scholarly journals The correct setting to improve the quality of health care process: a retrospective study in Internal Medicine Department

2018 ◽  
Vol 12 (4) ◽  
pp. 285-295
Author(s):  
Filomena Pietrantonio ◽  
Paola Aperti ◽  
Luca Tonoli ◽  
Elaine Tyndall ◽  
Orietta Meneghetti
Keyword(s):  
Internal Medicine ◽  
Health Care ◽  
Retrospective Study ◽  
Hospital Stay ◽  
Medical Records ◽  
Clinical Severity ◽  
Early Warning Score ◽  
Care Process ◽  
Technical Equipment

The definition of the role of hospitals and communities in terms of the response to patients’ health care needs is essential in the Lombardy region health-care reform development (LR. 23/2015). The stratification of patients according to clinical severity and care complexity for adequate clinical health care, is achieved by delineating care settings, staff standards, required technical equipment and crucial aspects of clinical pathways. An observational and retrospective study at Manerbio Hospital Internal Medicine Unit (IMU) was carried out to define: i) characteristics of IMU patients; ii) role of IMU physician in management of poly-pathological patients; iii) alternative organizational models. After a Literature review, clinical severity was defined by modifying early warning score, complexity and co-morbidities by cumulative illness rating scale (CIRS) and by intensity of care through care intensity index (IIA). All medical records of patients admitted in the first quarter of 2016 were analyzed. A total of 393 medical records were examined: 199 M/194 F, median age 81 years. Critical patients (requiring continuous monitoring using advanced equipment): 27% of the sample (10% with intensive care transfer criteria). Co-morbidity: between 5 and 6 active diseases for most of the sample; 53% with CIRS between 7 and 12. Elevated care intensity (IIA) was found in 46% of the sample, remaining constant throughout hospital stay. Medium stay: 9.35 days. 27% of IMU patients needs subintensive care. About a quarter of patients has unresolved social problems contributing to acute presentations in the emergency room. Agreement on appropriate links between hospital and community care structures is advisable to reduce hospital stay, adequately responding to patients’ needs.

scholarly journals Role of Multiple Comorbidities and Therapies in Conditioning the Clinical Severity of DRESS: A Mono-Center Retrospective Study of 25 Cases

2021 ◽  
Vol 22 (13) ◽  
pp. 7072
Author(s):  
Andrea Toniato ◽  
Chiara Gamba ◽  
Jan Walter Schroeder ◽  
Valeria Fabbri ◽  
Scarlett Valeria Bernal Ortiz ◽  
...  
Keyword(s):  
Risk Factors ◽  
Drug Reaction ◽  
Retrospective Study ◽  
Clinical Severity ◽  
Severe Reaction ◽  
Skin Involvement ◽  
Inflammatory State ◽  
Reaction Severity ◽  
Clinical Conditions

DRESS/DiHS is a complex and potentially fatal drug reaction. Little is known about risk factors and elements that can help to identify patients with a severe reaction early. The aim of the study was to investigate those factors favoring the disease and its severity by analyzing the clinical conditions and therapies preceding the reaction. We conducted a retrospective analysis on patients admitted to our center between 2010 and 2020 who were discharged with a diagnosis of DRESS. We used the RegiSCAR diagnostic criteria. We defined the severity of DRESS using the criteria of Mizukawa et al. We included 25 patients (15 females) with a median age of 66 years. Skin involvement, eosinophilia, and liver injury were the most important aspects. Allopurinol was found to be the most involved drug. Reaction severity was significantly associated with the number of daily medications (p=0.0067) and an age of at least 68 years (p=0.013). In addition, 75% of severe cases had at least three comorbidities in history, and most of the severe cases were female. In our study the advanced age, the high number of comorbidities and home therapies, and the inflammatory state were found to be predisposing elements to the development of the disease and its severity.

CHEST X RAY SCORE AND CLINICAL SEVERITY IN COVID-19 PATIENTS

2021 ◽  
pp. 31-32
Author(s):  
Sheeba Rana ◽  
Vicky Bakshi ◽  
Yavini Rawat ◽  
Zaid Bin Afroz
Keyword(s):  
Retrospective Study ◽  
Medical Records ◽  
Scoring Systems ◽  
Clinical Severity ◽  
X Rays ◽  
Antigen Test ◽  
X Ray ◽  
Classi Cation ◽  
Chest X Ray ◽  
Male Subjects

