scholarly journals Esophageal, Gastric, and Duodenal Histologic Findings in Patients with Feeding Difficulties

Nutrients ◽  
2020 ◽  
Vol 12 (9) ◽  
pp. 2822
Author(s):  
Jensen Edwards ◽  
Craig Friesen ◽  
Amy Issa ◽  
Sarah Edwards
Keyword(s):  
Abdominal Pain ◽  
Retrospective Analysis ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Feeding Disorders ◽  
Feeding Intolerance ◽  
Feeding Difficulties ◽  
Feeding Program ◽  
Abnormal Pathology

Currently, there are inconsistencies in the recommendations of when to obtain an esophagogastroduodenoscopy (EGD) in children with feeding difficulties. The aim of our study was to identify EGD findings in patients presenting to a large, outpatient feeding program. Additionally, we investigated the presence of any relationship between abnormal pathology seen on biopsies (inflammation) and symptoms of feeding intolerance such as vomiting, gagging, retching, or abdominal pain. Retrospective analysis of electronic medical records (EMRs) was conducted for all new patients aged 0–17 years presenting to the Multidisciplinary Feeding Clinic. Three hundred and thirty patients (50.2%) had an EGD with complete biopsies. Of these 330 patients, biopsies revealed esophagitis in 40%, gastritis in 33.6%, and duodenitis in 15.2%. Overall, 61.21% had an abnormal pathology in at least one site. We found that children with feeding disorders commonly have esophagitis, gastritis, and/or duodenitis and that symptoms are poor predictors of pathology. This study underscores the importance of gastrointestinal evaluation as part of a multidisciplinary evaluation in patients with feeding difficulties.

scholarly journals Gastrointestinal Conditions in Children With Severe Feeding Difficulties

2019 ◽  
Vol 6 ◽  
pp. 2333794X1983853 ◽  
Author(s):  
Desiree Rivera-Nieves ◽  
Anita Conley ◽  
Keri Nagib ◽  
Kaiya Shannon ◽  
Karoly Horvath ◽  
...  
Keyword(s):  
Medical Records ◽  
Bacterial Overgrowth ◽  
Small Intestinal Bacterial Overgrowth ◽  
Feeding Disorders ◽  
Upper Endoscopy ◽  
Feeding Difficulties ◽  
Intestinal Bacterial Overgrowth ◽  
Gastrointestinal Conditions ◽  
Feeding Program ◽  
Small Intestinal

Feeding aversion in children may progress to severe feeding difficulties. While oral-motor and sensory issues are usually the leading causes, organic etiologies should be considered. This study aimed to assess the prevalence of gastrointestinal conditions in children with severe feeding difficulties. We conducted a retrospective study of 93 children requiring an intensive feeding program. The medical records, radiologic and diagnostic tests, use of gastric tube feedings, preexisting medical conditions, and medications were reviewed. Fifty-two percent (52%) had esophagitis, 26.2% gastritis, and 40.7% lactase deficiency in upper endoscopy. In those who underwent an upper endoscopy, 26% of patients that were also tested for small intestinal bacterial overgrowth were found to be positive. Allergy testing was abnormal in 56.6% of those tested, while 27.5% and 75% had abnormal gastric emptying times and pH impedance results, respectively. Constipation was present in 76.3%. Thirteen of 32 were weaned off tube feedings. We conclude that gastrointestinal conditions are common in children with feeding disorders and should be investigated prior to feeding therapy.

Erythropoiesis stimulating agent (ESA) administration at Hb <10 g/dL for chemotherapy-induced anemia (CIA) following the National Coverage Decision (NCD)

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e20627-e20627
Author(s):  
S. A. Hulnick ◽  
G. Hess ◽  
J. Hill ◽  
H. N. Viswanathan ◽  
R. J. Nordyke
Keyword(s):  
Retrospective Analysis ◽  
Cancer Patients ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Darbepoetin Alfa ◽  
Epoetin Alfa ◽  
Coverage Decision ◽  
Medicare Coverage

