-01

    Missed or delayed detection of progressive neuronal damage after traumatic brain injury (TBI) may have negative impact on the outcome. We investigated whether routine follow-up CT is beneficial in sedated and mechanically ventilated trauma patients. The study design is a retrospective chart review. A routine follow-up cCT was performed 6 hours after the admission scan. We defined 2 groups of patients, group I: patients with equal or recurrent pathologies and group II: patients with new findings or progression of known pathologies. A progression of intracranial injury was found in 63 patients (42%) and 18 patients (12%) had new findings in cCT 2 (group II). In group II a change in therapy was found in 44 out of 81 patients (54%). 55 patients with progression or new findings on the second cCT had no clinical signs of neurological deterioration. Of those 24 patients (44%) had therapeutic consequences due to the results of the follow-up cCT. We found new diagnosis or progression of intracranial pathology in 54% of the patients. In 54% of patients with new findings and progression of pathology, therapy was changed due to the results of follow-up cCT. In trauma patients who are sedated and ventilated for different reasons a routine follow-up CT is beneficial.

  9. A cross-platform survey of CT image quality and dose from routine abdomen protocols and a method to systematically standardize image quality

    NASA Astrophysics Data System (ADS)

    Favazza, Christopher P.; Duan, Xinhui; Zhang, Yi; Yu, Lifeng; Leng, Shuai; Kofler, James M.; Bruesewitz, Michael R.; McCollough, Cynthia H.

    2015-11-01

    Through this investigation we developed a methodology to evaluate and standardize CT image quality from routine abdomen protocols across different manufacturers and models. The influence of manufacturer-specific automated exposure control systems on image quality was directly assessed to standardize performance across a range of patient sizes. We evaluated 16 CT scanners across our health system, including Siemens, GE, and Toshiba models. Using each practice’s routine abdomen protocol, we measured spatial resolution, image noise, and scanner radiation output (CTDIvol). Axial and in-plane spatial resolutions were assessed through slice sensitivity profile (SSP) and modulation transfer function (MTF) measurements, respectively. Image noise and CTDIvol values were obtained for three different phantom sizes. SSP measurements demonstrated a bimodal distribution in slice widths: an average of 6.2  ±  0.2 mm using GE’s ‘Plus’ mode reconstruction setting and 5.0  ±  0.1 mm for all other scanners. MTF curves were similar for all scanners. Average spatial frequencies at 50%, 10%, and 2% MTF values were 3.24  ±  0.37, 6.20  ±  0.34, and 7.84  ±  0.70 lp cm-1, respectively. For all phantom sizes, image noise and CTDIvol varied considerably: 6.5-13.3 HU (noise) and 4.8-13.3 mGy (CTDIvol) for the smallest phantom; 9.1-18.4 HU and 9.3-28.8 mGy for the medium phantom; and 7.8-23.4 HU and 16.0-48.1 mGy for the largest phantom. Using these measurements and benchmark SSP, MTF, and image noise targets, CT image quality can be standardized across a range of patient sizes.

  10. A cross-platform survey of CT image quality and dose from routine abdomen protocols and a method to systematically standardize image quality

    PubMed Central

    Favazza, Christopher P.; Duan, Xinhui; Zhang, Yi; Yu, Lifeng; Leng, Shuai; Kofler, James M.; Bruesewitz, Michael R.; McCollough, Cynthia H.

    2015-01-01

    Through this investigation we developed a methodology to evaluate and standardize CT image quality from routine abdomen protocols across different manufacturers and models. The influence of manufacturer-specific automated exposure control systems on image quality was directly assessed to standardize performance across a range of patient sizes. We evaluated 16 CT scanners across our health system, including Siemens, GE, and Toshiba models. Using each practice’s routine abdomen protocol, we measured spatial resolution, image noise, and scanner radiation output (CTDIvol). Axial and in-plane spatial resolutions were assessed through slice sensitivity profile (SSP) and modulation transfer function (MTF) measurements, respectively. Image noise and CTDIvol values were obtained for three different phantom sizes. SSP measurements demonstrated a bimodal distribution in slice widths: an average of 6.2 ± 0.2 mm using GE’s “Plus” mode reconstruction setting and 5.0 ± 0.1 mm for all other scanners. MTF curves were similar for all scanners. Average spatial frequencies at 50%, 10%, and 2% MTF values were 3.24 ± 0.37, 6.20 ± 0.34, and 7.84 ± 0.70 lp/cm, respectively. For all phantom sizes, image noise and CTDIvol varied considerably: 6.5–13.3 HU (noise) and 4.8–13.3 mGy (CTDIvol) for the smallest phantom; 9.1–18.4 HU and 9.3–28.8 mGy for the medium phantom; and 7.8–23.4 HU and 16.0–48.1 mGy for the largest phantom. Using these measurements and benchmark SSP, MTF, and image noise targets, CT image quality can be standardized across a range of patient sizes. PMID:26459751

  11. Primary angioplasty and routine utilization of thrombus aspiration devices: feasibility and results in a consecutive series of 486 patients.

    PubMed

    Varbella, Ferdinando; Gagnor, Andrea; Luceri, Stefania; Bongioanni, Sergio; Nannini, Cristiana; Masi, Andrea Sibona; Tripodi, Rosario; Pron, Paolo Giay; Mainardi, Loredana; Badalì, Antonino; Conte, Maria R

    2007-04-01

    Primary percutaneous transluminal coronary angioplasty (PTCA) is the treatment of choice for acute ST-segment elevation myocardial infarction (STEMI) in high-volume centres with experienced operators, but is often limited by a suboptimal microvascular perfusion due to distal embolization and impaired myocardial perfusion. The present study investigates whether routine use of thrombus aspiration (TA) devices is feasible in daily practice, along with its safety and effectiveness. This study is based on a series of 486 consecutive STEMI patients treated at our single institution by the same three operators (from 2001 to 2005). They underwent primary PTCA with or without TA according to these angiographic features: infarct related artery (IRA) diameter>or=3 mm; thrombotic occlusion or angiographic evidence of thrombus; absence of severe proximal tortuosity or calcification. We evaluate the efficacy of TA in terms of procedural success, coronary thrombolysis in myocardial infarction (TIMI) flow, myocardial blush grade (MBG), resolution>or=50% of ST segment elevation, and clinical events during hospital stay and at 6-month follow-up. A total of 486 primary PTCAs were performed, 217 (44.6%) with TA as a first device using RESCUE (n=65), EXPORT (n=140) and DIVER-CE (n=12) catheters. In 141 (65%) cases, macroscopic material was aspirated. The patients submitted to TA were more often males (84.7% versus 71.7%, P<0.05) and younger (age: 61.02+/-11.91 versus 64.47+/-10.59 years, P<0.01) than patients treated with traditional PTCA and the IRA was more frequently occluded at angiography (basal TIMI 0: 70.5% versus 47.9%). Application of the TA did not increase the complexity of the procedure (door-to-balloon times, minutes of fluoroscopy and amount of dye). TA alone was effective to restore TIMI 3 flow in 187 cases (86.2%) as a first device and in three other cases (1.4%) after predilatation with balloon. Direct stenting without predilatation was possible in 144 cases (66

  12. Evaluation of Noncompletion Bias and Long-Term Adherence in a 10-Year Patient-Reported Outcome Monitoring Program in Clinical Routine.

    PubMed

    Gamper, Eva Maria; Nerich, Virginie; Sztankay, Monika; Martini, Caroline; Giesinger, Johannes M; Scarpa, Lorenza; Buxbaum, Sabine; Jeller, Martin; Holzner, Bernhard; Virgolini, Irene

    2017-04-01

    Currently there is little knowledge on real-life sustainability of routine patient-reported outcome (PRO) measurement and the representativeness of collected data. The investigation of routine PRO with regard to noncompletion bias and long-term adher- ence, considering the potential impact of mode of assessment (MOA) (paper-pencil vs. electronic PRO [ePRO]) and patient characteristics. At our department, routine PRO measurement in oncological patients is being done since 2005 using different MOA (paper-pencil assessment until 2011 and ePRO assessment from 2011 onward). We analyzed two different patient groups: patients eligible in both periods (both-MOA group) and patients eligible in only one period (one-MOA group). The primary outcome was PRO noncompletion (100% missing questionnaires). The secondary outcome was poor PRO adherence (>20% missing questionnaires). Multivariate logistic regression models were developed, testing the impact of MOA and patient characteristics on the outcomes in the different patient groups. Data from 1484 eligible patients were included in the analyses. Most of the patients could be included in PRO assessment at least once. PRO noncompletion rates were clearly higher during paper-pencil assessment (odds ratios between 2.72 and 4.31), as were poor PRO adherence rates (odd ratio 2.23). Analyses of potential bias by patient characteristics showed that male patients had a higher risk of poor adherence. Other factors with significant impact were age, country, and cancer diagnosis, but results were indecisive. ePRO increased the feasibility of our clinical routine PRO data for retrospective analyses by increasing completion rates. In general, potential completion bias regarding certain patient characteristics requires attention before generalizing results to the respective populations. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  13. CCU patient survey tool: all-out recovery.

    PubMed

    Bradford, D; Carvalho, M; Conti, M; Davis, J; Dix, S K; Hartman, E; Iding, L; Mueller, L; Porth, C M; Sunstrom, C

    1998-09-01

    Studies show that patients' recall of their CCU stays is extremely limited due to various factors. To monitor patient satisfaction in this area, a team of CCU managers developed a survey and began an "All-Out Recovery Program."

  14. The management of uncomplicated adult gonococcal infection: should test of cure still be routine in patients attending genitourinary medicine clinics?

    PubMed

    Harry, C

    2004-07-01

    .5%). We have now discontinued routine attendance for a test of cure and encourage our patients to telephone for their results with recall only of patients whose antimicrobial susceptibility indicate inappropriate first line therapy or who are still symptomatic.

  15. National survey of family physicians to define functional decline in elderly patients with minor trauma.

    PubMed

    Abdulaziz, Kasim E; Brehaut, Jamie; Taljaard, Monica; Émond, Marcel; Sirois, Marie-Josée; Lee, Jacques S; Wilding, Laura; Perry, Jeffrey J

    2016-08-22

    Failing to assess elderly patients for functional decline at the time around a minor injury may result in adverse health outcomes. This study was conducted to define what constitutes clinically significant functional decline and the sensitivity required for a clinical decision instrument to identify such functional decline after an injury in previously independent elderly patients. After a thorough development process, a survey questionnaire was administered to a random sample of 178 family physicians. The surveys were distributed using a modified Dillman technique. From 143 eligible surveys, we received 67 completed surveys (response rate, 46.9 %). Respondents indicated that a drop of at least 3 points on the 28-point Older Americans Resources and Services (OARS) ADL Scale was considered clinically significant by 90 % of physicians. Ninety percent (90 %) of physicians would be satisfied with a sensitivity of 90 % or more for a clinical decision instrument to detect patients at risk of functional decline at 6 months following an injury. The majority of family physicians do not routinely assess the majority of the tasks on the OARS scale for injured elderly patients. A high proportion of physicians (90 %) would consider a drop of 3 points on the OARS ADL Scale as significant to define functional decline and would be satisfied with a sensitivity of 90 % for a clinical decision instrument to detect such a decline. Any instrument to identify patients at elevated risk for subsequent decline should consider these outcome measures to be clinically useful.

  16. The development of the Patient Expectations of Shoulder Surgery survey.

    PubMed

    Koorevaar, Rinco C T; Haanstra, Tsjitske; Van't Riet, Esther; Lambers Heerspink, Okke F O; Bulstra, Sjoerd K

    2017-06-07

    Patient satisfaction after a surgical procedure is dependent on meeting preoperative expectations. There is currently no patient expectations survey available for patients undergoing shoulder surgery that is validated, reliable, and easy to use in daily practice. The aim of this study was to develop a Patient Expectations of Shoulder Surgery (PESS) survey. In 315 patients, answers to an open-ended question about patient expectations were collected before shoulder surgery to develop the PESS survey. Patients' expectations of the PESS survey were associated with clinical outcome (change of Disabilities of the Arm, Shoulder, and Hand score). Content validity was assessed by a panel of 10 patients scheduled for shoulder surgery, and test-retest reliability was evaluated. Six items were included in the PESS survey: pain relief, improved range of motion, improved ability to perform daily activities, improved ability to perform work, improved ability to participate in recreational activities and sports, and stop shoulder from dislocating. Three of the 6 expectations were significantly associated with clinical outcome after shoulder surgery. Test-retest reliability was high with an intraclass correlation coefficient of 0.52-0.92. The PESS survey is a valid and reliable survey that can be used in future clinical research and in daily orthopedic practice. We believe that the preoperative evaluation of patient expectations should be a standard procedure before shoulder surgery. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  17. Routine hospital admission versus out-patient or home care in children at diagnosis of type 1 diabetes mellitus.

    PubMed

    Clar, C; Waugh, N; Thomas, S

    2003-01-01

    In many places, children newly diagnosed with type 1 diabetes mellitus are admitted to hospital for metabolic stabilisation and training, even if they are not acutely ill. Out-patient or home based management of these children could avoid the stress associated with a hospital stay, could provide a more natural learning environment for the child and its family, and might reduce costs for both the health care system and the families. To assess the effects of routine hospital admission compared to out-patient or home-based management in children newly diagnosed with type 1 diabetes who are not acutely ill, on metabolic control, wellbeing and self-efficacy of the patient and his/her family. We searched the Cochrane Library (including the Cochrane Controlled Trials Register), Medline, Embase, Cinahl, and the British Nursing Index. Additionally, we searched reference lists of relevant studies identified and contacted one of the trialists about further studies. Date of latest search: February 2003. Comparative studies of initial hospitalisation compared to home-based and/or out-patient management in children with newly diagnosed type 1 diabetes. Studies were independently selected by two reviewers. Data extraction and quality assessment of trials were done independently by two reviewers. Any differences in opinion were resolved by discussion. Authors of included studies were contacted for missing information. Results were summarised descriptively, using tables and text. Six studies were included in the review, including a total of 237 children in the out-patient/home group. Two studies were randomised controlled trials, three were retrospective cohort studies, and one was a prospective cohort study. Except for one randomised controlled trial that included children in the intervention group who were initially hospitalised for a brief period, studies were of low quality. The one high quality trial identified suggested that home-based management of children with newly

  18. Do patients with lactose intolerance exhibit more frequent comorbidities than patients without lactose intolerance? An analysis of routine data from German medical practices

    PubMed Central

    Schiffner, Rebecca; Kostev, Karel; Gothe, Holger

    2016-01-01

    Background The increase in food intolerances poses a burgeoning problem in our society. Food intolerances not only lead to physical impairment of the individual patient but also result in a high socio-economic burden due to factors such as the treatment required as well as absenteeism. The present study aimed to explore whether lactose intolerant (LI) patients exhibit more frequent comorbidities than non-LI patients. Methods The study was conducted on a case-control basis and the results were determined using routine data analysis. Routine data from the IMS Disease Analyzer database were used for this purpose. A total of 6,758 data records were processed and analyzed. Results There were significant correlations between LI and the incidence of osteoporosis, changes in mental status, and the presence of additional food intolerances. Comparing 3,379 LI vs. 3,379 non-LI patients, 34.5% vs. 17.7% (P<0.0001) suffered from abdominal pain; 30.6% vs. 17.2% (P<0.0001) from gastrointestinal infections; and 20.9% vs. 16.0% (P=0.0053) from depression. Adjusted odds ratios (OR) were the highest for fructose intolerance (n=229 LI vs. n=7 non-LI; OR 31.06; P<0.0001), irritable bowel syndrome (n=247 LI vs. n=44 non-LI; OR 5.23; P<0.0001), and bloating (n=351 LI vs. n=68 non-LI; OR 4.94; P<0.0001). Conclusion The study confirms that LI should not be regarded as an isolated illness but considered a possible trigger for further diseases. Additional research is necessary to assert more precise statements. PMID:27065730

  19. Differences in routine laboratory parameters related to cachexia between patients with hematological diseases and patients with solid tumors or heart failure - is there only one cachexia?

    PubMed

    Letilovic, Tomislav; Perkov, Sonja; Mestric, Zlata Flegar; Vrhovac, Radovan

    2013-01-07

    Cachexia is a state of involuntary weight loss common to many chronic diseases. Experimental data, showing that cachexia is related to the enhancement of acute phase response reaction, led to the new definition of cachexia that included, aside from the principal criterion of weight loss, other "minor criteria", Amongst them are levels of C-reactive protein (CRP), albumin and hemoglobin. However, there is paucity of data regarding possible differences of these laboratory parameters in patients with various diseases known to be related to cachexia. CRP, albumin and hemoglobin were evaluated in 119 patients, divided into two disease groups, hematological (ones with diagnosis of non-Hodgkin lymphoma or Hodgkin disease) and non-hematological (solid tumor patients and patients with chronic heart failure). Patients were further subdivided into two nutritional groups, cachectic and non-cachectic ones according to the principal criterion for cacxehia i.e. loss of body weight. We found that cachectic patients had higher levels of CRP, and lower levels of both hemoglobin and albumin compared to non-cachectic patients, regardless of the disease group they fitted. On the other hand, the group of hematological patients had lower levels of CRP primarily due to the differences found in the non-cachectic group. Higher levels of albumin were also found in the hematological group regardless of the nutritional group they fitted. Limitations of cut-off values, proposed by definition, were found, mostly regarding their relatively low sensitivity and low negative predictive value. As expected, differences in values of routine laboratory parameters used in definition of cachexia were found between cachectic and non-cachectic patients. Their values differed between hematological and non-hematological patients both in cachectic and non-cachectic group. Cut-off levels currently used in definition of cachexia have limitations and should be further evaluated.

  20. Routine Responses to Disruption of Routines

    ERIC Educational Resources Information Center

    Guha, Mahua

    2015-01-01

    "Organisational routines" is a widely studied research area. However, there is a dearth of research on disruption of routines. The few studies on disruption of routines discussed problem-solving activities that are carried out in response to disruption. In contrast, this study develops a theory of "solution routines" that are a…

  1. Multicenter Survey of Routine Determinations of Resistance of Helicobacter pylori to Antimicrobials over the Last 20 Years (1990 to 2009) in Belgium▿

    PubMed Central

    Miendje Deyi, V. Y.; Bontems, P.; Vanderpas, J.; De Koster, E.; Ntounda, R.; Van den Borre, C.; Cadranel, S.; Burette, A.

    2011-01-01

    We analyzed the rates of antimicrobial resistance of Helicobacter pylori strains isolated from patients from 1990 to 2009 and identified risk factors associated with resistance. Gastric biopsy specimens were collected from several digestive disease centers in Brussels, Belgium. We routinely performed antimicrobial susceptibility testing for clarithromycin (CLR), metronidazole, amoxicillin, tetracycline, and ciprofloxacin. Evaluable susceptibility testing was obtained for 9,430 strains isolated from patients who were not previously treated for Helicobacter pylori infection (1,527 isolates from children and 7,903 from adults) and 1,371 strains from patients who were previously treated (162 isolates from children and 1,209 from adults). No resistance to amoxicillin was observed, and tetracycline resistance was very rare (<0.01%). Primary metronidazole resistance remained stable over the years, with significantly lower rates for isolates from children (23.4%) than for isolates from adults (30.6%). Ciprofloxacin resistance remained rare in children, while it increased significantly over the last years in adults. Primary clarithromycin resistance increased significantly, reaching peaks in 2000 for children (16.9%) and in 2003 for adults (23.7%). A subsequent decrease of resistance rates down to 10% in both groups corresponded to a parallel decrease in macrolide consumption during the same period. Multivariate logistic regression revealed that female gender, age of the patient of 40 to 64 years, ethnic background, the number of previously unsuccessful eradication attempts, and the different time periods studied were independent risk factors of resistance to clarithromycin, metronidazole, and ciprofloxacin. Our study highlights the need to update local epidemiological data. Thus, the empirical CLR-based triple therapy proposed by the Maastricht III consensus report remains currently applicable to our population. PMID:21450969

  2. Comparing routine administrative data with registry data for assessing quality of hospital care in patients with myocardial infarction using deterministic record linkage.

    PubMed

    Maier, Birga; Wagner, Katrin; Behrens, Steffen; Bruch, Leonhard; Busse, Reinhard; Schmidt, Dagmar; Schühlen, Helmut; Thieme, Roland; Theres, Heinz

    2016-10-21

    Assessment of quality of care in patients with myocardial infarction (MI) should be based on data that effectively enable determination of quality. With the need to simplify measurement techniques, the question arises whether routine data can be used for this purpose. We therefore compared data from a German sickness fund (AOK) with data from the Berlin Myocardial Infarction Registry (BMIR). We included patients hospitalised for treatment of MI in Berlin from 2009-2011. We matched 2305 patients from AOK and BMIR by using deterministic record linkage with indirect identifiers. For matched patients we compared the frequency in documentation between AOK and BMIR for quality assurance variables and calculated the kappa coefficient (KC) as a measure of agreement. There was almost perfect agreement in documentation between AOK and BMIR data for matched patients for: catheter laboratory (KC: 0.874), ST elevation MI (KC: 0.826), diabetes (KC: 0.818), percutaneous coronary intervention (KC: 0.860) and hospital mortality (KC: 0.952). The remaining variables compared showed moderate or less than moderate agreement (KC < 0.6), and were grouped in Category II with less frequent documentation in AOK for risk factors and aspects of patients' history; in Category III with more frequent documentation in AOK for comorbidities; and in Category IV for medication at and after hospital discharge. Routine data are primarily collected and defined for reimbursement purposes. Quality assurance represents merely a secondary use. This explains why only a limited number of variables showed almost perfect agreement in documentation between AOK and BMIR. If routine data are to be used for quality assessment, they must be constantly monitored and further developed for this new application. Furthermore, routine data should be complemented with registry data by well-established methods of record linkage to realistically reflect the situation - also for those quality-associated variables not

  3. What percentage of patients presenting for routine eye examinations require referral for secondary care? A study of referrals from optometrists to ophthalmologists.

    PubMed

    Dobbelsteyn, David; McKee, Katherine; Bearnes, Reece D; Jayanetti, Sujani N; Persaud, David D; Cruess, Alan F

    2015-05-01

    The aim was to investigate the percentage of asymptomatic patients presenting for routine optometric eye examinations that have pathology or pathology-related risk factors warranting referral for ophthalmological consultation. This was a retrospective, cohort case study and the inclusion criteria for participants included: (i) the patient presented for routine optometric eye care during a specified period of time; (ii) the patient was found to have pathology (or showed enough risk of pathology) resulting in referral to an ophthalmologist; and (iii) a referral report was received from the consulting ophthalmologist stating the diagnosis and the treatment plan. The data set was further reviewed to indicate presenting symptoms and patient age. Adult patients, ages 20 to 64 years, were reviewed separately; this age group is not covered by provincial health services for routine eye care in Nova Scotia. Files were obtained from two clinics through an electronic charting program. A database was created that included date of referral, clinical reasons for the referral, diagnosis and treatment plan. Clinical reasons for referral were extracted from the referral letters and reports and sorted into six disease categories: age-related macular degeneration, cataract, glaucoma, diabetic retinopathy, retinopathy and 'other'. The overall referral rate for the combined data set was nine per cent for all ages; 2.4 per cent of the overall patients were asymptomatic. There was a similar number of asymptomatic patients referred in the adult (20 to 64 years) age group compared to all ages (2.5 per cent). A significant number of patients that present for routine eye examinations without any symptoms indicative of ocular disease are subsequently found to have a degree of pathology or risk thereof requiring referral for ophthalmological consultation. These referrals occur for adults under 64 years as much as for all patients of all ages. © 2015 The Authors. Clinical and Experimental

  4. The use of routine EEG in acute ischemic stroke patients without seizures: generalized but not focal EEG pathology is associated with clinical deterioration.

