Trends in Pediatric MRI sedation/anesthesia at a tertiary medical center over time

2021 ◽  
Author(s):  
Amy E. Vinson ◽  
James Peyton ◽  
Anna Kordun ◽  
Steven J. Staffa ◽  
Joseph Cravero
Keyword(s):  
Medical Center ◽  
Pediatric Mri ◽  
Over Time

scholarly journals Clinical and echocardiographic trends in percutaneous balloon mitral valvuloplasty

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Ofir Koren ◽  
Asaf Israeli ◽  
Ehud Rozner ◽  
Nassem Darawshy ◽  
Yoav Turgeman
Keyword(s):  
Heart Failure ◽  
Medical Center ◽  
Success Rates ◽  
Mitral Valvuloplasty ◽  
Percutaneous Balloon Mitral Valvuloplasty ◽  
Developing Heart ◽  
Percutaneous Balloon ◽  
Study Population ◽  
Procedural Success ◽  
Over Time

Abstract Background The prevalence of Rheumatic Mitral Stenosis (MS) has significantly changed over the last decades. We intend to examine patient demographics, Echocardiographic characteristics, procedural success rates, and complications throughout 30-years. Methods We conducted a single-center descriptive observational study. The study population consists of patients undergone percutaneous balloon mitral valvuloplasty (PBMV) at Emek Medical Center in Israel from January 1990 to May 2019. Results Four hundred seventeen patients underwent PBMV during the study period and were eligible for the study. Age did not change significantly over time (p = 0.09). The prevalence of Male and patients who were smoking and had multiple comorbidities such as hypertension, dyslipidemia, ischemic heart disease, and chronic kidney disease became increases over time (p = 0.02, p = 0.02, p = 0.001, p = 0.01, p = 0.02, and p = 0.001, respectively). Wilkins score and all its components increased over time, and the total score was higher in females (p = 0.01). Seventy-nine (18.9%) patients had complications. The rate of complications did not change over decades. Patients with Wilkins score > 8, post-procedural MR of ≥2, and post-procedural MVA < 1.5 had the highest risk for the need of Mitral valve replacement (MVR) surgery in 2 years following PBMV (3.64, 4.03, 2.44, respectively, CI 95%, p < .0001 for all). The median time in these patients was 630 days compared to 4–5 years in the entire population. Patients with Post-procedural MR of ≥2 and post-procedural MVA < 1.5 had ten times risk for developing heart failure (HR 9.07 and 10.06, respectively, CI 95%, P < .0001). Conclusion Our research reveals trends over time in patients’ characteristics and echocardiographic features. Our study population consists of more male patients with multiple comorbidities and more complex and calcified valvular structures in the last decade. Wilkins score > 8, post-procedural MR of ≥2, and post-procedural MVA < 1.5 cm2 were in-depended predictors for the time for surgery and heart failure hospitalization.

Natural course of untreated cluster headache: A retrospective cohort study

Cephalalgia ◽  
2017 ◽  
Vol 38 (4) ◽  
pp. 655-661 ◽  
Author(s):  
Mi Ji Lee ◽  
Hyun Ah Choi ◽  
Jong Hwa Shin ◽  
Hea Ree Park ◽  
Chin-Sang Chung
Keyword(s):  
Cluster Headache ◽  
Disease Duration ◽  
Medical Center ◽  
Natural Course ◽  
Duration Of Disease ◽  
Lost To Follow Up ◽  
Active Patients ◽  
Single Predictor ◽  
Over Time

