scholarly journals Cohort profile: A prospective study of clinical and epidemiological characteristics of COVID-19 patients post-discharge in Tehran, Iran (Tele-COVID-19) (Preprint)

2020 ◽  
Author(s):  
Laya Jalilian Khave ◽  
Mohammad Vahidi ◽  
Dorsa Shirini ◽  
Ghazal Sanadgol ◽  
Farzad Ashrafi ◽  
...  
Keyword(s):  
Healthcare Delivery ◽  
Teaching Hospitals ◽  
Post Discharge ◽  
Discharge Data ◽  
The Mean ◽  
Hospital To Home ◽  
A Prospective Study ◽  
Epidemiological Characteristics ◽  
Severe Shortage

BACKGROUND Coronavirus disease 2019 (COVID-19) was declared a pandemic on March 11, 2020. Given the severe shortage of hospital beds leading to early discharges and insufficient patient education regarding home care routines and isolation protocols, close follow-up with patients and their immediate relatives is an integral part of care transition from hospital to home among COVID-19 patients. OBJECTIVE We designed the Tele-COVID-19 prospective cohort to follow-up COVID-19 patients in Tehran, Iran in order to help improve healthcare delivery and recording of patients’ clinical profile post-discharge. METHODS All adult patients admitted to COVID-19 wards of teaching hospitals of Tehran, Iran are eligible to participate. In the baseline wave, patients were recruited from four major hospitals from March 9, 2020 to May 20, 2020. Telephone follow-ups led by volunteer medical students were made on days 1, 2, 3, 5, 7, 10, and 14 post-discharge. Data was collected on a range of socio-demographic, epidemiological, and clinical characteristics using a standard questionnaire. RESULTS Out of 950 confirmed COVID-19 patients who were approached, 823 consented and were enrolled in the cohort (response rate = 86.6%). A total of 449 (54.5%) participants were male and the mean (SD) age of participants was 50.1 (12.6). CONCLUSIONS Tele-COVID-19 will provide the patients with sufficient education on homecare and isolation as well as medical advice on care and proper use of drugs. In addition, by preventing unnecessary hospital returns and diagnosis of household transmissions at the earliest stages, this cohort would help disease management in resource restricted settings.

scholarly journals Biological and clinical impact of hemangioblastoma-associated peritumoral cysts in von Hippel-Lindau disease

2016 ◽  
Vol 124 (4) ◽  
pp. 971-976 ◽  
Author(s):  
Kristin Huntoon ◽  
Tianxia Wu ◽  
J. Bradley Elder ◽  
John A. Butman ◽  
Emily Y. Chew ◽  
...  
Keyword(s):  
Clinical Impact ◽  
Anatomical Location ◽  
Von Hippel Lindau ◽  
Study Enrollment ◽  
Common Location ◽  
Younger Age ◽  
The Mean ◽  
A Prospective Study ◽  
Vhl Disease

OBJECT Peritumoral cysts are frequently associated with CNS hemangioblastomas and often underlie neurological morbidity and mortality. To determine their natural history and clinical impact, the authors prospectively analyzed hemangioblastoma-associated peritumoral cysts in patients with von Hippel-Lindau (VHL) disease. METHODS Patients with VHL disease who had 2 or more years of follow-up and who were enrolled in a prospective study at the National Institutes of Health were included. Serial prospectively acquired laboratory, genetic, imaging, and clinical data were analyzed. RESULTS One hundred thirty-two patients (of 225 in the VHL study with at least 2 years of follow-up) had peritumoral cysts that were followed for more than 2 years (total of 292 CNS peritumoral cysts). The mean age at study entrance was 37.4 ± 13.1 years ([mean ± SD], median 37.9, range 12.3–65.1 years). The mean follow-up was 7.0 ± 1.7 years (median 7.3, range 2.1–9.0 years). Over the study period, 121 of the 292 peritumoral cysts (41.4%) became symptomatic. Development of new cysts was associated with a larger number cysts at study enrollment (p = 0.002) and younger age (p < 0.0001). Cyst growth rate was associated with anatomical location (cerebellum cysts grew faster than spine and brainstem cysts; p = 0.0002 and p = 0.0008), younger age (< 35 years of age; p = 0.0006), and development of new neurological symptoms (p < 0.0001). Cyst size at symptom production depended on anatomical location (p < 0.0001; largest to smallest were found, successively, in the cerebellum, spinal cord, and brainstem). The most common location for peritumoral cysts was the cerebellum (184 cysts [63%]; p < 0.0001). CONCLUSIONS Peritumoral cysts frequently underlie symptom formation that requires surgical intervention in patients with VHL disease. Development of new cysts was associated with a larger number of cysts at study enrollment and younger age. Total peritumoral cyst burden was associated with germline partial deletion of the VHL gene.