    PubMed

    Wolf, Marc E; Ebert, Anne D; Chatzikonstantinou, Anastasios

    2017-05-01

    Specialized electroencephalography (EEG) methods have been used to provide clues about stroke features and prognosis. However, the value of routine EEG in stroke patients without (suspected) seizures has been somewhat neglected. We aimed to assess this in a group of acute ischemic stroke patients in regard to short-term prognosis and basic stroke features. We assessed routine (10-20) EEG findings in 69 consecutive acute ischemic stroke patients without seizures. Associations between EEG abnormalities and NIHSS scores, clinical improvement or deterioration as well as MRI stroke characteristics were evaluated. Mean age was 69 ± 18 years, 43 of the patients (62.3%) were men. Abnormal EEG was found in 40 patients (58%) and was associated with higher age (p = 0.021). The most common EEG pathology was focal slowing (30; 43.5%). No epileptiform potentials were found. Abnormal EEG in general and generalized or focal slowing in particular was significantly associated with higher NIHSS score on admission and discharge as well as with hemorrhagic transformation of the ischemic lesion. Abnormal EEG and generalized (but not focal) slowing were associated with clinical deterioration ( p = 0.036, p = 0.003). Patients with lacunar strokes had no EEG abnormalities. Abnormal EEG in general and generalized slowing in particular are associated with clinical deterioration after acute ischemic stroke. The study demonstrates the value of routine EEG as a simple diagnostic tool in the evaluation of stroke patients especially with regard to short-term prognosis.

  5. Characteristics, management and attainment of lipid target levels in diabetic and cardiac patients enrolled in Disease Management Program versus those in routine care: LUTZ registry.

    PubMed

    Bestehorn, Kurt; Jannowitz, Christina; Karmann, Barbara; Pittrow, David; Kirch, Wilhelm

    2009-08-04

    Since 2002 the sick funds in Germany have widely implemented disease management programs (DMPs) for patients with type 2 diabetes mellitus (DM) and coronary heart disease (CHD). Little is known about the characteristics, treatment and target attainment lipid levels of these patients enrolled in DMPs compared to patients in routine care (non-DMP). In an open, non-interventional registry (LUTZ) in Germany, 6551 physicians documented 15,211 patients with DM (10,110 in DMP, 5101 in routine care) and 14,222 (6259 in DMP, 7963 in routine care) over a follow-up period of 4 months. They received the NCEP ATP III guidelines as a reminder on lipid level targets. While demographic characteristics of DMP patients were similar to routine care patients, the former had higher rates of almost all cardiovascular comorbidities. Patients in DMPs received pharmacological treatment (in almost all drug classes) more often than non-DMP patients (e.g. antiplatelets: in DM 27.0% vs 23.8%; in CHD 63.0% vs. 53.6%). The same applied for educational measures (on life style changes and diet etc.). The rate of target level attainment for low density lipoprotein cholesterol (LDL-C) < 100 mg/dl was somewhat higher in DMP patients at inclusion compared to non-DMP patients (DM: 23.9% vs. 21.3%; CHD: 30.6% vs. 23.8%) and increased after 4 months (DM: 38.3% vs. 36.9%; CHD: 49.8% vs. 43.3%). Individual LDL-C target level attainment rates as assessed by the treating physicians were higher (at 4 months in DM: 59.6% vs. 56.5%; CHD: 49.8% vs 43.3%). Mean blood pressure (BP) and HbA1c values were slightly lowered during follow-up, without substantial differences between DMP and non-DMP patients. Patients with DM, and (to a greater extent) with CHD in DMPs compared to non-DMP patients in routine care have a higher burden of comorbidities, but also receive more intensive pharmacological treatment and educational measures. The present data support that the substantial additional efforts in DMPs aimed at

  6. Characteristics, management and attainment of lipid target levels in diabetic and cardiac patients enrolled in Disease Management Program versus those in routine care: LUTZ registry

    PubMed Central

    2009-01-01

    Background Since 2002 the sick funds in Germany have widely implemented disease management programs (DMPs) for patients with type 2 diabetes mellitus (DM) and coronary heart disease (CHD). Little is known about the characteristics, treatment and target attainment lipid levels of these patients enrolled in DMPs compared to patients in routine care (non-DMP). Methods In an open, non-interventional registry (LUTZ) in Germany, 6551 physicians documented 15,211 patients with DM (10,110 in DMP, 5101 in routine care) and 14,222 (6259 in DMP, 7963 in routine care) over a follow-up period of 4 months. They received the NCEP ATP III guidelines as a reminder on lipid level targets. Results While demographic characteristics of DMP patients were similar to routine care patients, the former had higher rates of almost all cardiovascular comorbidities. Patients in DMPs received pharmacological treatment (in almost all drug classes) more often than non-DMP patients (e.g. antiplatelets: in DM 27.0% vs 23.8%; in CHD 63.0% vs. 53.6%). The same applied for educational measures (on life style changes and diet etc.). The rate of target level attainment for low density lipoprotein cholesterol (LDL-C) < 100 mg/dl was somewhat higher in DMP patients at inclusion compared to non-DMP patients (DM: 23.9% vs. 21.3%; CHD: 30.6% vs. 23.8%) and increased after 4 months (DM: 38.3% vs. 36.9%; CHD: 49.8% vs. 43.3%). Individual LDL-C target level attainment rates as assessed by the treating physicians were higher (at 4 months in DM: 59.6% vs. 56.5%; CHD: 49.8% vs 43.3%). Mean blood pressure (BP) and HbA1c values were slightly lowered during follow-up, without substantial differences between DMP and non-DMP patients. Conclusion Patients with DM, and (to a greater extent) with CHD in DMPs compared to non-DMP patients in routine care have a higher burden of comorbidities, but also receive more intensive pharmacological treatment and educational measures. The present data support that the substantial

  7. Incidence of caffeine in serum of patients undergoing dipyridamole myocardial perfusion stress test by an intensive versus routine caffeine history screening.

    PubMed

    Banko, Lesan T; Haq, Salman A; Rainaldi, Debroah A; Klem, Igor; Siegler, Jason; Fogel, Joshua; Sacchi, Terrence J; Heitner, John F

    2010-05-15

    The coronary vasodilatory effect of dipyridamole is competitively blocked by caffeine. The purposes of this study were to (1) assess the incidence of having detectable serum caffeine and (2) evaluate whether an intensive caffeine history screening strategy was superior to routine history screening before dipyridamole myocardial perfusion imaging. One hundred ninety-four patients who were randomized to an intensive or a routine screening history strategy were prospectively evaluated. Serum caffeine levels were determined in all patients. Outcomes data, including death, nonfatal myocardial infarction, and history of revascularization, were obtained at 24 months. Nearly 1 in 5 patients (19%) who screened negative by history had detectable serum caffeine. In patients who screened negative by history, there was no statistically significant difference in the percentage of caffeine seropositivity between the intensive and routine arms (16% vs 22%, respectively, p = 0.31). The incidence of combined end points of death, myocardial infarction, or revascularization was 22.9% and 7.3% in patients with and without detectable serum caffeine, respectively (p = 0.01). In conclusion, despite initial negative results on screening by history, a considerably high percentage of patients had positive serum caffeine levels. These results do not support the use of an intensive screening strategy. Detectable serum caffeine was associated with a higher incidence of adverse outcomes.

  8. Care of the transgender patient: a survey of gynecologists' current knowledge and practice.

    PubMed

    Unger, Cécile A

    2015-02-01

    Medical school and residency curricula are lacking in content on the care of the transgender patient. As a result, many providers do not have enough experience and knowledge to adequately care for this patient population. The aim of this study was to assess gynecologists' preferences and knowledge base with regard to transgender healthcare. This was a cross-sectional survey of obstetrics and gynecology (OBGYN) providers. An anonymous survey was sent via electronic mail to nine academic OBGYN departments across the United States. Survey questions were designed to assess provider experience and practice environment, education about transgender health practices, personal experience with transgender patients, and knowledge base regarding current recommendations for the care of gender minority patients. Of the 352 providers who received the survey, 141 responded, for a 40.1% response rate. Of the respondents, 61.7% (87 of 141) were generalist OBGYNs, and 86% (117 of 136) practiced in an academic institution; 80% (113 of 141) did not receive training in residency on the care of transgender patients. Time in practice was not associated with having learned about transgender care. Only 35.3% and 29% were comfortable caring for male-to-female and female-to-male transsexual patients, respectively; and, 88.7% and 80.4% were willing to perform screening Pap smears on female-to-male transsexual patients and routine breast examinations on male-to-female patients, respectively. Eighty-two of 138 providers (59.4%) did not know the recommendations for breast cancer screening in male-to-female patients. Efforts should be made to educate trainees on the important aspects of transgender care, and comprehensive guidelines should be published for practicing providers.

  9. Learning Difficulties of Diabetic Patients: A Survey of Educators.

    ERIC Educational Resources Information Center

    Bonnet, Caroline; Gagnayre, Remi; d'Ivernois, Jean-Francois

    1998-01-01

    Surveys 85 health care professionals on the learning difficulties of diabetic patients. Results show that educators find it easy to teach techniques: patients master procedures well and make few mistakes. In contrast, diabetic patients seem to have problems learning skills, such as insulin dose adjustment, that require complex problem-solving.…

  10. Learning Difficulties of Diabetic Patients: A Survey of Educators.

    ERIC Educational Resources Information Center

    Bonnet, Caroline; Gagnayre, Remi; d'Ivernois, Jean-Francois

    1998-01-01

    Surveys 85 health care professionals on the learning difficulties of diabetic patients. Results show that educators find it easy to teach techniques: patients master procedures well and make few mistakes. In contrast, diabetic patients seem to have problems learning skills, such as insulin dose adjustment, that require complex problem-solving.…

  11. Acute Hemodynamic Changes After Rapid Intravenous Bolus Dosing of Dexmedetomidine in Pediatric Heart Transplant Patients Undergoing Routine Cardiac Catheterization

    PubMed Central

    Jooste, EH; Muhly, WT; Ibinson, JW; Suresh, T; Damian, D; Phadke, A; Callahan, P; Miller, S; Feingold, B; Lichtenstein, SE; Cain, JG; Chrysostomou, C; Davis, PJ

    2011-01-01

    Introduction Dexmedetomidine is a highly selective α2-adrenoceptor agonist with sedative, anxiolytic and analgesic properties that has minimal effects on respiratory drive. Its sedative and hypotensive effects are mediated via central α2A and imidazoline type 1 receptors while activation of peripheral α2B–adrenoceptors result in an increase in arterial blood pressure and systemic vascular resistance (SVR). In this randomized, prospective, clinical study we attempted to quantify the short-term hemodynamic effects resulting from a rapid IV bolus administration of dexmedetomidine in pediatric cardiac transplant patients. Methods Twelve patients, aged ≤10 years of age, weighing ≤40kg, presenting for routine surveillance of right and left heart cardiac catheterization after cardiac transplantation were enrolled. After an inhaled or IV induction, the tracheas were intubated and anesthesia was maintained with 1 minimum alveolar concentration of isoflurane in room air, fentanyl (1mcg/kg) and rocuronium (1mg/kg). At the completion of the planned cardiac catheterization, 100% oxygen was administered. After recording a set of baseline values that included heart rate (HR), systolic blood pressure, diastolic blood pressure, central venous pressure, systolic pulmonary artery pressure, diastolic pulmonary artery pressure, pulmonary artery wedge pressure and thermodilution-based cardiac output, a rapid IV dexmedetomidine bolus of either 0.25mcg/kg or 0.5mcg/kg was administered over 5 seconds. The hemodynamic measurements were repeated at 1 min and 5 mins. Results There were 6 patients in each group. Investigation suggested that systolic blood pressure, diastolic blood pressure, systolic pulmonary artery pressure, diastolic pulmonary artery pressure, pulmonary artery wedge pressure and systemic vascular resistance all increased at 1 minute after rapid IV bolus for both doses, and decreased significantly to near baseline for both doses by 5 minutes. The transient increase

  12. Systematic Adverse Drug Reaction Monitoring of Patients Under Newer Antiepileptic Drugs Using Routine Clinical Data of Inpatients.

    PubMed

    Hilgers, Annika; Schaefer, Marion

    2016-06-01

    Based on data of clinical trials, new agents are receiving approval to the pharmaceutical market, for which information concerning safety issues under real-life conditions is not yet available. The aim was to evaluate the tolerability of newer antiepileptic drugs (AEDs), such as topiramate, levetiracetam, zonisamide, pregabalin, extended-release oxcarbazepine, lacosamide and eslicarbazepine, under real-life conditions by means of an assessment of routine clinical data of inpatients. Over 2.75 years data of all inpatients receiving one of the newer AEDs were documented. Occurring adverse drug reactions (ADRs) were classified according to the WHO-UMC Causality Assessment concerning their likely relationship to the prescribed AEDs. For each AED, the total number of patients without and with ADRs, assessed as at least possibly related to the particular drug, was calculated and corresponding incidences compared with reference data provided in the Summary of Product Characteristics (SmPC). For statistical evaluation Spearman correlation (rs), estimated relative risk and logistic regression analysis were used. In total, the data of 562 patients were assessed, of which 90 % received up to six different AEDs. The proportion of off-label use with regard to dosage varied between 6.4 and 64.7 %. Levetiracetam and oxcarbazepine as an extended-release formulation were most commonly used, and levetiracetam showed the best tolerance. By using logistic regression, the occurrence of ADRs was significantly associated with the number of AEDs (p < 0.001) as well as the defined daily doses (p = 0.003). In total, ADRs of AEDs were documented for 318 patients (56.6 %). The most common referred to electrolyte imbalance, e.g., low sodium (n = 79, 14.1 %) and potassium (n = 25, 4.4 %) levels, the central nervous system, including dizziness (n = 61, 10.9 %), disturbed vision (n = 47, 8.4 %), fatigue (n = 40, 7.1 %), nystagmus (n = 36, 6.4 %) and ataxia (n = 29, 5

  13. Nurse perspectives on the implementation of routine telemonitoring for high-risk diabetes patients in a primary care setting.

    PubMed

    Vest, Bonnie M; Hall, Victoria M; Kahn, Linda S; Heider, Arvela R; Maloney, Nancy; Singh, Ranjit

    2017-01-01

    Aims The purpose of this qualitative evaluation was to explore the experience of implementing routine telemonitoring (TM) in real-world primary care settings from the perspective of those delivering the intervention; namely the TM staff, and report on lessons learned that could inform future projects of this type.

  14. The mode of death in implantable cardioverter-defibrillator and cardiac resynchronization therapy with defibrillator patients: results from routine clinical practice.

    PubMed

    Thijssen, Joep; van Rees, Johannes B; Venlet, Jeroen; Borleffs, C Jan Willem; Höke, Ulas; Putter, Hein; van der Velde, Enno T; van Erven, Lieselot; Schalij, Martin J

    2012-10-01

    Although data on the mode of death of implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy with defibrillator (CRT-D) patients have been examined in randomized clinical trials, in routine clinical practice data are scarce. To provide reasonable expectations and prognosis for patients and physicians, this study assessed the mode of death in routine clinical practice. To assess the mode of death in ICD/CRT-D recipients in routine clinical practice. All patients who underwent an ICD or CRT-D implantation at the Leiden University Medical Center, the Netherlands, between 1996 and 2010 were included. Patients were divided into primary prevention ICD, secondary prevention ICD, and CRT-D patients. For patients who died during follow-up, the mode of death was retrieved from hospital and general practitioner records and categorized according to a predetermined classification: heart failure death, other cardiac death, sudden death, noncardiac death, and unknown death. A total of 2859 patients were included in the analysis. During a median follow-up of 3.4 years (interquartile range 1.7-5.7 years), 107 (14%) primary prevention ICD, 253 (28%) secondary prevention ICD, and 302 (25%) CRT-D recipients died. The 8-year cumulative incidence of all-cause mortality was 39.9% (95% confidence interval 37.0%-42.9%). Heart failure death and noncardiac death were the most common modes of death for all groups. Sudden death accounted for approximately 7%-8% of all deaths. For all patients, heart failure and noncardiac death are the most common modes of death. The proportion of patients who died suddenly was low and comparable for primary and secondary ICD and CRT-D patients. Copyright © 2012 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  15. A survey of physiotherapeutic provision for patients undergoing thoracic surgery in the U.K.

    PubMed

    Agostini, P; Reeve, J; Dromard, S; Singh, S; Steyn, R S; Naidu, B

    2013-03-01

    Evaluation of physiotherapeutic provision for patients undergoing open thoracotomy and lung surgery in the U.K. Timing of physiotherapy, modalities used and factors influencing practice were also investigated. Survey. Tertiary centres performing thoracic surgery. Forty U.K. centres were identified, and senior physiotherapists were invited to participate. A postal survey was distributed to identified centres in August 2008, with further follow-up of non-responders. This was adapted from a similar study conducted in Australia and New Zealand. Thirty-one responses were received (78%). Pre-operative physiotherapy was provided by 87% of respondents: 10% provided physiotherapy for all patients and 77% only provided physiotherapy for high-risk patients. Pre-operative pulmonary rehabilitation was reported in 13% of centres. Postoperative physiotherapeutic assessment was undertaken routinely by 97% of respondents: 81% provided physiotherapy to all patients, and 16% only provided physiotherapy when a specific problem was identified. The treatments given were relatively standardised. The provision of physiotherapy following hospital discharge was generally very sparse. This study provides a guide for physiotherapists working with patients undergoing thoracic surgery to use to compare their current practices. Postoperative physiotherapy is provided extensively to UK patients undergoing open thoracotomy. However, pre-operative provision is more variable and is mainly provided for high-risk patients. Despite the subsequent publication of pre- and postoperative pulmonary rehabilitation studies, UK physiotherapy practice remained similar to that reported in Australia and New Zealand. Further research in this field is necessary to investigate the role of pre-operative physiotherapy, the role of pre- and postoperative pulmonary rehabilitation, and the effectiveness of routine postoperative physiotherapy. Copyright © 2012 Chartered Society of Physiotherapy. Published by Elsevier Ltd

  16. Introducing routine HIV screening for patients on an internal medicine residency inpatient service: a quality improvement project

    PubMed Central

    Padrnos, Leslie J; Barr, Patrick J; Klassen, Christine L; Fields, Heather E; Azadeh, Natalya; Mendoza, Neil; Saadiq, Rayya A; Pauwels, Emanuel M; King, Christopher S; Chung, Andrew A; Sakata, Kenneth K; Blair, Janis E

    2016-01-01

    The US Centers for Disease Control and Prevention (CDC) recommend human immunodeficiency virus (HIV) screening for all persons aged 13 to 64 years who present to a health care provider. We sought to improve adherence to the CDC guidelines on the Internal Medicine Resident Hospital Service. We surveyed residents about the CDC guidelines, sent email reminders, provided education, and engaged them in friendly competition. Credit for guideline adherence was awarded if an offer of HIV screening was documented at admission, if a screening test was performed, or if a notation in the resident sign out sheet indicated why screening was not performed. We examined HIV screening of a postintervention group of patients admitted between August 8, 2012, and June 30, 2013, and compared them to a preintervention group admitted between August 1, 2011, and June 30, 2012. Postintervention offers of HIV screening increased significantly (7.9% [44/559] vs 55.5% [300/541]; P<.001), as did documentation of residents' contemplation of screening (8.9% [50/559] vs 67.5% [365/541]; P<.001). A significantly higher proportion of HIV screening tests was ordered postintervention (7.7% [43/559] vs 44.4% [240/541]; P<.001). Monthly HIV screening documentation ranged from 0% (0/53) to 17% (9/53) preintervention, whereas it ranged from 30.6% (11/36) to 100% (62/62) postintervention. HIV screening adherence can be improved through resident education, friendly competition, and system reminders. Barriers to achieving sustained adherence to the CDC guidelines include a heterogeneous patient population and provider discomfort with the subject. PMID:27239302

  17. Implementing RapidArc into clinical routine: A comprehensive program from machine QA to TPS validation and patient QA

    SciTech Connect

    Van Esch, Ann; Huyskens, Dominique P.; Behrens, Claus F.; Samsoee, Eva; Sjoelin, Maria; Bjelkengren, Ulf; Sjoestroem, David; Clermont, Christian; Hambach, Lionel; Sergent, Francois

    2011-09-15

    Purpose: With the increased commercial availability of intensity modulated arc therapy (IMAT) comes the need for comprehensive QA programs, covering the different aspects of this newly available technology. This manuscript proposes such a program for the RapidArc (RA) (Varian Medical Systems, Palo Alto) IMAT solution. Methods: The program was developed and tested out for a Millennium120 MLC on iX Clinacs and a HighDefinition MLC on a Novalis TX, using a variety of measurement equipment including Gafchromic film, 2D ion chamber arrays (Seven29 and StarCheck, PTW, Freiburg, Germany) with inclinometer and Octavius phantom, the Delta4 systam (ScandiDos, Uppsala, Sweden) and the portal imager (EPID). First, a number of complementary machine QA tests were developed to monitor the correct interplay between the accelerating/decelerating gantry, the variable dose rate and the MLC position, straining the delivery to the maximum allowed limits. Second, a systematic approach to the validation of the dose calculation for RA was adopted, starting with static gantry and RA specific static MLC shapes and gradually moving to dynamic gantry, dynamic MLC shapes. RA plans were then optimized on a series of artificial structures created within the homogeneous Octavius phantom and within a heterogeneous lung phantom. These served the double purpose of testing the behavior of the optimization algorithm (PRO) as well as the precision of the forward dose calculation. Finally, patient QA on a series of clinical cases was performed with different methods. In addition to the well established in-phantom QA, we evaluated the portal dosimetry solution within the Varian approach. Results: For routine machine QA, the ''Snooker Cue'' test on the EPID proved to be the most sensitive to overall problem detection. It is also the most practical one. The ''Twinkle'' and ''Sunrise'' tests were useful to obtain well differentiated information on the individual treatment delivery components. The AAA8

  18. Implementing RapidArc into clinical routine: a comprehensive program from machine QA to TPS validation and patient QA.

    PubMed

    Van Esch, Ann; Huyskens, Dominique P; Behrens, Claus F; Samsoe, Eva; Sjolin, Maria; Bjelkengren, Ulf; Sjostrom, David; Clermont, Christian; Hambach, Lionel; Sergent, Francois

    2011-09-01

    With the increased commercial availability of intensity modulated arc therapy (IMAT) comes the need for comprehensive QA programs, covering the different aspects of this newly available technology. This manuscript proposes such a program for the RapidArc (RA) (Varian Medical Systems, Palo Alto) IMAT solution. The program was developed and tested out for a Millennium120 MLC on iX Clinacs and a HighDefinition MLC on a Novalis TX, using a variety of measurement equipment including Gafchromic film, 2D ion chamber arrays (Seven29 and StarCheck, PTW, Freiburg, Germany) with inclinometer and Octavius phantom, the Delta4 systam (ScandiDos, Uppsala, Sweden) and the portal imager (EPID). First, a number of complementary machine QA tests were developed to monitor the correct interplay between the accelerating/decelerating gantry, the variable dose rate and the MLC position, straining the delivery to the maximum allowed limits. Second, a systematic approach to the validation of the dose calculation for RA was adopted, starting with static gantry and RA specific static MLC shapes and gradually moving to dynamic gantry, dynamic MLC shapes. RA plans were then optimized on a series of artificial structures created within the homogeneous Octavius phantom and within a heterogeneous lung phantom. These served the double purpose of testing the behavior of the optimization algorithm (PRO) as well as the precision of the forward dose calculation. Finally, patient QA on a series of clinical cases was performed with different methods. In addition to the well established in-phantom QA, we evaluated the portal dosimetry solution within the Varian approach. For routine machine QA, the "Snooker Cue" test on the EPID proved to be the most sensitive to overall problem detection. It is also the most practical one. The "Twinkle" and "Sunrise" tests were useful to obtain well differentiated information on the individual treatment delivery components. The AAA8.9 dose calculations showed excellent

  19. Role of routine imaging in detecting recurrent lymphoma: A review of 258 patients with relapsed aggressive non-Hodgkin and Hodgkin lymphoma.

    PubMed

    El-Galaly, T C; Mylam, Karen Juul; Bøgsted, Martin; Brown, Peter; Rossing, Maria; Gang, Anne Ortved; Haglund, Anne; Arboe, Bente; Clausen, Michael Roost; Jensen, Paw; Pedersen, Michael; Bukh, Anne; Jensen, Bo Amdi; Poulsen, Christian Bjørn; d'Amore, Francesco; Hutchings, Martin

    2014-06-01

    After first-line therapy, patients with Hodgkin lymphoma (HL) and aggressive non-HL are followed up closely for early signs of relapse. The current follow-up practice with frequent use of surveillance imaging is highly controversial and warrants a critical evaluation. Therefore, a retrospective multicenter study of relapsed HL and aggressive non-HL (nodal T-cell and diffuse large B-cell lymphomas) was conducted. All included patients had been diagnosed during the period 2002-2011 and relapsed after achieving complete remission on first-line therapy. Characteristics and outcome of imaging-detected relapses were compared with other relapses. A total of 258 patients with recurrent lymphoma were included in the study. Relapse investigations were initiated outside preplanned visits in 52% of the patients. Relapse detection could be attributed to patient-reported symptoms alone or in combination with abnormal blood tests or physical examination in 64% of the patients. Routine imaging prompted relapse investigations in 27% of the patients. The estimated number of routine scans per relapse was 91-255 depending on the lymphoma subtype. Patients with imaging-detected relapse had lower disease burden (P = 0.045) and reduced risk of death following relapse (hazard ratio = 0.62, P = 0.02 in multivariate analysis). Patient-reported symptoms are still the most common factor for detecting lymphoma relapse and the high number of scans per relapse calls for improved criteria for use of surveillance imaging. However, imaging-detected relapse was associated with lower disease burden and a possible survival advantage. The future role of routine surveillance imaging should be defined in a randomized trial. © 2014 Wiley Periodicals, Inc.

