scholarly journals Ambulatory Urodynamic Findings Change Patient Outcomes

2021 ◽  
Vol 2 (6) ◽  
pp. 354-361
Author(s):  
Richard G. Axell ◽  
Vahit Guzelburc ◽  
Habiba Yasmin ◽  
Bogdan Toia ◽  
Mahreen H. Pakzad ◽  
...  
Keyword(s):  
Clinical Diagnosis ◽  
Care Pathway ◽  
Symptom Assessment ◽  
Primary Diagnosis ◽  
Urinary Symptoms ◽  
Patient Demographics ◽  
Urinary Tract Symptoms ◽  
Before And After ◽  
Symptomatic Outcome ◽  
Ambulatory Urodynamics

Objectives Whilst ambulatory urodynamics (aUDS) may be used as a second-stage test for patients with refractory lower urinary tract symptoms (LUTS) having non-diagnostic conventional urodynamics (UDS), the evidence for their use is limited. We have assessed the diagnostic utility and consequent symptomatic outcome of aUDS in patients with refractory LUTS. Methods A retrospective review of a prospectively acquired urodynamics database was made of 84 consecutive patients (23 male) with a median age 50.5 years (range 18 to 79) having aUDS following non-diagnostic or contradictory baseline UDS over a 12-month period. Patient demographics and urodynamic and clinical diagnosis before and after aUDS were recorded. Forty-six patients (55%) had formal urinary symptom assessment recorded before and a minimum of 6 months following aUDS-related change in management. Results Eighty-two patients (98%) had a urodynamic diagnosis made following aUDS, 57(68%) of whom had detrusor overactivity (DO); the final 2 patients had no abnormalities detected on aUDS. Change in primary UDS diagnosis occurred in 66 patients (79%). Of these 66 patients, 59 (89%) also had their clinical diagnosis changed, and 55 (83%) had their management pathway changed. There was a significant improvement in urinary symptoms 6 months following aUDS. Conclusion Change in primary diagnosis following aUDS led to a significant change in treatment care pathway and resulted in significant improvement in urinary symptoms.

Trends in Craniofacial Injuries Associated with the Introduction of Electric Scooter Sharing Services

FACE ◽  
2021 ◽  
pp. 273250162199244
Author(s):  
Elizabeth M. Boudiab ◽  
Thomas D. Zaikos ◽  
Christopher Issa ◽  
Kongkrit Chaiyasate ◽  
Stephen M. Lu
Keyword(s):  
Maxillofacial Surgery ◽  
Age Groups ◽  
Injury Surveillance System ◽  
Patient Demographics ◽  
Time Period ◽  
Electric Scooter ◽  
Before And After ◽  
Trends Over Time ◽  
Patterns Of Injury ◽  
Craniofacial Fractures

Electric scooters are an increasingly common and convenient mode of transportation worldwide and have effectively revolutionized the shared micromobility industry. As electric scooter sharing companies have increased in popularity there has been a concomitant increase in the frequency of all electric scooter-related injuries. The purpose of this study is to describe the most up-to-date trends in craniofacial fractures and lacerations related to electric scooter use among all age groups. We queried the National Electronic Injury Surveillance System (NEISS) for craniofacial fractures and lacerations related to e-scooters between 2010 and 2019. We then compared injury trends over time and between time periods before and after 2017 when electric scooter share apps revolutionized micromobility. We compared incidence of injury overall and by day of the week, patient demographics, and case severity based on clinical disposition. We identified an increase in the frequency of craniofacial lacerations and fractures in the 3 years following the introduction of electric scooter share services in 2017 (2017 and 2019), compared to the 3 years before this time (2014-2016). Young adults (18-39 years) were the age group with the greatest interval increase in craniofacial injuries. There was also an increase in number of craniofacial injuries occurring on Mondays and a decrease number occurring on Fridays in the later time period. Finally, patients who presented with electric scooter-related craniofacial injuries in this later time period showed a higher frequency of overnight observation and hospital admission for their injuries. The number of craniofacial injuries secondary to electric scooter use has increased dramatically since the introduction of share services. Craniofacial fractures and lacerations are a common reason for craniofacial or maxillofacial surgery consultation and understanding these patterns of injury will help prepare surgeons for patient care, preventative education, and public advocacy.