Blepharochalasis:Clinical and Epidemiological Characteristics, Surgical Strategy and Prognosis-- A Retrospective Cohort Study with 93 Cases

2021 ◽  
Author(s):  
Jinqiong Zhou ◽  
Jingwen Ding ◽  
dongmei li
Keyword(s):  
Cohort Study ◽  
Lacrimal Gland ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Acute Attack ◽  
Surgical Strategy ◽  
Lacrimal Gland Prolapse ◽  
The Mean ◽  
Epidemiological Characteristics

Abstract Background: Blepharochalasis is a rare eyelid disorder but eventually leading to destructive eyelid deformation. Until now the clinical and epidemiological data is unavailable. This study aimed o report the manifestations, epidemiological characteristics and surgical strategy of a large series of blepharochalasis patients with long-term follow up, the prognosis of different clinical deformities was also investigated. Methods: This is a retrospective cohort study, included consecutive patients diagnosed with blepharochalasis in a single center. Blepharoplasty and other surgical approaches were scheduled according to the various manifestations, after a 2-year quiescent period with no recurrent attacks and exacerbation of lesions. Prognosis after surgery was recorded.Results: A total of 93 patients, with a mean follow-up of 5.29±2.07 (range: 3-10) years before surgery, and 2(range:1-4) years follow-up after surgery were included. Of all those 93 patients, 72.04% were females (67, P=0.02 ). The mean age of onset of blepharochalasis symptoms was 10.09±3.32 (range: 5-16) years, mostly (83.87%) consisted with the onset of the puberty. With the average of 5 times per year, the mean duration of each acute attack was 28.12±1.01 (rang: 2-192)hours. The mean duration from the onset of acute attack to the quiescent stage lasted for 7.33 ± 2.05 (range: 4-10) years. Most of the cases (88, 94.62%) had more than one manifestation at the end of the last follow-up before surgery. Ptosis (48.39%) was the most common deformity. Followed by lacrimal gland prolapse (44.09%), canthal angle deformity(29.04%), lower eyelid retraction(17.20%). After surgery, the functional and cosmetically acceptable results were achieved in all patients except for overcorrection in 5 (11.90%) patients with ptosis. The lacrimal gland prolapse recurred in two (4.00%) patients at 29 and 36 months after surgery. Conclusions: Blepharochalasis is rare but mostly occurred in adolescent females. The process from the onset to the stable stage usually lasted for about 7 years, might be associated with the onset of puberty. Surgical management of clinical manifestations after at least 2-year follow-up period of quiescence would be appropriate in order to observe a great plastic effect, low overcorrection and recurrence rate.

Abstract 202: The NIH Stroke Scale Can Miss Improvement After IV tPA For Acute Ischemic Stroke

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Elisabeth B Marsh ◽  
Erin Lawrence ◽  
Rafael H Llinas
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Post Treatment ◽  
Functional Improvement ◽  
Stroke Severity ◽  
Post Discharge ◽  
Significant Difference ◽  
The Mean ◽  
Iv Tpa

Background and Objective: The National Institute of Health Stroke Scale (NIHSS) is the most commonly used metric to evaluate stroke severity and improvement following intervention. Despite its advantages as a rapid, reproducible screening tool, it may be too insensitive to adequately capture functional improvement following treatment. We evaluated the difference in rate of improvement by previously accepted criteria (change of ≥4 NIHSS points) versus physician documentation in patients receiving IV tissue plasminogen activator (tPA) for acute ischemic stroke. Methods: Prospectively collected data on all patients receiving IV tPA over a 15 month period were retrospectively reviewed. NIHSS 24 hours post-treatment and on discharge were extrapolated based on examination and compared to NIHSS on presentation. NIHSS scores at post-discharge follow-up were also recorded. Two reviewers evaluated the medical record and determined improvement based on physician documentation. Using tests of proportion, ‘significant improvement’ by NIHSS was compared to physician documentation at each time point. Results: Forty-one patients were treated with IV tPA. The mean admission NIHSS was 8.6 and improved to 6.4 24 hours post-tPA. Twenty-nine of 41 patients (79%) were “better” by documentation; however only 11/41 (27%) met NIHSS criteria for improvement (p compared to documentation <0.001). On discharge, 20/41 patients (49%) met NIHSS criteria for improvement; however a significant difference between physician documentation remained (p=0.04). The mean post-discharge follow-up NIHSS score was 2.0. 20/21 patients (95%) were “better” compared to 16/21 (76%) meeting NIHSS criteria (p=0.08). Conclusion: The NIHSS may inadequately capture functional improvement post-treatment, especially in the days immediately following intervention.

