scholarly journals Topical Amitriptyline-Ketamine for Treatment of Rectal, Genital, and Perineal Pain and Discomfort

2012 ◽  
Vol 6;15 (6;12) ◽  
pp. 485-488
Author(s):  
Mark D. P. Davis
Keyword(s):  
Adverse Effects ◽  
Pelvic Pain ◽  
Retrospective Review ◽  
Medical Records ◽  
Academic Medical Center ◽  
The United States ◽  
High Rate ◽  
Perineal Pain ◽  
Complete Relief ◽  
Patient Reported

Background: Pain in the rectal, genital, and perineal area is a common condition treated by pain physicians. These chronic pain syndromes are therapeutically challenging because both interventional and drug therapies often are ineffective. Objectives: To determine if pelvic pain can be treated effectively with compounded topical amitriptyline-ketamine. Study Design: A retrospective review of medical records. Setting: A single academic medical center in the United States. Methods: We identified all patients treated with topical amitriptyline-ketamine from January 1, 2004, through November 28, 2011. Medical records were evaluated to determine the diagnosis for which the medication was prescribed. Treatment efficacy and any adverse effects were recorded. Results: Of the 1,068 patients who received amitriptyline-ketamine, 13 had the medication prescribed for genital, rectal, or perineal pain and had medication efficacy recorded. These patients were treated with a topical combination of amitriptyline 1-2% and ketamine 0.5%. Of these 13 patients, one (8%) had complete relief, 6 (46%) had substantial relief, 4 (31%) had some relief, and 2 (15%) had no response. One patient reported occasional irritation while using topical amitriptyline-ketamine with lidocaine; no other patients reported local or systemic adverse effects. Limitations: Retrospective review; lack of uniform system for pain grading; concurrent use of other medications. Conclusions: Topical amitriptyline-ketamine provided a high rate of pain relief with a low adverse-effect burden in patients with pelvic pain. This topical medication could offer an effective, noninvasive, nonopioid therapy for pain in the rectum, perineum, and genitals. Key words: Amitriptyline, rectal, compounded medication, genital, ketamine, pain, pelvic, perineal.

scholarly journals Morbidity after intracranial tumor surgery: sensitivity and specificity of retrospective review of medical records compared with patient-reported outcomes at 30 days

2015 ◽  
Vol 123 (4) ◽  
pp. 972-977 ◽  
Author(s):  
Christina Drewes ◽  
Lisa Millgård Sagberg ◽  
Asgeir Store Jakola ◽  
Sasha Gulati ◽  
Ole Solheim
Keyword(s):  
Sensitivity And Specificity ◽  
Retrospective Review ◽  
Medical Records ◽  
Patient Reported Outcomes ◽  
Intracranial Tumor ◽  
Neurological Deficits ◽  
Tumor Surgery ◽  
Hospital Records ◽  
Retrospective Assessment ◽  
Patient Reported

OBJECT Published outcome reports in neurosurgical literature frequently rely on data from retrospective review of hospital records at discharge, but the sensitivity and specificity of retrospective assessments of surgical morbidity is not known. The aim of this study was to elucidate the sensitivity and specificity of retrospective assessment of morbidity after intracranial tumor surgery by comparing it to patient-reported outcomes at 30 days. METHODS In 191 patients who underwent surgery for the treatment of intracranial tumors, we evaluated newly acquired neurological deficits within the motor, language, and cognitive domains. Traditional retrospective discharge data were collected by review of hospital records. Patient-reported data were obtained by structured phone interviews at 30 days after surgery. Data on perioperative medical and surgical complications were obtained from both hospital records and patient interviews conducted 30 days postoperatively. RESULTS Sensitivity values for retrospective review of hospital records as compared with patient-reported outcomes were 0.52 for motor deficits, 0.4 for language deficits, and 0.07 for cognitive deficits. According to medical records, 158 patients were discharged with no new or worsened deficits, but only 117 (74%) of these patients confirmed this at 30 days after surgery. Specificity values were high (0.97–0.99), indicating that new deficits were unlikely to be found by retrospective review of hospital records at discharge when the patients did not report any at 30 days. Major perioperative complications were all identified through retrospective review of hospital records. CONCLUSIONS Retrospective assessment of medical records at discharge from hospital may greatly underestimate the incidence of new neurological deficits after brain tumor surgery when compared with patient-reported outcomes after 30 days.

