scholarly journals Combined Topical and Oral Antimicrobial Therapy for the Eradication of Methicillin-ResistantStaphylococcus aureus(Mrsa) Colonization in Hospitalized Patients

2002 ◽  
Vol 13 (5) ◽  
pp. 287-292 ◽  
Author(s):  
Scott K Fung ◽  
Marie Louie ◽  
Andrew E Simor
Keyword(s):  
Medical Devices ◽  
Antimicrobial Therapy ◽  
Chart Review ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Hospitalized Patients ◽  
Urinary Catheters ◽  
Mupirocin Ointment ◽  
Mrsa Colonization

OBJECTIVE: How to eradicate methicillin-resistantStaphylo-coccus aureus(MRSA) colonization in hospitalized patients is uncertain. We reviewed our experience with MRSA decolonization therapy in hospitalized patients.SETTING: An 1100-bed, university-affiliated tertiary care teaching hospital in Toronto, Ontario.DESIGN: Retrospective chart review of 207 adult inpatients with MRSA colonization hospitalized between February 1996 and March 1999.INTERVENTIONS: All patients with MRSA colonization were assessed for possible decolonization therapy with a combination of 4% chlorhexidine soap for bathing and washing, 2% mupirocin ointment applied to the anterior nares three times/day, rifampin (300 mg twice daily) and either trimethoprim/sulfamethoxazole (160 mg/800 mg twice daily) or doxycycline (100 mg twice daily). This treatment was given for seven days.RESULTS: A total of 207 hospitalized patients with MRSA colonization were identified and 103 (50%) received decolonization therapy. Patients who received decolonization therapy were less likely than untreated patientsto have intravenous (P=0.004) or urinary catheters (P<0.001), or extranasal sites of colonization (P=0.001). Successful decolonization was achieved in 90% of the 43 patients who were available for at least three months of follow-up.CONCLUSIONS: Combined topical and oral antimicrobial therapy was found to be effective in eradicating MRSA colonization in selected hospitalized patients, especially those without indwelling medical devices or extranasal sites of colonization.

Defining Success of Parathyroidectomy in Hyperparathyroidism

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P36-P36 ◽  
Author(s):  
Yalon Dolev ◽  
Martin J Black ◽  
Michael P Hier ◽  
Michael Tamilia ◽  
Richard J Payne
Keyword(s):  
Primary Hyperparathyroidism ◽  
Serum Calcium ◽  
Chart Review ◽  
Care Center ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Tertiary Care Center ◽  
The Mean ◽  
Normal Calcium

Objective To clearly define what constitutes successful parathyroidectomy in patients with primary hyperparathyroidism and to review our institution's results. Methods A retrospective chart review was conducted for consecutive patients who underwent parathyroidectomy at a university-affiliated tertiary care center between January 1998 and February 2006. Intraoperative pre- and post-excision PTH levels were recorded. PTH and calcium levels were recorded at 3 – 6 month intervals in the first 2 years and then yearly. Results 84 patients were analyzed. 50 (60%) had normal calcium and normal PTH levels following surgery, 28 (33%) had normal calcium and elevated PTH following surgery, and 6 (7%) had both elevated calcium and PTH. The mean follow-up time was 2.23 years, with a range of 0.25 to 5 years. Conclusions Surgery was successful, as indicated by normocalcemia, in 78 patients (93%). Of these 78 patients, 28 (33%) developed persistent PTH elevation without developing hypercalcemia. Other studies have studied this subgroup of patients with normalized post-operative calcium and consistently elevated PTH levels and noted that these new set points persist. Consequently, successful parathyroidectomy should be defined by serum calcium and not PTH levels.

scholarly journals Neurocognitive Changes in Tertiary Neurosyphilis: A Retrospective Chart Review

2014 ◽  
Vol 41 (4) ◽  
pp. 452-458 ◽  
Author(s):  
Philippe Beauchemin ◽  
Robert Laforce
Keyword(s):  
Chart Review ◽  
Tertiary Care ◽  
Care Facility ◽  
Public Health Problem ◽  
Retrospective Chart Review ◽  
Quality Data ◽  
Major Public Health Problem ◽  
Tertiary Care Facility ◽  
Behavioral Impairments

