scholarly journals P047: Emergency department practice patterns of UTI investigation among the delirious elderly: a retrospective chart review

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S81-S81
Author(s):  
R. Pinnell ◽  
P. Joo
Keyword(s):  
Emergency Department ◽  
Elderly Patients ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Patient Characteristics ◽  
Urinary Symptoms ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Indwelling Catheter ◽  
Exact Test

Introduction: Delirium is a common emergency department (ED) presentation in elderly patients. Urinary tract infection (UTI) investigation and treatment are often initiated in delirious patients in the absence of specific urinary symptoms, despite a paucity of evidence to support this practice. The purpose of this study is to describe the prevalence of UTI investigation, diagnosis and treatment in delirious elderly patients in the ED. Methods: We performed a retrospective chart review of elderly patients presenting to the ED at The Ottawa Hospital between January 15-July 30, 2018 with a chief complaint of confusion or similar. Exclusion criteria were pre-existing and current UTI diagnosis, Glasgow Coma Scale <13, current indwelling catheter or nephrostomy tube, transfers between hospitals, and leaving without being seen. The primary outcome was the proportion of patients for whom urine tests (urinalysis or culture) or antibiotic treatment were ordered. Secondary outcomes were associations between patient characteristics, rates of UTI investigation, and patient outcomes. Descriptive values were reported as proportions with exact binomial confidence intervals for categorical variables and means with standard deviations for continuous variables. Comparisons were conducted with Fischer's exact test for categorical variables and t-tests for continuous variables. Results: After analysis of 1039 encounters with 961 distinct patients, 499 encounters were included. Urine tests were conducted in 324 patients (64.9% [60.6-69.1]) and antibiotics were prescribed to 176 (35.2% [31.1-39.6]). Overall 57 patients (11.4% [8.8-14.5]) were diagnosed with UTI, of which only 12 (21.1% [11.4-33.9]) had any specific urinary symptom. For those patients who had no urinary symptoms or other obvious indication for antibiotics (n = 342), 199 (58.2% [52.8-63.5]) received urine tests and 62 (18.1% [14.2-22.6]) received antibiotics. Patients who received urine tests were older (82.4 ± 8.8 vs. 78.3 ± 8.4 years, p < 0.001) but did not differ in sex distribution from those than those who did not. Additionally, patients who received antibiotics were more likely to be admitted (OR = 2.6 [1.48-4.73]) and had higher mortality at 30 days (OR = 4.2 [1.35-12.91]) and 6 months (OR = 3.2 [1.33-7.84]) than those who did not. Conclusion: Delirious patient without urinary symptoms in the ED were frequently investigated and treated for UTI despite a lack of evidence regarding whether this practice is beneficial.

scholarly journals A multidisciplinary pulmonary embolism response team (PERT)—experience from a national multicenter consortium

2019 ◽  
Vol 9 (3) ◽  
pp. 204589401882456 ◽  
Author(s):  
Jacob Schultz ◽  
Nicholas Giordano ◽  
Hui Zheng ◽  
Blair A. Parry ◽  
Geoffrey D. Barnes ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Patient Characteristics ◽  
Risk Groups ◽  
The United States ◽  
Categorical Variables ◽  
P Value ◽  
Continuous Variables ◽  
Exact Test ◽  
Advanced Therapy ◽  
Chi Squared

Background We provide the first multicenter analysis of patients cared for by eight Pulmonary Embolism Response Teams (PERTs) in the United States (US); describing the frequency of team activation, patient characteristics, pulmonary embolism (PE) severity, treatments delivered, and outcomes. Methods We enrolled patients from the National PERT Consortium™ multicenter registry with a PERT activation between 18 October 2016 and 17 October 2017. Data are presented combined and by PERT institution. Differences between institutions were analyzed using chi-squared test or Fisher's exact test for categorical variables, and ANOVA or Kruskal-Wallis test for continuous variables, with a two-sided P value < 0.05 considered statistically significant. Results There were 475 unique PERT activations across the Consortium, with acute PE confirmed in 416 (88%). The number of activations at each institution ranged from 3 to 13 activations/month/1000 beds with the majority originating from the emergency department (281/475; 59.3%). The largest percentage of patients were at intermediate–low (141/416, 34%) and intermediate–high (146/416, 35%) risk of early mortality, while fewer were at high-risk (51/416, 12%) and low-risk (78/416, 19%). The distribution of risk groups varied significantly between institutions ( P = 0.002). Anticoagulation alone was the most common therapy, delivered to 289/416 (70%) patients with confirmed PE. The proportion of patients receiving any advanced therapy varied between institutions ( P = 0.0003), ranging from 16% to 46%. The 30-day mortality was 16% (53/338), ranging from 9% to 44%. Conclusions The frequency of team activation, PE severity, treatments delivered, and 30-day mortality varies between US PERTs. Further research should investigate the sources of this variability.