scholarly journals Chronic Pelvic Pain and Infertility Resulting from Unrecognized Retained Laminaria

2017 ◽  
Vol 2017 ◽  
pp. 1-3
Author(s):  
Wesley Nilsson ◽  
Sasha Mikhael ◽  
Jennifer Kaplan
Keyword(s):  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Transvaginal Ultrasound ◽  
Laminaria Japonica ◽  
The United States ◽  
Pathology Report ◽  
Operative Hysteroscopy ◽  
Menstrual Cycles ◽  
Patient Reported ◽  
Delayed Complications

Background. In 2013, the abortion rate in the United States was found to be 200 abortions per 1,000 live births. Of these, the CDC estimates that nearly 49% were performed using unsafe measures. Even when these procedures are safely performed, patients are at risk for immediate or delayed complications. In second-trimester terminations, mechanical dilation with an osmotic dilator is common to allow for delivery of the fetus. The Japanese seaweed Laminaria japonica is used to achieve this purpose. Case. A 28-year-old primigravida presented with chronic pelvic pain and infertility. She had irregular menstrual cycles and reported scant yellow discharge. A transvaginal ultrasound revealed an abnormally appearing endometrium with an elongated structure suspicious for a foreign body. The patient reported a voluntary termination of pregnancy twelve years earlier, for which laminaria were placed prior to the dilation and extraction. She underwent an operative hysteroscopy confirming our suspicion for retained laminaria. The pathology report demonstrated chronic severe endometritis and plant based material. Conclusion. Retained laminaria are associated with chronic pelvic pain and chronic infertility. Since they can be difficult to detect on conventional imaging, proper counting prior to insertion and after removal is an essential physician responsibility.

scholarly journals 314. A Retrospective Review of Dalbavancin Utilization at an Academic Medical Center

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S229-S229
Author(s):  
Emma Napoli ◽  
Jasmin K Badwal ◽  
Emily R Kirkpatrick ◽  
Ruth Serrano Pinilla ◽  
Chen-Pin Wang ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Retrospective Review ◽  
Medical Center ◽  
Academic Medical Center ◽  
University Hospital ◽  
Source Control ◽  
Adherence Rate ◽  
Infectious Disease Physician ◽  
Outpatient Parenteral Antimicrobial Therapy

Abstract Background Dalbavancin is a novel long-acting lipoglycopeptide with increasing utilization for management of bone and joint infections as a two-dose regimen. The purpose of this study is to describe the patient characteristics, evaluate clinical outcomes, and calculate inpatient hospital days saved with use of dalbavancin as outpatient parenteral antimicrobial therapy (OPAT). Methods A retrospective review of patients treated with dalbavancin at University Hospital was conducted from Aug 2019- March 2020. Patients ≥ 17 yrs of age with plan to receive at least 1 dose of dalbavancin were included. All patients were initially evaluated by, and had clinic follow up with, an infectious disease physician. Information on baseline demographics, infection characteristics, treatments, and outcomes were recorded from the EMR. Results 42 patients met the study criteria. 62% were males with a median age of 49 yrs. 67% of patients had diabetes and 12% had a documented history of intravenous drug use. The most common indication was osteomyelitis (71%). S. aureus was the most commonly isolated organism in monomicrobial infections (MRSA 24%, MSSA 9.5%) and often a component of polymicrobial infections (33%). 90.5% of patients were adherent to their prescribed therapy; 1 patient missed both doses and 3 only received 1 of their recommended doses. Adverse effects were mild and noted in only 4 patients. 24 patients (57%) received concomitant antibiotics. 45% of patients achieved a cure with another 12% were classified as improved but requiring further antibiotics. 31% (N=13) had failure of therapy of which, 69% (N=9) did not achieve prior source control. 5 patients were lost to follow up. Our health system saved 160 inpatient days through dalbavancin use. Conclusion Dalbavancin treatment had a high adherence rate with minimal adverse effects and achieved a positive outcome in 57% of patients. Of patients that failed, the majority did not have appropriate source control. Dalbavancin use has the potential to save inpatient days while offering a more convenient option for treatment. However, further studies should be conducted to evaluate its efficacy in comparison to standard of care therapy at our institution. Disclosures All Authors: No reported disclosures

scholarly journals Comorbid Dysphagia and Dyspnea in Muscle Tension Dysphonia: A Global Laryngeal Musculoskeletal Problem