Context:Since the beginning of the new millennium, prevalence of syphilis has re-increased and is once again, a major public health problem. Neurosyphilis is the extension of syphilitic infection to the nervous system. It is considered by many as a cause of reversible dementia, when treated early. However, scarce data exist on the evolution of cognitive and behavioral impairments in patients affected by tertiary neurosyphilis.Objectives:The aim of this study was to explore the cognitive and behavioral changes in a cohort of patients diagnosed with neurosyphilis.Design:A retrospective study based on systematized chart review between 2000 and 2012 in a large neurological tertiary care facility.Outcome measure:Clinical evaluations by treating physicians.Results:Eighteen patients were identified with tertiary neurosyphilis. Out of this group, only two had systematic neuropsychological follow-up despite physician reports of significant and persistent cognitive and psychiatric changes. For these two cases, only slight improvements were noted in memory and executive skills while improvements in attention were marked. None of our patients had previous psychiatric history yet a large proportion developed symptoms after the infection.Conclusion:Although neurosyphilis is traditionally considered a reversible form of dementia, we found limited support for this claim in our two patients with close follow-up. Quality data on the cognitive and psychiatric changes in the rest of our cohort was dramatically lacking, and this could not be explained by absence of symptoms at presentation. Given the recrudescence of syphilis, we propose a systematic approach to the evaluation and follow-up of this disorder.

scholarly journals Results of Combined Endocyclophotocoagulation and Phacoemulsification in Patients of African Descent: A Retrospective Study

2019 ◽  
Author(s):  
Corey W. Waldman ◽  
Manishi Desai ◽  
Effie Zhu Rahman ◽  
Babak Eliassi-Rad
Keyword(s):  
Chart Review ◽  
Primary Outcome ◽  
Open Angle Glaucoma ◽  
African Descent ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Glaucoma Surgery ◽  
Exclusion Criteria ◽  
Robust Response

Abstract Background: To evaluate the outcomes of combined endocyclophotocoagulation (ECP) and phacoemusification in regards to vision, refraction, intraocular pressure, medication dependence, and complications in patients of African descent at a tertiary care glaucoma practice. Methods: A retrospective chart review including all cases of ECP combined with phacoemulsification cataract surgery from October 2015 to March 2017 was performed. Exclusion criteria consisted of patients who were not of African descent and patients with < 1 month follow up. The primary outcome measured was IOP at the latest follow-up. Results: 32 eyes of 29 patients were included in the study. Average IOP decreased from 17.30 ±6.30 mmHg preoperatively to 15.88 ±4.23 mmHg at the last post-operative visit (p = 0.301). 2/8 patients who did not demonstrate a difference in pre- and post-operative IOP changes were able to be weaned off all of their IOP lowering medications. The average follow-up was 5.05 ± 4.08 months with a range of 1 to 18 months. The average number of medications used per patient for IOP control decreased from 2.59 ±1.01 preoperatively to 1.97 ±1.38 (p = 0.045). Average visual acuity improved from 20/50 preoperatively to an average of 20/25 (p = 0.002). The post-operative complication rate was low. Conclusions: ECP combined with phacoemulsification can be effective at decreasing IOP lowering medication dependence in patients of African descent while also demonstrating variable IOP outcomes. While some patients with primary open angle glaucoma (POAG) and prior glaucoma surgery may experience a robust response to this treatment, others may not. We found that combined ECP and phacoemulsification can lead to a significantly decreased dependence on IOP lowering drops, with some patients demonstrating complete independence from drops following surgery. Although there was not a significant decrease in IOP post-operatively when analyzed collectively, larger studies may be able to find such an association. Combined ECP and phacoemulsification has been shown to be a safe combination in patients with refractive glaucoma and may be considered if a patient desires less dependence on IOP lowering drops once other first-line methods have failed, or as a bridge between conservative and more definitive surgical treatment. Keywords: Endocyclophotocoagulation, phacoemusification, African decent

Comparative Morbidity Profile of Elective vs Therapeutic Neck Dissection

2021 ◽  
pp. 019459982110089
Author(s):  
Quinn Dunlap ◽  
James Reed Gardner ◽  
Amanda Ederle ◽  
Deanne King ◽  
Maya Merriweather ◽  
...  
Keyword(s):  
Neck Dissection ◽  
Surgical Complications ◽  
Chart Review ◽  
Care Center ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Neck Surgery ◽  
Continuous Variables ◽  
Significant Difference ◽  
History Of

Objective Neck dissection (ND) is one of the most commonly performed procedures in head and neck surgery. We sought to compare the morbidity of elective ND (END) versus therapeutic ND (TND). Study Design Retrospective chart review. Setting Academic tertiary care center. Methods Retrospective chart review of 373 NDs performed from January 2015 to December 2018. Patients with radical ND or inadequate chart documentation were excluded. Demographics, clinicopathologic data, complications, and sacrificed structures during ND were retrieved. Statistical analysis was performed with χ2 and analysis of variance for comparison of categorical and continuous variables, respectively, with statistical alpha set a 0.05. Results Patients examined consisted of 224 males (60%) with a mean age of 60 years. TND accounted for 79% (n = 296) as compared with 21% (n = 77) for END. Other than a significantly higher history of radiation (37% vs 7%, P < .001) and endocrine pathology (34% vs 2.6%, P < .001) in the TND group, no significant differences in demographics were found between the therapeutic and elective groups. A significantly higher rate of structure sacrifice and extranodal extension within the TND group was noted to hold in overall and subgroup comparisons. No significant difference in rate of surgical complications was appreciated between groups in overall or subgroup analysis. Conclusion While the significantly higher rate of structure sacrifice among the TND population represents an increased morbidity profile in these patients, no significant difference was found in the rate of surgical complications between groups. The significant difference seen between groups regarding history of radiation and endocrine pathology likely represents selection bias.