scholarly journals Reoperation Rates of Percutaneous and Paddle Leads in Spinal Cord Stimulator Systems: A Single-Center Retrospective Analysis

Pain Medicine ◽  
2020 ◽  
Author(s):  
Devin D Antonovich ◽  
Willy Gama ◽  
Alexandra Ritter ◽  
Bethany Jacobs Wolf ◽  
Ryan H Nobles ◽  
...  
Keyword(s):  
Spinal Cord ◽  
South Carolina ◽  
Cox Regression ◽  
Retrospective Chart Review ◽  
Patient Characteristics ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Single Center ◽  
Diabetes Status ◽  
Reoperation Rates

Abstract Objective We hypothesize that reoperation rates of spinal cord stimulation (SCS) systems utilizing percutaneous leads are comparable to those utilizing paddle leads. We attempt here to characterize causes for those reoperations and identify any related patient characteristics. Design and Subjects This study is a single-center retrospective chart review of 291 subjects (410 operations) who underwent at least one permanent SCS implantation utilizing percutaneous or paddle leads over a 10-year period at the Medical University of South Carolina. Methods Charts were reviewed for height, weight, body mass index, gender, race, age, stimulator type, type of reoperation, diabetes status, history and type of prior back surgery, top lead location, and number of leads placed. Comparisons of patient and procedural characteristics were conducted using a two-sample t test (continuous variables), chi-square, or Fisher exact approach (categorical variables). Univariate and multivariate Cox regression models were developed, identifying associations between patient characteristics, SCS characteristics, reoperation rates, and time to reoperation. Results Thirty point five eight percent of subjects (89/291), required at least one reoperation. The reoperation rate was 27.84% for percutaneous systems (N = 54/194) and 27.78% for percutaneous systems (N = 60/216). Time to reoperation also did not differ between the two systems (hazard ratio [HR] = 1.06, 95% CI = 0.70–1.60). Of all factors examined, younger age at time of placement was the only factor associated with risk of reoperation (HR = 0.73, 95% CI = 0.62–0.87, P &lt; 0.001). Conclusions Our data suggest that reoperation rates and time to reoperation between percutaneous and paddle leads are clinically similar; therefore, rates of reoperation should have no bearing on which system to choose.

Vanishing congenital lung malformations: What is the incidence of true regression?

2021 ◽  
pp. 1-7
Author(s):  
C. Griggs ◽  
M. Schmaedick ◽  
C. Gerall ◽  
W. Fan ◽  
C. Orlas ◽  
...  
Keyword(s):  
Neonatal Intensive Care ◽  
Statistical Significance ◽  
Multivariable Analysis ◽  
Retrospective Chart Review ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Chi Square ◽  
Exact Test ◽  
Congenital Lung Malformation ◽  
Nicu Admission

BACKGROUND: A congenital lung malformation (CLM) that is diagnosed on prenatal ultrasound exam may subsequently become undetectable on later scans, a “vanishing” CLM. OBJECTIVE: The purpose of our study is to characterize the prenatal natural history and postnatal outcomes of “vanishing” lesions treated at our institution. METHODS: We performed a retrospective chart review of 107 patients diagnosed prenatally with CLM at our institution. Comparisons were made using Kruskal-Wallis or t-test for continuous variables and Fisher’s exact test or Chi-Square test for categorical variables. Multivariable analysis using logistic regression was performed. RESULTS: Of the 104 patients, 59 (56.7%) had lesions that became sonographically undetectable on serial ultrasound scans. Patients with lesions that vanished prenatally tended to need less Neonatal Intensive Care Unit (NICU) admission at birth (persistent CLM: 54.8%vs vanished CLM: 28.8%), decreased need for supplemental O2 at birth (persistent CLM: 31.0%vs vanished CLM: 11.9%), and decreased delay in feeds (persistent CLM: 26.2%vs vanished CLM: 8.5%) compared to those with persistent CLM. After multivariate analysis controlling for maternal steroid administration and sex, admission to NICU maintained a slight statistical significance, with patients in the vanishing CLM group 2.5 times less likely to be admitted to the NICU. None of our patients whose lesions vanished prenatally required mechanical ventilation. Eighty-six patients underwent postnatal computed tomography (CT) chest. Only 2 patients had lesions that regressed on postnatal CT. CONCLUSION: Lesions that vanish on prenatal imaging may be associated with improved clinical outcomes. The rate of true regression at our institution was as low as 2.3%.