Objective To determine the natural course of cluster headache. Methods We screened patients with cluster headache who were diagnosed at Samsung Medical Center and lost to follow-up for ≥5 years. Eligible patients were interviewed by phone about the longitudinal changes in headache characteristics and disease course. Remission was defined as symptom-free 1) for longer than twice the longest between-bout period and 2) for ≥5 years. Results Forty-two patients lost to follow-up for mean 7.5 (range, 5.0–15.7) years were included. The length of the last bout did not differ from the first one, while the last between-bout period was longer than the first one ( p = 0.012). Characteristics of cluster headache decreased over time: Side-locked unilaterality (from 92.9% to 78.9%), seasonal and circadian rhythmicity (from 63.9% to 60.9% and from 62.2 to 40.5%, respectively), and autonomic symptoms (from 95.2% to 75.0%). Remission occurred in 14 (33.3%) patients at a mean age of 42.3 (range, 27–65) years, which was not different from the age of last bouts in active patients ( p = 0.623). There was a trend for more seasonal and circadian predilection at baseline in the active group ( p = 0.056 and 0.063, respectively) and fewer lifetime bouts and shorter disease duration in patients in remission ( p = 0.063 and 0.090). Conclusions This study first shows the natural courses of cluster headache. Features of cluster headache become less prominent over time. Remission occurred regardless of age. Although no single predictor of remission was found, our data suggest that remission of cluster headache might not be a consequence of more advanced age, longer duration of disease, or accumulation of lifetime bouts.

Growth and Management of Repaired Complete Tracheal Rings after Slide Tracheoplasty

2019 ◽  
Vol 161 (1) ◽  
pp. 164-170 ◽  
Author(s):  
Lyndy J. Wilcox ◽  
Claudia Schweiger ◽  
Catherine K. Hart ◽  
Alessandro de Alarcon ◽  
Nithin S. Peddireddy ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Balloon Dilation ◽  
Case Series ◽  
Slide Tracheoplasty ◽  
Time Period ◽  
Academic Medical ◽  
Operative Notes ◽  
Over Time

ObjectiveThis study documents the growth and course of repaired complete tracheal rings over time after slide tracheoplasty.Study DesignCase series with review.SettingTertiary pediatric academic medical center.Subjects/MethodsMedical records of pediatric patients with confirmed tracheal rings on bronchoscopy who underwent slide tracheoplasty between January 2001 and December 2015 were reviewed. Patients who had operative notes documenting tracheal sizing over time were included. Exclusion criteria included tracheal stenosis not caused by complete tracheal rings, surgical repair prior to presentation at our institution, or lack of adequate sizing information. The postoperative follow-up was examined and airway growth over time documented.ResultsOf 197 slide tracheoplasties performed during the study time period, 139 were for complete tracheal rings, and 40 of those children met inclusion criteria. The median age at time of surgery was 7 months, and the median initial airway size was 3.9 mm (n = 34). The median growth postoperatively was 1.9 mm over a median follow-up period of 57 months (0.42 mm/year), which is similar to growth rates of unrepaired complete tracheal rings ( P = .53). Children underwent a median of 10 postoperative endoscopies, with time between endoscopies increasing further out from surgery. The most commonly performed adjunctive procedure was balloon dilation.ConclusionsThis is the first study documenting continued growth of repaired complete tracheal rings after slide tracheoplasty. Postoperative endoscopic surveillance ensures adequate growth. Intervals between airway endoscopies can be increased as the child gets older, as the airway increases in size, and as long as symptoms are minimal.

A decade of health assessments in Appalachia

2017 ◽  
Vol 30 (4) ◽  
pp. 312-318
Author(s):  
E. Scott Sills ◽  
Xiang Li
Keyword(s):  
Emergency Services ◽  
Performance Metrics ◽  
Medical Center ◽  
Stroke Care ◽  
Assessment Instrument ◽  
Additional Stress ◽  
Process Of Care ◽  
Underserved Area ◽  
Content Type ◽  
Over Time