OTO Open ◽  
2018 ◽  
Vol 2 (3) ◽  
pp. 2473974X1879567 ◽  
Author(s):  
Patrick O. McGarey ◽  
Nicholas A. Barone ◽  
Michael Freeman ◽  
James J. Daniero
Keyword(s):  
Assessment Tool ◽  
Medical Center ◽  
Academic Medical Center ◽  
Muscle Tension ◽  
Retrospective Chart Review ◽  
Clinical History ◽  
High Rate ◽  
Musculoskeletal Problem ◽  
Muscle Tension Dysphonia ◽  
Patient Reported

Objective To characterize the associated symptoms of dysphagia and dyspnea among patients presenting with muscle tension dysphonia (MTD). Study Design Retrospective chart review performed over a 14-month period from October 2014 to December 2015. Setting Voice and swallowing center of a tertiary academic medical center. Subjects and Methods Thirty-eight patients with MTD were included for analysis. Clinical data were collected and analyzed, including perceptual voice evaluation and patient-reported outcomes measures. Results Among patients with a diagnosis of MTD, the incidence of reported dysphagia during clinical history and examination was 44.7%. Among patients with MTD, 60.5% had an EAT-10 (10-item Eating Assessment Tool) score ≥3 (ie, abnormal). Patients who reported dysphagia and/or had abnormal EAT-10 score (≥3) had significantly greater voice impairment than that of patients without dysphagia ( P = .02). Patients who reported dysphagia also had significantly higher Clinical COPD Questionnaire scores than those of patients who reported only dysphonia ( P = .002). Conclusions Patients presenting for dysphonia who are diagnosed with MTD have a high rate of comorbid dysphagia. Patients who reported dysphagia had significantly higher self-reported voice impairment and greater severity of breathing dysfunction as measured by the Clinical COPD Questionnaire. The coincidence of these symptoms in this patient cohort may suggest an underlying pathophysiology that has yet to be elucidated. Further prospective studies are needed to clarify the underlying cause of dysphagia and breathing dysfunction in the setting of MTD and to investigate diagnostic and therapeutic paradigms.

scholarly journals Rates and Predictors of Patient Underreporting of Hospitalizations During Follow-Up After Acute Myocardial Infarction

2020 ◽  
Vol 13 (7) ◽  
Author(s):  
César Caraballo ◽  
Rohan Khera ◽  
Philip G. Jones ◽  
Carole Decker ◽  
Wade Schulz ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Medical Records ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
The United States ◽  
Self Report ◽  
Multicenter Cohort Study ◽  
Patient Reported

Background: Many clinical investigations depend on participant self-report as a principal method of identifying health care events. If self-report is used as the trigger to collect and adjudicate medical records, any event that is not reported by the patient will be missed by the investigators, reducing the power of the study and misrepresenting the risk of its participants. We sought to determine the rates and predictors of underreporting hospitalization events during the follow-up period of a prospective study of patients hospitalized with an acute myocardial infarction. Methods and Results: The TRIUMPH (Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction Patients’ Health Status) registry, a longitudinal multicenter cohort study of people with acute myocardial infarction in the United States, queried patients for hospitalization events during interviews at 1, 6, and 12 months. To validate these self-reports, medical records for all events at every hospital where the patient reported receiving care were acquired for adjudication, not just those for the reported events. Of the 4340 participants in TRIUMPH, 1209 (28%) reported at least one hospitalization. After medical records abstraction and adjudication, we identified 1086 hospitalizations from 639 participants (60.2±12 years of age, 38.2% women). Of these hospitalizations, 346 (31.9%) were underreported by the participants. Rates of underreporting ranged from 22.5% to 55.6% based on different patient characteristics. The odds of underreporting were highest for those not currently working (adjusted odds ratio, 1.66 [95% CI, 1.04–2.63]), lowest for those married (adjusted odds ratio, 0.50 [95% CI, 0.33–0.76]), and increased the longer the elapsed time between the admission and the patient’s follow-up interview (adjusted odds ratio per month, 1.16 [95% CI, 1.08–1.24]). There was a substantial within-individual variation on the accuracy of reporting. Conclusions: Hospitalizations after acute myocardial infarction are commonly underreported in interviews and should not be used alone to determine event rates in clinical studies.