  20. Routine drug monitoring of serum concentrations of morphine, morphine-3-glucuronide and morphine-6-glucuronide do not predict clinical observations in cancer patients.

    PubMed

    Klepstad, Pål; Borchgrevink, Petter C; Dale, Ola; Zahlsen, Kolbjørn; Aamo, Trond; Fayers, Peter; Fougner, Bjørn; Kaasa, Stein

    2003-12-01

    The clinical importance of routine drug monitoring of serum concentrations of morphine, morphine-6-glucuronide (M6G) and morphine-3-glucuronide (M3G) during chronic morphine therapy is not established. We measured morphine, M6G and M3G serum concentrations in cancer pain patients receiving oral (n = 263, median dose 80 mg/24 hours) or subcutaneous (sc) (n = 35, median dose 110 mg/24 hours) morphine. Regression analyses were performed to investigate if serum concentrations of morphine, M3G and M6G predicted pain intensity (Brief Pain Inventory), health-related quality-of-life variables (EORTC QLQ-C30) and cognitive function (Mini-Mental Score). Serum concentrations were also compared in patients categorized as morphine 'treatment successes' and 'treatment failures'. We observed that serum concentrations of morphine, M6G or M3G did not predict pain intensity, cognitive function, nausea or tiredness. 'Treatment failures' caused by nausea, tiredness, cognitive failure or constipation did not have statistically significant different morphine, M6G and M3G serum concentrations than patients classified as 'treatment successes'. In conclusion, this study did not observe any concentration-effect relationships of morphine, M3G or M6G with pain intensity, nausea, constipation, tiredness or cognitive failure in blood samples obtained during routine clinical drug monitoring in cancer patients. This result suggests that therapeutic drug monitoring as a routine tool during chronic morphine treatment has limited value for clinical decision making.

  1. Patient Suicide: A Survey of Therapists' Reactions

    ERIC Educational Resources Information Center

    Wurst, Friedrich Martin; Mueller, Sandra; Petitjean, Sylvie; Euler, Sebastian; Thon, Natasha; Wiesbeck, Gerhard; Wolfersdorf, Manfred

    2010-01-01

    A substantial proportion of therapists will at some point in their professional life experience the loss of a patient to suicide. Our aims were to assess how therapists react to patient's suicide over time and which factors contribute to the reaction. One third of the therapists, mostly women, suffer from severe distress. The impact is not…

  2. Evaluation of Patient Satisfaction Surveys in Pediatric Orthopaedics.

    PubMed

    Segal, Lee S; Plantikow, Carla; Hall, Randon; Wilson, Kristina; Shrader, M Wade

    2015-01-01

    Patient satisfaction survey scores are increasingly being tied to incentive compensation, impact how we practice medicine, influence decisions on where patients seek care, and in the future may be required for accreditation. The goal of this study is to compare the results of an internal distribution of patient satisfaction surveys at the point of care to responses received by mail in a hospital-based, high-volume pediatric orthopaedic practice. A pediatric outpatient survey is used at our institution to evaluate patient satisfaction. Surveys are randomly mailed out to families seen in our clinic by the survey vendor, and the results are determined on a quarterly basis. We distributed the same survey in a similar manner in our clinic. The results of the surveys, external/mailed (EXM) versus internal/point of care (INP) over the same 3-month time period (second quarter 2013) were compared. The survey questions are dichotomized from an ordinal scale into either excellent (9 to 10) or not excellent (0 to 8) commonly used in patient satisfaction methodology. We evaluated the raw data from the INP surveys for the question on provider rating by evaluating the mean score, the standard excellent response (9 to 10), and an expanded excellent response (8 to 10). Response rate was 72/469 (15.4%) for EXM, and 231/333 (69.4%) for INP. An excellent response for the "rating your provider" question was 72.2% (EXM) versus 84.8% (INP) (P=0.015). Our analysis of the raw data (INP) has a mean rating of 9.42. The expanded scale (8 to 10) for an excellent response increased the provider rating to 94.4% (P=0.001). Waiting time response within 15 minutes was the only item that correlated with rating of provider (P=0.02). For the majority of the items, the INP responses were consistently higher than the EXM responses, including 6/7 responses that were statistically significant (P<0.05). As mandated by the Centers for Medicare and Medicaid Services, patient satisfaction surveys will be

  3. The use of preoperative routine measurement of basal serum thyrocalcitonin in candidates for thyroidectomy due to nodular thyroid disorders: results from 2733 consecutive patients.

    PubMed

    Chambon, Guillaume; Alovisetti, Caroline; Idoux-Louche, Catherine; Reynaud, Christophe; Rodier, Michel; Guedj, Anne-Marie; Chapuis, Héliette; Lallemant, Jean-Gabriel; Lallemant, Benjamin

    2011-01-01

    The preoperative routine measurement of basal serum thyrocalcitonin (CT) in candidates for thyroidectomy due to thyroid nodules is currently a subject of debate. The objective of this study was to evaluate the role of systematic basal serum CT measurement in improving the diagnosis and surgical treatment of medullary thyroid carcinoma (MTC) in patients undergoing thyroidectomy for nodular thyroid disorders, regardless of preoperative CT levels. We determined basal serum CT levels in 2733 consecutive patients before thyroid surgery and performed a pentagastrin test in patients with hypercalcitoninemia. We correlated basal and stimulated CT levels with intraoperative and definitive histopathological findings, and we analyzed the impact of these results on surgical procedures. Twelve MTCs were found among the 43 patients with basal serum CT level of 10 pg/ml or greater. Two MTCs were present among the 2690 patients with normal CT levels. MTC was always present in patients with a basal CT of 60 pg/ml or greater. For CT levels ranging from 10 to 59 pg/ml, MTC was diagnosed in 11% of patients. When preoperative hypercalcitoninemia was present, total thyroidectomy associated with comprehensive intraoperative histopathological analysis allowed the intraoperative diagnosis of five latent, subclinical MTCs. The pentagastrin test gave no additional diagnostic information for the management of patients with elevated preoperative basal serum CT level. Routine measurement of CT in the preoperative work-up of nodular thyroid disorders is useful. This procedure improves intraoperative diagnosis of MTC and enables adapted initial surgery, the most determinant factor of treatment success.

  4. Buprenorphine/naloxone treatment practices in Malaysia: Results of national surveys of physicians and patients.

    PubMed

    Vicknasingam, B; Dazali, M N M; Singh, D; Schottenfeld, R S; Chawarski, M C

    2015-07-01

    Medication assisted treatment with buprenorphine/naloxone (Bup/Nx), including prescribing and dispensing practices of general practitioners (GPs) in Malaysia and their patients' experiences with this treatment have not been systematically examined. The current study surveyed GPs providing Bup/Nx treatment and patients receiving office-based Bup/Nx treatment in Malaysia. Two cross-sectional surveys of GPs (N=115) providing outpatient Bup/Nx maintenance treatment and of patients (N=253) currently receiving Bup/Nx treatment throughout peninsular Malaysia. Physicians prescribed Bup/Nx dosages in the range of 2-4mg daily for 70% of patients and conducted urine testing in the past month on approximately 16% of their patients. In the patient survey, 79% reported taking daily Bup/Nx doses of 2mg or less; 82% reported that no urine toxicology testing had been conducted on them in the past month, 36% had an opiate positive urine test at the time of the survey, 43% reported illicit opiate use, 15% reported injection of heroin and 22% reported injection of Bup/Nx in the past month. Low daily Bup/Nx doses, lack of behavioral monitoring or counseling, and high rates of continued drug use, including injection of drugs and medications during Bup/Nx treatment in Malaysia, indicate continuing problems with implementation and less than optimal treatment effectiveness. High cost of Bup/Nx in Malaysia may deter patients from seeking treatment and contribute to taking low Bup/Nx dosages. Improved training of physicians and establishing standards for Bup/Nx dosing, routine toxicology testing, and counseling may be needed to improve care and treatment response. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  5. Can we routinely measure patient involvement in treatment decision-making in chronic kidney care? A service evaluation in 27 renal units in the UK

    PubMed Central

    Durand, Marie-Anne; Bekker, Hilary L.; Casula, Anna; Elias, Robert; Ferraro, Alastair; Lloyd, Amy; van der Veer, Sabine N.; Metcalfe, Wendy; Mooney, Andrew; Thomson, Richard G.; Tomson, Charles R.V.

    2016-01-01

    Background Shared decision making is considered an important aspect of chronic disease management. We explored the feasibility of routinely measuring kidney patients' involvement in making decisions about renal replacement therapy (RRT) in National Health Service settings. Methods We disseminated a 17-item paper questionnaire on involvement in decision-making among adult patients with established kidney failure who made a decision about RRT in the previous 90 days (Phase 1) and patients who had been receiving RRT for 90–180 days (Phase 2). Recruitment rates were calculated as the ratio between the number of included and expected eligible patients (I : E ratio). We assessed our sample's representativeness by comparing demographics between participants and incident patients in the UK Renal Registry. Results Three hundred and five (Phase 1) and 187 (Phase 2) patients were included. For Phase 1, the I : E ratio was 0.44 (range, 0.08–2.80) compared with 0.27 (range, 0.04–1.05) in Phase 2. Study participants were more likely to be white compared with incident RRT patients (88 versus 77%; P < 0.0001). We found no difference in age, gender or social deprivation. In Phases 1 and 2, the majority reported a collaborative decision-making style (73 and 69%), and had no decisional conflict (85 and 76%); the median score for shared decision-making experience was 12.5 (Phase 1) and 10 (Phase 2) out of 20. Conclusion Our study shows the importance of assessing the feasibility of data collection in a chronic disease context prior to implementation in routine practice. Routine measurement of patient involvement in established kidney disease treatment decisions is feasible, but there are challenges in selecting the measure needed to capture experience of involvement, reducing variation in response rate by service and identifying when to capture experience in a service managing people's chronic disease over time. PMID:26985377

  6. Can we routinely measure patient involvement in treatment decision-making in chronic kidney care? A service evaluation in 27 renal units in the UK.

    PubMed

    Durand, Marie-Anne; Bekker, Hilary L; Casula, Anna; Elias, Robert; Ferraro, Alastair; Lloyd, Amy; van der Veer, Sabine N; Metcalfe, Wendy; Mooney, Andrew; Thomson, Richard G; Tomson, Charles R V

    2016-04-01

    Shared decision making is considered an important aspect of chronic disease management. We explored the feasibility of routinely measuring kidney patients' involvement in making decisions about renal replacement therapy (RRT) in National Health Service settings. We disseminated a 17-item paper questionnaire on involvement in decision-making among adult patients with established kidney failure who made a decision about RRT in the previous 90 days (Phase 1) and patients who had been receiving RRT for 90-180 days (Phase 2). Recruitment rates were calculated as the ratio between the number of included and expected eligible patients (I : E ratio). We assessed our sample's representativeness by comparing demographics between participants and incident patients in the UK Renal Registry. Three hundred and five (Phase 1) and 187 (Phase 2) patients were included. For Phase 1, the I : E ratio was 0.44 (range, 0.08-2.80) compared with 0.27 (range, 0.04-1.05) in Phase 2. Study participants were more likely to be white compared with incident RRT patients (88 versus 77%; P < 0.0001). We found no difference in age, gender or social deprivation. In Phases 1 and 2, the majority reported a collaborative decision-making style (73 and 69%), and had no decisional conflict (85 and 76%); the median score for shared decision-making experience was 12.5 (Phase 1) and 10 (Phase 2) out of 20. Our study shows the importance of assessing the feasibility of data collection in a chronic disease context prior to implementation in routine practice. Routine measurement of patient involvement in established kidney disease treatment decisions is feasible, but there are challenges in selecting the measure needed to capture experience of involvement, reducing variation in response rate by service and identifying when to capture experience in a service managing people's chronic disease over time.

  7. Patient Mortality During Unannounced Accreditation Surveys at US Hospitals.

    PubMed

    Barnett, Michael L; Olenski, Andrew R; Jena, Anupam B

    2017-05-01

    In the United States, hospitals receive accreditation through unannounced on-site inspections (ie, surveys) by The Joint Commission (TJC), which are high-pressure periods to demonstrate compliance with best practices. No research has addressed whether the potential changes in behavior and heightened vigilance during a TJC survey are associated with changes in patient outcomes. To assess whether heightened vigilance during survey weeks is associated with improved patient outcomes compared with nonsurvey weeks, particularly in major teaching hospitals. Quasi-randomized analysis of Medicare admissions at 1984 surveyed hospitals from calendar year 2008 through 2012 in the period from 3 weeks before to 3 weeks after surveys. Outcomes between surveys and surrounding weeks were compared, adjusting for beneficiaries' sociodemographic and clinical characteristics, with subanalyses for major teaching hospitals. Data analysis was conducted from January 1 to September 1, 2016. Hospitalization during a TJC survey week vs nonsurvey weeks. The primary outcome was 30-day mortality. Secondary outcomes were rates of Clostridium difficile infections, in-hospital cardiac arrest mortality, and Patient Safety Indicators (PSI) 90 and PSI 4 measure events. The study sample included 244 787 and 1 462 339 admissions during survey and nonsurvey weeks with similar patient characteristics, reason for admission, and in-hospital procedures across both groups. There were 811 598 (55.5%) women in the nonsurvey weeks (mean [SD] age, 72.84 [14.5] years) and 135 857 (55.5%) in the survey weeks (age, 72.76 [14.5] years). Overall, there was a significant reversible decrease in 30-day mortality for admissions during survey (7.03%) vs nonsurvey weeks (7.21%) (adjusted difference, -0.12%; 95% CI, -0.22% to -0.01%). This observed decrease was larger than 99.5% of mortality changes among 1000 random permutations of hospital survey date combinations, suggesting that observed mortality changes were

  8. Patient knowledge, perceptions, expectations and satisfaction on allergen-specific immunotherapy: a survey.

    PubMed

    Baiardini, Ilaria; Puggioni, Francesca; Menoni, Stefania; Boot, Johan Diderik; Diamant, Zuzana; Braido, Fulvio; Canonica, Giorgio Walter

    2013-03-01

    Assessing patient's perspective provides useful information enabling a customized approach which has been advocated by current guidelines. In this multicentre cross-sectional study we evaluated personal viewpoints on allergen-specific immunotherapy (SIT) in patients treated with subcutaneous (SCIT) or sublingual (SLIT) immunotherapy. A survey of 28 questions assessing patient's knowledge, perceptions, expectations and satisfaction was developed by an expert panel and was applied by physicians from allergology centres in patients with respiratory allergy treated with SIT. Treating physicians independently reported their satisfaction level regarding SIT for each patient. Fully completed surveys from 434 patients (55.3% male; 66.7% poly-sensitized, 74% SLIT) were analysed. Mean duration of SIT was 2.5 years with different allergens. Most patients acquired their SIT knowledge from their physician (95%) and consequently, their physicians' opinion in their choice to start with SIT was important. Most patients perceived SIT to be safe and easy to integrate into their daily routine. The main motivations for SIT were its supposed potential to alter the course of the disease (45.7%), less need of (28.2%), or dissatisfaction with current pharmacotherapy (19.3%). Both patients' and physicians' satisfaction was high (VAS-scores 74/100 and 78/100, respectively) and showed a significant correlation (SCIT: r=0.612; SLIT: r=0.608). No major difference was found in patients' answers based on the level of education. In this real life study evaluating different aspects of patient's perspective on SIT, the majority of patients had an adequate level of knowledge, perceptions, expectations and satisfaction about SIT, which corresponded well with the physician's perceptions and satisfaction. Our data warrant the use of patient's perspectives on chronic SIT treatment. Copyright © 2012 Elsevier Ltd. All rights reserved.

  9. Dental orthopantomography: survey of patient dose

    SciTech Connect

    Bartolotta, A.; Calenda, E.; Calicchia, A.; Indovina, P.L.

    1983-03-01

    Absorbed dose to specific regions of the head and neck during dental orthopantomography with various commercial units was assessed using a Rando ''standard man'' phantom and TLD-100 LiF dosimeters. Relevance to patient protection is discussed.

  10. Routine delirium monitoring is independently associated with a reduction of hospital mortality in critically ill surgical patients: A prospective, observational cohort study.

    PubMed

    Luetz, Alawi; Weiss, Bjoern; Boettcher, Sebastian; Burmeister, Johann; Wernecke, Klaus-Dieter; Spies, Claudia

    2016-10-01

    Although delirium monitoring is recommended in international guidelines, there is lacking evidence for improved outcome due to it. We hypothesized that adherence to routine delirium monitoring would improve clinical outcome in adult critically ill patients. We present the results of a prospective, noninterventional, observational cohort study that was conducted on 2 intensive care units (ICUs) of a tertiary care medical center between July and October 2007 (International Standard Registered Clinical Trial Record identifier: 76100795). We assessed delirium-monitoring and outcome parameters on a daily basis. Besides multivariate logistic and robust linear regression to analyze the relationship between delirium monitoring and outcome, we used the doubly robust augmented inverse probability weighting method for observational data to estimate effect sizes. Of 355 screened patients, we included 185 surgical ICU patients into our final analysis, of which 87 were mechanically ventilated. We found an independent association between delirium-monitoring adherence and in-hospital mortality for ventilated patients (odds ratio, 0.973; P= .041). Estimating the effect size, delirium monitoring indicated a reduction of 22% of in-hospital mortality if conducted 50% or more of ICU days per patient. The average ICU length of stay of 46 days was estimated to be reduced by 19 days (P= .031) if patients were sufficiently monitored. Our data suggest an improved outcome for mechanically ventilated patients being screened for delirium in clinical routine. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Utility of Routine Exercise Testing to Detect Rate-Related QRS Widening in Patients Without Structural Heart Disease on Class Ic Antiarrhythmic Agents (Flecainide and Propafenone).

    PubMed

    Vallurupalli, Srikanth; Pothineni, Naga Venkata K; Deshmukh, Abhishek; Paydak, Hakan

    2015-09-01

    Class Ic antiarrhythmic agents are effective in the treatment of various atrial tachyarrhythmias. They are known to cause rate-related QRS widening in the presence of structural heart disease, which can lead to life-threatening arrhythmias. The role of routine exercise electrocardiography in patients without structural heart disease is unknown. All patients initiated on class Ic antiarrhythmic agents and who had exercise electrocardiography performed from June 2009 to June 2013 were included. Symptom-limited treadmill electrocardiography was performed to detect significant QRS widening at peak exercise (defined as an increase of >25% of baseline QRS). Fifty-six patients were included in the study. All patients were screened for structural heart disease before initiation of the medication. Significant QRS widening and atrial tachycardia occurred in a single patient, which terminated with cessation of exercise. This patient had a history of tachycardia-mediated cardiomyopathy with normalization of ejection fraction 3 years before being placed on flecainide. In conclusion, routine exercise testing to detect QRS widening is not warranted in patients with no structural heart disease. Copyright © 2015 Elsevier Inc. All rights reserved.

  12. Comparing two safety culture surveys: safety attitudes questionnaire and hospital survey on patient safety.

    PubMed

    Etchegaray, Jason M; Thomas, Eric J

    2012-06-01

    To examine the reliability and predictive validity of two patient safety culture surveys-Safety Attitudes Questionnaire (SAQ) and Hospital Survey on Patient Safety Culture (HSOPS)-when administered to the same participants. Also to determine the ability to convert HSOPS scores to SAQ scores. Employees working in intensive care units in 12 hospitals within a large hospital system in the southern United States were invited to anonymously complete both safety culture surveys electronically. All safety culture dimensions from both surveys (with the exception of HSOPS's Staffing) had adequate levels of reliability. Three of HSOPS's outcomes-frequency of event reporting, overall perceptions of patient safety, and overall patient safety grade-were significantly correlated with SAQ and HSOPS dimensions of culture at the individual level, with correlations ranging from r=0.41 to 0.65 for the SAQ dimensions and from r=0.22 to 0.72 for the HSOPS dimensions. Neither the SAQ dimensions nor the HSOPS dimensions predicted the fourth HSOPS outcome-number of events reported within the last 12 months. Regression analyses indicated that HSOPS safety culture dimensions were the best predictors of frequency of event reporting and overall perceptions of patient safety while SAQ and HSOPS dimensions both predicted patient safety grade. Unit-level analyses were not conducted because indices did not indicate that aggregation was appropriate. Scores were converted between the surveys, although much variance remained unexplained. Given that the SAQ and HSOPS had similar reliability and predictive validity, investigators and quality and safety leaders should consider survey length, content, sensitivity to change and the ability to benchmark when selecting a patient safety culture survey.

  13. Patient Satisfaction Survey as a Tool Towards Quality Improvement

    PubMed Central

    Al-Abri, Rashid; Al-Balushi, Amina

    2014-01-01

    Over the past 20 years, patient satisfaction surveys have gained increasing attention as meaningful and essential sources of information for identifying gaps and developing an effective action plan for quality improvement in healthcare organizations. However, there are very few published studies reporting of the improvements resulting from feedback information of patient satisfaction surveys, and in most cases, these studies are contradictory in their findings. This article investigates in-depth a number of research studies that critically discuss the relationship of dependent and independent influential attributes towards overall patient satisfaction in addition to its impact on the quality improvement process of healthcare organizations. PMID:24501659

  14. Measuring Quality of Healthcare Outcomes in Type 2 Diabetes from Routine Data: a Seven-nation Survey Conducted by the IMIA Primary Health Care Working Group.

    PubMed

    Hinton, W; Liyanage, H; McGovern, A; Liaw, S-T; Kuziemsky, C; Munro, N; de Lusignan, S

    2017-08-01

    Background: The Institute of Medicine framework defines six dimensions of quality for healthcare systems: (1) safety, (2) effectiveness, (3) patient centeredness, (4) timeliness of care, (5) efficiency, and (6) equity. Large health datasets provide an opportunity to assess quality in these areas. Objective: To perform an international comparison of the measurability of the delivery of these aims, in people with type 2 diabetes mellitus (T2DM) from large datasets. Method: We conducted a survey to assess healthcare outcomes data quality of existing databases and disseminated this through professional networks. We examined the data sources used to collect the data, frequency of data uploads, and data types used for identifying people with T2DM. We compared data completeness across the six areas of healthcare quality, using selected measures pertinent to T2DM management. Results: We received 14 responses from seven countries (Australia, Canada, Italy, the Netherlands, Norway, Portugal, Turkey and the UK). Most databases reported frequent data uploads and would be capable of near real time analysis of healthcare quality.The majority of recorded data related to safety (particularly medication adverse events) and treatment efficacy (glycaemic control and microvascular disease). Data potentially measuring equity was less well recorded. Recording levels were lowest for patient-centred care, timeliness of care, and system efficiency, with the majority of databases containing no data in these areas. Databases using primary care sources had higher data quality across all areas measured. Conclusion: Data quality could be improved particularly in the areas of patient-centred care, timeliness, and efficiency. Primary care derived datasets may be most suited to healthcare quality assessment. Georg Thieme Verlag KG Stuttgart.

  15. Routine Checkup Should Assess Fitness, Too

    MedlinePlus

    ... news/fullstory_162856.html Routine Checkup Should Assess Fitness, Too Cardiorespiratory test would help gauge patients' heart ... checked regularly, but an exercise expert says cardiorespiratory fitness should also be part of a routine medical ...