scholarly journals Rethink Your Transjugular Intrahepatic Portosystemic Shunt (TIPS): Pre-TIPS Infection Predicts Post-TIPS Infection and Post-TIPS Portosystemic Encephalopathy

2020 ◽  
pp. 34-41
Author(s):  
Jenna Koblinski ◽  
Margaret C. Liu ◽  
Roy U. Bisht ◽  
Paul Kang ◽  
Mark Wong ◽  
...  
Keyword(s):  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Odds Ratio ◽  
Portal Pressure ◽  
Retrospective Chart Review ◽  
Portosystemic Shunt ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Exact Test ◽  
Portosystemic Encephalopathy ◽  
Intrahepatic Portosystemic Shunt

Abstract Objective: Transjugular intrahepatic portosystemic shunt (TIPS) is used for decompression of elevated portal pressure; however, there are potential complications. The aim of this study was to compare the risk of complications of TIPS in those who had an episode of infection within 6 months prior to TIPS to those without an infection prior. Methods: A retrospective chart review was performed on patients who underwent TIPS at a single transplant centre over 8 years. They were divided into two groups: patients without infection during the 6 months prior to TIPS (n=349) and those with an infection prior (bacterial/fungal) (n=53). The Wilcoxon rank-sum test was used to compare continuous variables while chi-squared analysis and Fisher’s exact test was used for categorical variables. Multiple logistic regression was used to ascertain the association between pre-TIPS infection status and likelihood of post-TIPS infection. Results: In the group of patients who had an infection before TIPS, 26.4% (n=14) had an episode of infection after the procedure, while in the group without infection prior, 16.2% (n=55) had an infection after the procedure (p=0.047; odds ratio: 2.08). In the pre-TIPS infection group, 54.7% (n=29) had an episode of portosystemic encephalopathy post-TIPS versus 39.6% (n=134) in the group without infection before TIPS (p=0.046; odds ratio: 1.93). Conclusion: Pre-TIPS infection within 6 months of TIPS procedure is a risk factor for post-TIPS portosystemic encephalopathy and infection. Further studies are needed to determine the potential benefit of antibiotic prophylaxis in patients who had an infection in the 6 months preceding TIPS placement.

Trained Clinician's Documentation of Serious Illness Conversations and Use of Billing CPT 99497

2021 ◽  
pp. 082585972110491
Author(s):  
Jeanette M. Daly ◽  
Megan E. Schmidt ◽  
Kate DuChene Thoma ◽  
Barcey T. Levy
Keyword(s):  
Risk Score ◽  
Mortality Risk ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Care Program ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Chi Square ◽  
Serious Illness ◽  
Significant Difference

Background Advance care planning (ACP) involves patients and family members in discussions with clinicians about their values, goals, and preferences regarding future medical care. Objectives: To (1) assess whether an ACP conversation using the Serious Illness Conversation (SIC) was initiated and documented; (2) assess which components of SIC were documented; (3) determine how frequently clinicians trained to use the SIC guide used ACP billing codes during the study time period, (4) determine whether there was a significant difference in mortality risk score according to documentation of each component of the SIC. Methods; Thirteen clinicians at three family medicine offices were trained in the Serious Illness Care Program and asked to document SICs in the electronic medical record (EMR). A retrospective chart review of SIC components was conducted in the EMRs of patients who presumably had ACP conversations initiated by the trained clinicians. Patients were identified using the billing codes for ACP conversations and through referrals from another study that requires clinicians to have ACP conversations with their patients. Pearson chi-square test for categorical variables and t-tests for continuous variables were conducted. Results: A total of 157 patients were included in this study; 131 patients referred from another ACP study and an additional 26 patients using the billing codes of ACP conversations. Through retrospective chart review, the mean age of patients was 72 years and 54 were male. Sixty-two (40%) charts had one or more SIC components documented. “Explore key topics” was documented most frequently for 58 (38%) patients by the 13 participating clinicians. Mean mortality risk score was 10.7 and higher scores were significantly correlated with more SIC components documented ( rp = 0.217, P = 0.007). Conclusion: Little use of the SIC guide among trained physicians was found in the EMR. It was expected that provision of an EMR template for documenting the SIC would have facilitated documentation of SICs.