Securing discharge follow-up appointments in a women’s cancer program.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 81-81
Author(s):  
Carole Dalby ◽  
Susana M. Campos ◽  
Lisa Doverspike ◽  
Melissa Spinks ◽  
Joseph O. Jacobson
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Outpatient Setting ◽  
Outpatient Services ◽  
Post Discharge ◽  
Post Intervention ◽  
Discharge Data ◽  
Patient Dissatisfaction ◽  
Hospital Readmission Rates

81 Background: Ensuring patients have a follow-up appointment scheduled prior to discharge is one of several key interventions shown to reduce hospital readmission rates (Hansen L.O., Young R.S., Hinami K., et al. [2011, October]. Interventions to reduce 30-day rehospitalization: a systematic review. Annals of Internal Medicine, 155[8], 520-528). Lack of follow-up diminishes continuity between the inpatient and outpatient setting, can lead to patient dissatisfaction, as well as delays in proposed therapy. Methods: A three-month review of discharge data highlighted 49% of Women’s Cancer Gynecologic patients at an academic medical center were discharged from the hospital without securing a follow-up appointment. A multidisciplinary team involved in the scheduling process was assembled and determined failure to schedule appointments was attributed to a lack of communication between the inpatient and outpatient services, a complicated scheduling process, as well as ambiguity regarding when patient’s should return. Several rapid PDSA cycles were implemented over a three month period of time. The intervention created a standardized electronic template, including the establishment of standard time frames for follow-up appointments post discharge (7 to 10 days). The template details all required scheduling elements such as services requested, required laboratory studies, and patient preferences. Within the electronic template is the ability to directly email essential staff through a centralized email address embedded within the form. Staff engaged through reviewing of data, identification of the importance of securing a follow-up appointment, and weekly huddles. Results: Post intervention, the rate of compliance of scheduled discharge follow-up appointments rose from 49% to 87%. Staff reported high satisfaction with the new process, highlighting its simplicity and efficiency. Conclusions: Securing a follow-up appointment prior to discharge is feasible as evidence by increased compliance from baseline 49% to 87%. Future endeavors will implement this process across other disease programs in hopes of obtaining similar results.

Attachment-oriented Endoscopic Surgical Strategy for Sinonasal Inverted Papilloma

2008 ◽  
Vol 22 (6) ◽  
pp. 629-634 ◽  
Author(s):  
Roee Landsberg ◽  
Oren Cavel ◽  
Yoram Segev ◽  
Avi Khafif ◽  
Dan M. Fliss
Keyword(s):  
Frozen Section ◽  
Attachment Site ◽  
Nasolacrimal Duct ◽  
Surgical Strategy ◽  
Nasolacrimal Duct Stenosis ◽  
The Mean ◽  
The One ◽  
A Prospective Study ◽  
Duct Stenosis

Background It is well documented that inverted papillomas (IP) have a localized attachment site. Still, instead of concentrating on the attachment site, endoscopic surgeons often perform an extended resection similar to the one achieved after external surgery. Objective Our objective was to evaluate an attachment-oriented endoscopic surgical strategy and to determine IP attachment diameter and location. Methods A prospective study was conducted. Thirty-three consecutive patients who underwent endoscopic IP excision (2001-2007) were enrolled. Thirty patients had adequate follow-up. Attachment diameters were measured in 25/33 patients. Surgery included debulking, identifying the precise mucosal attachment site, subperiosteal dissection and excision of the attachment, frozen section control, and resection/drilling of underlying bone. Results The mean measured attachment diameter (n = 25) was 8.4 ± 6 mm (range, 3-23 mm). Attachment locations included maxillary sinus (39%), ethmoid sinus (21%), nasal cavity (21%), frontal sinus (6%), sphenoid sinus (6%), lamina papyracea (3%), and cribriform plate (3%). The mean follow-up (n = 30) was 40 ± 21 months. Three patients had Krouse stage 1, 10 patients had stage 2, and 17 patients had stage 3. Nine patients had undergone previous surgeries. After attachment-oriented endoscopic surgery, three patients had persistent disease. Nasolacrimal duct stenosis was the only complication (n = 1). Conclusion Even advanced IP have small attachments. Their Identification facilitates efficacious resection with minimal morbidity.