scholarly journals How accurate are digital symptom assessment apps for suggesting conditions and urgency advice? A clinical vignettes comparison to GPs

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e040269
Author(s):  
Stephen Gilbert ◽  
Alicia Mehl ◽  
Adel Baluch ◽  
Caoimhe Cawley ◽  
Jean Challiner ◽  
...  
Keyword(s):  
Gold Standard ◽  
Symptom Assessment ◽  
Primary Diagnosis ◽  
Safety Performance ◽  
Digital Tool ◽  
Alphabetical Order ◽  
Clinical Vignettes ◽  
Gps Buoy ◽  
Coverage Accuracy ◽  
Young Old

ObjectivesTo compare breadth of condition coverage, accuracy of suggested conditions and appropriateness of urgency advice of eight popular symptom assessment apps.DesignVignettes study.Setting200 primary care vignettes.Intervention/comparatorFor eight apps and seven general practitioners (GPs): breadth of coverage and condition-suggestion and urgency advice accuracy measured against the vignettes’ gold-standard.Primary outcome measures(1) Proportion of conditions ‘covered’ by an app, that is, not excluded because the user was too young/old or pregnant, or not modelled; (2) proportion of vignettes with the correct primary diagnosis among the top 3 conditions suggested; (3) proportion of ‘safe’ urgency advice (ie, at gold standard level, more conservative, or no more than one level less conservative).ResultsCondition-suggestion coverage was highly variable, with some apps not offering a suggestion for many users: in alphabetical order, Ada: 99.0%; Babylon: 51.5%; Buoy: 88.5%; K Health: 74.5%; Mediktor: 80.5%; Symptomate: 61.5%; Your.MD: 64.5%; WebMD: 93.0%. Top-3 suggestion accuracy was GPs (average): 82.1%±5.2%; Ada: 70.5%; Babylon: 32.0%; Buoy: 43.0%; K Health: 36.0%; Mediktor: 36.0%; Symptomate: 27.5%; WebMD: 35.5%; Your.MD: 23.5%. Some apps excluded certain user demographics or conditions and their performance was generally greater with the exclusion of corresponding vignettes. For safe urgency advice, tested GPs had an average of 97.0%±2.5%. For the vignettes with advice provided, only three apps had safety performance within 1 SD of the GPs—Ada: 97.0%; Babylon: 95.1%; Symptomate: 97.8%. One app had a safety performance within 2 SDs of GPs—Your.MD: 92.6%. Three apps had a safety performance outside 2 SDs of GPs—Buoy: 80.0% (p<0.001); K Health: 81.3% (p<0.001); Mediktor: 87.3% (p=1.3×10-3).ConclusionsThe utility of digital symptom assessment apps relies on coverage, accuracy and safety. While no digital tool outperformed GPs, some came close, and the nature of iterative improvements to software offers scalable improvements to care.

Evaluation of Outcomes Before and After Implementation of a Standardized Postoperative Care Pathway in Pediatric Posterior Spinal Fusion Patients

2020 ◽  
Vol 39 (4) ◽  
pp. 257-263
Author(s):  
Kembral L. Nelson ◽  
Lindsey L. Locke ◽  
Leslie N. Rhodes ◽  
William A. Mabry ◽  
Jeffrey R. Sawyer ◽  
...  
Keyword(s):  
Spinal Fusion ◽  
Postoperative Care ◽  
Care Pathway ◽  
Posterior Spinal Fusion ◽  
Before And After

Abstract 275: Concomitant Statin Use With Ezetimibe Or Colesevelam For Treatment Of Hypercholesterolemia