INTRODUCTION: Various chest X-ray scoring systems have been discovered and are employed to correlate with clinical severity, outcome and progression of diseases. With, the coronavirus outbreak, few chest radiograph classication were formulated, like the BSTI classication and the Brixia chest X-ray score. Brixia CXR scoring is used for assessing the clinical severity and outcome of COVID-19. This study aims to compare the Brixia CXR score with clinical severity of COVID-19 patients. MATERIAL& METHODS:This was a retrospective study in which medical records of patients aged 18 years or above, who tested for RTPCR or st st Rapid Antigen Test (RAT) for COVID positive from 1 February 2021 to 31 July 2021 (6 months) were taken. These subjects were stratied into mild, moderate and severe patients according to the ICMR guidelines. Chest X Rays were obtained and lesions were classied according to Brixia scoring system. RESULTS: Out of these 375 patients, 123 (32.8%) were female and 252 (67.2%) were male subjects. The average brixia score was 11.12. Average Brixia CXR score for mild, moderate and severe diseased subjects were 5.23, 11.20, and 14.43 respectively. DISCUSSION:The extent of chest x-ray involvement is proportional to the clinical severity of the patient. Although, a perplexing nding was that the average Brixia score of the female subjects were slightly higher than their male counterparts in the same clinical groups. CONCLUSION: Brixia CXR score correlates well with the clinical severity of the COVID-19.

scholarly journals Inappropriate requests for tumor markers in patients aged 50 years and older: lessons not learned

2021 ◽  
Vol 15 ◽  
Author(s):  
Valter Paz Nascimento-Júnior ◽  
Einstein Francisco Camargos
Keyword(s):  
Internal Medicine ◽  
Health Care ◽  
Health Insurance ◽  
Medical Records ◽  
Private Health Insurance ◽  
Medical Specialty ◽  
Health Care Managers ◽  
Inappropriate Use ◽  
Care Managers ◽  
Previous Diagnosis

OBJECTIVE: To investigate, within a private health insurance, the ordering frequency and the costs related to inappropriate TM test orders. METHODS: This study analyzed data regarding TM requests within a private health insurance between 2010 and 2017. Patients included in this analysis were ≥ 50 years old, had available medical records, and had at least 1 TM tested within the study period. Tests were considered inappropriate when TMs were used in screening for neoplasms, ie, when there was no previous diagnosis. We evaluated data regarding age, sex, the ordering physician’s medical specialty, and test costs. RESULTS: Between 2010 and 2017, 1,112 TM tests were performed and increased from 52 to 262 per year. Our sample consisted mostly of women (69.50%) with a mean age of 59.40 (SD, 8.20) years. Most orders were inappropriate (87.80%) and represented 79.40% of all expenses with TM tests. Cardiology professionals were the medical specialty that requested the most TM tests (23.90%), followed by internal medicine specialists (22.70%) and gynecologists (19.20%). CONCLUSIONS: We observed a high percentage of inappropriate test orders in the study period, resulting in elevated costs. Studies of this nature deserve the attention of health care managers, and interventions should be performed in order to reduce the inappropriate use of TM tests in clinical practice.

scholarly journals Demographic Characteristics of Mothers Who Delivered Children with Birth Defetcs

2018 ◽  
pp. 222-227
Author(s):  
Yudianto B Saroyo ◽  
Christian Wijaya ◽  
Putri M T Marsubin
Keyword(s):  
Retrospective Study ◽  
Birth Weight ◽  
Antenatal Care ◽  
Birth Defects ◽  
Medical Records ◽  
Birth Defect ◽  
Demographic Characteristics ◽  
Comorbid Disease ◽  
Increased Risk

