Retrospective chart review to assess domains of quality of death (recognition of dying, appropriate limitations, symptom monitoring, anticipatory prescribing) of patients dying in the acute hospital under the care of a nephrology service with renal supportive care support over time

Nephrology ◽  
2019 ◽  
Vol 24 (5) ◽  
pp. 511-517
Author(s):  
Agnes K Urban ◽  
Celine Foote ◽  
Frank P Brennan ◽  
Mark Brown ◽  
Brendon W H Lee
Keyword(s):  
Supportive Care ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Acute Hospital ◽  
Symptom Monitoring ◽  
Quality Of Death ◽  
Over Time ◽  
Care Support

scholarly journals 65 Quality of death of renal patients dying in acute hospital – does renal supportive care (rsc) lead to better deaths?

2018 ◽  
Author(s):  
Kat Urban ◽  
Celine Foote ◽  
Frank Brennan ◽  
Mark Brown ◽  
Jenny Burman ◽  
...  
Keyword(s):  
Supportive Care ◽  
Acute Hospital ◽  
Quality Of Death

scholarly journals Development of a Multidisciplinary Aerodigestive Program: An Institutional Experience

Children ◽  
2021 ◽  
Vol 8 (7) ◽  
pp. 535
Author(s):  
Seung Kim ◽  
Mireu Park ◽  
Eunyoung Kim ◽  
Ga Eun Kim ◽  
Jae Hwa Jung ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Multidisciplinary Management ◽  
Neurologic Disease ◽  
Institutional Experience ◽  
Swallowing Difficulty ◽  
The Common ◽  
Chronic Comorbidities

We share our experience on the implementation of a multidisciplinary aerodigestive program comprising an aerodigestive team (ADT) so as to evaluate its feasibility. We performed a retrospective chart review of the patients discussed at the monthly ADT meetings and analyzed the data. A total of 98 children were referred to the ADT during the study period. The number of cases increased steadily from 3.5 cases per month in 2019 to 8.5 cases per month in 2020. The median age of patients was 34.5 months, and 55% were male. Among the chronic comorbidities, neurologic disease was the most common (85%), followed by respiratory (36%) and cardiac (13%) disorders. The common reasons for consultation were suspected aspiration (56%), respiratory difficulty (44%), drooling/stertor (30%), regurgitation/vomiting (18%), and feeding/swallowing difficulty (17%). Following discussions, 58 patients received active interventions, including fundoplication, gastrostomy, laryngomicrosurgery, tracheostomy, and primary dilatation of the airway. According to the questionnaire of the caregiver, the majority agreed that the main symptoms and quality of life of patients had improved (88%), reducing the burden on caregivers (77%). Aerodigestive programs may provide comprehensive and multidisciplinary management for children with complex airway and digestive tract disorders.

Cochlear Implantation in the Elderly: Results and Quality-of-Life Assessment

2002 ◽  
Vol 111 (10) ◽  
pp. 890-895 ◽  
Author(s):  
Hamid R. Djalilian ◽  
Sharon L. Smith ◽  
Timothy A. King ◽  
Samuel C. Levine
Keyword(s):  
Quality Of Life ◽  
Complication Rate ◽  
Cochlear Implantation ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
The Elderly ◽  
Life Assessment ◽  
Test Results

To assess the efficacy, quality of life, and complication rate of cochlear implantation in patients over 60 years of age, we performed a retrospective chart review of 31 cochlear implant patients more than 60 years old at the time of surgery (mean, 70 years; range, 62 to 86 years). All patients had improvement in their audiological test results after operation. Twenty-eight patients (93%) are regular implant users at a median follow-up of 12 months. Major complications occurred in 2 patients (6%). We conclude that cochlear implantation in the elderly population has excellent results, with a complication rate similar to that in patients less than 60 years old, and yields an improved quality of life.