Treatment of postpartum psychosis in a mother-baby unit: do both mother and baby benefit?

2019 ◽  
Vol 27 (2) ◽  
pp. 121-124 ◽  
Author(s):  
Rebecca Hill ◽  
Daphne Law ◽  
Chris Yelland ◽  
Anne Sved Williams
Keyword(s):  
Atypical Antipsychotic ◽  
Retrospective Review ◽  
Medical Records ◽  
Growth And Development ◽  
High Rate ◽  
Postpartum Psychosis ◽  
Risks And Benefits ◽  
Normative Growth ◽  
Inpatient Psychiatric Unit ◽  
Lithium Augmentation

Objectives: To describe characteristics and treatments of mother-baby dyads affected by postpartum psychosis admitted to a specialist mother-baby inpatient psychiatric unit in Australia. Methods: A retrospective review of medical records for all mothers with postpartum psychosis and their babies admitted to a mother-baby unit over a 5-year period was conducted. Results: A total of 25 dyads met the study criteria. Affected women were found to be severely ill with a high rate of involuntary status (64%). They waited an average 4.7 days for a bed in the mother-baby unit. All received an atypical antipsychotic, with 16% receiving lithium augmentation. Infants were found to have generally normative growth and development, with relationship concerns noted in 5. A total of 36% of the cohort maintained some breastfeeding, and all had their infants in their care at discharge. Conclusions: The mother-baby unit enabled severely ill women to remain with their infants during treatment. While a minority of infants showed developmental concerns, appropriate development was noted in most. Future efforts should focus on determining the most effective treatments and further defining the risks and benefits for infants in mother-baby units.

scholarly journals Real-world impact of fremanezumab on migraine symptoms and resource utilization in the United States

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Peter McAllister ◽  
Lois Lamerato ◽  
Lynda J. Krasenbaum ◽  
Joshua M. Cohen ◽  
Krishna Tangirala ◽  
...  
Keyword(s):  
Resource Utilization ◽  
Real World ◽  
Medical Records ◽  
Index Date ◽  
Statistical Significance ◽  
Cohort Analysis ◽  
The United States ◽  
Headache Frequency ◽  
Patient Reported ◽  
Before And After

Abstract Background Fremanezumab, a fully humanized monoclonal antibody (IgG2Δa) that selectively targets calcitonin gene-related peptide (CGRP), is approved for migraine prevention in adults. Real-world data on the effectiveness of fremanezumab are limited. This retrospective, observational cohort study assessed patient-reported migraine symptoms, health care resource utilization (HCRU), and direct medical costs before and after fremanezumab treatment initiation. Methods Data were extracted from September 2018 through June 2020 from the Midwest component of EMRClaims+®, an integrated health services database containing > 20 million medical records from national commercial insurance claims, Medicare claims, and regional electronic medical records. Patients included in the cohort analysis were aged ≥ 18 years and were administered fremanezumab, with enrollment or treatment history for ≥ 6 months prior (pre-index) to initiating fremanezumab (index date) and ≥ 1 month after the index date (post-index), and without pregnancy or pregnancy-related encounters during the study period. Patient-reported headache frequency, migraine pain intensity (MPI), composite migraine symptoms, and HCRU were assessed pre-index and ≥ 1 month after fremanezumab initiation. Wilcoxon signed-rank tests were used to compare means of migraine symptoms and outcomes and HCRU before and after fremanezumab initiation. Results Overall, 172 patients were eligible for analysis. Of patients who self-reported (n = 129), 83.7% reported improvement in headache frequency or symptoms after fremanezumab treatment. Specifically, headache frequency decreased by 63% after fremanezumab initiation: mean (standard deviation) headache frequency was 22.24 (9.29) days per month pre-index versus 8.24 (7.42) days per month post-index (P < 0.0001). Mean MPI also decreased by 18% after fremanezumab initiation: MPI was 5.47 (3.19) pre-index versus 4.51 (3.34) post-index (P = 0.014). Mean emergency room (ER) visits per month decreased from 0.72 to 0.54 (P = 0.003), and mean outpatient visits per month decreased from 1.04 to 0.81 (P < 0.001). Mean hospitalizations per month decreased, but the results did not reach statistical significance (P = 0.095). Hospitalization and ER costs decreased, while outpatient costs increased, from pre-index to post-index, but differences were not statistically significant (P ≥ 0.232). Conclusions Significant reductions in headache frequency, MPI, and HCRU were observed after fremanezumab initiation in patients with migraine in a US real-world setting.