Late endoscopic evaluation of the ostium size after external dacryocystorhinostomy

2020 ◽  
pp. 112067212097604
Author(s):  
Reem R Al Huthail ◽  
Yasser H Al-Faky
Keyword(s):  
Chart Review ◽  
Retrospective Chart Review ◽  
Tertiary Hospital ◽  
Nasal Endoscope ◽  
Long Term Follow Up ◽  
Mean Size ◽  
External Dacryocystorhinostomy ◽  
The Mean

Objective: To evaluate the effect of chronicity on the size of the ostium after external dacryocystorhinostomy (DCR) with intubation. Methods: Design: A retrospective chart review of patients who underwent external DCR with intubation over 10 years from January 2003 at a tertiary hospital. All patients were recruited and examined with rigid nasal endoscope. Results: A total number of 66 (85 eyes) patients were included. The mean age at the time of evaluation was 53.1 years with gender distribution of 54 females (81.8 %). The mean duration ±SD between the date of surgery and the date of evaluation was 33.2 ± 33.6 (6–118 months). Our study showed an overall anatomical and functional success of 98.8% and 95.3%, respectively. The mean size of the ostium (±SD) was 23.0 (±15.7) mm2 (ranging from 1 to 80.4 mm2). The size of the ostium was not a significant factor for failure ( p = 0.907). No statistically significant correlation was found between the long-term duration after surgery and the size of the ostium ( R: 0.025, p = 0.157). Conclusions: Nasal endoscopy after DCR is valuable in evaluating the ostium with no observed potential correlation between the long-term follow-up after surgery and the size of the ostium.

Cholecystectomy for Biliary Hyperkinesia

2019 ◽  
Vol 85 (2) ◽  
pp. 219-222 ◽  
Author(s):  
Joshua Gazzetta ◽  
Betty Fan ◽  
Paul Bonner ◽  
John Galante
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Chart Review ◽  
Gallbladder Disease ◽  
Retrospective Chart Review ◽  
Biliary Colic ◽  
Study Cohort ◽  
Final Pathology ◽  
Pathology Reports ◽  
Histologic Changes

Patients with classic biliary colic symptoms and documented gallbladder ejection fractions on the higher end of the spectrum on hepatobiliary iminoacetic acid scans with cholecystokinin stimulation are presently understudied and the benefits of cholecystectomy are unclear. To determine whether patients with biliary-type pain and biliary hyperkinesia (defined as a gallbladder ejection fractions of 80% or greater) benefit from laparoscopic cholecystectomy, a retrospective chart review encompassing five community hospitals was performed. Patients 16 years and older with diagnosed biliary hyperkinesia who underwent laparoscopic cholecystectomy between January 1, 2010 and May 31, 2015 were included. Pathology reports were reviewed for histologic changes indicating cholecystitis. Resolution of biliary colic symptoms was reviewed one to three weeks after surgery in their postoperative follow-up documentation. Within our study cohort, we found 97 patients who underwent laparoscopic cholecystectomy for biliary hyperkinesia. Within this population, 84.5 per cent of patients undergoing laparoscopic cholecystectomy for biliary hyper-kinesia had positive findings for gallbladder disease on final pathology. Of the 77 patients with data available from their first postoperative visit, 70 (90.9%) reported improvement or resolution of symptoms. Our findings suggest that symptomatic biliary hyperkinesia may be treated successfully with surgery.