Retrospective Chart Review of Cryopreserved Amniotic Membrane for Knee Pain

2020 ◽  
Author(s):  
Ruben Berrocal Timmons
Keyword(s):  
Quality Of Life ◽  
Adverse Events ◽  
Amniotic Membrane ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Final Analysis ◽  
Mean Values ◽  
Number Of Patients ◽  
The Impact

Objective: Treatment of joint pain with an injection of the amniotic membrane has not been adequately studied. This study retrospectively reviewed Visual Analog Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and analgesic usage data from patients treated with the injection of cryopreserved amniotic membrane (CAM) in their knees to determine the impact of treatment on patients’ pain, quality of life, and analgesic usage. Methods: Chart review was conducted on 40 patients. Institutional Review Board (IRB) approval was obtained prior to initiation of the project. The membrane was utilized as per the FDA guidance of 21CFR1271. Retrospective data, including demographics, medical history, pain score, quality of life score, analgesic usage and adverse events, were collected from their medical records for each consenting patient through 6 months after CAM injection. Results: A total of 40 patients were considered in the final analysis. Mean VAS for pain level improved from 7.0 to 2.6 (p<0.001). WOMAC daily activity function score improved from a mean score of 52 to 28 (p<0.001). Opioid and non-steroidal anti-inflammatory drug (NSAID) usage decreased from 97% to 25% (p<0.001). No adverse events were reported. Conclusion: Mean values for VAS and WOMAC scores significantly improved at all time points and the number of patients who used analgesics decreased as compared to baseline. CAM injection into painful knee joints decreases pain, improves physical function, and decreases the use of analgesics in the absence of adverse events.

scholarly journals Assessing the quality of medication documentation: development and feasibility of the MediDocQ instrument for retrospective chart review in the hospital setting

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e034609 ◽  
Author(s):  
Antje Hammer ◽  
Anke Wagner ◽  
Monika A Rieger ◽  
Tanja Manser
Keyword(s):  
Development Process ◽  
Chart Review ◽  
Clinical Decision Making ◽  
Hospital Setting ◽  
Retrospective Chart Review ◽  
Medication Administration ◽  
Patient Records ◽  
Mean Values ◽  
Medication Documentation

ObjectiveThe medication process requires clear and transparent documentation in patient records. Incomplete or incorrect medication documentation may contribute to inappropriate clinical decision-making and adverse events. To comprehensively assess the quality of in-hospital medication documentation, we developed a retrospective chart review (RCR) instrument. We report on the development process, the feasibility of the instrument and describe our application of the instrument to a sample of patient records.DesignCross-sectional study using an RCR instrument to evaluate paper-based, non-standardised prescription and medication administration charts (MediDocQ).SettingTwo German university hospitals.ParticipantsRecords from 1361 patients admitted between April and July 2015 were evaluated.MethodsThe MediDocQ development process comprised six consecutive stages: focused literature review, web-based search, initial patient record screening, review by project advisory board, focus groups with professionals and pilot testing. The final 54-item RCR instrument covers three key components of medication documentation: (1) completeness of documented information (including prescription, medication administration and pro re nata (PRN) medication), (2) quality of transcriptions and (3) compliance with chart structure, legibility, handling of deletions and chart corrections. Descriptive statistics are presented as mean values, SD, median and interquartile ranges for individual items.ResultsOverall, 33 out of 54 items resulted in mean values above 0.75, indicating high-quality medication documentation. Documentation quality was particularly compromised for verbal and PRN orders (which involve more steps than standard orders) and when documentation was not completed at the same time as medication administration.ConclusionsMediDocQ is a patient safety instrument that can be used to evaluate the quality of medication documentation and identify components of the process where intervention is required. In our setting, standardisation of medication documentation, particularly regarding medication administration and PRN medication is a priority.