e20627 Background: Medicare coverage of ESA treatment for CIA was changed in 7/07 to a hemoglobin (Hb) < 10 g/dL prior to administration. We describe the proportion of ESA administrations at Hb < 10 g/dL over four quarters following the NCD. Methods: A retrospective analysis of ESA administrations from 7/07 - 6/08 using Varian and Impac electronic medical records for 304,654 cancer patients from 91 practice sites across 19 states. Episodes of ESA treatment were identified within chemotherapy episodes. A > 42 day gap in ESA use identified a completed ESA episode and a > 90 day gap in chemotherapy identified a chemotherapy episode. Hb ≤ 7 days prior to ESA administration date was identified for each ESA episode. The percent of ESA administrations at Hb < 10 g/dL was measured from Q3 07 to Q2 08 for darbepoetin alfa (DA) and epoetin alfa (EA) stratified by age. Results: For patients age ≥ 65, the percent of ESAs administered at Hb < 10 g/dL increased from Q3 07 to Q2 08 for initial and maintenance administrations. A less pronounced trend was observed in patients age < 65. Maintenance administrations at Hb < 10 g/dL in patients age < 65 were significantly lower for EA vs. DA. Conclusions: ESA administrations have been increasingly administered at Hb < 10 g/dL. A higher proportion of Medicare-eligible patients received maintenance ESA administrations at Hb < 10 g/dL. [Table: see text] [Table: see text]

scholarly journals Effects of COVID-19 on the Gut and the Liver - A Case Series of 711 Patients in New York City

2020 ◽  
Author(s):  
Sher Nazir Baig ◽  
Fuad Abaleka ◽  
Stephanie Herrera ◽  
Mina Daniel ◽  
Nigusse ◽  
...  
Keyword(s):  
New York ◽  
Abdominal Pain ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Medical Center ◽  
Laboratory Data ◽  
Case Series ◽  
Mild Degree ◽  
Digestive Disturbance ◽  
Upper Abdominal

Abstract Background As the COVID-19 epidemic is wreaking havoc with a staggering number of infections and fatalities worldwide, digestive symptoms are increasingly coming to the limelight. However, the data on the extent of gut and liver involvement has been variable and somewhat conflicting.Methods We identified 711 adults who had tested positive for COVID-19 at Richmond University Medical Center in New York between March 13 and May 13, 2020. We analyzed their clinical and laboratory data from electronic medical records.Results The average age of the patients was 60.5 years; 55% were men. 27.1% reported a gastrointestinal (GI) symptom and 56.9% had at least one abnormal liver enzyme. The most common was diarrhea with a frequency of 17.3% followed by nausea 16.2% and vomiting/anorexia 13.7%. Abdominal pain 5.6%, dysgeusia 3.2%, and GI bleeding 2.2% was the least common. Symptoms were mostly mild and lasted 3-5 days. The liver function was deranged in more than half of the patients. AST alone was elevated in 16.6%, both AST/ALT 15.7%, alkaline phosphatase 23%, and bilirubin 10%. Potential confounders were rare but included preexisting liver disease and hepatotoxic medications. Prothrombin time (PT) was mildly elevated in 13.4%. The lipase was elevated in 2.4% without upper abdominal pain. In 75%-90% of cases, liver test abnormalities were mild (1.5-3 x normal). Overall, 86.6% of patients were admitted primarily with respiratory failure and 28.5% died of their illness.Conclusions 27% of COVID-19 patients experienced a digestive disturbance and >55% showed a predominantly mild degree of liver dysfunction and cholestasis.

Electronic palliative care coordination system (EPaCCS) in practice: A useful tool?

2019 ◽  
pp. bmjspcare-2019-001897
Author(s):  
Pablo Millares Martin
Keyword(s):  
Palliative Care ◽  
Retrospective Analysis ◽  
Electronic Medical Records ◽  
Care Coordination ◽  
Medical Records ◽  
Place Of Death ◽  
Coordination System ◽  
Coordination Systems ◽  
Share Information

ObjectivesFirst, to assess if Electronic Palliative Care Coordination Systems (EPaCCS) was used by different organisations as a tool to share information; second, to assess whether there was a measurable benefit with patients dying at their preferred place of death.MethodsA retrospective analysis of the 65 decedents from last 12 months in the registered list of a single practice in Leeds was conducted.ResultsEPaCCS was present in 24 patients (36.9%). It was used by more than one organisation in 17 cases (70.9%). It facilitated death at the preferred place in 19 of the 20 cases (95%) were preferences were recorded.ConclusionsEPaCCS within the organisation was not used as widely as it could have been presumed. Having a patient with an EPaCCS in the electronic medical records did not imply there was sharing of information among the different organisations involved. Although there was a clear impact on individuals dying at their preferred place of death, preferences were not necessarily recorded in EPaCCS.