Abstract Objective: to determine the characteristics and background of mothers who delivered neonates with birth defects. Methods: A retrospective study was used by evaluating the medical records of patients with birth defects in Dr. Cipto Mangunkusumo Hospital during the period between September 2014 and June 2016. Results: A total of 67 (1.85%) out of 3,619 infants who were born in Dr. Cipto Mangunkusumo Hospital during the period between September 2014 and June 2016 had birth defects. Forty-seven (70.1%) mothers of the subjects irregularly attend antenatal care. The most frequent maternal comorbid disease in this study was asthma, which was found in 4 (5.97%) mothers of the subjects. 48 (58.7%) subjects had birth weight under 2500 g. Conclusion: In this retrospective study, the main highlight is that 70.1% of the mothers who delivered neonates with birth defects did not attend antenatal care regularly. 58.7% of the neonates with birth defects had low birth weight. This study could be used as base for further research investigating about the role of antenatal care in early detection and/or the planning of delivery for babies with birth defects. Trends in babies with birth defects suggested that fetuses diagnosed with IUGR/SGA should be given special attention, as they were at increased risk for birth defects. Keywords: birth defect, maternal description   Abstrak Tujuan: untuk mengetahui deskripsi/ciri-ciri  dan latar belakang ibu yang melahirkan janin dengan kelainan bawaan. Metode: Studi retrospektif digunakan dengan menggunakan data sekunder rekam medis pasien dengan kelainan bawaan di Rumah Sakit Umum Pusat Nasional Dr. Cipto Mangunkusumo pada periode September 2014-Juni 2016. Hasil: Sejumlah 67 (1.85%) dari 3,619 neonatus didapatkan dengan kelainan bawaan di RSUPN Cipto Mangunkusumo pada periode September 2014-Juni 2016 . Sejumlah 47 (70.1%) ibu dari subjek tidak teratur dalam melakukan kunjungan antenatal care. Penyakit komorbid ibu yang paling banyak ditemukan dalam studi ini adalah asma, yang ditemukan dalam 4 (5.97%) subjek. 48 (58.7%) subyek memiliki berat lahir di bawah 2500 g. Kesimpulan: Pada studi retrospektif ini didapatkan 70.1% ibu yang melahirkan bayi dengan kelainan bawaan tidak melakukan kunjungan antenatal care. Didapatkan bahwa 58,7% bayi yang lahir dengan kelainan bawaan memiliki berat badan lahir rendah (BBLR). Studi ini dapat dijadikan sebagai landasan dilakukannya studi yang lebih besar untuk mengevaluasi peran antenatal care terhadap deteksi dini dan/atau perencanaan persalinan bayi dengan kelainan bawaan. Tren pada bayi dengan kelainan bawaan menunjukkan bahwa janin yang pada antenatal care didapatkan IUGR/SGA patut diperhatikan lebih untuk kecurigaan kemungkinan adanya kelainan bawaan. Kata kunci:   deskripsi ibu,   kelainan bawaan,

Understanding the Need for a Non-invasive Wearable Real-time Database Device for Diabetic Patients

2018 ◽  
Vol 20 (2) ◽  
pp. 190-196 ◽  
Author(s):  
Elmer Jeto Gomes Ataide ◽  
Rajesh Kumar Sinha ◽  
G. Arun Maiya
Keyword(s):  
Health Care ◽  
Real Time ◽  
Medical Records ◽  
Wearable Devices ◽  
Care Process ◽  
Diabetic Patients ◽  
Quality Health Care ◽  
Non Invasive ◽  
Quality Health ◽  
Real Time Database

Diabetes occurs when the pancreas in the human body does not secrete sufficient insulin. It is a disease that is growing rapidly and affecting many lives. Hence, it needs constant monitoring. Wearable devices are those devices that are present on your person at all times. If the monitoring of this disease could be paired with wearable devices along with enabling real-time documentation in the patients’ medical records, it would benefit both the caregivers and the patients by saving time, money, effort and the amount of work put in by both during the health care process, hence, aiding in the delivery of quality health care. This article deals with identifying the existing wearable devices in detecting diabetes or risk of diabetes non-invasively and further scope of research in the respective area.

The role of electronic medical records in improving the quality of health care services: Comparative study

2019 ◽  
Vol 127 ◽  
pp. 63-67 ◽  
Author(s):  
Omar Ayaad ◽  
Aladeen Alloubani ◽  
Eyad Abu ALhajaa ◽  
Mohammad Farhan ◽  
Sami Abuseif ◽  
...  
Keyword(s):  
Health Care ◽  
Comparative Study ◽  
Electronic Medical Records ◽  
Quality Of Health Care ◽  
Medical Records ◽  
Health Care Services ◽  
Care Services

scholarly journals Intensity of medical care in internal medicine: impact on outcomes from a trend analysis over six years

2019 ◽  
Vol 13 (2) ◽  
pp. 95-102 ◽  
Author(s):  
Walter Spagnolli ◽  
Dimitri Peterlana ◽  
Stefania Dorigoni ◽  
Marta Rigoni ◽  
Emanuele Torri ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Medical Care ◽  
Clinical Judgment ◽  
Clinical Severity ◽  
Early Warning Score ◽  
Organizational Model ◽  
Bed Management ◽  
Clinical Instability

In large acute medical wards treating heterogenous and complex patients, intensity of patient care should be graduated according to clinical severity. We conducted a retrospective observational study on all unselected admissions (8838) to the internal medicine ward of the Santa Chiara Hospital of Trento from 2012 to 2017. During 2012 and 2013, a standard organizational model (SMC) was in place, while an organizational model for intensity of medical care (IMC) was introduced in 2014. In SMC, patient admission was performed according to bed availability only. In IMC, patients were allocated to three different ward settings (high, medium and post-acute care) based on the stratification of clinical instability. The National Early Warning Score (NEWS) was used for the stratification, together with the clinical judgment. The implementation of the IMC model led to a decrease of mortality and urgent transfers for clinical deterioration to Intensive Care Unit and to an increase of admissions from Intensive Care Unit and from regional spoke hospitals. Redesigning delivery processes based on IMC can play a pivotal role in improving patient outcomes and bed management.

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