scholarly journals Complementary and Integrative Medicine Use in Individuals Seeking Conventional Medical Oncology Care in Chile: Prevalence and Patient Characteristics

2019 ◽  
pp. 1-6
Author(s):  
Gabriel Lopez ◽  
Claudio Alejandro Salas ◽  
Fernando Cadiz ◽  
Carolina Barriga ◽  
Pilar Gonzalez ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Integrative Medicine ◽  
Medical Oncology ◽  
Patient Characteristics ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Exact Test ◽  
Improved Outcomes ◽  
Complementary And Integrative Medicine ◽  
Oncology Care

PURPOSE Complementary and integrative medicine (CIM) use during cancer care has increased in Western medical settings. Little is known about interest in and use of CIM approaches by oncology patients in Chile and South America. PATIENTS AND METHODS Patients presenting for conventional outpatient or inpatient medical oncology care at the Clinica Alemana in Santiago, Chile, from March to June 2017 were asked to complete a survey about their interest in and use of CIM approaches. Goals included determining the prevalence of CIM use and exploring associations between CIM use and patient characteristics. Statistical analyses included a two-tailed t test for continuous variables, Fischer’s exact test for categorical variables, and logistic regression for association between CIM use and other variables. RESULTS Of 432 patients surveyed, 66.9% were diagnosed with breast cancer, 84.8% were women, the majority of patients (58.1%) were between age 40 and 60 years, and 51.5% (n = 221) reported CIM use. No association was found between CIM use and the sociodemographic variables of sex, age, education, or income. In all, 44.6% of patients with breast cancer reported CIM use compared with 64.8% of patients with other cancer types ( P > .001). Most commonly reported types of CIM used included herbals (49.1%), vitamins and minerals (40.8%), and prayer or meditation (40.4%). Most frequent reasons for CIM use were to “do everything possible” (72%) and to “improve my immune function” (67.8%). Most patients (43.4%) reported starting CIM use at the time of cancer diagnosis, with only 55.4% sharing information regarding CIM use with their medical team. CONCLUSION The majority of patients surveyed reported engaging in CIM use, with just over half the users communicating with their oncology team about their CIM use. Increased awareness of regional differences in CIM use may help increase communication regarding this subject and contribute to improved outcomes.

Complementary and integrative medicine use for individuals seeking conventional medical oncology care in Chile: Prevalence and patient characteristics.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 110-110
Author(s):  
Gabriel Lopez ◽  
Claudio Alejandro Salas ◽  
Fernando Cadiz ◽  
Carolina Barriga ◽  
Pilar Gonzalez ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Integrative Medicine ◽  
Medical Oncology ◽  
Patient Characteristics ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Exact Test ◽  
Improved Outcomes ◽  
Complementary And Integrative Medicine ◽  
Oncology Care

110 Background: Complementary and integrative medicine (CIM) use during cancer care has increased in western medical settings. Little is known about interest in and use of CIM approaches by oncology patients in South America. Methods: Patients presenting for conventional outpatient or inpatient medical oncology care at the Clinica Alemana in Santiago, Chile (March-June, 2017) were asked to complete a survey about their interest in and use of CIM approaches. Goals included determining prevalence of CIM use and exploring associations between CIM use and patient characteristics. Statistical analyses included two-tailed t-test for continuous variables, Fischer’s exact test for categorical variables, and logistic regression for association between CIM use and other variables. Results: Of 432 patients surveyed, 66.7% had a diagnosis of breast cancer, 84.8% were women, the majority between ages 40-60 (32.7%). Of those surveyed, 221 (51.5%) reported CIM use. No association was found between CIM use and sociodemographic variables (sex, age, education, income). Patients with breast cancer (44.6%) reported CIM use, compared to 64.8% of other cancer types (p=0.0001). Most commonly reported CIM types used included herbals (49.1%), vitamins/minerals (40.8%), prayer/meditation (40.4%), and special diets (38.5%). Most frequent reasons for CIM use included “do everything possible” (72%), “improve my immune function” (67.8%), “reduce treatment related side effects” (32.7%), and “recommended by family/friend” (32.7%). Most (43.4%) reported starting CIM use at the time of cancer diagnosis, with only 55.4% sharing information regarding CIM use with their medical team. Majority reported benefits from CIM use (60%). No differences were observed in self-reported quality of life between those using versus not using CIM. Conclusions: The majority of patients receiving conventional oncology care reported engaging in CIM use, with just over half of users communicating with their oncology team about their CIM use. Increased awareness of regional differences in CIM use may help increase communication regarding this topic and contribute to improved outcomes.