Purpose The purpose of this paper is to describe standardized clinical process of care and quality performance metrics at Roane Medical Center (RMC) and compare data from 2005 to 2015. Design/methodology/approach Information was extracted from a nationwide sample of short-term acute care hospitals using the Hospital Quality Alliance (HQA) database, evaluating multiple parameters measured at RMC. HQA data from RMC were matched against state and national benchmarks; findings were also compared with similar reports from the same facility in 2005. Findings Information collected by HQA expanded substantially in ten years and queried different parameters over time, thus exact comparisons between 2005 and 2015 cannot be easily calculated. Nevertheless, analysis of process of care data for 2015 placed RMC at or above state- and national-average performance in 64.9 percent (24 of 37) and 56.5 percent (26 of 46) categories, respectively. RMC registered superior process of care scores in heart failure care, pneumonia care, thrombus prevention and care, as well as stroke care. While RMC continues to perform favorably against state and national reference groups, the differences between RMC vs state and RMC vs national averages using current reporting metrics were both statistically smaller in 2015 compared to 2005 (p<0.05). Research limitations/implications Perhaps the most significant interval health event for the RMC service area since 2005 was a coal ash spill at the nearby Tennessee Valley Authority facility in December 2008. Although reports on environmental and health effects following one of the largest domestic industrial toxin releases reached a number of important conclusions, the consequences for RMC in terms of potential added clinical burden on emergency services and impact on chronic health conditions have not been specifically studied. This could explain data reported on emergency department services at RMC but additional research will be needed to establish causality. Practical implications While tracking of care processes at all US hospitals will be facilitated by refinements in HQA tools, longitudinal evaluations for any specific unit will be more meaningful if the assessment instrument undergoes limited change over time. Social implications Appalachia remains one of several regions in the USA often identified as medically underserved. Hospitals here have confronted the challenge of diminished reimbursement, high expenses, limited staffing and other financial hardships in a variety of ways. Since the last published report on RMC, a particularly severe global recession has placed additional stress on organizations offering crucial health services in the region. Originality/value As a follow-up study to track potential changes which have been registered in the decade 2005-2015, this is the first report to provide original, longitudinal analysis on RMC, an institution operating in a rural and underserved area.

scholarly journals Assessing Change Over Time in Voice Handicap and Voice-Related Perceived Control Using Ecological Momentary Assessment

2019 ◽  
Vol 128 (9) ◽  
pp. 829-837 ◽  
Author(s):  
Viann N. Nguyen-Feng ◽  
Patricia A. Frazier ◽  
Ali Stockness ◽  
Scott Lunos ◽  
Alexis N. Hoedeman ◽  
...  
Keyword(s):  
Ecological Momentary Assessment ◽  
Perceived Control ◽  
Medical Center ◽  
Voice Disorders ◽  
Completion Rates ◽  
Cross Sectional ◽  
Modeling Analysis ◽  
Ecological Momentary ◽  
Momentary Assessment ◽  
Over Time

Objectives: Voice handicap has generally been measured at a single timepoint. Little is known about its variability from hour to hour or day to day. Voice handicap has been shown to be negatively related to voice-related perceived control in cross-sectional studies, but the within-person variability in voice-related perceived control is also unknown. We aimed to use ecological momentary assessment (EMA) to (1) assess the feasibility of EMA to examine daily voice handicap and voice-related perceived control in patients with voice disorders, (2) measure within-person variability in daily voice handicap and perceived control, and (3) characterize temporal associations (eg, correlations over time) between daily voice handicap and perceived control. Methods: Adults with voice problems were recruited from a large public university medical center in the Midwest. They completed baseline measures, followed by twice-daily assessments, including selected items measuring voice handicap and perceived control, and then repeated the baseline measures at the final timepoint. Feasibility was assessed via completion rates. Within-person variability was measured using standard deviations. Temporal associations were characterized using simulation modeling analysis. Results: EMA of voice handicap and perceived control was feasible in this patient population. Momentary voice handicap varied more than perceived control, though both were variable. Multiple patterns of temporal associations between daily voice handicap and perceived control were found. Conclusions: These findings identified important variability in (1) measures of voice handicap and perceived control and (2) their associations over time. Future EMA studies in patients with voice disorders are both feasible and warranted.