Dosage Changes in Long-Term Botox Use for Laryngeal Dystonia

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P49-P49
Author(s):  
Hakan Birkent ◽  
Nicole C Maronian ◽  
Patricia F. Waugh ◽  
Albert L Merati ◽  
David Perkel ◽  
...  
Keyword(s):  
Total Dose ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Duration Of Effect ◽  
Laryngeal Dystonia ◽  
Patient Reported ◽  
Number Of Treatment ◽  
Over Time

Objective Botulinum toxin (BTX) injections continue to be the mainstay of treatment for laryngeal dystonia (LD). Many patients are entering their 2nd and 3rd decade of treatment. In this study, the dosage consistency of BTX injections over time was examined in patients with long-term BTX use for LD. Methods Retrospective chart review, 1990–2007. Patients with adductor-type LD who had received at least 20 injections to the thyroarytenoid (TA) muscles were included in the study. The change of total dose and patient-reported effective weeks were investigated; data of the first 5 injections were excluded to eliminate initial dose searching. Results 55 patients (11 male, 44 female, mean age 60.6) with a mean follow-up period of 149.9 ± 43.7 months (range 44 to 211 months) were identified. Total number of treatment episodes was 1825 with a mean of 33.18 ± 10.37 (range 20 to 58) and a mean interval of 19.1 ± 1.3 (range 2 to 118) weeks. The average total dose of BTX for each treatment episode was 2.15 ± 0.37 U (range 0.125 to 10.00 U). The total dose trended downward over time; this trend became statistically significant at 13th injection. The overall mean duration of effect was 15.5 ± 1.1 (range 1 to 58) weeks and did not show a significant change over time. Conclusions The BTX dose needed for a constant response in the treatment of LD decreases over time, raising the concern that neural recovery from repeated BTX is not infinite.

scholarly journals Pregnant women admitted with urinary tract infections to a public sector hospital in South Africa: Are there lessons to learn?

2016 ◽  
Vol 31 (3) ◽  
pp. 79-83
Author(s):  
Francois Kamgang ◽  
Hopolang Maise ◽  
Jagidesa Moodley
Keyword(s):  
South Africa ◽  
Urinary Tract ◽  
Pregnant Women ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Public Health Facility ◽  
Public Sector Hospital ◽  
Study Population ◽  
Tract Infections

Background: Urinary tract infection (UTI) is associated with poor maternal and foetal outcomes. There is little information on UTI in pregnancy in South Africa. Objectives: To evaluate the frequency of UTI admissions of pregnant women admitted to a public health facility; and, to describe the outcomes of pregnancies complicated by UTI in our study population. Methods: A retrospective chart review of pregnant women admitted with the diagnosis of UTI during the period of 1 January 2012 to 31 December 2012 was conducted. A midstream urine sample of women admitted with symptoms suggestive of UTI was collected for culture. The diagnosis was confirmed if the culture was positive. The data was analysed using SPSS version 21 and descriptive statistics, viz. percentages, frequency and means were estimated. Results: Of 9,881 admissions, 494 (5%) had a diagnosis of UTI based on clinical features. Sixty had positive cultures and were confirmed as having UTI. Women with UTI had high rates of preterm ruptured membranes (n = 5, 8.3%), preterm deliveries (n = 19, 31.6%), anaemia (n = 26, 43.3%) and renal impairment (n = 4, 6.6%). Two cases of pyelonephritis required admission to an ICU because they developed acute respiratory distress syndrome. The most common pathogen isolated using cultures was Escherichia coli (n = 24, 40%). Only 10% had repeat urine cultures. Conclusion: UTI represents 5% of admissions at the study site. This study highlights the need to improve the quality of care of pregnant women with UTI.

scholarly journals Efficacy of botulinum toxin for treating cramps in peripheral neuropathy

2021 ◽  
Vol 2 (3) ◽  
Author(s):  
Tejas Mehta ◽  
Richard Sommers ◽  
Raghav Govindarajan
Keyword(s):  
Botulinum Toxin ◽  
Peripheral Neuropathy ◽  
Pain Score ◽  
Chart Review ◽  
Botulinum Toxin A ◽  
Retrospective Chart Review ◽  
Wilcoxon Test ◽  
Safe Procedure