scholarly journals Factors predicting reoperation of chronic subdural hematoma following primary surgical evacuation

2018 ◽  
Vol 129 (5) ◽  
pp. 1143-1150 ◽  
Author(s):  
Rouzbeh Motiei-Langroudi ◽  
Martina Stippler ◽  
Siyu Shi ◽  
Nimer Adeeb ◽  
Raghav Gupta ◽  
...  
Keyword(s):  
Subdural Hematoma ◽  
Medical Center ◽  
Academic Medical Center ◽  
Large Diameter ◽  
Multivariable Analysis ◽  
Chronic Subdural Hematoma ◽  
The United States ◽  
High Rate ◽  
Thickness Change ◽  
Surgical Evacuation

OBJECTIVEChronic subdural hematoma (CSDH) is commonly encountered in neurosurgical practice. However, surgical evacuation remains complicated by a high rate of reoperation. The optimal surgical approach to reduce the reoperation rate has not been determined. In the current study, the authors evaluated the prognostic value of clinical and radiographic factors to predict reoperation in the context of CSDH.METHODSA retrospective review of 325 CSDH patients admitted to an academic medical center in the United States, between 2006 and 2016, was performed. Clinical and radiographic factors predictive of the need for CSDH reoperation were identified on univariable and multivariable analyses.RESULTSUnivariable analysis showed that warfarin use, clopidogrel use, mixed hypo- and isointensity on T1-weighted MRI, greater preoperative midline shift, larger hematoma/fluid residual on first postoperative day CT, lesser decrease in hematoma size after surgery, use of monitored anesthesia care (MAC), and lack of intraoperative irrigation correlated with a significantly higher rate of reoperation. Multivariable analysis, however, showed that only the presence of loculation, clopidogrel or warfarin use, and percent of hematoma change after surgery significantly predicted the need for reoperation. Our results showed that 0% (no reduction), 50%, and 100% hematoma maximum thickness change (complete resolution of hematoma after surgery) were associated with a 41%, 6%, and < 1% rate of reoperation, respectively. The use of drains, either large diameter or small caliber, did not have any effect on the likelihood of reoperation.CONCLUSIONSAmong many factors, clopidogrel or warfarin use, hematoma loculation on preoperative CT, and the amount of hematoma evacuation on the first postoperative CT were the strongest predictors of reoperation.

Continuous Intravenous Morphine Infusions for Terminal Pain Control: A Retrospective Review

1986 ◽  
Vol 20 (12) ◽  
pp. 968-972 ◽  
Author(s):  
Glenda J. Stuart ◽  
E. Bruce Davey ◽  
Susan E. Wight
Keyword(s):  
Adverse Effects ◽  
Retrospective Review ◽  
Medical Records ◽  
Pain Control ◽  
Terminal Cancer ◽  
Dosage Calculation ◽  
Intravenous Morphine ◽  
Control Terminal ◽  
Effective Use ◽  
Infusion Duration

The continuous intravenous infusion of morphine may control terminal cancer pain unrelieved by conventional narcotic therapy. A retrospective review was conducted of the medical records of 79 terminal cancer patients who received a total of 84 intravenous morphine infusions. Data were recorded on morphine dosage, pain control, adverse effects, duration of infusion, and concomitant medication requirements. Infusion duration varied from less than 24 hours to 162 days (median: 7 days). Morphine dosage ranged from 0.5 to 300 mg/h. All patients experienced an improvement in baseline pain control; however, 54 percent required additional medication to enhance analgesia. Serious adverse effects, including marked sedation, hallucinations, diaphoresis, and respiratory depression, were recorded in 14 patients. These effects may be a reason for reducing the dose. Guidelines for the use of continuous intravenous morphine infusions are presented. Accurate pain assessment, morphine dosage calculation, and monitoring of adverse effects are essential to insure the safe and effective use of these infusions.

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