Initial Experience of an Anesthesiology-based Service for Perioperative Management of Pacemakers and Implantable Cardioverter Defibrillators

2015 ◽  
Vol 123 (5) ◽  
pp. 1024-1032 ◽  
Author(s):  
G. Alec Rooke ◽  
Stefan A. Lombaard ◽  
Gail A. Van Norman ◽  
Jörg Dziersk ◽  
Krishna M. Natrajan ◽  
...  
Keyword(s):  
Medical Center ◽  
Strong Support ◽  
Retrospective Chart Review ◽  
High Volume ◽  
Management Plan ◽  
Implantable Cardioverter Defibrillators ◽  
Device Management ◽  
Number Of Patients ◽  
Cardioverter Defibrillators ◽  
Over Time

Abstract Background Management of cardiovascular implantable electronic devices (CIEDs), including pacemakers and implantable cardioverter defibrillators, for surgical procedures is challenging due to the increasing number of patients with CIEDs and limited availability of trained providers. At the authors’ institution, a small group of anesthesiologists were trained to interrogate CIEDs, devise a management plan, and perform preoperative and postoperative programming and device testing whenever necessary. Methods Patients undergoing surgery between October 1, 2009 and June 30, 2013 at the University of Washington Medical Center were included in a retrospective chart review to determine the number of devices actively managed by the Electrophysiology/Cardiology Service (EPCS) versus the Anesthesiology Device Service (ADS), changes in workload over time, surgical case delays due to device management, and errors and problems encountered in device programming. Results The EPCS managed 254 CIEDs, the ADS managed 548, and 227 by neither service. Over time, the ADS providers managed an increasing percentage of devices with decreasing supervision from the EPCS. Only two CIEDs managed by the ADS required immediate assistance from the EPCS. Patients who were unstable postoperatively were referred to the EPCS. Although numerous issues in programming were encountered, primarily when restoring demand pacing after programming asynchronous pacing for surgery, no patient harm resulted from ADS or EPCS management of CIEDs. Conclusions An ADS can provide safe CIED management for surgery, but it requires specialized provider training and strong support from the EPCS. Due to the complexity of CIED management, an ADS will likely only be feasible in high-volume settings.

scholarly journals Treatment of Asymptomatic Bacteriuria after Implementation of an Inpatient Urine Culture Algorithm in the Electronic Medical Record

Pharmacy ◽  
2021 ◽  
Vol 9 (3) ◽  
pp. 138
Author(s):  
Dianne Osiemo ◽  
Danny K. Schroeder ◽  
Donald G. Klepser ◽  
Trevor C. Van Schooneveld ◽  
Andrew B. Watkins ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Antibiotic Treatment ◽  
Urine Culture ◽  
Medical Center ◽  
Academic Medical Center ◽  
Asymptomatic Bacteriuria ◽  
Provider Education ◽  
Quasi Experimental ◽  
Culture Algorithm ◽  
Over Time

Ordering urine cultures in patients without pyuria is associated with the inappropriate treatment of asymptomatic bacteriuria (ASB). In 2015, our institution implemented recommendations based on practice guidelines for the management of ASB and revised the urine culture ordering process to limit cultures in immunocompetent patients without pyuria. The purpose of this study was to determine how the treatment of ASB has changed over time since altering the urine culture ordering process to reduce unnecessary cultures at an academic medical center. A quasi-experimental study was conducted for inpatients with urine cultures from January to March of 2014, 2015, 2016 and 2020. The primary outcome was the antibiotic treatment of asymptomatic bacteriuria for over 24 h. The secondary outcomes were the total days of antibiotic therapy, type of antibiotic prescribed and overall urine culture rates at the hospital. A total of 200 inpatients with ASB were included, 50 at random from each year. In both 2014 and 2015, 70% of the patients with ASB received antibiotic treatment. Antibiotics were prescribed to 68% and 54% of patients with ASB in 2016 and 2020, respectively. The average duration of therapy decreased from 5.12 days in 2014 to 3.46 days in 2020. Although the urine cultures were reduced, there was no immediate impact in the prescribing rates for patients with ASB after implementing this institutional guidance and an altered urine culture ordering process. Over time, there was an observed improvement in prescribing and the total days of antibiotic therapy. This could be attributed to increased familiarity with the guidelines, culture ordering practices or improved documentation. Based on these findings, additional provider education is needed to reinforce the guideline recommendations on the management of ASB.