Abstract Introduction: Muscle cramps are a common occurrence in patients with peripheral neuropathy and are known to cause significant distress and decrease the quality of life. Although several drug formulations have been used in the management of cramps, there is significant variability in terms of efficacy and tolerability in patients with peripheral neuropathy. This study aims to assess the efficacy of botulinum toxin A in the management of lower limb cramps in patients with peripheral neuropathy.   Methods: This retrospective chart review included a total of ten patients with peripheral neuropathy with cramps. Relevant data such as age, gender, race, pain score and cause of peripheral neuropathy were documented. Statistical analyses to compare the variables was done using the Wilcoxon Test. The pain score before the administration, at 3-month, 6 month and 9 months follow up were compared.   Results All patients enrolled in the study showed improvement of pain assessed by visual pain analog scale. An improvement of 1.60 (95%CI, p<0.05), 2.70 (95%CI, p<0.05) and 3.50 (95%CI, p=0.05) was noted between test scores from before administration of botulinum toxin to 3-month, 6 months and 9 months follow up with a range of 6, 4 and 4 respectively.   Conclusion: Local BTX-A infiltration is a likely efficacious and safe procedure for improving pain associated with cramps in patients with peripheral neuropathy.

scholarly journals From SARS and MERS to COVID-19: a review of the quality and responsiveness of clinical management guidelines in outbreak settings

2021 ◽  
Author(s):  
Samuel Lipworth ◽  
Ishmeala Rigby ◽  
Vincent Cheng ◽  
Peter Bannister ◽  
Eli Harriss ◽  
...  
Keyword(s):  
Supportive Care ◽  
Clinical Management ◽  
Guideline Development ◽  
Specific Treatment ◽  
Health Agency ◽  
Agree Ii ◽  
Eligibility Criteria ◽  
Management Guidelines ◽  
Over Time

AbstractObjectiveTo assess the responsiveness and quality of clinical management guidelines (CMGs) in SARS, MERS and COVID-19 and determine whether this has improved over time.DesignRapid literature review, quality assessment and focus group consultation.Data Sources– Google and Google Scholar were systematically searched from inception to 6th June 2020.This was supplemented with hand searches of national and international public health agency and infectious disease society websites as well as directly approaching clinical networks in regions where few CMGs had been identified via the primary search.Eligibility CriteriaCMGs for the treatment of COVID-19/SARS/MERS providing recommendations on supportive care and/or specific treatment.MethodsData extraction was performed using a standardised form. The Appraisal of Guidelines for Research and Evaluation (AGREE-II) tool was used to evaluate the quality of the CMGs. Six COVID-19 treatments were selected to assess the responsiveness of a subset of guidelines and their updates to 20th November 2020. We ran two sessions of focus groups with patient advocates to elicit their views on guideline development.ResultsWe included 37 COVID-19, six SARS, and four MERS CMGs. Evidence appraisals in CMGs generally focused on novel drugs rather than basic supportive care; where evidence for the latter was provided it was generally of a low quality. Most CMGs had major methodological flaws (only two MERS-CoV and four COVID-19 CMGs were recommended for use by both reviewers without modification) and there was no evidence of improvement in quality over time. CMGs scored lowest in the following AGREE-II domains: scope and purpose, editorial independence, stakeholder engagement, and rigour of development. Of the COVID-19 CMGs, only eight included specific guidance for the management of elderly patients and only ten for high-risk groups; a further eight did not specify the target patient group at all. Early in the pandemic, multiple guidelines recommended unproven treatments and whilst in general findings of major clinical trials were eventually adopted, this was not universally the case. Eight guidelines recommended that use of unproven agents should be considered on a case-by-case basis. Patient representatives expressed concern about the lack of engagement with them in CMG development and that these documents are not accessible to non-experts.ConclusionThe quality of most CMGs produced in coronaviridae outbreaks is poor and we have found no evidence of improvement over time, highlighting that current development frameworks must be improved. There is an need to strengthen the evidence base surrounding basic supportive care and develop methods to engage patients in CMG development from the beginning in outbreak settings.Systematic review registrationPROSPERO CRD42020167361

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