Increasing Home Health Face-to-Face Certification: Impact of a Hospital-Based Intervention

2018 ◽  
Vol 30 (3) ◽  
pp. 110-115
Author(s):  
Kimberly Pelland ◽  
Emily Cooper ◽  
Alyssa DaCunha ◽  
Kathleen Calandra ◽  
Rebekah Gardner
Keyword(s):  
Chart Review ◽  
Retrospective Chart Review ◽  
Home Health ◽  
Hospitalized Patients ◽  
Post Intervention ◽  
Face To Face ◽  
Hospital Physicians ◽  
Health Agencies ◽  
Community Physician ◽  
Home Health Agencies

Medicare requires that home health patients have a face-to-face visit with a physician when services are initiated and that physicians provide certification of this encounter before home health agencies (HHAs) can be reimbursed. We assessed an intervention to increase completion of face-to-face certification by hospital physicians at discharge using a retrospective chart review. We found a shift in the source and timeliness of certification among intervention hospitals. Pre-intervention, hospital physicians completed face-to-face certifications for 18.7% of patients and community physicians completed certifications for 47.2% ( p < .001), compared with 44.4% and 24.3% ( p < .001) post-intervention. Shifting the source of certification from community to hospital physicians helped HHAs by reducing the burden of tracking down certification from community physician offices and facilitating timely care for recently hospitalized patients.

Kasai Procedure in Patients Older Than 90 Days: Worth a Cut

2021 ◽  
Author(s):  
Marie Uecker ◽  
Joachim F. Kuebler ◽  
Nagoud Schukfeh ◽  
Eva-Doreen Pfister ◽  
Ulrich Baumann ◽  
...  
Keyword(s):  
Treatment Option ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Primary Treatment ◽  
Inclusion Criteria ◽  
Bridge To Transplant ◽  
Kasai Procedure ◽  
Native Liver ◽  
Native Liver Survival

Abstract Introduction Age at Kasai portoenterostomy (KPE) has been identified as a predictive factor for native-liver survival in patients with biliary atresia (BA). Outcomes of pediatric liver transplantation (LT) have improved over recent years. It has been proposed to consider primary LT as a treatment option for late-presenting BA infants instead of attempting KPE. We present our experience with patients older than 90 days undergoing KPE. Materials and Methods A retrospective chart review of patients with BA undergoing KPE at our institution between January 2010 and December 2020 was performed. Patients 90 days and older at the time of surgery were included. Patients' characteristics, perioperative data, and follow-up results were collected. Eleven patients matched the inclusion criteria. Mean age at KPE was 108 days (range: 90–133 days). Results Postoperative jaundice clearance (bilirubin < 2 mg/dL) at 2-year follow-up was achieved in three patients (27%). Eight patients (73%) received a liver transplant at a mean of 626 days (range: 57–2,109 days) after KPE. Four patients (36%) were transplanted within 12 months post-KPE. Two patients died 237 and 139 days after KPE due to disease-related complications. One patient is still alive with his native liver, currently 10 years old. Conclusion Even when performed at an advanced age, KPE can help prolong native-liver survival in BA patients and offers an important bridge to transplant. In our opinion, it continues to represent a viable primary treatment option for late-presenting infants with BA.

scholarly journals 763. 30 Day Readmission Outcomes in Patients Over 80 Years of Age Enrolled in an Outpatient Parenteral Antibiotic Therapy (OPAT) Program

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S339-S340
Author(s):  
Kathleen R Sheridan ◽  
Joshua Wingfield ◽  
Lauren McKibben ◽  
Natalie Clouse
Keyword(s):  
Readmission Rate ◽  
Chart Review ◽  
Age Groups ◽  
Retrospective Chart Review ◽  
Model Of Care ◽  
Readmission Rates ◽  
Parenteral Antibiotic ◽  
Patient Demographics

Abstract Background OPAT is a well-established model of care for the monitoring of patients requiring long-term IV antibiotics1. We have previously reported a reduction in the 30-day readmission rate to our facility for patients managed in our OPAT program. However, little has been published to date regarding outcomes in OPAT patients over 80 years of age 2–3. Our OPAT program was established in 2013. Patients can be discharged to a facility or home to complete their course of antibiotics. Methods We conducted a retrospective chart review of all OPAT patients discharged from our facility from 2015 to 2018. Patients were divided into two groups based on age, <80 (n = 4618) and >80 (n = 562). Results Patient demographics are listed in Table 1. The overall 30-day readmission rate for patients older than 80 was 27.8%. For patients over 80 that had a follow-up ID clinic appointment, the 30-day readmission rate decreased to 15.7%. For patients younger than 80, the 30-day readmission rate was 36.0% with a decrease to 16.2% if patients were evaluated in the outpatient clinic. Figure 1. Staphylococcus Aureus was the predominant organism in both age categories. Vancomycin was the most common antibiotic used in both age groups followed by β lactams. Conclusion In general, patients aged over 80 years were more likely to be discharged to a facility to complete their antibiotic course than younger patients. These patients also were more likely to have other comorbidities. The 30-day readmission rate in each age group was relatively similar. OPAT in patients over age 80 can have similar 30-day readmission rates as for patients less than 80 years of age Disclosures All authors: No reported disclosures.

Sign in / Sign up

Export Citation Format

Share Document