scholarly journals SAT-643 Predictors of Technology Success in Cystic Fibrosis Related Diabetes

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Ashna Jain ◽  
Beth Anne Kaminski ◽  
Katherine Kutney
Keyword(s):  
Cystic Fibrosis ◽  
Negative Impact ◽  
Statistical Significance ◽  
Retrospective Chart Review ◽  
Patient Characteristics ◽  
Continuous Variables ◽  
Exact Test ◽  
Duration Of Diabetes ◽  
Insurance Type ◽  
Before And After

Abstract Background: As patients with cystic fibrosis live longer, cystic fibrosis related diabetes (CFRD) is becoming a more common complication. CFRD has a negative impact on lung function, nutrition, and survival. The ADA guidelines recommend that patients with CFRD be treated with insulin and monitor their glucose at least three times a day. Continuous glucose monitors (CGM) allow glucose to be measured by scanning a reading device or by automatic updates every 5 minutes. Little is known about factors predicting successful CGM use in patients with CFRD. Methods: We completed a retrospective chart review of all patients with insulin-treated CFRD at a single center. Successful CGM implementation was defined as CGM use for 3 months or more. Patient characteristics (age, BMI, ppFEV1, HbA1C, diabetes duration, insurance type) were compared between the CGM and no CGM groups. For the CGM group, HbA1C, ppFEV1, and BMI, were compared before and after CGM implementation. Paired and unpaired t-tests were used to evaluate continuous variables and fisher’s exact test was used to evaluate dichotomous variables. Results: Of the 55 patients eligible for inclusion, 12 patients (22%) had successfully implemented CGM in their diabetes routine. Age, BMI, ppFEV1, HbA1C, and insurance type were not significantly different between the CGM and no CGM groups. CGM users appeared to have a slightly longer duration of diabetes than non-implementers but this did not meet statistical significance (6.6 vs. 4.8 years, p=0.08). Among CGM users, BMI, ppFEV1, and hemoglobin A1C did not change significantly after implementation of CGM. The documented number of glucose checks did increase at the CFRD visit immediately after implementing CGM (1.9 vs. 3.3 checks per day, p=0.002). Conclusions: No patient factor was found to predict successful CGM implementation in our cohort. Our small study suggests that longer duration of diabetes may be associated with successful CGM implementation. Longer follow-up is needed to determine whether CGM therapy improves A1C, BMI, or ppFEV1 in patients with insulin-treated CFRD.

Harnessing the Chaplain’s Capacity to Identify Unmet Palliative Needs of Vulnerable Older Adults in the Emergency Department

2021 ◽  
pp. 082585972110033
Author(s):  
Elizabeth Hamill Howard ◽  
Rachel Schwartz ◽  
Bruce Feldstein ◽  
Marita Grudzen ◽  
Lori Klein ◽  
...  
Keyword(s):  
Emergency Department ◽  
Palliative Care ◽  
End Of Life Care ◽  
Older Patients ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Life Care ◽  
Emergency Medicine Physician ◽  
Medicine Physician ◽  
One Year

Objective: To explore chaplains’ ability to identify unmet palliative care (PC) needs in older emergency department (ED) patients. Methods: A palliative chaplain-fellow conducted a retrospective chart review evaluating 580 ED patients, age ≥80 using the Palliative Care and Rapid Emergency Screening (P-CaRES) tool. An emergency medicine physician and chaplain-fellow screened 10% of these charts to provide a clinical assessment. One year post-study, charts were re-examined to identify which patients received PC consultation (PCC) or died, providing an objective metric for comparing predicted needs with services received. Results: Within one year of ED presentation, 31% of the patient sub-sample received PCC; 17% died. Forty percent of deceased patients did not receive PCC. Of this 40%, chaplain screening for P-CaRES eligibility correctly identified 75% of the deceased as needing PCC. Conclusion: Establishing chaplain-led PC screenings as standard practice in the ED setting may improve end-of-life care for older patients.

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