Giant Cell Tumours of Tendon Sheath: Classification and Recurrence Rate

2001 ◽  
Vol 26 (1) ◽  
pp. 72-75 ◽  
Author(s):  
M. M. AL-QATTAN
Keyword(s):  
Prospective Study ◽  
Giant Cell ◽  
Giant Cell Tumour ◽  
Tendon Sheath ◽  
Type I ◽  
Type Ii ◽  
Giant Cell Tumours ◽  
The Mean ◽  
A Prospective Study

Forty-three consecutive cases of giant cell tumour of tendon sheath were included in a prospective study. The tumours were classified into two main types, depending on whether the entire tumour was, or was not, surrounded by one pseudocapsule as assessed by the surgeon during surgery. Each type was then sub-classified according to the thickness of the capsule, lobulation of the tumour, the presence of satellite lesions, and the diffuse or multicenteric nature of the tumour: these factors were also assessed by the surgeon. The mean follow-up period was 4 (range, 2–6) years. None of the type I tumours ( n=30) recurred, but recurrence occurred in five out of 13 type II tumours. Second recurrences were seen with type II B and C, but not type II A tumours.

scholarly journals Evaluation of functional outcome following ORIF of bimalleolar fractures of the ankle-A prospective study of 30 patients

2020 ◽  
Vol 11 (4) ◽  
pp. 6051-6055
Author(s):  
Yeshwanth subash ◽  
Vishnu S ◽  
Damodharan
Keyword(s):  
Functional Outcome ◽  
Functional Outcomes ◽  
Surgical Intervention ◽  
Early Mobilization ◽  
Foot And Ankle ◽  
The Mean ◽  
American Orthopaedic ◽  
A Prospective Study ◽  
Mean Time

Bimalleolar fractures are common injuries, and stable fracture patterns can be treated conservatively, while complicated, unstable fractures would require surgical intervention. This study aimed to evaluate the functional outcome following ORIF (Open reduction and internal fixation) of these fractures. This was a study of 30 patients with bimalleolar fractures who presented between January 2013 to January 2016 treated with ORIF with a follow-up period of 3 years. Functional outcome was performed with the AOFAS (American Orthopaedic Foot and ankle society) score. The mean age of the patients was 41.6 years. There was a female preponderance seen in our study with the left side being more commonly affected. The mean time to fracture union was 12.13 weeks, and we had excellent outcomes in 18 patients, good in 10, while two patients had a fair result. We did not lose any of our patients to follow up. All of our patients were happy with the functional outcome achieved. No significant complications were seen in our study. ORIF in bimalleolar fractures enables restoration of the ankle mortise to an anatomical position and facilitates early mobilization of the ankle resulting in good functional outcomes.

scholarly journals Treatment of Insertional Achilles Tendinopathy With Ultrasound-Guided Intrabursal Retrocalcaneal Hyaluronic Acid Injection - A Prospective Study

2020 ◽  
Author(s):  
Omer Slevin ◽  
David Segal ◽  
Nissim Ohana ◽  
Eugene Kots ◽  
Viktor Feldman ◽  
...  
Keyword(s):  
Hyaluronic Acid ◽  
Univariate Analysis ◽  
Achilles Tendinopathy ◽  
Ultrasound Guided ◽  
Functional Scores ◽  
Rank 2 ◽  
The Mean ◽  
A Prospective Study ◽  
Insertional Achilles Tendinopathy