Likelihood of a Subsequent Chemotherapy Induced Nausea and Vomiting Event In Patients with Hematologic Malignancies Receiving Chemotherapy.

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3819-3819
Author(s):  
Bruce Feinberg ◽  
Lee S. Schwartzberg ◽  
James Gilmore ◽  
Sally Haislip ◽  
James Jackson ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Hematologic Malignancies ◽  
Emetogenic Chemotherapy ◽  
Nausea And Vomiting ◽  
Substantial Impact ◽  
Chemotherapy Administration ◽  
Increased Risk ◽  
Cancer Specialists

Abstract Abstract 3819 Objective: Chemotherapy induced nausea and vomiting (CINV) is a common side effect and can have a substantial impact on patient quality of life and subsequent health-related resource utilization. In addition to other risk factors including chemotherapy emetogenicity, patient age, gender, and alcohol use, patients with prior history of CINV may have an increased risk of CINV. This study assessed the increased likelihood of a subsequent CINV following a first chemotherapy administration CINV in patients with a hematologic cancer diagnosis receiving single-day low emetogenic chemotherapy (LEC), moderately emetogenic chemotherapy (MEC), or high emetogenic chemotherapy (HEC). Methods: A retrospective analysis was conducted utilizing a merged data set comprised of Georgia Cancer Specialists, Florida Cancer Specialists, and ACORN's electronic medical records databases (April 2006 – June 2010). Patients with any hematologic malignancy (those diagnosed with any leukemia, lymphoma, and/or myeloma (ICD-9-CM 200.xx-208.xx) who received at least two single-day chemotherapy administrations (oral or intravenous) and had no chemotherapy 3 months prior to first chemotherapy administration [index date] were included. Two cohorts: 1) patients with a first chemotherapy administration CINV event and 2) those with no first chemotherapy administration CINV event, were identified and followed for six months. Uncontrolled CINV events were identified through ICD-9-CM codes [nausea and vomiting (N&V)], CPT codes (hydration), rescue medications, N&V hospitalizations, and/or antiemetic therapy after last chemotherapy administration of the cycle. A multivariate logistic regression was conducted to assess the likelihood of subsequent CINV. The model controlled for differences in demographic and clinical variables between the two cohorts including age, gender, Charlson comorbidity index, number of chemotherapy administrations, days between chemotherapy administrations, anti-emetic prophylaxis use with first chemotherapy administration, and chemotherapy emetogenicity. Result: A total of 1,121 patients met the inclusion criteria; 247 (22.0%) experienced a CINV within six months. Of those patients with CINV, 68 patients (27.5%) encountered a CINV event with the first chemotherapy administration. These 68 patients were younger [55.9 (SD: 16.5) vs. 60.8 (SD: 16.1) years; p=0.016] and had fewer chemotherapy administrations [6.4 (SD: 3.0) vs. 8.1 (SD: 5.9); p=0.0189] as compared to patients with no CINV with the first chemotherapy administration. Unadjusted subsequent CINV rate was higher for patients with first chemotherapy administration CINV (33.8% vs. 17.0%; p=0.0005) as compared to patients without a CINV event during first chemotherapy administration. After controlling for differences in covariates, patients with first chemotherapy administration CINV were 2.8 times more likely to have a subsequent CINV compared to patients without a first chemotherapy administration CINV [Odds Ratio (OR): 2.84 (95% CI: 1.63 – 4.96); p=0.0002]. Conclusion: In this retrospective analysis using merged electronic medical records data, patients with hematologic malignancies receiving single-day chemotherapy who had a first chemotherapy administration CINV event were at increased risk of a subsequent CINV event versus those without a CINV event during the first chemotherapy administration. Disclosures: Jackson: Xcenda: Xcenda received funding to conduct the study. Jain:Xcenda: Xcenda received funding to conduct the study. Balu:Eisai, Inc.: Employment. Buchner:Eisai, Inc: Employment.

Adolescent Substance Use Screening Integrated With Electronic Medical Records

2014 ◽  
Author(s):  
C. McKenna ◽  
B. Gaines ◽  
C. Hatfield ◽  
S. Helman ◽  
L. Meyer ◽  
...  
Keyword(s):  
Substance Use ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Adolescent Substance Use ◽  
Adolescent Substance
Sign in / Sign up

Export Citation Format

Share Document