  16. Tertiary survey in trauma patients: avoiding neglected injuries.

    PubMed

    Zamboni, Caio; Yonamine, Alexandre Maris; Faria, Carlos Eduardo Nunes; Filho, Marco Antonio Machado; Christian, Ralph Walter; Mercadante, Marcelo Tomanik

    2014-11-01

    Medical personnel in trauma centres in several countries have realised that undiagnosed injuries are common and are now focussing their attention on reducing the incidence of these injuries. Tertiary survey is a simple and easy approach to address the issue of undiagnosed injuries in trauma patients. Tertiary survey consists of reevaluating patients 24 hours after admission by means of an anamnesis protocol, physical examination, review of complementary tests and request for new tests when necessary. To show the importance of tertiary survey in trauma patients for diagnosing injuries undetected at the time of initial survey. A standardised protocol was used to perform a prospective observational study with patients admitted through the emergency department, Department of Orthopaedics and Trauma, Santa Casa de São Paulo. The patients were reevaluated 24 hours after admission or after recovering consciousness. New physical examinations were performed, tests performed on admission were reassessed and new tests were requested, when necessary. Between February 2012 and February 2013, 526 patients were evaluated, 81 (15.4%) were polytraumatised, and 445 (84.6%) had low-energy trauma. A total of 57 new injuries were diagnosed in 40 patients, 61.4% of which affected the lower limb. Diagnosis of 11 new injuries (19.3%) resulted in changes in procedure. The application of the protocol for tertiary survey proved to be easy, inexpensive and beneficial to patients (particularly polytraumatised patients) because it enabled identification of important injuries that were not detected on admission in a large group of patients. Copyright © 2014 Elsevier Ltd. All rights reserved.

  17. Proactive Routine Monitoring and Intervention to Reduce the Psychosocial Impact of Cancer Therapy

    ERIC Educational Resources Information Center

    Girgis, Afaf; Boyes, Allison

    2005-01-01

    Much of the psychosocial morbidity experienced by cancer patients goes undetected and therefore untreated. This paper describes infrastructure to routinely screen patients for psychosocial problems and provide targeted intervention in the cancer care setting. Cancer patients will complete a psychosocial screening survey via touchscreen computer at…

  18. Brain metastases detectability of routine whole body (18)F-FDG PET and low dose CT scanning in 2502 asymptomatic patients with solid extracranial tumors.

    PubMed

    Bochev, Pavel; Klisarova, Aneliya; Kaprelyan, Ara; Chaushev, Borislav; Dancheva, Zhivka

    2012-01-01

    As fluorine-18-fluorodesoxyglucose positron emission tomography/computed tomography ( (18)F-FDG PET/CT) is gaining wider availability, more and more patients with malignancies undergo whole body PET/CT, mostly to assess tumor spread in the rest of the body, but not in the brain. Brain is a common site of metastatic spread in patients with solid extracranial tumors. Gold standard in the diagnosis of brain metastases remains magnetic resonance imaging (MRI). However MRI is not routinely indicated and is not available for all cancer patients. Fluorine-18-FDG PET is considered as having poor sensitivity in detecting brain metastases, but this may not be true for PET/CT. The aim of our study was to assess the value of (18)F-FDG PET/CT in the detection of brain metastases found by whole body scan including the brain, in patients with solid extracranial neoplasms. A total of 2502 patients with solid extracranial neoplasms were studied. All patients underwent a routine whole body (18)F-FDG PET/CT scan with the whole brain included in the scanned field. Patients with known or suspected brain metastases were preliminary excluded from the study. Hypermetabolic and ring-like brain lesions on the PET scan were considered as metastases. Lesions with CT characteristics of brain metastases were regarded as such irrespective of their metabolic pattern. Lesions in doubt were verified by MRI during first testing or on follow-up or by operation. Our results showed that brain lesions, indicative of and verified to be metastases were detected in 25 out of the 2502 patients (1%), with lung cancer being the most common primary. Twenty three out of these 25 patients had no neurological symptoms by the time of the scan. The detection rate of brain metastases was relatively low, but information was obtained with a minimum increase of radiation burden. In conclusion, whole body (18)F-FDG PET/CT detected brain metastases in 1% of the patients if brain was included in the scanned field. Brain

  19. Capecitabine in the routine first-line treatment of elderly patients with advanced colorectal cancer--results from a non-interventional observation study.

    PubMed

    Stein, Alexander; Quidde, Julia; Schröder, Jan Klaus; Göhler, Thomas; Tschechne, Barbara; Valdix, Annette-Rosel; Höffkes, Heinz-Gert; Schirrmacher-Memmel, Silke; Wohlfarth, Tim; Hinke, Axel; Engelen, Andreas; Arnold, Dirk

    2016-02-10

    The purpose of this observational study was to evaluate feasibility, efficacy results and toxicity observations of capecitabine in routine first line treatment of patients with metastatic colorectal cancer, with particular regard of elderly patients (>75 years of age). Patients with colorectal cancer receiving capecitabine as part of their first-line treatment were recorded until detection of disease progression or up to a maximum of 12 cycles on standardized evaluation forms. Additional information on long-term outcomes, progression-free survival, and overall survival were retrieved at two follow-up time points. Obtained data were analyzed with regard to age up to 75 and >75 years of age. There were no specific requirements for patient selection and conduct of therapy, corresponding to the non-interventional nature of the study. In total, 1249 evaluable patients were enrolled in Germany. The median age of the study population was 74 years (range: 21-99). Capecitabine-based combination was administered in 56% of patients in the overall population. The median treatment duration was about 5 months. Severe toxicities occurred rarely without any difference regarding age groups. The most common hematological toxicity was anemia. Gastrointestinal side effects and hand-food-syndrome (HFS) were the most frequent non-hematologic toxicities. Overall response rate (ORR) was significantly higher in the patient group <=75 years compared to patients >75 years of age (38 vs. 32%, p=0.019). Median progression free survival (PFS 9.7 vs. 8.2 months, p=0.00021) and overall survival (OS 31.0 vs. 22.6 months, p<0.0001) was decreased in elderly patients. Efficacy and tolerability of capecitabine treatment either as single drug or in various combination regimens, as proven in randomized studies, could be confirmed in a clinical routine setting. Patients older than 75 years may derive a relevant benefit by first line capecitabine-based treatment with good tolerability.

  20. Comparison of Space Glucose Control and Routine Glucose Management Protocol for Glycemic Control in Critically Ill Patients: A Prospective, Randomized Clinical Study.

    PubMed

    Xu, Biao; Jiang, Wei; Wang, Chun-Yao; Weng, Li; Hu, Xiao-Yun; Peng, Jin-Min; Du, Bin

    2017-09-05

    The Space Glucose Control (SGC) system is a computer-assisted device combining infusion pumps with the enhanced Model Predictive Control algorithm to achieve the target blood glucose (BG) level safely. The objective of this study was to evaluate the efficacy and safety of glycemic control by SGC with customized BG target range of 5.8-8.9 mmol/L in the critically ill patients. It is a randomized controlled trial of seventy critically ill patients with mechanical ventilation and hyperglycemia (BG ≥ 9.0 mmol/L). Thirty-six patients in the SGC group and 34 in the routine glucose management group were observed for three consecutive days. Target BG for both groups was 5.8-8.9 mmol/L. The primary outcome was the percentage time in the target range. The percentage time within BG target range in the SGC group (69 ± 15%) was significantly higher than in the routine management group (52 ± 24%; P< 0.01). No measurement was ≤2.2 mmol/L, and there was only one episode of hypoglycemia (2.3-3.3 mmol/L) in each group. The average BG was significantly lower in the SGC group (7.8 ± 0.7 mmol/L) than in the routine management group (9.1 ± 1.6 mmol/L, P< 0.001). Target BG level was reached earlier in the SGC group than routine management group (2.5 ± 2.9 vs. 12.1 ± 15.3 h, P= 0.001). However, the SGC group performed worse for daily insulin requirement (59.8 ± 39.3 vs. 28.4 ± 36.7 U, P= 0.001) and sampling interval (2.0 ± 0.5 vs. 3.7 ± 0.5 h, P< 0.001) than the routine management group did. Multiple linear regression showed that the intervention group remained a significant individual predictor (P < 0.001) of the percentage time in target range. The SGC system, with a BG target of 5.8-8.9 mmol/L, resulted in effective and reliable glycemic control with few hypoglycemic episodes in critically ill patients with mechanical ventilation and hyperglycemia. However, the workload was increased. http://www.clinicaltrials.gov, NCT 02491346; https://www.clinicaltrials.gov/ct2/show

  1. Clinical value of routine serum squamous cell carcinoma antigen in follow-up of patients with locally advanced cervical cancer treated with radiation or chemoradiation

    PubMed Central

    Oh, Jinju; Lee, Hyun Joo; Lee, Tae Sung; Kim, Ju Hyun; Koh, Suk Bong

    2016-01-01

    Objective The objective of this study was to evaluate the clinical benefits of routine squamous cell carcinoma antigen (SCC-Ag) monitoring of patients with locally advanced cervical squamous cell carcinoma treated with radiation or chemoradiation. Methods A total of 53 patients with recurrent cervical squamous cell carcinoma treated with radiotherapy or chemoradiation were enrolled in this study. A retrospective review of medical records was conducted. The role of routine monitoring of serum SCC-Ag was evaluated in terms of cost effectiveness and effect on survival after diagnosis of recurrence. Results Serum SCC-Ag abnormality (≥2.5 ng/mL) was observed in 62.3% of patients when recurrent disease was diagnosed. The first indicator of relapse was abnormal serum SCC-Ag level in 21 patients (39.6%), 10 of whom had asymptomatic recurrent disease amenable to salvage therapy. Adding SCC-Ag measurement to the basic follow up protocol improved the sensitivity for detecting recurrence (The sensitivity of the basic protocol vs. addition of SCC-Ag: 49.1% vs. 88.7%, P<0.001). Twenty-three patients who were candidates for salvage therapy with curative intent showed better survival compared with those who were not candidates for therapy (5-year survival: 36.6% vs. 0%, P=0.012). Conclusion Surveillance with routine serum SCC-Ag monitoring can better detect asymptomatic recurrent disease that is potentially amenable to salvage therapy with curative intent. Early diagnosis of recurrent disease that can be treated with salvage therapy may lead to better survival. PMID:27462593

  2. Routine dyspnea assessment and documentation: Nurses' experience yields wide acceptance.

    PubMed

    Baker, Kathy M; DeSanto-Madeya, Susan; Banzett, Robert B

    2017-01-01

    Dyspnea (breathing discomfort) is a common and distressing symptom. Routine assessment and documentation can improve management and relieve suffering. A major barrier to routine dyspnea documentation is the concern that it will have a deleterious effect on nursing workflow and that it will not be readily accepted by nurses. Nurses at our institution recently began to assess and document dyspnea on all medical-surgical patients upon admission and once per shift throughout their hospitalization. A year after dyspnea measurement was implemented we explored nurses' approach to dyspnea assessment, their perception of patient response, and their perception of the utility and burden of dyspnea measurement. We obtained feedback from nurses using a three-part assessment of practice: 1) a series of recorded focus group interviews with nurses, 2) a time-motion observation of nurses performing routine dyspnea and pain assessment, and 3) a randomized, anonymous on-line survey based, in part, on issues raised in focus groups. Ninety-four percent of the nurses surveyed reported administering the dyspnea assessment is "easy" or "very easy". None of the nurses reported that assessing dyspnea negatively impacted workflow and many reported that it positively improved their practice by increasing their awareness. Our time-motion data showed dyspnea assessment and documentation takes well less than a minute. Nurses endorsed the importance of routine measurement and agreed that most patients were able to provide a meaningful rating of their dyspnea. Nurses found the patient report very useful, and used it in conjunction with observed signs to respond to changes in a patient's condition. In this study, we have demonstrated that routine dyspnea assessment and documentation was widely accepted by the nurses at our institution. Our nurses fully incorporated routine dyspnea assessment and documentation into their practice and felt that it improved patient-centered care.

  3. Is routine viral screening useful in patients with recent-onset polyarthritis of a duration of at least 6 weeks? Results from a nationwide longitudinal prospective cohort study.

    PubMed

    Varache, Sophie; Narbonne, Valérie; Jousse-Joulin, Sandrine; Guennoc, Xavier; Dougados, Maxime; Daurès, Jean Pierre; Devauchelle-Pensec, Valerie; Saraux, Alain

    2011-11-01

    To study the contribution of routine viral screening tests in patients with early rheumatoid arthritis (RA) or a potential for progressing to RA. Eight hundred thirteen patients with swelling of at least 2 joints for at least 6 weeks and a symptom duration of less than 6 months in the ESPOIR cohort were screened for parvovirus B19 (IgG and IgM anti-parvovirus B19 antibodies), hepatitis B virus (HBV; hepatitis B surface antigen), hepatitis C virus (HCV; anti-HCV antibodies), and human immunodeficiency virus (HIV; anti-HIV-1 and -2 antibodies). Parvovirus B19 testing was performed in 806 patients and showed longstanding immunity in 574 (71.2%) and no antibodies in 223 (27.7%). Among the 9 remaining patients (7 IgG positive/IgM positive, 1 IgG negative/IgM positive, and 1 IgG indeterminate/IgM positive), only 2 (0.25%; 95% confidence interval [95% CI] 0-0.99%) had a positive polymerase chain reaction test for parvovirus B19; these patients (women ages 34 and 40 years) had no extraarticular signs. HIV seroprevalence was 0.12% (n = 1 of 813; 95% CI 0.01-0.8%) and HCV seroprevalence was 0.86% (n = 7 of 808, 95% CI 0.38-1.86%). HCV-related arthritis was diagnosed in 4 patients (0.5%). HCV-seropositive patients had significantly higher transaminase levels than the other patients (P = 0.001), with no significant differences for the other laboratory data. HBV seroprevalence was 0.12% (n = 1 of 808; 95% CI 0.01-0.8%); the positive HBV status was known before study inclusion, and the patient had no diagnosis of HBV-related arthritis. Finally, routine viral testing identified 2 patients with parvovirus B19 infection and 3 with HBV infection (0.6%; 95% CI 0.2-1.5%). Cost was €85.05 per patient (total €68,720). Routine serologic testing did not contribute substantially to the diagnosis in this context. Copyright © 2011 by the American College of Rheumatology.

  4. Discussing sexuality with patients with Parkinson's disease: a survey among Dutch neurologists.

    PubMed

    van Hees, Petra J M; van der Plas, Anton A; van Ek, Gaby F; Putter, Hein; Den Oudsten, Brenda L; den Ouden, Marjolein E M; Elzevier, Henk W

    2017-03-01

    Sexual functioning is often impaired in patients with Parkinson's disease (PD) and may affect quality of life of patients and their spouse. However, little is known about the practice patterns of neurologists with regard to discussing sexuality in this field. The aim of this cross-sectional study was to evaluate to what extent neurologists discuss sexuality with PD patients. A 22-item questionnaire was sent to 139 neurologists specializing in PD. The survey contained questions about their attitudes, knowledge, and practice patterns with respect to sexual dysfunction (SD) in patients with PD. The response rate of the survey was 66.9%. Most participants (56.8%) stated that they address sexuality in less than half of their PD patients. High age of patients (42.0%), insufficient consultation time (37.5%), and a lack of patients' initiative to raise the topic themselves (36.4%) were frequently reported barriers towards discussing sexuality. The majority of participants considered that discussing sexuality is a responsibility that lay with neurologists (85.2%), nurses (73.9%), and patients (72.7%). One quarter of the neurologists reported to have insufficient or no knowledge on SD. The majority of participants regarded screening for SD important or slightly important (85.2%). A large proportion of Dutch neurologists specializing in PD do not routinely discuss sexuality with their PD patients. Sexual healthcare in PD patients may benefit from time-efficient tools and agreements on who is responsible for discussing SD. Furthermore, recommendations in PD guidelines on screening and managing SD should be adapted to fit everyday practice.

  5. Scaling up routine HIV testing at specialty clinics: assessing the effectiveness of an academic detailing approach.

    PubMed

    Lubelchek, Ronald J; Hotton, Anna L; Taussig, Daniel; Amarathithada, David; Gonzalez, Marisol

    2013-11-01

    Scaling up routine HIV testing represents a key component of the National HIV/AIDS Strategy. Barriers to routine HIV testing have limited widespread adoption. Although many patients visit specialty care providers, few efforts to increase routine HIV testing in specialty care settings have been made. We report on use of a survey of barriers to routine testing coupled with academic detailing-type educational sessions to increase routine testing at specialty clinics in Chicago's main safety-net health system. We devised a survey to assess specialty provider knowledge, attitudes, and barriers to routine HIV testing. We administered this at 3 specialty clinics. Each clinic's survey responses informed content for academic detailing-type presentations to each clinic's medical providers. We provide descriptive statistics summarizing survey responses. We report changes in the HIV testing rates and use logistic regression to examine associations between time period and odds of testing at each clinic. Specialty clinic providers demonstrated varying knowledge regarding routine HIV testing guidelines-with trauma providers having the least knowledge. Concerns regarding arranging follow-up for patients with positive results was the most cited barrier to testing. Two of the 3 specialty clinics experienced significant increases in routine HIV testing, whereas the third specialty service, which uses more rotating residents, had downtrending routine testing rates. The increase in routine HIV testing in 2 of 3 specialty services suggests that academic detailing-type interventions can improve routine testing uptake in public safety-net specialty care settings and may represent a useful component to incorporate into system-wide scale-up efforts.

  6. Scaling up routine HIV testing at specialty clinics: Assessing the effectiveness of an academic detailing approach

    PubMed Central

    Hotton, Anna L.; Taussig, Daniel; Amarathithada, David; Gonzalez, Marisol

    2013-01-01

    Introduction Scaling up routine HIV testing represents a key component of the National HIV/AIDS Strategy. Barriers to routine HIV testing have limited widespread adoption. While many patients visit specialty care providers, few efforts to increase routine HIV testing in specialty care settings have been made. We report on use of a survey of barriers to routine testing, coupled with academic detailing-type educational sessions to increase routine testing at specialty clinics in Chicago’s main safety-net health system. Methods We devised a survey to assess specialty provider knowledge, attitudes and barriers to routine HIV testing. We administered this at three specialty clinics. Each clinic’s survey responses informed content for academic detailing-type presentations to each clinic’s medical providers. We provide descriptive statistics summarizing survey responses. We report changes in the HIV testing rates and use logistic regression to examine associations between time period and odds of testing at each clinic. Results Specialty clinic providers demonstrated varying knowledge regarding routine HIV testing guidelines – with trauma providers having the least knowledge. Concerns regarding arranging follow-up for patients with positive results was the most cited barrier to testing. Two of the three specialty clinics experienced significant increases in routine HIV testing, while the third specialty service, which utilizes more rotating residents, had down-trending routine testing rates. Discussion The increase in routine HIV testing in two of three specialty services suggests that academic detailing-type interventions can improve routine testing uptake in public safety-net specialty care settings and may represent a useful component to incorporate into system-wide scale-up efforts. PMID:24126444

  7. Utility of Routine Left Ventricular Ejection Fraction Measurement Before Anthracycline-Based Chemotherapy in Patients With Diffuse Large B-Cell Lymphoma

    PubMed Central

    Conrad, Amber L.; Gundrum, Jacob D.; McHugh, Vicki L.; Go, Ronald S.

    2012-01-01

    Purpose: Despite the lack of evidence, routine left ventricular ejection fraction (LVEF) measurement in diffuse large B-cell lymphoma (DLBCL) before anthracycline-based chemotherapy (ABC) is recommended by practice guidelines and required in DLBCL trials in the United States. Methods: We determined the frequency of the following in 197 consecutive patients with newly diagnosed DLBCL treated at our institution: one, LVEF measurement before ABC; two, finding of asymptomatic LV dysfunction (ALVD); and three, modification in treatment strategy as a result of LVEF measurement. Results: The median age was 71 years, and 54% of patients were men. LVEF was measured in 128 patients (65%) pretreatment, including in 15 with prior congestive heart failure (CHF). The reasons for not measuring LVEF were: clinically low risk for ALVD (n = 32), medical frailty (n = 15), palliative care (n = 3), ABC not standard therapy (n = 12), and prior CHF (n = 7). Among patients without prior CHF who had LVEF assessed (n = 113), ALVD was detected in four (4%), with LVEF ranging from 41% to 48%. Four patients were not treated despite normal LVEF because of comorbidities and anticipated toxicities. In contrast, all four patients with ALVD received ABC. No patient had a modification in treatment strategy as a result of LVEF measurement. After a median follow-up of 60 months, among those who remained alive, CHF developed in 15% versus 6% of patients receiving ABC who did and did not have LVEF measured, respectively (P = .246). Conclusion: Our findings challenge the utility of routine LVEF measurement in patients with DLBCL before ABC. Potential cost savings to our health care system could be substantial. PMID:23598842

  8. Utilizing patient satisfaction surveys to prepare for Medicaid managed care.

    PubMed

    Fields, T T; Gomez, P S

    2001-02-01

    To prepare for Medicaid managed care, a community health center incorporated the business principle of continuous quality improvement, often used in the private sector to improve customer service, into its planning process. The initial endeavor was to create a patient satisfaction survey that was appropriate for the uniqueness of the community. The survey, taken monthly, resulted in both staff and patients making active improvements in the clinic environment. Staff showed more enthusiasm, and patients were more assertive in their attitudes toward the clinic. The empowerment of the patient to take ownership in the clinic will be coupled with the next step of the formalized plan, that of educating patients on the steps necessary to ensure that their Medicaid managed care facility will be the local community health center.

  9. Survey among patients with basal cell carcinoma in The Netherlands.

    PubMed

    Gerritsen, M J P; De Rie, M A; Beljaards, R C; Thissen, M R T M; Kuipers, M V

    2009-01-01

    This paper describes the findings of a survey distributed among Dutch patients with basal cell carcinoma (BCC). The questionnaire comprised a list of questions related to demographic characteristics, features of BCC, reason for consulting a dermatologist, anxiety, type of treatment and the satisfaction with this treatment and desired benefits of treatment. In total, 220 patients completed the survey. The age of these responders varied between 27 and 89 years (mean 64.6 years). Half of the patient group had already previously experienced a BCC. Most patients (52%) indicated that the diagnosis 'skin cancer' frightened them, but that they knew it could be treated. Accordingly, most patients (70%) indicated that BCC had no or hardly any influence on their quality of life. From the patient's perspective, efficacy, low recurrence rate and no or minor scarring are important features of a BCC treatment. Surgery was the most popular therapy. The number of BCC patients is growing, which will lead to a definite burden for dermatologists in the near future. Our survey demonstrated that patients are mostly interested in the efficacy, low recurrence rates and cosmetic outcome of their therapies. Newly efficacious and non-invasive therapies, such as the recently introduced photodynamic therapy or home treatment with imiquimod, can help to overcome these concerns.

  10. 75 FR 32539 - Agency Information Collection (Dental Patient Satisfaction Survey) Activities Under OMB Review

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-08

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF VETERANS AFFAIRS Agency Information Collection (Dental Patient Satisfaction Survey) Activities Under OMB Review... Form 10-0503).'' Title: Survey of Healthcare Experiences, Dental Patient Satisfaction Survey, VA...

  11. Societal cost-of-illness in patients with borderline personality disorder one year before, during and after dialectical behavior therapy in routine outpatient care.

    PubMed

    Wagner, Till; Fydrich, Thomas; Stiglmayr, Christian; Marschall, Paul; Salize, Hans-Joachim; Renneberg, Babette; Fleßa, Steffen; Roepke, Stefan

    2014-10-01

    Societal cost-of-illness in a German sample of patients with borderline personality disorder (BPD) was calculated for 12 months prior to an outpatient Dialectical Behavior Therapy (DBT) program, during a year of DBT in routine outpatient care and during a follow-up year. We retrospectively assessed resource consumption and productivity loss by means of a structured interview. Direct costs were calculated as opportunity costs and indirect costs were calculated according to the Human Capital Approach. All costs were expressed in Euros for the year 2010. Total mean annual BPD-related societal cost-of-illness was €28026 (SD = €33081) during pre-treatment, €18758 (SD = €19450) during the DBT treatment year for the 47 DBT treatment completers, and €14750 (SD = €18592) during the follow-up year for the 33 patients who participated in the final assessment. Cost savings were mainly due to marked reductions in inpatient treatment costs, while indirect costs barely decreased. In conclusion, our findings provide evidence that the treatment of BPD patients with an outpatient DBT program is associated with substantial overall cost savings. Already during the DBT treatment year, these savings clearly exceed the additional treatment costs of DBT and are further extended during the follow-up year. Correspondingly, outpatient DBT has the potential to be a cost-effective treatment for BPD patients. Efforts promoting its implementation in routine care should be undertaken. Copyright © 2014 Elsevier Ltd. All rights reserved.