Mandatory Child Life Consultation and Its Impact on Pediatric MRI Workflow in an Academic Medical Center

2015 ◽  
Vol 12 (6) ◽  
pp. 594-598 ◽  
Author(s):  
Daniel J. Durand ◽  
Mollie Young ◽  
Paul Nagy ◽  
Aylin Tekes ◽  
Thierry A.G.M. Huisman
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Child Life ◽  
Academic Medical ◽  
Pediatric Mri

Transfusion Practice in the Intensive Care Unit: A Ten-Year Analysis.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 2111-2111
Author(s):  
Giora Netzer ◽  
Xinggang Liu ◽  
Anthony Harris ◽  
Bennett Edelman ◽  
John Hess ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Single Unit ◽  
Medical Center ◽  
Transfusion Practice ◽  
Transfusion Strategy ◽  
Time Period ◽  
The Mean ◽  
Restrictive Transfusion Strategy ◽  
Over Time

Abstract Abstract 2111 Poster Board II-88 Introduction: Since the 1990s, there has been increasing evidence to support a restrictive transfusion strategy in the intensive care unit. While prior studies have evaluated transfusion practice in the short term, the impact of the Transfusion Requirements in Critical Care (TRICC) recommendations and related guidelines over the course of a prolonged time period has not been evaluated. We describe and assess transfusion practice during the period 1997-2007 in a large, academic medical center medical intensive care unit (MICU). Patients and Methods: We conducted a single center, retrospective, observational study of 3533 patients with single admissions to the University of Maryland Medical Center MICU between 1997 and 2007. Patients with acute coronary syndromes, hemorrhage and hemoglobinopathies were excluded, as were patients less than 13 years of age. Baseline characteristics of transfused and non-transfused patients were compared. We described the mean MICU admission hemoglobin (Hgb) levels, percentages of patients transfused as a whole and by MICU admission Hgb strata, mean pre-transfusion Hgb levels in transfused patients and nadir Hgb in the non-transfused, proportion of patients transfused with pre-transfusion Hgb<7.0 g/dL, mean number of units transfused in patients receiving transfusion, and the proportion of single unit transfusion episodes over time. Changes over 9 intervals of time between 1997-2007 were assessed with linear or logistic regression. Results: MICU admission Hgb did not change in any important way over the study period (-0.022 g/dL per interval, 95% CI -0.0051–0.007, p=0.13). The proportion of transfused patients decreased over time from 31.0% in 1997-1998 to 18.0% in 2006-2007 (p<0.001). The strongest and most consistent evidence of a steep decline in percentage of patients transfused was in the first half of the decade studied, among patients whose MICU admission Hgb levels were ≥7.0 g/dL and <10.0 g/dL. Among patients receiving transfusion, the mean pre-transfusion Hgb decreased over time from 7.9±1.3 to 7.3±1.3 g/dL (p<0.001). The nadir Hgb in non-transfused patients also decreased from a mean Hgb 11.2±2.2 g/dL in 1997-1999 to Hgb10.4±2.3 in 2006–2007 (p<0.001). The mean number of units transfused decreased during this time period from 4.3 to 3.0 units per patient transfused (p<0.001). The proportion of patients transfused at Hgb<7.0 g/dL increased by an absolute increment of 3.2% (95%CI: 2.1-4.3%) per interval (p<0.001), as did the proportion of single unit transfusions during the first transfusion episode with an absolute proportion of 1.4% per year (95% CI:0.2-2.6%, p=0.03) from 40.2% in 1997-1998 to 53.1% in 2006-2007. Conclusions: Between 1997 and 2007, important and sustained changes have occurred in MICU physician transfusion behavior, with overall reductions in the proportion of patients transfused, mean pre-transfusion Hgb level, and nadir Hgb level in patients who were not transfused. While physicians moved closer to the restrictive transfusion strategy reflected in guidelines and tested in a multi-center clinical trial, there may still be room for improvement. Disclosures: No relevant conflicts of interest to declare.

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