Abstract Background: Insertional Achilles tendinopathy (IAT) is a chronic degenerative enthesopathy involving fibrocartilage changes that resemble osteoarthritic changes in articular cartilage. Thus, our primary goal was to evaluate the effect of hyaluronic acid (HA) injections on IAT. Methods: Fifteen IAT ankles (14 patients) were treated with three consecutive weekly ultrasound-guided retrocalcaneal intrabursal injections of hylan G-F 20 (Synvisc®). Patients answered the "Victorian Institute of Sport Assessment – Achilles" (VISA-A) questionnaire before every injection and on 1 month and 6 months follow-up visits. Univariate analysis was performed to identify differences in functional scores. Results: The mean (VISA-A) score improved significantly following HA injections from 34.8 ± 15.2 (range, 11-63) points before the first injection to 53.6 ± 20.9 (range, 15-77) points after 1 month, and 50.7 ± 18.6 (20-75) points after 6 months. No adverse drug reactions were noted.Conclusions: Three consecutive ultrasound-guided intrabursal retrocalcaneal HA injections were found in our cohort to be beneficial in treating IAT.Trial registration: NCT02368561. Registered 23 February 2015. https://clinicaltrials.gov/ct2/show/NCT02368561?term=insertional+achilles&draw=2&rank=2

scholarly journals Risk of Complications in Spine Surgery: A Prospective Study

2015 ◽  
Vol 9 (1) ◽  
pp. 20-25 ◽  
Author(s):  
Rodolfo Casimiro Reis ◽  
Matheus Fernandes de Oliveira ◽  
José Marcus Rotta ◽  
Ricardo Vieira Botelho
Keyword(s):  
Risk Factors ◽  
Prospective Study ◽  
Spine Surgery ◽  
Absolute Risk ◽  
Surgical Site Infections ◽  
Spine Instrumentation ◽  
Increased Risk ◽  
The Mean ◽  
A Prospective Study ◽  
Epidemiological Characteristics

Purpose : Complications are the chief concern of patients and physicians when considering spine surgery. The authors seek to assess the incidence of complications in patients undergoing spine surgery and identify risk factors for their occurrence. Methods : Prospective study of patients undergoing spine surgery from 1 February 2013 to 1 February 2014. Epidemiological characteristics and complications during the surgical hospitalization were recorded and analyzed. Results : The sample comprised 95 patients (mean age, 59 years). Overall, 23% of patients were obese (BMI =30). The mean BMI was 25.9. Approximately 53% of patients had comorbidities. Complications occurred in 23% of cases; surgical site infections were the most common (9%). There were no significant differences between patients who did and did not develop complications in terms of age (60.6 vs 59.9 years, p = 0.71), sex (56% female vs 54% female, p = 0.59), BMI (26.6 vs 27.2, p = 0.40), or presence of comorbidities (52% vs 52.8%, p = 0.87). The risk of complications was higher among patients submitted to spine instrumentation than those submitted to non-instrumented surgery (33% vs 22%), p=0.8. Conclusion : Just over one-quarter of patients in the sample developed complications. In this study, age, BMI, comorbidities were not associated with increased risk of complications after spine surgery. The use of instrumentation increased the absolute risk of complications.

Recurrent spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension: a prospective study

2003 ◽  
Vol 99 (5) ◽  
pp. 840-842 ◽  
Author(s):  
Wouter I. Schievink ◽  
M. Marcel Maya ◽  
Mary Riedinger
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Hypotension ◽  
Surgical Repair ◽  
Csf Leak ◽  
Content Type ◽  
Cerebrospinal Fluid Leaks ◽  
The Mean ◽  
A Prospective Study ◽  
Fine Print

Object. Intracranial hypotension due to a spontaneous spinal cerebrospinal fluid (CSF) leak is an increasingly recognized cause of postural headaches, but reliable follow-up data are lacking. The authors undertook a study to determine the risk of a recurrent spontaneous spinal CSF leak. Methods. The patient population consisted of a consecutive group of 18 patients who had been evaluated for consideration of surgical repair of a spontaneous spinal CSF leak. The mean age of the 15 women and three men was 38 years (range 22–55 years). The mean duration of follow up was 36 months (range 6–132 months). The total follow-up time was 654 months. A recurrent spinal CSF leak was defined on the basis of computerized tomography myelography evidence of a CSF leak in a previously visualized but unaffected spinal location. Five patients (28%) developed a recurrent spinal CSF leak; the mean age of these four women and one man was 36 years. A recurrent CSF leak developed in five (38%) of 13 patients who had undergone surgical CSF leak repair, compared with none (0%) of five patients who had been treated non-surgically (p = 0.249). The recurrent leak occurred between 10 and 77 months after the initial CSF leak, but within 2 or 3 months of successful surgical repair of the leak in all patients. Conclusions. Recurrent spontaneous spinal CSF leaks are not rare, and the recent successful repair of such a leak at another site may be an important risk factor.

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