  12. Routine Use of Three-Dimensional Contrast-Enhanced Moving-Table MR Angiography in Patients with Peripheral Arterial Occlusive Disease: Comparison with Selective Digital Subtraction Angiography

    SciTech Connect

    Deutschmann, Hannes A.; Schoellnast, Helmut; Portugaller, Horst R.; Preidler, Klaus W.; Reittner, Pia; Tillich, Manfred; Pilger, Ernst; Szolar, Dieter H. M.

    2006-10-15

    Purpose. To compare the diagnostic accuracy of contrast-enhanced (CE) three-dimensional (3D) moving-table magnetic resonance (MR) angiography with that of selective digital subtraction angiography (DSA) for routine clinical investigation in patients with peripheral arterial occlusive disease. Methods. Thirty-eight patients underwent CE 3D moving-table MR angiography of the pelvic and peripheral arteries. A commercially available large-field-of-view adapter and a dedicated peripheral vascular phased-array coil were used. MR angiograms were evaluated for grade of arterial stenosis, diagnostic quality, and presence of artifacts. MR imaging results for each patient were compared with those of selective DSA. Results. Two hundred and twenty-six arterial segments in 38 patients were evaluated by both selective DSA and MR angiography. No complications related to MR angiography were observed. There was agreement in stenosis classification in 204 (90.3%) segments; MR angiography overgraded 16 (7%) segments and undergraded 6 (2.7%) segments. Compared with selective DSA, MR angiography provided high sensitivity and specificity and excellent interobserver agreement for detection of severe stenosis (97% and 95%, {kappa} = 0.9 {+-} 0.03) and moderate stenosis (96.5% and 94.3%, {kappa} = 0.9 {+-} 0.03). Conclusion. Compared with selective DSA, moving-table MR angiography proved to be an accurate, noninvasive method for evaluation of peripheral arterial occlusive disease and may thus serve as an alternative to DSA in clinical routine.

  13. Uniform data collection in routine clinical practice in cardiovascular patients for optimal care, quality control and research: The Utrecht Cardiovascular Cohort.

    PubMed

    Asselbergs, Folkert W; Visseren, Frank Lj; Bots, Michiel L; de Borst, Gert J; Buijsrogge, Marc P; Dieleman, Jan M; van Dinther, Baukje Gf; Doevendans, Pieter A; Hoefer, Imo E; Hollander, Monika; de Jong, Pim A; Koenen, Steven V; Pasterkamp, Gerard; Ruigrok, Ynte M; van der Schouw, Yvonne T; Verhaar, Marianne C; Grobbee, Diederick E

    2017-01-01

    Background Cardiovascular disease remains the major contributor to morbidity and mortality. In routine care for patients with an elevated cardiovascular risk or with symptomatic cardiovascular disease information is mostly collected in an unstructured manner, making the data of limited use for structural feedback, quality control, learning and scientific research. Objective The Utrecht Cardiovascular Cohort (UCC) initiative aims to create an infrastructure for uniform registration of cardiovascular information in routine clinical practice for patients referred for cardiovascular care at the University Medical Center Utrecht, the Netherlands. This infrastructure will promote optimal care according to guidelines, continuous quality control in a learning healthcare system and creation of a research database. Methods The UCC comprises three parts. UCC-1 comprises enrolment of all eligible cardiovascular patients in whom the same information will be collected, based on the Dutch cardiovascular management guideline. A sample of UCC-1 will be invited for UCC-2. UCC-2 involves an enrichment through extensive clinical measurements with emphasis on heart failure, cerebral ischaemia, arterial aneurysms, diabetes mellitus and elevated blood pressure. UCC-3 comprises on-top studies, with in-depth measurements in smaller groups of participants typically based on dedicated project grants. All participants are followed up for morbidity and mortality through linkage with national registries. Conclusion In a multidisciplinary effort with physicians, patients and researchers the UCC sets a benchmark for a learning cardiovascular healthcare system. UCC offers an invaluable resource for future high quality care as well as for first-class research for investigators.

  14. Does routine psychosocial screening improve referral to psychosocial care providers and patient-radiotherapist communication? A cluster randomized controlled trial.

    PubMed

    Braeken, Anna P B M; Lechner, Lilian; Eekers, Daniëlle B P; Houben, Ruud M A; van Gils, Francis C J M; Ambergen, Ton; Kempen, Gertrudis I J M

    2013-11-01

    This study tests whether using a screening instrument improves referral to psychosocial care providers (e.g. psychologist) and facilitates patient-radiotherapist communication. A cluster randomized controlled trial was used. Fourteen radiotherapists were randomly allocated to the experimental or control group and 568 of their patients received care in accordance with the group to which their radiotherapist was allocated. Patients in the experimental group were asked to complete a screening instrument before and at the end of the radiation treatment period. All patients were requested to complete questionnaires concerning patient-physician communication after the first consultation and concerning psychosocial care 3 and 12 months post-intervention. Patients who completed the screening instrument were referred to social workers at an earlier stage than patients who did not (P<0.01). No effects were observed for numbers of referred patients, or for improved patient-radiotherapist communication. Our results suggest that a simple screening procedure can be valuable for the timely treatment of psychosocial problems in patients. Future efforts should be directed at appropriate timing of screening and enhancing physicians' awareness regarding the importance of identifying, discussing and treating psychosocial problems in cancer patients. Psychosocial screening can be enhanced by effective radiotherapist-patient communication. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  15. Do doctors know how much nutrition patients need--a survey from Germany?

    PubMed

    Wirth, R; Smoliner, C; Spamer, C; Marburger, C; Schreiber, F S; Willschrei, H P; Lenzen-Großimlinghaus, R; Schäfer, R; Volkert, D

    2014-07-01

    For the diagnosis, prevention and therapy of malnutrition, it is important to estimate the energy and fluid requirements of an individual patient. To our knowledge, it is unknown how accurately medical doctors can estimate the energy and fluid requirements of patients in a clinical routine situation. Hence, we conducted the following survey. A written face-to-face survey about the energy and fluid requirements of and tube feeding and fluid recommendations for a typical patient was performed with 179 medical doctors. An estimation error of >15% was defined as relevant. The results revealed substantial variations in estimating the energy and fluid needs of the patient. A total of 25% of the participants underestimated the energy requirements, and 47% of the participants underestimated the fluid requirements. In addition, 68% of the participants recommended a daily dose of tube feeding that was <85% of the reference value. A substantial proportion of medical doctors show a lack of knowledge concerning energy and fluid requirements, which demonstrates a need for better medical education with regard to nutrition.

  16. Caregiver survey results related to handling of oral chemotherapy for pediatric patients with acute lymphoblastic leukemia.

    PubMed

    Held, Kristin; Ryan, Robin; Champion, Judy M; August, Keith; Radhi, Mohamed A

    2013-08-01

    Oral chemotherapy is commonly administered in the home; however, there may be harmful effects on healthy individuals who handle these medications. Caregivers of pediatric patients were surveyed to establish educational needs for safe handling of oral chemotherapy agents. An 11-question self-report survey was developed to characterize handling practices for patients in maintenance therapy for acute lymphoblastic leukemia related to caregiver education, use of protective gear, preparation, and disposal of oral chemotherapy agents. Fifty questionnaires were collected. Seventy-two percent of responders reported receiving instruction on safe handling of oral chemotherapy. Ninety percent of responders reported that they did not utilize protective gear during preparation of oral chemotherapy. Although tablet crushers were designated for use with oral chemotherapy by 61% of responders, 22% used the same device to crush other nonchemotherapy medications. The majority of responders disposed of medication waste with regular garbage or poured the remainder down the sink. Caregiver survey responses demonstrated that personal safeguards were not routinely utilized by pediatric caregivers while handling oral chemotherapy. Future educational efforts should be directed to improve caregiver understanding related to the use of protective equipment, designation of supplies for use with chemotherapy agents, and safe disposal.

  17. The use of routine non density calibrated clinical computed tomography data as a potentially useful screening tool for identifying patients with osteoporosis

    PubMed Central

    Burke, Christopher John; Didolkar, Manjiri M.; Barnhart, Huiman X.; Vinson, Emily N.

    2016-01-01

    Summary Objectives To evaluate whether lumbar vertebral body density CT attenuation values measured in Hounsfield Units (HUs) on routine Computed Tomography (CT) examinations can be reliably measured with limited variability, and to evaluate for a correlation between HUs and bone mineral density as measured by dual energy X-ray absorptiometry (DXA) scan. Methods Retrospective review of a total of 249 routine MDCT examinations, performed to measure HUs at the first non-rib bearing lumbar vertebral body on axial images, cross-referenced to the lateral scout image. Results The overall ICC and RC for intra-reader variability on CT HU were 0.987 (95% CI 0.973 – 0.999) and 15.664 (95% CI 11.66–16.97). The overall ICC and RDC for inter-reader variability on CT HU were 0.952 (95% CI 0.892 – 0.999) and 30.20 (95% CI 23.73 – 34.48). The ICC and RC for interscanner variability were 0.98 (95% CI 0.95 – 0.99) and 16.67 (95% CI 13.13 – 22.85). The correlation between the L1 HUs and L1 BMD, L1 t-score, and overall t-score was 0.437, 0.392, and 0.400, respectively. Conclusions CT attenuation values of the first lumbar vertebra can be measured on routine abdomen CTs with limited variability despite multiple readers and scanners. Correlation between HU and BMD as measured by DXA scan was only weakly positive, and by this method measuring the density of a lumbar vertebral body from a routine MDCT scan does not provide the sensitivity or specificity necessary for a screening test. However above a certain measured value (180 HU), patients have a low chance of osteoporosis and therefore may not need additional screening, potentially limiting radiation exposure and cost. PMID:27920811

  18. An alternative to satisfaction surveys: let the patients talk.

    PubMed

    Alemi, Farrokh; Jasper, Harry

    2014-01-01

    We propose to replace the standardized 27-item hospital version of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey with 1-item questionnaire that asks "What worked well and what needs improvement?" Sentiment analysis can take the responses to this single question and reconstruct a report on frequency of dissatisfied customers and reasons for dissatisfaction similar to reports received from longer surveys. This article shows, by way of an example, how benchmarked and quantitative reports can be generated from patients' comments. The CAHPS survey asks more leading questions, is less granular in its feedback, has lower response rate, has costly repeated reminders, and may not be as timely as sentiment analysis of a single, open-ended question. This article also shows the implementation of the proposed approach in one critical access hospital and its affiliated clinic and calls for additional research to compare sentiment analysis and CAHPS satisfaction surveys.

  19. Adverse events in total knee arthroplasty: Results of a physician independent survey in 260 patients

    PubMed Central

    2010-01-01

    Purpose Identification of all common and potentially avoidable adverse events is crucial to further improve the quality of medical care. The intention of the current study was to evaluate a standardized physician independent survey format on adverse events in total knee arthroplasty. The protocol for reporting adverse drug events following the International Conference of Harmonisation of technical requirements for registration of pharmaceuticals for human use (ICH) was adopted for adverse events occurring during surgical interventions. Material and methods Data of a prospective sequential cohort trial introducing a clinical pathway for total knee arthroplasty was analysed. Reporting of adverse events was done by a physician independent study nurse using the modified ICH-Good Clinical Practice (GCP) format (Structure and Content of Clinical study reports - E3) in 260 patients. The adverse events were graded to their severity and their potential relation to surgical treatment. Results A total of 55 patients (21%) suffered from an adverse event and 16 (6%) from a serious adverse event. In 38 patients' one adverse event occurred, 12 patients showed 2 adverse events and 5 patients suffered from a combination of an adverse and a serious adverse event. A serious adverse event alone occurred in 11 patients. The incidence of adverse events (Fisher p = 0.448) and serious adverse (p = 0.126) events showed no significant difference between the two cohorts. The most common adverse events were deep vein thrombosis (8% and 5%) followed by wound healing problems (1% and 0%) and haematoma (1% and 3%). A wide range of non surgical adverse events were recorded with low incidence levels. Conclusion The use of the modified ICH-GCP format supports standardization of adverse event reporting. Routine assessment of adverse events by a study nurse revealed higher incidence rates of adverse events in total knee arthroplasty. We recommend the implementation of trained paramedical staff for

  20. Simplified risk stratification criteria for identification of patients with MRSA bacteremia at low risk of infective endocarditis: implications for avoiding routine transesophageal echocardiography in MRSA bacteremia.

    PubMed

    Buitron de la Vega, P; Tandon, P; Qureshi, W; Nasr, Y; Jayaprakash, R; Arshad, S; Moreno, D; Jacobsen, G; Ananthasubramaniam, K; Ramesh, M; Zervos, M

    2016-02-01

    The aim of this study was to identify patients with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia with low risk of infective endocarditis (IE) who might not require routine trans-esophageal echocardiography (TEE). We retrospectively evaluated 398 patients presenting with MRSA bacteremia for the presence of the following clinical criteria: intravenous drug abuse (IVDA), long-term catheter, prolonged bacteremia, intra-cardiac device, prosthetic valve, hemodialysis dependency, vertebral/nonvertebral osteomyelitis, cardio-structural abnormality. IE was diagnosed using the modified Duke criteria. Of 398 patients with MRSA bacteremia, 26.4 % of cases were community-acquired, 56.3 % were health-care-associated, and 17.3 % were hospital-acquired. Of the group, 44 patients had definite IE, 119 had possible IE, and 235 had a rejected diagnosis. Out of 398 patients, 231 were evaluated with transthoracic echocardiography (TTE) or TEE. All 44 patients with definite IE fulfilled at least one criterion (sensitivity 100 %). Finally, a receiver operator characteristic (ROC) curve was obtained to evaluate the total risk score of our proposed criteria as a predictor of the presence of IE, and this was compared to the ROC curve of a previously proposed criteria. The area under the ROC curve for our criteria was 0.710, while the area under the ROC curve for the criteria previously proposed was 0.537 (p < 0.001). The p-value for comparing those 2 areas was less than 0.001, indicating statistical significance. Patients with MRSA bacteremia without any of our proposed clinical criteria have very low risk of developing IE and may not require routine TEE.

  1. Cooperation of German ophthalmologists in routine care of patients with neovascular age-related macular degeneration: results of the non-interventional BRIDGE study.

    PubMed

    Wachtlin, Joachim; Ringwald, Andreas; Maulhardt, Tobias; Pohl, Karin; Wiedon, Annette

    2016-08-01

    In the non-interventional ophthalmological study 'BRIDGE' the routine care of patients with neovascular age-related macular degeneration (nAMD) treated with ranibizumab was observed in Germany. A patient regularly sees the general ophthalmologist (GO) for monitoring and, if needed, the injecting ophthalmologist (IO) for intravitreal injections (IVI). Thus, patients are routinely treated by two ophthalmologists in parallel and patient care depends on their collaboration. This cooperation was evaluated based on network questionnaires. 'BRIDGE' was a multicenter, national, open-label, prospective, observational study, conducted between July 2010 and December 2012. The network questionnaire for GOs consisted of 51 questions, while the similar questionnaire for IOs consisted of 43 questions, addressing the type and details of the individual collaboration. The statistical analysis was purely descriptive. The network questionnaire for GOs was completed by 152 GOs, regularly cooperating with 2.5 ± 1.1 IOs, while the questionnaire for IOs was completed by 43 IOs, regularly cooperating with 23.2 ± 23.6 GOs. Generally, both GOs and IOs stated that they regularly exchange information regarding the patients' situation. Diagnostic standards were only established for 15 % of the GOs' collaborations and for 35 % of the IOs' collaborations. After initial treatment, both GOs and IOs agreed on the medical significance of regular monitoring visits performed by the GOs. Agreements on re-treatment criteria were only established in the case of 16 % of the GOs and 28 % of the IOs. Overall, both GOs and IOs were satisfied with the current situation, with regard to the medical treatment situation for patients and to the cooperation within the networks. The network questionnaires revealed well-established cooperation between IOs and GOs in Germany with an accepted division of responsibilities for the routine care of patients with nAMD. However, the cooperation between two

  2. Effects of Survey Mode, Patient Mix, and Nonresponse on CAHPS® Hospital Survey Scores

    PubMed Central

    Elliott, Marc N; Zaslavsky, Alan M; Goldstein, Elizabeth; Lehrman, William; Hambarsoomians, Katrin; Beckett, Megan K; Giordano, Laura

    2009-01-01

    Objective To evaluate the need for survey mode adjustments to hospital care evaluations by discharged inpatients and develop the appropriate adjustments. Data Source A total of 7,555 respondents from a 2006 national random sample of 45 hospitals who completed the CAHPS® Hospital (HCAHPS [Hospital Consumer Assessments of Healthcare Providers and Systems]) Survey. Study Design/Data Collection/Extraction Methods We estimated mode effects in linear models that predicted each HCAHPS outcome from hospital-fixed effects and patient-mix adjustors. Principal Findings Patients randomized to the telephone and active interactive voice response (IVR) modes provided more positive evaluations than patients randomized to mail and mixed (mail with telephone follow-up) modes, with some effects equivalent to more than 30 percentile points in hospital rankings. Mode effects are consistent across hospitals and are generally larger than total patient-mix effects. Patient-mix adjustment accounts for any nonresponse bias that could have been addressed through weighting. Conclusions Valid comparisons of hospital performance require that reported hospital scores be adjusted for survey mode and patient mix. PMID:19317857

  3. Diet and acne: an exploratory survey study of patient beliefs

    PubMed Central

    Nguyen, Quynh-Giao; Markus, Ramsey; Katta, Rajani

    2016-01-01

    Background: In the past, medical literature reflected that diet was not a proven cause of acne. However, studies in recent years have substantiated a link between certain dietary factors and acne. It is unclear whether patients are aware of recent research findings. Objectives: Acne patients were surveyed to explore beliefs regarding the link between diet and acne, to determine whether these beliefs translated into behavior change and to identify health information sources. Patients/Methods: Upon Institutional Review Board (IRB) approval, surveys were administered to 50 acne patients at an academic dermatology clinic in 2014, with 49 completed in full and included in this analysis. Results: Ninety-two percent of respondents believed that diet could affect acne. Seventy-one percent attempted to change their diet to improve acne. Seventy-one percent believed acne to be caused by fried or greasy foods, although chocolate (53%), dairy (47%), and soda drinks (35%) were highly implicated. Patients obtained information from Google searches (49%), dermatologists (43%), family members and TV (41% each), and medical websites (31%). Conclusions: In this exploratory study, patients reported utilizing a diversity of information sources, a majority from the Internet. In those surveyed, there was a persistence of long-held belief that fried/greasy foods and chocolate may serve as acne triggers, and less belief in trigger foods supported by recent research, including refined carbohydrates and sugar. Given the multiplicity of beliefs and utilized sources among acne patients in our survey, there is a need to establish up-to-date and reliable methods to educate patients on diet and acne. PMID:27222768

  4. Alarming rates of virological failure and drug resistance in patients on long-term antiretroviral treatment in routine HIV clinics in Togo.

    PubMed

    Konou, Abla A; Dagnra, Anoumou Y; Vidal, Nicole; Salou, Mounerou; Adam, Zakillatou; Singo-Tokofai, Assétina; Delaporte, Eric; Prince-David, Mireille; Peeters, Martine

    2015-11-28

    Information on efficacy of long-term antiretroviral treatment (ART) exposure in resource-limited countries is still scarce. In 767 patients attending routine HIV centers in Togo and receiving first-line ART for more than four years, 42% had viral load greater than 1000 copies/ml and either were on a completely ineffective ART regime or were with only a single drug active. The actual conditions to ensure lifelong ART in resource-limited countries can have dramatic long-term outcomes.

  5. Survey of Threats and Assaults by Patients on Psychiatry Residents

    ERIC Educational Resources Information Center

    Dvir, Yael; Moniwa, Emiko; Crisp-Han, Holly; Levy, Dana; Coverdale, John H.

    2012-01-01

    Objective: The authors sought to determine the prevalence of threats and assaults by patients on psychiatry residents, their consequences, and the perceived adequacy of supports and institutional responses. Method: Authors conducted an anonymous survey of 519 psychiatry residents in 13 psychiatry programs across the United States. The survey…

  6. Survey of Threats and Assaults by Patients on Psychiatry Residents

    ERIC Educational Resources Information Center

    Dvir, Yael; Moniwa, Emiko; Crisp-Han, Holly; Levy, Dana; Coverdale, John H.

    2012-01-01

    Objective: The authors sought to determine the prevalence of threats and assaults by patients on psychiatry residents, their consequences, and the perceived adequacy of supports and institutional responses. Method: Authors conducted an anonymous survey of 519 psychiatry residents in 13 psychiatry programs across the United States. The survey…

  7. Improvement of Physical Activity by a Kiosk-based Electronic Screening and Brief Intervention in Routine Primary Health Care: Patient-Initiated Versus Staff-Referred.

    PubMed

    Leijon, Matti; Arvidsson, Daniel; Nilsen, Per; Stark Ekman, Diana; Carlfjord, Siw; Andersson, Agneta; Johansson, Anne Lie; Bendtsen, Preben

    2011-11-22

    Interactive behavior change technology (eg, computer programs, Internet websites, and mobile phones) may facilitate the implementation of lifestyle behavior interventions in routine primary health care. Effective, fully automated solutions not involving primary health care staff may offer low-cost support for behavior change. We explored the effectiveness of an electronic screening and brief intervention (e-SBI) deployed through a stand-alone information kiosk for promoting physical activity among sedentary patients in routine primary health care. We further tested whether its effectiveness differed between patients performing the e-SBI on their own initiative and those referred to it by primary health care staff. The e-SBI screens for the physical activity level, motivation to change, attitudes toward performing the test, and physical characteristics and provides tailored feedback supporting behavior change. A total of 7863 patients performed the e-SBI from 2007 through 2009 in routine primary health care in Östergötland County, Sweden. Of these, 2509 were considered not sufficiently physically active, and 311 of these 2509 patients agreed to participate in an optional 3-month follow-up. These 311 patients were included in the analysis and were further divided into two groups based on whether the e-SBI was performed on the patient´s own initiative (informed by posters in the waiting room) or if the patient was referred to it by staff. A physical activity score representing the number of days being physically active was compared between baseline e-SBI and the 3-month follow-up. Based on physical activity recommendations, a score of 5 was considered the cutoff for being sufficiently physically active. In all, 137 of 311 patients (44%) were sufficiently physically active at the 3-month follow-up. The proportion becoming sufficiently physically active was 16/55 (29%), 40/101 (40%), and 81/155 (52%) for patients with a physical activity score at baseline of 0, 1 to

  8. Improvement of Physical Activity by a Kiosk-based Electronic Screening and Brief Intervention in Routine Primary Health Care: Patient-Initiated Versus Staff-Referred

    PubMed Central

    Nilsen, Per; Stark Ekman, Diana; Carlfjord, Siw; Andersson, Agneta; Johansson, Anne Lie; Bendtsen, Preben

    2011-01-01

    Background Interactive behavior change technology (eg, computer programs, Internet websites, and mobile phones) may facilitate the implementation of lifestyle behavior interventions in routine primary health care. Effective, fully automated solutions not involving primary health care staff may offer low-cost support for behavior change. Objectives We explored the effectiveness of an electronic screening and brief intervention (e-SBI) deployed through a stand-alone information kiosk for promoting physical activity among sedentary patients in routine primary health care. We further tested whether its effectiveness differed between patients performing the e-SBI on their own initiative and those referred to it by primary health care staff. Methods The e-SBI screens for the physical activity level, motivation to change, attitudes toward performing the test, and physical characteristics and provides tailored feedback supporting behavior change. A total of 7863 patients performed the e-SBI from 2007 through 2009 in routine primary health care in Östergötland County, Sweden. Of these, 2509 were considered not sufficiently physically active, and 311 of these 2509 patients agreed to participate in an optional 3-month follow-up. These 311 patients were included in the analysis and were further divided into two groups based on whether the e-SBI was performed on the patient´s own initiative (informed by posters in the waiting room) or if the patient was referred to it by staff. A physical activity score representing the number of days being physically active was compared between baseline e-SBI and the 3-month follow-up. Based on physical activity recommendations, a score of 5 was considered the cutoff for being sufficiently physically active. Results In all, 137 of 311 patients (44%) were sufficiently physically active at the 3-month follow-up. The proportion becoming sufficiently physically active was 16/55 (29%), 40/101 (40%), and 81/155 (52%) for patients with a physical

  9. Physiotherapists' perceptions of patient adherence to prescribed self-management strategies: a cross-sectional survey of Australian physiotherapists.

    PubMed

    Peek, Kerry; Carey, Mariko; Sanson-Fisher, Robert; Mackenzie, Lisa

    2017-09-01

    Physiotherapists often prescribe self-management strategies for their patients. However, the effectiveness of these strategies in improving patient outcome is related to the rate of patient adherence. The aims of this study were to explore physiotherapists' views on the importance and perceived rates of patient adherence to physiotherapist prescribed self-management strategies; the perceived importance of methods physiotherapists can employ to aid patient adherence and the barriers to employing these methods. A cross-sectional web-based survey was emailed to 808 physiotherapist members of the Australian Physiotherapy Association. To maximize response rates, two reminder emails were utilized. In total, 352 physiotherapists completed the survey (response rate 44%). A majority of physiotherapists (89%) believed that patient self-management strategies were important in improving patient outcomes; however, the mean perceived rate of patient adherence across all strategies was only 67%. Physiotherapists reported that there were a number of important methods that can be employed to aid patient adherence such as providing patient education and allowing time for patient practice; with minimal perceived barriers to employing these methods. Results indicate that physiotherapists perceive that patient outcomes can be positively impacted by patient adherence to a range of self-management strategies. Physiotherapists should be encouraged to implement into their routine clinical practice evidence-based methods to aid patient adherence. Implications for Rehabilitation Physiotherapists believe that patient self-management strategies are important for improving patient outcomes, however, the perceived rates of patient adherence could be improved. Physiotherapists should adopt a collaborative approach with their patients to address any barriers to adherence to positively impact on patient outcome. Physiotherapists perceive that there are a number of modifiable characteristics which

  10. A pilot study of usefulness of clinician-patient videoconferencing for making routine medical decisions in the nursing home.

    PubMed

    Laflamme, Mark R; Wilcox, David C; Sullivan, Jacquelyn; Schadow, Gunther; Lindbergh, Donald; Warvel, Jill; Buchanan, Heydon; Ising, Terry; Abernathy, Greg; Perkins, Susan M; Daggy, Joanne; Frankel, Richard M; Dexter, Paul; McDonald, Clement J; Weiner, Michael

    2005-08-01

    To pilot and assess the role of videoconferencing in clinicians' medical decision-making and their interactions with nursing home residents (NHRs). Paired virtual and bedside examinations. Face-to-face (FTF) examination of NHRs by off-site clinicians immediately followed videoconferencing between the same clinician-NHR pair. A 240-bed, county-managed, urban nursing home. NHRs (n=35) and clinicians (n=3) receiving or providing routine care between 2002 and 2003. Orders generated by clinicians, clinicians' ratings of videoconferencing, and coded review of video encounters. After both examinations, clinicians rated the encounters and generated orders necessary for NHRs. Orders were categorized and counted according to timing (before or after the FTF visit). Clinician-NHR interactions were assessed using coding videos with a 31-item instrument. For 71% of the encounters, clinicians stated that videoconferencing facilitated their assessment. Difficulties included sound quality (19%) and participants' familiarity with videoconferencing (7%). Although NHRs were alert in 50% of encounters, 62% of alert NHRs did not indicate understanding of the recommended treatment. FTF examination was superior for most assessments, but videoconferencing was judged to be valuable, especially for wound care. Even when NHRs were alert, informed medical decision-making by NHRs with their clinicians was limited. Enhancing videoconferencing quality and providing more training about informed decision-making using videoconferencing might improve the effectiveness of the technology.

  11. Low-risk young adult patients with chest pain may not benefit from routine cardiac stress testing: a Bayesian analysis.

    PubMed

    Dawson, Matthew; Youngquist, Scott; Bledsoe, Joseph; Madsen, Troy; Bossart, Philip; Davis, Virgil; Barton, Erik

    2010-09-01

    Low-risk emergency department (ED) chest pain patients with a nondiagnostic electrocardiogram (ECG) and negative cardiac biomarkers are commonly evaluated with cardiac stress testing to detect undiagnosed coronary artery disease. Provocative testing incurs certain costs and may require additional time investment either in the ED or in an observation setting. Recent research has questioned the utility of provocative testing in young adults with negative cardiac biomarkers and nondiagnostic ECG. We sought to evaluate the utility of cardiac stress testing in our population of young adult patients with chest pain. We performed a retrospective chart review of all chest pain patients aged 40 years and younger who were admitted to our ED observation unit over the 14-month period between April 2006 and May 2007. We included all patients who were admitted to the observation unit for serial biomarkers and provocative testing and had normal or nondiagnostic ECG, no history of coronary disease, and an initial negative troponin. We recorded baseline characteristics and stress test results of these patients and reviewed the patient charts for the 30-day period following discharge to identify repeat hospital visits and adverse events. We used Bayesian analysis to estimate the rate of true-positive stress testing in this population, using the only prior study of unit patients showing as high as 2 of 220 patients testing positive as a prior estimate. A total of 36 patients met inclusion criteria; average age was 34.6 years old (range: 22-40 years) and 61% were male. Patient risk factors included hypertension (19%), diabetes (6%), family history (42%), and smoking (44%). All patients had negative serial cardiac biomarkers and a negative treadmill stress echocardiogram. Thirty-day follow-up demonstrated no adverse cardiac events. We performed Bayesian analysis through the addition of the 36 patients to the 220 patients represented by prior data. The posterior probability distribution

  12. Payer Status, Race/Ethnicity, and Acceptance of Free Routine Opt-Out Rapid HIV Screening Among Emergency Department Patients

    PubMed Central

    Hopkins, Emily; Sasson, Comilla; Al-Tayyib, Alia; Bender, Brooke; Haukoos, Jason S.

    2012-01-01

    Objectives. We estimated associations between payer status, race/ethnicity, and acceptance of nontargeted opt-out rapid HIV screening in the emergency department (ED). Methods. We analyzed data from a prospective clinical trial between 2007 and 2009 at Denver Health. Patients in the ED were offered free HIV testing. Patient demographics and payer status were collected, and we used multivariable logistic regression to estimate associations with HIV testing acceptance. Results. A total of 31 525 patients made 44 765 unique visits: 40% were White, 37% Hispanic, 14% Black, 1% Asian, and 7% unknown race/ethnicity. Of all visits, 10 237 (23%) agreed to HIV testing; 27% were self-pay, 23% state-sponsored, 18% Medicaid, 13% commercial insurance, 12% Medicare, and 8% another payer source. Compared with commercial insurance patients, self-pay patients (odds ratio [OR] = 1.63; 95% confidence interval [CI] = 1.51, 1.75), state-sponsored patients (OR = 1.64; 95% CI = 1.52, 1.77), and Medicaid patients (OR = 1.24; 95% CI = 1.14, 1.34) had increased odds of accepting testing. Compared with White patients, Black (OR = 1.29; 95% CI = 1.21, 1.38) and Hispanic (OR = 1.17; 95% CI = 1.11, 1.23) patients had increased odds of accepting testing. Conclusions. Many ED patients are uninsured or subsidized through government programs and are more likely to consent to free rapid HIV testing. PMID:22420816

  13. An Electronic Patient-Reported Outcome Measures System in UK Chiropractic Practices: A Feasibility Study of Routine Collection of Outcomes and Costs.

    PubMed

    Newell, Dave; Diment, Emily; Bolton, Jenni E

    2016-01-01

    The purpose of this study was to test the feasibility of collecting valid and widely used health outcomes, including information concerning cost of care, using a Web-based patient-driven patient-reported outcome measure (PROM) collection process within a cohort of UK chiropractic practices. A Web-based PROM system (Care Response) was used. Patients with low back and neck pain were recruited from a group of chiropractic practices located in the United Kingdom. Information collected included demographic data, generic and condition-specific PROMs at the initial consultation and 90 days later, patient-reported experience measures, and additional health seeking to estimate costs of care. A group of 33 clinics provided information from a total of 1895 patients who completed baseline questionnaires with 844 (45%) completing the measures at 90-day follow-up. Subsequent outcomes suggest that more than 70% of patients improved over the course of treatment regardless of the outcome used. Using the baseline as a virtual counterfactual with respect to follow-up, we calculated quality-adjusted life years and the cost thereof resulting in a mean quality-adjusted life years gained of 0.8 with an average cost of £895 per quality-adjusted life year. Routine collection of PROMs, including information about cost, is feasible and can be achieved using an online system within a clinical practice environment. We describe a Web-based collection system and discuss the choice of measures leading to a comprehensive understanding of outcomes and costs in routine practice. Copyright © 2016 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.

  14. The challenges of implementing ADHD clinical guidelines and research best evidence in routine clinical care settings: Delphi survey and mixed-methods study.

    PubMed

    Hall, Charlotte L; Taylor, John A; Newell, Karen; Baldwin, Laurence; Sayal, Kapil; Hollis, Chris

    2016-01-01

    The landmark US Multimodal Treatment of ADHD (MTA) study established the benefits of individualised medication titration and optimisation strategies to improve short- to medium-term outcomes in attention-deficit hyperactivity disorder (ADHD). This individualised medication management approach was subsequently incorporated into the National Institute for Health and Care Excellence (NICE) ADHD Clinical Guidelines (NICE CG78). However, little is known about clinicians' attitudes towards implementing these medication management strategies for ADHD in routine care. To examine National Health Service (NHS) healthcare professionals' consensus on ADHD medication management strategies. Using the Delphi method, we examined perceptions on the importance and feasibility of implementing 103 ADHD treatment statements from sources including the UK NICE ADHD guidelines and US medication management algorithms. Certain recommendations for ADHD medication management were judged as important and feasible to implement, including a stepwise titration of stimulant medication. Other recommendations were perceived as important but not feasible to implement in routine practice, such as weekly clinic follow-up with the family during titration and collection of follow-up symptom questionnaires. Many of the key guideline recommendations for ADHD medication management are viewed by clinicians as important and feasible to implement. However, some recommendations present significant implementation challenges within the context of routine NHS clinical care in England. C.H. and K.S. were members of the Guideline Development Group for the NICE ADHD Clinical Guideline (NICE CG78). © 2016 The Royal College of Psychiatrists. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.

  15. A randomised, controlled crossover comparison of the C-MAC videolaryngoscope with direct laryngoscopy in 150 patients during routine induction of anaesthesia

    PubMed Central

    2011-01-01

    Background The C-MAC® (Karl Storz, Tuttlingen, Germany) has recently been introduced as a new device for videolaryngoscopy guided intubation. The purpose of the present study was to compare for the first time the C-MAC with conventional direct laryngoscopy in 150 patients during routine induction of anaesthesia. Methods After approval of the institutional review board and written informed consent, 150 patients (ASA I-III) with general anaesthesia were enrolled. Computer-based open crossover randomisation was used to determine the sequence of the three laryngoscopies: Conventional direct laryngoscopy (HEINE Macintosh classic, Herrsching, Germany; blade sizes 3 or 4; DL group), C-MAC size 3 (C-MAC3 group) and C-MAC size 4 (C-MAC4 group) videolaryngoscopy, respectively. After 50 patients, laryngoscopy technique in the C-MAC4 group was changed to the straight blade technique described by Miller (C-MAC4/SBT). Results Including all 150 patients (70 male, aged (median [range]) 53 [20-82] years, 80 [48-179] kg), there was no difference of glottic view between DL, C-MAC3, C-MAC4, and C-MAC4/SBT groups; however, worst glottic view (C/L 4) was only seen with DL, but not with C-MAC videolaryngoscopy. In the subgroup of patients that had suboptimal glottic view with DL (C/L≥2a; n = 24), glottic view was improved in the C-MAC4/SBT group; C/L class improved by three classes in 5 patients, by two classes in 2 patients, by one class in 8 patients, remained unchanged in 8 patients, or decreased by two classes in 1 patient. The median (range) time taken for tracheal intubation in the DL, C-MAC3, C-MAC4 and C-MAC4/SBT groups was 8 sec (2-91 sec; n = 44), 10 sec (2-60 sec; n = 37), 8 sec (5-80 sec; n = 18) and 12 sec (2-70 sec; n = 51), respectively. Conclusions Combining the benefits of conventional direct laryngoscopy and videolaryngoscopy in one device, the C-MAC may serve as a standard intubation device for both routine airway management and educational purposes. However, in

  16. Physical Therapy Management for Adult Patients Undergoing Cardiac Surgery: A Canadian Practice Survey

    PubMed Central

    Anderson, Cathy M.; Jackson, Jennifer; Lucy, S. Deborah; Prendergast, Monique; Sinclair, Susanne

    2010-01-01

    ABSTRACT Purpose: To determine current Canadian physical therapy practice for adult patients requiring routine care following cardiac surgery. Methods: A telephone survey was conducted of a selected sample (n=18) of Canadian hospitals performing cardiac surgery to determine cardiorespiratory care, mobility, exercises, and education provided to patients undergoing cardiac surgery. Results: An average of 21 cardiac surgeries per week (range: 6–42) were performed, with an average length of stay of 6.4 days (range: 4.0–10.6). Patients were seen preoperatively at 7 of 18 sites and on postoperative day 1 (POD-1) at 16 of 18 sites. On POD-1, 16 sites performed deep breathing and coughing, 7 used incentive spirometers, 13 did upper-extremity exercises, and 12 did lower-extremity exercises. Nine sites provided cardiorespiratory treatment on POD-3. On POD-1, patients were dangled at 17 sites and mobilized out of bed at 13. By POD-3, patients ambulated 50–120 m per session 2–5 times per day. Sternal precautions were variable, but the lifting limit was reported as ranging between 5 lb and 10 lb. Conclusions: Canadian physical therapists reported the provision of cardiorespiratory treatment after POD-1. According to current available evidence, this level of care may be unnecessary for uncomplicated patients following cardiac surgery. In addition, some sites provide cardiorespiratory treatment techniques that are not supported by evidence in the literature. Further research is required. PMID:21629599

  17. The questioning for routine monthly monitoring of proteinuria in patients with β-thalassemia on deferasirox chelation.

    PubMed

    Bayhan, Turan; Ünal, Şule; Ünlü, Ozan; Küçüker, Hakan; Tutal, Anıl Doğukan; Karabulut, Erdem; Gümrük, Fatma

    2017-05-01

    Iron chelation therapy is one of the mainstays of the management of the patients with β-thalassemia (BT) major. Deferasirox is an oral active iron chelating agent. Proteinuria is one of the potential renal adverse effects of deferasirox, and monthly follow-up for proteinuria is suggested by Food and Drug Administration and European Medicine Agency. We aimed to investigate the necessity for monthly monitoring for proteinuria among patients with BT on deferasirox. A retrospective laboratory and clinic data review was performed for patients with BT major or intermedia who were treated with deferasirox chelation therapy. All patients were monitored for proteinuria for every 3 or 4 weeks after the initiation of deferasirox with serum creatinine and spot urine protein/creatinine ratios. The median follow-up time of the 37 (36 BT major and one BT intermedia) patients was 44 months. Seven patients (18.9%) developed significant proteinuria (ratio ≥0.8). Of the 1490 measurements, 12 tests (0.8%) were proteinuric. Urine proteinuria resolved in all of the patients during the follow-up. The risk of proteinuria was higher at ages below a cut-off point of 23 years (p = 0.019). Patients, who were on deferasirox at doses above a cut-off dose of 29 mg/kg/day, were found to have higher risk of proteinuria development (p = 0.004). Proteinuria resolves without any complication or major intervention according to our results. Potentially more risky groups (age below 23 years old and receivers above a dose of 29 mg/kg/day) might be suggested to be followed monthly, besides monitoring all of the patients.

  18. [Economy and ethics in daily hospital routine - physicians in conflict between the well-being of patients and profitability].

    PubMed

    Salomon, Fred

    2010-02-01

    Medical decision making is affected by different aims and influencing factors. Nowadays economic aspects are so important that they influence the structure of hospitals, the number and quality of personnel, and the treatment and care of patients. This leads to conflicts with moral aims, especially when the necessary service cannot be provided due to financial reasons or when doubtful offers are supposed to increase revenues. Examples demonstrate cases in which economic aspects become more important than patients' interests because physicians are corruptible. It is necessary to communicate values. Patients' health should be first and economy should be a subordinated service.

  19. Current state of hereditary angioedema management: a patient survey.

    PubMed

    Banerji, Aleena; Busse, Paula; Christiansen, Sandra C; Li, Henry; Lumry, William; Davis-Lorton, Mark; Bernstein, Jonathan A; Frank, Michael; Castaldo, Anthony; Long, Janet F; Zuraw, Bruce L; Riedl, Marc

    2015-01-01

    Hereditary angioedema (HAE) is a chronic disease with a high burden of disease that is poorly understood and often misdiagnosed. Availability of treatments, including C1 esterase inhibitor (C1INH) replacement, ecallantide, and icatibant, marks a significant advance for HAE patients. We aimed to better understand the current state of HAE care, from a patient perspective, after the introduction of several novel therapies. One session of the United States Hereditary Angioedema Association 2013 patient summit was devoted to data collection for this study. Patients attending the summit were self-selected, and HAE diagnosis was self-reported. Survey questions assessed patient characteristics, burden of disease, and treatment. Participant responses were captured using an audience response system. We surveyed 149 (80%) type I and II HAE (HAE-C1INH) and 37 (20%) HAE with normal C1INH (HAE-nlC1INH) patients. HAE-C1INH (72%) and HAE-nlCINH patients (76%) equally reported that HAE had a significant impact on quality of life (QOL). A third of HAE-C1INH patients were diagnosed within one year of their first HAE attack, but another third reported a delay of more than 10 years. Most HAE-C1INH (88%) and HAE-nlC1INH (76%) patients had on-demand treatment available. HAE-C1INH patients frequently had an individual treatment plan (76%) compared with 50% of HAE-nlC1INH patients. Most HAE-C1INH patients went to the emergency department (ED) or were hospitalized less than once every six months (80%). Our findings show that HAE management is improving with good access to on-demand and prophylactic treatment options. However, HAE patients still have a significant burden of disease and continued research and educational efforts are needed.

  20. Current state of hereditary angioedema management: A patient survey

    PubMed Central

    Busse, Paula; Christiansen, Sandra C.; Li, Henry; Lumry, William; Davis-Lorton, Mark; Bernstein, Jonathan A.; Frank, Michael; Castaldo, Anthony; Long, Janet F.; Zuraw, Bruce L.; Riedl, Marc

    2015-01-01

    Hereditary angioedema (HAE) is a chronic disease with a high burden of disease that is poorly understood and often misdiagnosed. Availability of treatments, including C1 esterase inhibitor (C1INH) replacement, ecallantide, and icatibant, marks a significant advance for HAE patients. We aimed to better understand the current state of HAE care, from a patient perspective, after the introduction of several novel therapies. One session of the United States Hereditary Angioedema Association 2013 patient summit was devoted to data collection for this study. Patients attending the summit were self-selected, and HAE diagnosis was self-reported. Survey questions assessed patient characteristics, burden of disease, and treatment. Participant responses were captured using an audience response system. We surveyed 149 (80%) type I and II HAE (HAE-C1INH) and 37 (20%) HAE with normal C1INH (HAE-nlC1INH) patients. HAE-C1INH (72%) and HAE-nlCINH patients (76%) equally reported that HAE had a significant impact on quality of life (QOL). A third of HAE-C1INH patients were diagnosed within one year of their first HAE attack, but another third reported a delay of more than 10 years. Most HAE-C1INH (88%) and HAE-nlC1INH (76%) patients had on-demand treatment available. HAE-C1INH patients frequently had an individual treatment plan (76%) compared with 50% of HAE-nlC1INH patients. Most HAE-C1INH patients went to the emergency department (ED) or were hospitalized less than once every six months (80%). Our findings show that HAE management is improving with good access to on-demand and prophylactic treatment options. However, HAE patients still have a significant burden of disease and continued research and educational efforts are needed. PMID:25976438

  1. Comparison of structured use of routine laboratory tests or near-patient assessment with clinical judgement in the management of bleeding after cardiac surgery.

    PubMed

    Avidan, M S; Alcock, E L; Da Fonseca, J; Ponte, J; Desai, J B; Despotis, G J; Hunt, B J

    2004-02-01

    Using algorithms based on point of care coagulation tests can decrease blood loss and blood component transfusion after cardiac surgery. We wished to test the hypothesis that a management algorithm based on near-patient tests would reduce blood loss and blood component use after routine coronary artery surgery with cardiopulmonary bypass when compared with an algorithm based on routine laboratory assays or with clinical judgement. Patients (n=102) undergoing elective coronary artery surgery with cardiac bypass were randomized into two groups. In the point of care group, the management algorithm was based on information provided by three devices, the Hepcon, thromboelastography and the PFA-100 platelet function analyser. Management in the laboratory test group depended on rapidly available laboratory clotting tests and transfusion of haemostatic blood components only if specific criteria were met. Blood loss and transfusion was compared between these two groups and with a retrospective case-control group (n=108), in which management of bleeding had been according to the clinician's discretion. All three groups had similar median blood losses. The transfusion of packed red blood cells (PRBCs) and blood components was greater in the clinician discretion group (P<0.05) but there was no difference in the transfusion of PRBCs and blood components between the two algorithm-guided groups. Following algorithms based on point of care tests or on structured clinical practice with standard laboratory tests does not decrease blood loss, but reduces the transfusion of PRBCs and blood components after routine cardiac surgery, when compared with clinician discretion. Cardiac surgery services should use transfusion guidelines based on laboratory-guided algorithms, and the possible benefits of point of care testing should be tested against this standard.

  2. Routine molecular profiling of patients with advanced non-small-cell lung cancer: results of a 1-year nationwide programme of the French Cooperative Thoracic Intergroup (IFCT).

    PubMed

    Barlesi, Fabrice; Mazieres, Julien; Merlio, Jean-Philippe; Debieuvre, Didier; Mosser, Jean; Lena, Hervé; Ouafik, L'Houcine; Besse, Benjamin; Rouquette, Isabelle; Westeel, Virginie; Escande, Fabienne; Monnet, Isabelle; Lemoine, Antoinette; Veillon, Rémi; Blons, Hélène; Audigier-Valette, Clarisse; Bringuier, Pierre-Paul; Lamy, Régine; Beau-Faller, Michèle; Pujol, Jean-Louis; Sabourin, Jean-Christophe; Penault-Llorca, Frédérique; Denis, Marc G; Lantuejoul, Sylvie; Morin, Franck; Tran, Quân; Missy, Pascale; Langlais, Alexandra; Milleron, Bernard; Cadranel, Jacques; Soria, Jean-Charles; Zalcman, Gérard

    2016-04-02

    The molecular profiling of patients with advanced non-small-cell lung cancer (NSCLC) for known oncogenic drivers is recommended during routine care. Nationally, however, the feasibility and effects on outcomes of this policy are unknown. We aimed to assess the characteristics, molecular profiles, and clinical outcomes of patients who were screened during a 1-year period by a nationwide programme funded by the French National Cancer Institute. This study included patients with advanced NSCLC, who were routinely screened for EGFR mutations, ALK rearrangements, as well as HER2 (ERBB2), KRAS, BRAF, and PIK3CA mutations by 28 certified regional genetics centres in France. Patients were assessed consecutively during a 1-year period from April, 2012, to April, 2013. We measured the frequency of molecular alterations in the six routinely screened genes, the turnaround time in obtaining molecular results, and patients' clinical outcomes. This study is registered with ClinicalTrials.gov, number NCT01700582. 18,679 molecular analyses of 17,664 patients with NSCLC were done (of patients with known data, median age was 64·5 years [range 18-98], 65% were men, 81% were smokers or former smokers, and 76% had adenocarcinoma). The median interval between the initiation of analysis and provision of the written report was 11 days (IQR 7-16). A genetic alteration was recorded in about 50% of the analyses; EGFR mutations were reported in 1947 (11%) of 17,706 analyses for which data were available, HER2 mutations in 98 (1%) of 11,723, KRAS mutations in 4894 (29%) of 17,001, BRAF mutations in 262 (2%) of 13,906, and PIK3CA mutations in 252 (2%) of 10,678; ALK rearrangements were reported in 388 (5%) of 8134 analyses. The median duration of follow-up at the time of analysis was 24·9 months (95% CI 24·8-25·0). The presence of a genetic alteration affected first-line treatment for 4176 (51%) of 8147 patients and was associated with a significant improvement in the proportion of patients

  3. [Oral osmotic hydromorphone (OROS) in patients with chronic severe pain due to osteoarthritis under daily routine conditions].

    PubMed

    Müller-Schwefe, G H H; Blimke, B; Hesselbarth, S; Giesecke, T

    2014-04-17

    Objective of this prospective, non-interventional study was to obtain data under a therapy with oral osmotic hydromorphone (OROS) in patients with chronic severe pain due to osteoarthritis under daily routineconditions. Using the Brief Pain Inventory (BPI) patients assessed pain relief as well as the impact of pain on activities of daily living. Pain control, treatment satisfaction (by patient and investigator), physical therapy capability and the WOMAC-Index (Western Ontario and McMaster Universities Osteoarthritis) were additionally evaluated. Adverse events were continuously monitored throughout the study. 206 patients with chronic severe pain due to osteoarthritis and an initial pain intensity of 6 (NRS 0-10) received oral OROS-hydromorphone for three months. Under this treatment pain relief as well as the impact of pain on activities of daily living improved significantly. At the last examination, the patients reported a mean pain reduction of 2.5 (rest)/3.0 (movement) by day and of 2.6 (rest)/3.1 (movement) bynight (p < 0.0001). The very good pain control was accompanied by a high treatment satisfaction and an improved sleep quality. Physical therapy capability improved in 77.9% of the patients, the WOMAC index as indicator of pain and function in osteoarthritis decreased significantly from 13.3 (baseline) to 7.5 (V6). The most frequently reported adverse events were obstipation, nausea, dizziness and fatigue. 17.5% of the patients cut the study short because of adverse events. The treatment of patients with chronic pain due to osteoarthritis with oral osmotic hydromorphone resulted in a significant reduction of all documented pain related assessments.

  4. Routine diversion of patients with STEMI to high-volume PCI centres: modelling the financial impact on referral hospitals

    PubMed Central

    Pathak, Elizabeth Barnett; Comins, Meg M; Forsyth, Colin J; Strom, Joel A

    2015-01-01

    Objective To quantify possible revenue losses from proposed ST-elevation myocardial infarction (STEMI) patient diversion policies for small hospitals that lack high-volume percutaneous coronary intervention (PCI) capability status (ie, ‘STEMI referral hospitals’). Background Negative financial impacts on STEMI referral hospitals have been discussed as an important barrier to implementing regional STEMI bypass/transfer protocols. However, there is little empirical data available that directly quantifies this potential financial impact. Methods Using detailed financial charges from Florida hospital discharge data, we examined the potential negative financial impact on 112 STEMI referral hospitals from losing all inpatient STEMI revenue. The main outcome was projected revenue loss (PRL), defined as total annual patient with STEMI charges as a proportion of total annual charges for all patients. We hypothesised that for most community hospitals (>90%), STEMI revenue represented only a small fraction of total revenue (<1%). We further examined the financial impact of the ‘worst case’ scenario of loss of all acute coronary syndrome (ACS) (ie, chest pain) patients. Results PRLs were $0.33 for every $100 of patient revenue statewide for STEMI and $1.73 for ACS. At the individual hospital level, the 90th centile PRL was $0.74 for STEMI and $2.77 for ACS. PRLs for STEMI were not greater in rural areas compared with major metropolitan areas. Hospital revenue centres that would be most impacted by loss of patients with STEMI were cardiology procedures and intensive care units. Conclusions Loss of patient with STEMI revenues would result in only a small financial impact on STEMI referral hospitals in Florida under proposed STEMI diversion/rapid transfer protocols. However, spillover loss of patients with ACS would increase revenue loss for many hospitals. PMID:26196014

  5. Awareness level of obstructive sleep apnea syndrome during routine unstructured interviews of a standardized patient by primary care physicians.

    PubMed

    Reuveni, Haim; Tarasiuk, Ariel; Wainstock, Tamar; Ziv, Amitai; Elhayany, Asher; Tal, Asher

    2004-12-15

    To assess the awareness level of primary care physicians of obstructive sleep apnea syndrome during patient-physician encounters. A prospective study using a standardized patient approach, conducted between December 2001 and March 2002. Ten sleep experts reviewed and approved the checklist questionnaire. Primary care clinics of Clalit Health Care Services, in the central region of Israel. Thirty physicians (100% compliance) randomly selected (matched by age, sex, board certification) from the 261 primary care givers in the region. A standardized patient incorporated into the physicians' daily practices. From the original checklist questionnaire, we identified 2 related question areas that at least 90% of sleep experts would pursue in light of the presenting scenario, "Do the patients snore, choke, or stop breathing in sleep?" and "Does the patient have sleepiness, unrefreshed sleep/fall asleep at undesirable times?" During the unstructured interview, only 10% of the physicians asked 3 or more questions. More than 85% of primary care physicians identified the need for polysomnography evaluation (27 physicians) or continuous positive airway pressure (26 physicians) treatment for obstructive sleep apnea syndrome. However, only 16% and 50% discussed possible complications of obstructive sleep apnea syndrome such as motor vehicle and work accidents and cardiovascular events, respectively. Primary care physicians cannot identify a common disorder associated with cardiovascular and neurobehavioral disease and could not identify the sleepiness as a source of dangerous driving. While understanding the algorithms for the diagnosis of sleep apnea, physicians cannot identify the patients for whom the diagnostics are needed. Education programs need to be developed to increase the level of suspicion of obstructive sleep apnea syndrome among practicing primary care physicians. Activities can be monitored and evaluated over time in the daily practice by standardized patients

  6. Costs and outcomes of treating chronic hepatitis C patients in routine care - results from a nationwide multicenter trial.

    PubMed

    Stahmeyer, J T; Krauth, C; Bert, F; Pfeiffer-Vornkahl, H; Alshuth, U; Hüppe, D; Mauss, S; Rossol, S

    2016-02-01

    Viral hepatitis is a major public health problem affecting millions of people worldwide. Long-term consequences are the development of liver cirrhosis and hepatocellular carcinoma. The aim of the study was to assess outcomes and costs of treating patients with chronic hepatitis C in clinical practice in Germany. We carried out a prospective noninterventional study. Information on treatment outcomes, resource utilization and quality of life was provided by 281 physicians throughout Germany. Data of 3708 monoinfected HCV-patients treated between 2008 and 2011 were analysed. Therapy consisted of peginterferon/ribavirin. Mean age of patients was 43.7 years, 60.3% were male and estimated duration of infection was 13.6 years. Predominantly genotype 1 (61.3%) or 3 (28.5%) infections were observed. Sustained viral response (SVR)-rates in most frequently observed genotypes were 49.2% in GT-1 and 61.9% in GT-3 treatment-naive patients (Relapser: GT-1: 35.3% and GT-3: 57.3%; Nonresponder: GT-1: 25.0% and GT-3: 33.3%). Average treatment costs were lowest in treatment-naive patients (€18 965) and higher in patients who failed previous treatments (relapsers: €24 753; nonresponders: €19 511). Differences according to genotype were observed. Average costs per SVR in treatment-naive patients were €44 744 for GT-1 and €22 218 for GT-3. Treatment was associated with a decrease in quality of life; post-treatment quality of life was higher in patients achieving SVR. Our insight on real-life treatment outcomes and costs can serve as a reference for a comparison with other treatments. There is high need for short-term and long-term cost-effectiveness analysis in real-life settings as newly introduced treatment strategies with direct acting antivirals result in high SVR-rates but are more costly. © 2015 John Wiley & Sons Ltd.

  7. 78 FR 53195 - Proposed Information Collection (Dental Patient Satisfaction Survey) Activity: Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-28

    ... AFFAIRS Proposed Information Collection (Dental Patient Satisfaction Survey) Activity: Comment Request... patient satisfaction with VA's dental services. DATES: Written comments and recommendations on the... refer to ``OMB Control No. 2900-0764 (Dental Patient Satisfaction Survey)'' in any...

  8. A survey of European and Canadian rheumatologists regarding the treatment of patients with ankylosing spondylitis and extra-articular manifestations.

    PubMed

    Van den Bosch, Filip

    2010-03-01

    Ankylosing spondylitis (AS) is a disabling inflammatory disease accompanied by a variety of extra-articular manifestations in a significant number of patients. These manifestations, including Crohn's disease, ulcerative colitis, psoriasis, and uveitis, share a similar inflammatory mechanism with one another and with AS. Extra-articular manifestations are observed in a larger percentage of patients with AS and spondyloarthritides (SpAs) than the normal population; therefore, it is important to identify these and other inflammatory-mediated conditions and consider them when treating SpAs. How rheumatologists approach patients with both AS and extra-articular manifestations may lead to a better understanding of what treatment approaches could be taken to optimize patient outcomes. Rheumatologists (N = 453) from five European countries and Canada who treat AS were surveyed to determine treatment practices and management of both AS and its associated extra-articular manifestations. Most rheumatologists (93%) believe AS could be diagnosed earlier as the average time between symptom onset and diagnosis was approximately 4 years. In total, 60% routinely screen patients with AS for extra-articular manifestations, although this varied considerably across countries. The majority (97%) agrees that controlling inflammation is critical during treatment, and patients with extra-articular manifestations tend to have poorer prognoses than those patients with only axial AS. Treatment considerations varied depending on whether patients presented with only axial AS or had extra-articular manifestations, where use of biologics became more common. Rheumatologists agree that patients with both AS and extra-articular manifestations require a different treatment strategy than patients with AS alone. Results of this survey highlight areas where rheumatologists differ in their clinical management of patients with AS including tools used for disease assessment and the routine screening, or

  9. Glucose levels and hemodynamic changes in patients submitted to routine dental treatment with and without local anesthesia

    PubMed Central

    Bortoluzzi, Marcelo Carlos; Manfro, Rafael; Nardi, Anderson

    2010-01-01

    OBJECTIVE: The aim of this study was to (1) observe the extent to which hemodynamic and glucose measurements change in patients submitted to a dental procedure with and without a local anesthetic and a vasoconstrictor (LAVA; 2% mepivacaine with adrenaline 1∶100,000) and (2) correlate those parameters with the patients' anxiety levels. METHOD: This was an unblinded, random, prospective, and observational study with paired groups. Patients were evaluated during two different consultations during which they either did or did not receive a local anesthetic/vasoconstrictor. RESULTS: Thirty‐seven patients ranging in age from 18 to 45 years (mean 30.4 ± 5.5 years) were evaluated. Hemodynamic parameters, including systolic blood pressure, diastolic blood pressure, heart rate, and glucose levels, did not change significantly in healthy patients, regardless of whether a LAVA was administered during the dental treatment. CONCLUSION: The patients' anxiety statuses neither varied significantly nor showed any correlation with the studied hemodynamic parameters and glucose levels, regardless of whether local anesthetics were used. PMID:21120297

  10. Glucose levels and hemodynamic changes in patients submitted to routine dental treatment with and without local anesthesia.

    PubMed

    Bortoluzzi, Marcelo Carlos; Manfro, Rafael; Nardi, Anderson

    2010-01-01

    The aim of this study was to (1) observe the extent to which hemodynamic and glucose measurements change in patients submitted to a dental procedure with and without a local anesthetic and a vasoconstrictor (LAVA; 2% mepivacaine with adrenaline 1100,000) and (2) correlate those parameters with the patients' anxiety levels. This was an unblinded, random, prospective, and observational study with paired groups. Patients were evaluated during two different consultations during which they either did or did not receive a local anesthetic/vasoconstrictor. Thirty-seven patients ranging in age from 18 to 45 years (mean 30.4 ± 5.5 years) were evaluated. Hemodynamic parameters, including systolic blood pressure, diastolic blood pressure, heart rate, and glucose levels, did not change significantly in healthy patients, regardless of whether a LAVA was administered during the dental treatment. The patients' anxiety statuses neither varied significantly nor showed any correlation with the studied hemodynamic parameters and glucose levels, regardless of whether local anesthetics were used.

  11. Implementation of chronic illness care in German primary care practices--how do multimorbid older patients view routine care? A cross-sectional study using multilevel hierarchical modeling.

    PubMed

    Petersen, Juliana J; Paulitsch, Michael A; Mergenthal, Karola; Gensichen, Jochen; Hansen, Heike; Weyerer, Siegfried; Riedel-Heller, Steffi G; Fuchs, Angela; Maier, Wolfgang; Bickel, Horst; König, Hans-Helmut; Wiese, Birgitt; van den Bussche, Hendrik; Scherer, Martin; Dahlhaus, Anne

    2014-08-07

    In primary care, patients with multiple chronic conditions are the rule rather than the exception. The Chronic Care Model (CCM) is an evidence-based framework for improving chronic illness care, but little is known about the extent to which it has been implemented in routine primary care. The aim of this study was to describe how multimorbid older patients assess the routine chronic care they receive in primary care practices in Germany, and to explore the extent to which factors at both the practice and patient level determine their views. This cross-sectional study used baseline data from an observational cohort study involving 158 general practitioners (GP) and 3189 multimorbid patients. Standardized questionnaires were employed to collect data, and the Patient Assessment of Chronic Illness Care (PACIC) questionnaire used to assess the quality of care received. Multilevel hierarchical modeling was used to identify any existing association between the dependent variable, PACIC, and independent variables at the patient level (socio-economic factors, weighted count of chronic conditions, instrumental activities of daily living, health-related quality of life, graded chronic pain, no. of contacts with GP, existence of a disease management program (DMP) disease, self-efficacy, and social support) and the practice level (age and sex of GP, years in current practice, size and type of practice). The overall mean PACIC score was 2.4 (SD 0.8), with the mean subscale scores ranging from 2.0 (SD 1.0, subscale goal setting/tailoring) to 3.5 (SD 0.7, delivery system design). At the patient level, higher PACIC scores were associated with a DMP disease, more frequent GP contacts, higher social support, and higher autonomy of past occupation. At the practice level, solo practices were associated with higher PACIC values than other types of practice. This study shows that from the perspective of multimorbid patients receiving care in German primary care practices, the

  12. Cost-effectiveness analysis of fesoterodine flexible dose in newly diagnosed patients with overactive bladder in routine clinical practice in Spain

    PubMed Central

    Peral, Carmen; Sánchez-Ballester, Francisco; García-Mediero, José M; Ramos, Jaime; Rejas, Javier

    2016-01-01

    Objective To carry out cost-effectiveness analysis from the Spanish National Health System perspective, of treating overactive bladder (OAB), in newly diagnosed patients with two flexible doses of fesoterodine in routine clinical practice. Patients and methods Economic evaluation of flexible-dose fesoterodine in newly diagnosed patients, including two treatment groups: standard escalating from 4 to 8 mg or fast escalating to 8 mg. Costs were estimated from health care resources utilization related to OAB, and were expressed in 2015 Euros. Quality-adjusted life-years (QALYs) were obtained from overactive bladder questionnaire-short form. Univariate and probabilistic sensitivity analyses were carried out. Results Three hundred and ninety symptomatic OAB patients treated with fesoterodine and newly diagnosed (141 in fast escalating group and 249 in standard escalating) were analyzed. Adjusted health care total costs were not statistically different; difference −€4.1 (confidence interval: −153.3; 25.1) P=0.842. QALYs were higher in fast escalating to high dose vs standard escalating group, resulting in a cost of −€16,020/QALY gained for fast escalating vs standard escalating group. Conclusion When the cost-effectiveness threshold is set at a maximum value of €30,000/QALY gained, fesoterodine fast escalating group was cost-effective vs standard escalating group 67.6% of the time. The treatment with fesoterodine, in female patients newly diagnosed, fast escalating to 8 mg was a cost-effective option relative to escalating traditionally from 4 to 8 mg, in the management of OAB in routine clinical practice, from the Spanish National Health System perspective. PMID:27713646

  13. Mind the Gap: Gaps in Antidepressant Treatment, Treatment Adjustments, and Outcomes among Patients in Routine HIV Care in a Multisite U.S. Clinical Cohort

    PubMed Central

    Cholera, Rushina; Pence, Brian W.; Bengtson, Angela M.; Crane, Heidi M.; Christopoulos, Katerina; Cole, Steven R.; Fredericksen, Rob; Gaynes, Bradley N.; Heine, Amy; Mathews, W. Christopher; Mimiaga, Matthew J.; Moore, Richard; Napravnik, Sonia; O’Clerigh, Conall; Safren, Steven; Mugavero, Michael J.

    2017-01-01

    Background Depression affects 20–30% of HIV-infected patients and is associated with worse HIV outcomes. Although effective depression treatment is available, depression is largely untreated or undertreated in this population. Methods We quantified gaps in antidepressant treatment, treatment adjustments, and outcomes among US patients in routine HIV care in the nationally distributed CNICS observational clinical cohort. This cohort combines detailed clinical data with regular, self-reported depressive severity assessments (Patient Health Questionnaire-9, PHQ-9). We considered whether participants with likely depression received antidepressants, whether participants on antidepressants with persistently high depressive symptoms received timely dose adjustments, and whether participants achieved depression remission. We considered a cross-sectional analysis (6,219 participants in care in 2011–2012) and a prospective analysis (2,936 participants newly initiating CNICS care when PHQ-9 screening was active). Results The cross-sectional sample was 87% male, 53% Caucasian, 25% African American, and 18% Hispanic; the prospective sample was similar. In both samples, 39–44% had likely depression, with 44–60% of those receiving antidepressants. Of participants receiving antidepressants, 20–26% experienced persistently high depressive symptoms; only a small minority of those received antidepressant dose adjustments. Overall, 35–40% of participants on antidepressants achieved full depression remission. Remission among participants with persistently high depressive symptoms was rare regardless of dose adjustments. Conclusions In this large, diverse cohort of US patients engaged in routine HIV care, we observed large gaps in antidepressant treatment, timely dose adjustment to address persistently high depressive symptoms, and antidepressant treatment outcomes. These results highlight the importance of more effective pharmacologic depression treatment models for HIV

  14. Mind the Gap: Gaps in Antidepressant Treatment, Treatment Adjustments, and Outcomes among Patients in Routine HIV Care in a Multisite U.S. Clinical Cohort.

    PubMed

    Cholera, Rushina; Pence, Brian W; Bengtson, Angela M; Crane, Heidi M; Christopoulos, Katerina; Cole, Steven R; Fredericksen, Rob; Gaynes, Bradley N; Heine, Amy; Mathews, W Christopher; Mimiaga, Matthew J; Moore, Richard; Napravnik, Sonia; O'Clerigh, Conall; Safren, Steven; Mugavero, Michael J

    2017-01-01

    Depression affects 20-30% of HIV-infected patients and is associated with worse HIV outcomes. Although effective depression treatment is available, depression is largely untreated or undertreated in this population. We quantified gaps in antidepressant treatment, treatment adjustments, and outcomes among US patients in routine HIV care in the nationally distributed CNICS observational clinical cohort. This cohort combines detailed clinical data with regular, self-reported depressive severity assessments (Patient Health Questionnaire-9, PHQ-9). We considered whether participants with likely depression received antidepressants, whether participants on antidepressants with persistently high depressive symptoms received timely dose adjustments, and whether participants achieved depression remission. We considered a cross-sectional analysis (6,219 participants in care in 2011-2012) and a prospective analysis (2,936 participants newly initiating CNICS care when PHQ-9 screening was active). The cross-sectional sample was 87% male, 53% Caucasian, 25% African American, and 18% Hispanic; the prospective sample was similar. In both samples, 39-44% had likely depression, with 44-60% of those receiving antidepressants. Of participants receiving antidepressants, 20-26% experienced persistently high depressive symptoms; only a small minority of those received antidepressant dose adjustments. Overall, 35-40% of participants on antidepressants achieved full depression remission. Remission among participants with persistently high depressive symptoms was rare regardless of dose adjustments. In this large, diverse cohort of US patients engaged in routine HIV care, we observed large gaps in antidepressant treatment, timely dose adjustment to address persistently high depressive symptoms, and antidepressant treatment outcomes. These results highlight the importance of more effective pharmacologic depression treatment models for HIV-infected patients.

  15. Benefits of a Routine Opt-Out HIV Testing and Linkage to Care Program for Previously Diagnosed Patients in Publicly Funded Emergency Departments in Houston, TX

    PubMed Central

    Flash, Charlene A.; Pasalar, Siavash; Hemmige, Vagish; Davila, Jessica A.; Hallmark, Camden J.; McNeese, Marlene; Miertschin, Nancy; Ruggerio, Michael C.; Giordano, Thomas P.

    2015-01-01

    Background The Routine Universal Screening for HIV (RUSH) program provides opt-out HIV testing and linkage to care for emergency department (ED) patients in Harris Health System, Houston, TX. Seventy-five percent of patients testing positive in this program have been previously diagnosed. Whether linkage to care is increased among these patients is unknown. Methods We conducted a retrospective cohort study of persons tested for HIV in the ED between 2008–2012 but had a previously documented positive HIV test ≥1 year prior. Outcomes were engagement in care (≥1 HIV outpatient visits in 6 months), retention in care (≥2 HIV outpatient visits in 12 months, at least 3 months apart) and virologic suppression (<200 c/ml in 12 months) compared before and after the ED visit. Analysis was conducted using McNemar’s test and multivariate conditional logistic regression. Results A total of 202,767 HIV tests identified 2068 previously diagnosed patients. The mean age was 43 years with 65% male and 87% racial and ethnic minorities. Engagement in care increased from 41.3% pre-visit to 58.8% post-visit (P<0.001). Retention in care increased from 32.6% pre-visit to 47.1% post-visit (P<0.001). Virologic suppression increased from 22.8% pre-visit to 34.0% post-visit (P<0.001). Analyses revealed that engagement in care after visit improved most among younger participants (ages 16 to 24), retention improved across all groups, and virologic suppression improved most among participants 25 to 34 years old. Conclusions Routine opt-out HIV testing in an ED paired with standardized service linkage improves engagement, retention, and virologic suppression in previously diagnosed patients. PMID:25867782

  16. Bedside quantification of dead-space fraction using routine clinical data in patients with acute lung injury: secondary analysis of two prospective trials

    PubMed Central

    2010-01-01

    Introduction Dead-space fraction (Vd/Vt) has been shown to be a powerful predictor of mortality in acute lung injury (ALI) patients. The measurement of Vd/Vt is based on the analysis of expired CO2 which is not a part of standard practice thus limiting widespread clinical application of this method. The objective of this study was to determine prognostic value of Vd/Vt estimated from routinely collected pulmonary variables. Methods Secondary analysis of the original data from two prospective studies of ALI patients. Estimated Vd/Vt was calculated using the rearranged alveolar gas equation: Vd/Vt=1−[(0.86×V˙CO2est)/(VE×PaCO2)] where V˙CO2est is the estimated CO2 production calculated from the Harris Benedict equation, minute ventilation (VE) is obtained from the ventilator rate and expired tidal volume and PaCO2 from arterial gas analysis. Logistic regression models were created to determine the prognostic value of estimated Vd/Vt. Results One hundred and nine patients in Mayo Clinic validation cohort and 1896 patients in ARDS-net cohort demonstrated an increase in percent mortality for every 10% increase in Vd/Vt in a dose response fashion. After adjustment for non-pulmonary and pulmonary prognostic variables, both day 1 (adjusted odds ratio-OR = 1.07, 95%CI 1.03 to 1.13) and day 3 (OR = 1.12, 95% CI 1.06 to 1.18) estimated dead-space fraction predicted hospital mortality. Conclusions Elevated estimated Vd/Vt predicts mortality in ALI patients in a dose response manner. A modified alveolar gas equation may be of clinical value for a rapid bedside estimation of Vd/Vt, utilizing routinely collected clinical data. PMID:20670411

  17. Patient and caregiver needs in oncology. An Italian survey.

    PubMed

    Berardi, Rossana; Ballatore, Zelmira; Bacelli, Weruska; Silva, Rosa Rita; Menichetti, Ettore Tito; Marcellini, Massimo; Duca, Monia; Giacomini, Giusi; Marilungo, Katia; Cascinu, Stefano

    2015-01-01

    Cancer is a disease that has far-reaching consequences for patients and their families. The present study targets unmet caregiver needs so that better support can be provided and planned for. The first phase of the study was to conduct a survey designed to explore basic needs (medical and nursing information, psychological support, social welfare). The survey also investigated the caregiver's personal details (age, sex, degree of kinship). The survey was distributed to caregivers coming to the day hospitals of the 4 oncology departments involved in the study. A total of 137 relatives of cancer patients completed the survey. Among the explored needs, the most recurrent was the availability of a doctor who provides full information on the treatment choices. A further important request was for consistency between the information provided by doctors and that provided by other health-care workers, with specific reference to a patient-centered approach that can be easily and fully understood, available therapeutic options especially at home, and prognosis. The study showed that the need for exhaustive and simple information provided by a referral physician is still an unmet need in the Internet age.

  18. Glucose Levels and Hemodynamic Changes in Patients submitted to Routine Dental Extraction under Local Anesthesia with and without Adrenaline.

    PubMed

    Byakodi, Sanjay; Gurjar, Vivek; Soni, Sushant

    2017-01-01

    In maxillofacial surgery, the simplest procedure that we perform is dental extraction. However, this simple procedure is challenged by the patient's poor medical condition. We generally use local anesthesia in combination with adrenaline; however, as we come across patients with diabetes mellitus and cardiovascular diseases who seek dental extraction, we need to be doubly cautious while using adrenaline. In this study, we intend to compare the effects of local anesthesia with adrenaline and local anesthesia without adrenaline on hemodynamic changes (blood pressure and pulse rate) and random blood sugar levels. The comparison is both within the group and between the two groups. Healthy patients between the ages 20 and 60 years were included and randomized into two groups of 50 each. In one group, plain local anesthesia was used, whereas in the other group, local anesthetic solution containing adrenaline was used. Medically compromised patients were excluded from the study. Random blood sugar levels, blood pressures, and pulse rates were recorded in both groups before and 10 minutes after injecting the solutions. The findings were compared. When results are compared within the group, a modest increase in the blood sugar level was noted with the group receiving local anesthetic with adrenaline. However, blood pressure and pulse rate showed no significant difference. Similarly, when between-the-groups comparison was done, not a single variable showed any significant difference. The patients injected with local anesthesia containing adrenaline showed similar results to that observed in the patients injected with local anesthesia without adrenaline. However, there is a statistically significant rise in blood sugar levels when a local anesthetic is injected with adrenaline. Dental extractions in healthy individuals can be safely performed with local anesthetic containing adrenaline. However, in diabetic patients, it should be cautiously used.

  19. General practitioners’ perceptions of introducing near-patient testing for common infections into routine primary care: A qualitative study

    PubMed Central

    Butler, Christopher C.; Simpson, Sharon; Wood, Fiona

    2008-01-01

    Objective Near-patient tests are promoted for guiding management of common infections in primary care with a view to enhancing the effectiveness of prescribing decisions and containing antimicrobial resistance. Changes in clinical practice should be based on appraisals of the factors that might influence change, viewed from the perspective of those expected to implement the change. We therefore explored the views of general practitioners concerning the possible introduction of near-patient tests for managing common infections. Design Qualitative semi-structured interview study. Interviews were recorded and analysed using thematic content analysis. Setting General practices in south-east Wales, UK. Subjects A total of 26 general practitioners (GPs) from high fluroquinolone antibiotics prescribing practices and 14 GPs from practices that prescribed fluroquinolones close to the south-east Wales mean. Results There was strong enthusiasm for a hypothetical near-patient, finger-prick blood tests that could distinguish viral from bacterial infections. Many GPs emphasized that such tests would be valuable in “selling” decisions not to prescribe antibiotics to patients. Concerns included limited additional useful information to guide prescribing above clinical diagnosis alone, that patients might deteriorate even if the tests correctly identified a viral aetiology, and that GPs would need to be convinced by research evidence supporting uptake. Several indicated that tests would be useful only for a limited number of patients and they were concerned by time pressures, apparatus maintenance and quality control, cost, and possible objections from patients, especially children. Conclusions Despite GP enthusiasm for the concept of a rapid test to distinguish viral from bacterial infection, strategies to promote uptake would be enhanced if concerns were addressed regarding the importance and feasibility of such tests in daily practice. PMID:18297558

  20. Revisiting Routine Questions

    ERIC Educational Resources Information Center

    Hughes, Rebecca; Monaghan, John; Shingadia, Eisha; Vaughan, Stephen

    2006-01-01

    What is a routine question? The focus of this paper is routine questions and time (in years) since a hitherto routine question was last attempted by the solver. The data comes from undergraduate students' work on solving two calculus questions. The data was selected for reporting purposes because it is well documented and because it threw up…

  1. The correlation between the number of eligible patients in routine clinical practice and the low recruitment level in clinical trials: a retrospective study using electronic medical records.

    PubMed

    Sumi, Eriko; Teramukai, Satoshi; Yamamoto, Keiichi; Satoh, Motohiko; Yamanaka, Kenya; Yokode, Masayuki

    2013-12-11

    A number of clinical trials have encountered difficulties enrolling a sufficient number of patients upon initiating the trial. Recently, many screening systems that search clinical data warehouses for patients who are eligible for clinical trials have been developed. We aimed to estimate the number of eligible patients using routine electronic medical records (EMRs) and to predict the difficulty of enrolling sufficient patients prior to beginning a trial. Investigator-initiated clinical trials that were conducted at Kyoto University Hospital between July 2004 and January 2011 were included in this study. We searched the EMRs for eligible patients and calculated the eligible EMR patient index by dividing the number of eligible patients in the EMRs by the target sample size. Additionally, we divided the trial eligibility criteria into corresponding data elements in the EMRs to evaluate the completeness of mapping clinical manifestation in trial eligibility criteria into structured data elements in the EMRs. We evaluated the correlation between the index and the accrual achievement with Spearman's rank correlation coefficient. Thirteen of 19 trials did not achieve their original target sample size. Overall, 55% of the trial eligibility criteria were mapped into data elements in EMRs. The accrual achievement demonstrated a significant positive correlation with the eligible EMR patient index (r = 0.67, 95% confidence interval (CI), 0.42 to 0.92). The receiver operating characteristic analysis revealed an eligible EMR patient index cut-off value of 1.7, with a sensitivity of 69.2% and a specificity of 100.0%. Our study suggests that the eligible EMR patient index remains exploratory but could be a useful component of the feasibility study when planning a clinical trial. Establishing a step to check whether there are likely to be a sufficient number of eligible patients enables sponsors and investigators to concentrate their resources and efforts on more achievable trials.

  2. Implementation of chronic illness care in German primary care practices – how do multimorbid older patients view routine care? A cross-sectional study using multilevel hierarchical modeling

    PubMed Central

    2014-01-01

    Background In primary care, patients with multiple chronic conditions are the rule rather than the exception. The Chronic Care Model (CCM) is an evidence-based framework for improving chronic illness care, but little is known about the extent to which it has been implemented in routine primary care. The aim of this study was to describe how multimorbid older patients assess the routine chronic care they receive in primary care practices in Germany, and to explore the extent to which factors at both the practice and patient level determine their views. Methods This cross-sectional study used baseline data from an observational cohort study involving 158 general practitioners (GP) and 3189 multimorbid patients. Standardized questionnaires were employed to collect data, and the Patient Assessment of Chronic Illness Care (PACIC) questionnaire used to assess the quality of care received. Multilevel hierarchical modeling was used to identify any existing association between the dependent variable, PACIC, and independent variables at the patient level (socio-economic factors, weighted count of chronic conditions, instrumental activities of daily living, health-related quality of life, graded chronic pain, no. of contacts with GP, existence of a disease management program (DMP) disease, self-efficacy, and social support) and the practice level (age and sex of GP, years in current practice, size and type of practice). Results The overall mean PACIC score was 2.4 (SD 0.8), with the mean subscale scores ranging from 2.0 (SD 1.0, subscale goal setting/tailoring) to 3.5 (SD 0.7, delivery system design). At the patient level, higher PACIC scores were associated with a DMP disease, more frequent GP contacts, higher social support, and higher autonomy of past occupation. At the practice level, solo practices were associated with higher PACIC values than other types of practice. Conclusions This study shows that from the perspective of multimorbid patients receiving care in German

  3. Do patient surveys work? The influence of a national survey programme on local quality-improvement initiatives

    PubMed Central

    Reeves, R; Seccombe, I

    2008-01-01

    Objectives: To assess current attitudes towards the national patient survey programme in England, establish the extent to which survey results are used and identify barriers and incentives for using them. Design: Qualitative interviews with hospital staff responsible for implementing the patient surveys (survey leads). Setting: National Health Service (NHS) hospital organisations (trusts) in England. Participants: Twenty-four patient survey leads for NHS trusts. Results: Perceptions of the patient surveys were mainly positive and were reported to be improving. Interviewees welcomed the surveys’ regular repetition and thought the questionnaires, survey methods and reporting of results, particularly inter-organisational benchmark charts, were of a good standard. The survey results were widely used in action planning and were thought to support organisational patient-centredness. There was variation in the extent to which trusts disseminated survey findings to patients, the public, staff and their board members. The most common barrier to using results was difficulty engaging clinicians because survey findings were not sufficiently specific to specialties, departments or wards. Limited statistical expertise and concerns that the surveys only covered a short time frame also contributed to some scepticism. Other perceived barriers included a lack of knowledge of effective interventions, and limited time and resources. Actual and potential incentives for using survey findings included giving the results higher weightings in the performance management system, financial targets, Payment by Results (PbR), Patient Choice, a patient-centred culture, leadership by senior members of the organisation, and boosting staff morale by disseminating positive survey findings. Conclusion: The national patient surveys are viewed positively, their repetition being an important factor in their success. The results could be used more effectively if they were more specific to smaller units

  4. ASHP national survey of pharmacy practice in hospital settings: Monitoring and patient education--2009.

    PubMed

    Pedersen, Craig A; Schneider, Philip J; Scheckelhoff, Douglas J

    2010-04-01

    Results of the 2009 ASHP national survey of pharmacy practice in hospital settings that pertain to monitoring and patient education are presented. A stratified random sample of pharmacy directors at 1364 general and children's medical-surgical hospitals in the United States were surveyed by mail. SDI Health supplied data on hospital characteristics; the survey sample was drawn from SDI's hospital database. The response rate was 40.5%. Virtually all hospitals (97.3%) had pharmacists regularly monitor medication therapy in some capacity; nearly half monitored 75% or more of their patients. Over 92% had pharmacists routinely monitor serum medication concentrations or their surrogate markers, and most hospitals allowed pharmacists to order initial serum concentrations (80.1%) and adjust dosages (79.2%). Interdisciplinary committees reviewed adverse drug events in 89.3% of hospitals. Prospective analysis was conducted by 66.2% of hospitals, and retrospective analysis was performed by 73.6%. An assessment of safety culture had been conducted by 62.8% of hospitals. Most hospitals assigned oversight for patient medication education to nursing (89.0%), but many hospitals (68.9%) reported that pharmacists provided medication education to 1-25% of patients. Computerized prescriber-order-entry systems with clinical decision support were in place in 15.4%, bar-code-assisted medication administration systems were used by 27.9%, smart infusion pumps were used in 56.2%, and complete electronic medical record systems were in place in 8.8% of hospitals. The majority of hospitals (64.7%) used an integrated pharmacy practice model using clinical generalists. Pharmacists were significantly involved in monitoring medication therapy. Pharmacists were less involved in medication education activities. Technologies to improve the use of medications were used in an increasing percentage of hospitals. Hospital pharmacy practice was increasingly integrated, with pharmacists having both

  5. Does Routine Midazolam Administration Prior to Nasogastric Tube Insertion in the Emergency Department Decrease Patients' Pain? (A Pilot Study).

    PubMed

    Manning, Chelsea Taylor; Buinewicz, Jacob Dillon; Sewatsky, Thomas Patrick; Zgonis, Evangelia; Gutierrez, Kathy; O'Keefe, Michael F; Freeman, Kalev

    2016-07-01

    Patients report pain and discomfort with nasogastric tube (NGT) intubation. We tested the hypothesis that premedication with midazolam alleviates pain during NGT placement in the emergency department (ED) by > 13 on a 100-mm visual analog scale (VAS). We performed a double-blind randomized controlled pilot study, assigning ED patients requiring NGT placement to midazolam or placebo. All patients received intranasal cophenylcaine; additionally, they received an intravenous (IV) dose of the study drug, either 2 mg of IV midazolam or saline control. Nurses placed NGTs while observed by research staff, who then interviewed subjects to determine the primary outcome of pain using a VAS. Additional data collected from patients and their nurses included discomfort during the procedure, difficulty of tube insertion, and complications. We enrolled 23 eligible patients and obtained complete data in all: 10 midazolam and 13 controls. We found a significant reduction in mean pain VAS score of -31 (95% confidence interval = -53 to -9 mm) with 2 mg of midazolam (mean ± SD = 52 ± 30 mm), compared to placebo (mean ± SD = 21 ± 18 mm), more than double the effect size considered clinically relevant. Treatment did not impact ease of placement and there were no serious adverse effects. Premedication with 2 mg of IV midazolam reduces pain of NGT insertion in ED patients without the need for full procedural sedation. © 2016 by the Society for Academic Emergency Medicine.

  6. HIV-1 tropism: a comparison between RNA and proviral DNA in routine clinical samples from Chilean patients

    PubMed Central

    2013-01-01

    Background HIV in Chile has a notification rate of 0.01%. Coreceptor antagonists are a family of antiretroviral drugs that are used with the prior knowledge of patients HIV-1 tropism. Viral RNA-based tropism detection requires a plasma viral load ≥1000 copies/mL, while proviral DNA-based detection can be performed regardless of plasma viral load. This test is useful in patients with low or undetectable viral loads and would benefit with a proper therapy. The aim of this study was to determine the correlation between HIV RNA and proviral genotypic DNA tropism tests. Findings Forty three Chilean patients were examined using population-based V3 sequencing, and a geno2pheno false-positive rate (FPR) cutoff values of 5, 5.75, 10 and 20%. With cutoff 5.75% a concordance of 88.4% in tropism prediction was found after a simultaneous comparison between HIV tropism assessment by RNA and DNA. In total, five discrepancies (11.6%) were found, 3 patients were RNA-R5/DNA-X4 and two were RNA-X4/DNA-R5. Proviral DNA enabled the prediction of tropism in patients with a low or undetectable viral load. For cutoff 5 and 5.75% genotypic testing using proviral DNA showed a similar sensitivity for X4 as RNA. We found that the highest sensitivity for detecting the X4 strain occurred with proviral DNA and cutoff of 10 and 20%. Viral loads were higher among X4 strain carriers than among R5 strain carriers (p < 0.05). Conclusions A high degree of concordance was found between tropism testing with RNA and testing with proviral DNA. Our results suggest that proviral DNA-based genotypic tropism testing is a useful option for patients with low or undetectable viral load who require a different therapy. PMID:24165156

  7. Cognitive interviewing in risk minimization survey development: patient and healthcare professional surveys.

    PubMed

    DiBenedetti, Dana B; Price, Mark A; Andrews, Elizabeth B

    2013-07-01

    Risk minimization programs are often required for selected drugs and other products to ensure that the benefits of these prescription products outweigh their risks. Regulators in the USA and Europe have recently called for more rigorous standards in developing measures for risk minimization program assessment. Cognitive pretesting interviews are a critical step in the development of survey instruments used to evaluate patients' and healthcare professionals' knowledge and behaviors associated with the safe use of products requiring a risk minimization program. This article is intended as a guide for the researcher who is charged with the development of survey instruments used in these programs and focuses on the role of cognitive pretesting interviews in successful survey instrument design, data analysis and interpretation.

  8. Monitoring outcomes of arthritis and longitudinal data collection in routine care using a patient questionnaire that incorporates a clinical note on one piece of paper.

    PubMed

    Yazici, Yusuf

    2007-08-01

    Patient questionnaires are the quantitative tools available to rheumatologists to monitor their patients' health status and responses to therapy. The Health Assessment Questionnaire (HAQ) and its derivatives have been shown to be the most significant predictors of functional and work disability, costs, joint replacement surgery, and mortality; generally at higher levels of significance than joint counts, radiographs, and laboratory tests. Every encounter of a patient with a rheumatologist provides an opportunity to collect data. Yet patient questionnaires, which can be used in all rheumatic diseases, including osteoarthritis, systemic lupus erythematosus, fibromyalgia, scleroderma, and ankylosing spondylitis, are not included in routine care by most rheumatologists. Questionnaires can be adapted to include a simple subjective-objective-assessment-plan (SOAP) clinical encounter note that helps with data entry and also provides all the necessary information for clinical decision making in one sheet of paper. Data that are feasible to collect in clinical care provide the optimal approach to assessing quantitatively how patients are doing. If data are not collected and recorded, that opportunity, on that day, is lost forever. Rheumatologists would find it valuable to adapt questionnaires to the care they provide for all their patients, to document and improve the care they provide, and add quantitative data to standard clinical care.

  9. [Metabolic changes and nutritional status in the spinal cord injured patient ASIA A. Evaluation and monitoring with routine laboratories, a feasible option].

    PubMed

    Dufoo, Manuel; Oseguera, Araceli Cruz; Dufoo-Olvera, Manuel; López, Ozcar García; Palacios, Jesús López; Trejo, Antonio Aburto; Toledo, Gabriel Carranco; Esparza, Everardo de la Rosa; Zazueta, Alberto Ibarra; Ortíz, Eloy Vásquez

    2007-01-01

    Spinal Cord Injury ASIA A (tetraplegia) is a frequent pathology that may affect population regardless of age, sex or race, and that can induce metabolic abnormalities that may worsen the nutritional status of these patients. There are no existing specific protocols to treat these disorders in the specialized units in Mexico. We analyzed 16 patients at the Spine Clinic SS-DF, 18 years or older without any drug treatment or any previous disease, known or diagnosed when admitted to the hospital. Laboratory samples were obtained as well as the nutritional status was calculated at their admittance and discharge. Individually calculated nutritional support was administered starting at their third day of hospital stay. 100% of the patients showed some type of metabolic disorder associated to the neurological injury. 50% of the patients were classified with severe malnutrition, 25% moderate and 25% mild, all improved at their discharge. We confirmed the presence of metabolic changes in these patients, the efficacy of routine laboratory in the Spine Clinic SS-DF for their evaluation, and that adequate nutritional support may help correct metabolic disorders in this patients.

  10. Cost-effectiveness analysis of fesoterodine flexible dose in newly diagnosed patients with overactive bladder in routine clinical practice in Spain.

    PubMed

    Peral, Carmen; Sánchez-Ballester, Francisco; García-Mediero, José M; Ramos, Jaime; Rejas, Javier

    2016-01-01

    To carry out cost-effectiveness analysis from the Spanish National Health System perspective, of treating overactive bladder (OAB), in newly diagnosed patients with two flexible doses of fesoterodine in routine clinical practice. Economic evaluation of flexible-dose fesoterodine in newly diagnosed patients, including two treatment groups: standard escalating from 4 to 8 mg or fast escalating to 8 mg. Costs were estimated from health care resources utilization related to OAB, and were expressed in 2015 Euros. Quality-adjusted life-years (QALYs) were obtained from overactive bladder questionnaire-short form. Univariate and probabilistic sensitivity analyses were carried out. Three hundred and ninety symptomatic OAB patients treated with fesoterodine and newly diagnosed (141 in fast escalating group and 249 in standard escalating) were analyzed. Adjusted health care total costs were not statistically different; difference -€4.1 (confidence interval: -153.3; 25.1) P=0.842. QALYs were higher in fast escalating to high dose vs standard escalating group, resulting in a cost of -€16,020/QALY gained for fast escalating vs standard escalating group. When the cost-effectiveness threshold is set at a maximum value of €30,000/QALY gained, fesoterodine fast escalating group was cost-effective vs standard escalating group 67.6% of the time. The treatment with fesoterodine, in female patients newly diagnosed, fast escalating to 8 mg was a cost-effective option relative to escalating traditionally from 4 to 8 mg, in the management of OAB in routine clinical practice, from the Spanish National Health System perspective.

  11. Treatment referral before and after the introduction of the Liverpool Patients Concerns Inventory (PCI) into routine head and neck oncology outpatient clinics.

    PubMed

    Ghazali, Naseem; Kanatas, Anastasios; Langley, Daniel J R; Scott, Barry; Lowe, Derek; Rogers, Simon N

    2011-11-01

    Holistic needs assessment is a key recommendation in improving supportive and palliative care in adults with cancer. The Patients Concerns Inventory (PCI) is a holistic needs assessment tool designed for head and neck cancer survivors in outpatient setting. Routine screening of potential unmet needs in a clinic may result in increased onward referrals, thus placing a burden on existing healthcare services. The aim of this study was to compare the referral trends following consultation in the time periods before and after introduction of PCI in an oncology outpatient clinic. A cross-sectional cohort of disease-free survivors of oral/oropharyngeal cancers of a single consultant was prospectively exposed to PCI from July 2007 to April 2009. The PCI is a self-completed questionnaire consisting of 55 items of patient needs/concern and a list of multidisciplinary professionals, whom patients may wish to talk to or be referred to. Retrospective analysis of referral patterns from clinic letters in two periods in the pre-PCI and post-PCI exposure was performed. Prospective analysis of consultations was performed to determine the outcome of PCI-highlighted items. There was no change in the prevalence of onward referral with the introduction of PCI, i.e. 21 referrals per 100 patients seen in outpatients. However, the proportion of referrals to oral rehabilitation and psychological support increased. Referrals to certain services, e.g. speech and language and dentistry, remained consistently in demand. Many PCI-highlighted needs were dealt in a clinic with by the consultant and/or other professionals during a multidisciplinary consultation. Routine use of PCI promotes target efficiency by directing and apportioning appropriate services to meet the needs for supportive care of head and neck cancer survivors.

  12. Implementation and effects of pulse-contour- automated SVV/CI guided goal directed fluid therapy algorithm for the routine management of pancreatic surgery patients.

    PubMed

    Kratz, Thomas; Simon, Christina; Fendrich, Volker; Schneider, Ralph; Wulf, Hinnerk; Kratz, Caroline; Efe, Turgay; Schüttler, Karl F; Zoremba, Martin

    2016-11-14

    Goal directed fluid management in major abdominal surgery has shown to reduce perioperative complications. The approach aims to optimize the intravascular fluid volume by use of minimally invasive devices which calculate flow-directed variables such as stroke volume (SV) and stroke volume variation (SVV). We aimed to show the feasibility of routinely implementing this type of hemodynamic monitoring during pancreatic surgery, and to evaluate its effects in terms of perioperative fluid management and postoperative outcomes. All patients undergoing pancreatic surgery at a university hospital during two successive 12 months periods were included in this retrospective cohort analysis. Twelve months after the implementation of a standard operating procedure for a goal directed therapy (GDT, N = 45) using a pulse contour automated hemodynamic device were compared with a similar period before its use (control, N = 31) regarding mortality, length of hospital and ICU stay, postoperative complications and the use of fluids and vasopressors. Overall, 76 patients were analysed. Significantly less crystalloids were used in the GDT group. Patients receiving GDT showed significantly fewer severe complications (insufficiency of intestinal anastomosis: 0 vs. 5 (P = 0.0053) and renal failure: 0 vs. 4 (P = 0.0133). Mortality for pancreatic surgery was 1 vs. 3 patients, (P = 0.142), and length of stay (LOS) in the intensive care unit (ICU) was 4.38 ± 3.63 vs. 6.87 ± 10.02 (P= 0.0964) days. Use of blood products was significantly less within the GDT group. Implementation of a SOP for a GDT in the daily routine using flow-related parameters is feasible and is associated with better outcomes in pancreatic surgery.

  13. Transfusion burden in non-dialysis chronic kidney disease patients with persistent anemia treated in routine clinical practice: a retrospective observational study

    PubMed Central

    2012-01-01

    Background Transfusion patterns are not well characterized in non-dialysis (ND) chronic kidney disease (CKD) patients. This study describes the proportion of patients transfused, units of blood transfused and trigger-hemoglobin (Hb) levels for transfusions in severe anemic, ND-CKD patients in routine practice. Methods A retrospective cohort study of electronic medical record data from the Henry Ford Health System identified 374 adult, ND-CKD patients with severe anemia (Hb < 10 g/dL and subsequent use of erythropoiesis-stimulating agents [ESA] therapy, blood transfusions, or a second Hb < 10 g/dL) between January 2004 and June 2008. Exclusions included those with prior diagnoses of cancer, renal or liver transplant, end-stage renal disease, acute bleeding, trauma, sickle cell disease, or aplastic anemia. A gap of ≥ 1 days between units of blood transfused was counted as a separate transfusion. Results At least 1 transfusion (mean of 2 units; range, 1-4) was administered to 20% (75/374) of ND-CKD patients with mean (± SD) follow-up of 459 (± 427) days. The mean (± SD) Hb level closest and prior to a transfusion was 8.8 (± 1.5) g/dL. Patients who were hospitalized in the 6 months prior to their first anemia diagnosis were 6.3 times more likely to receive a blood transfusion than patients who were not hospitalized (p < 0.0001). Patients with peripheral vas