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Xin Ye ◽  
Harold Bays ◽  
Philip Schwab
Keyword(s):  
Index Date ◽  
Claims Data ◽  
Study Objective ◽  
Factors Associated ◽  
Patient Demographics ◽  
Pharmacy Claims ◽  
Before And After ◽  
Charlson Comorbidity Score ◽  
Claims Data Analysis ◽  
Statin Use

OBJECTIVES: Ezetimibe or colesevelam are often used for treating hypercholesterolemia when statin therapy is insufficient or not well tolerated. Our study objective was to examine prevalence of concomitant statin use and associated factors among hypercholesterolemia patients newly treated with ezetimibe or colesevelam. METHODS: This analysis evaluated a large health plan’s Commercial and Medicare Advantage claims data from 1/1/08 to 7/31/12. The first ezetimibe (excluding fixed combination therapy of ezetimibe/simvastatin) or colesevelam prescription fill date during this period was identified as the index date. Patients were assigned to either ezetimibe or colesevelam cohort based on the index drug and were required to have ≥ 2 consecutive prescriptions for the index drug and have at least 6 months and 12 months continuous enrollment before and after the index date, respectively. Prevalence of concomitant statin use was identified based on pharmacy claims. Patient demographics and clinical characterisitics were explored to examine the factors associated with concomitant statin use using multivariate logistic regression. RESULTS: A total of 679 colesevelam and 1439 ezetimibe patients were included in this study. The concomitant use of statins was 24% among colesevelam and 50% among ezetimibe patients, respectively. After adjustment for patient demographics and comorbidities, ezetimibe patients were 3.2 times more likely than colesevelam patients to have concomitant statin use (OR= 3.168, 95% CI: 2.573, 3.900, P<0.001). Other significant factors associated with higher concomitant statin use include: male gender (OR= 1.296, 95%: 1.079, 1.558, P=0.006), presence of diabetes mellitus (OR=1.262, 95% CI: 1.035, 1.539, P=0.021) and higher Charlson comorbidity score (OR=1.114, 95% CI: 1.046, 1.187, P<0.001) CONCLUSIONS: In this claims data analysis, statins were administered along with ezetimibe more frequently than administered with colesevelam, which should be taken into account when evaluating effectiveness of ezetimibe vs. colesevelam in the real-world treatment of hypercholesterolemia.

scholarly journals The pre- and postoperative illness trajectory in patients with pituitary tumours

2019 ◽  
Vol 8 (7) ◽  
pp. 878-886 ◽  
Author(s):  
Eva Jakobsson Ung ◽  
Ann-Charlotte Olofsson ◽  
Ida Björkman ◽  
Tobias Hallén ◽  
Daniel S Olsson ◽  
...  
Keyword(s):  
Postoperative Care ◽  
Care Pathway ◽  
Pituitary Surgery ◽  
Pituitary Tumour ◽  
Postoperative Recovery ◽  
Endocrine Treatment ◽  
Pituitary Tumours ◽  
Care And Support ◽  
Before And After ◽  
Operative Evaluation

Objective Experiences and need of support during surgery and start of replacement therapy in patients with pituitary tumours are highly unknown. This study aimed at exploring patient experiences during pre- and postoperative care and recovery after pituitary surgery in patients with a pituitary tumour. Methods Within a qualitative study design, 16 consecutive patients who underwent surgery for pituitary tumours were repeatedly interviewed. In total, 42 interviews were performed before and after surgery. Analysis was performed using qualitative interpretation. Results Suffering a pituitary tumour was overwhelming for many patients and struggling with existential issues was common. Patients expressed loneliness and vulnerability before and after surgery. How professionals handled information in connection with diagnosis greatly affected the patients. Other patients with the same diagnosis were experienced as the greatest support. Normalisation of bodily symptoms and relationships with others were reported during postoperative recovery. However, a fear that the tumour would return was present. Conclusions Patients with pituitary tumours need structured support, including peer support, which acknowledges physical, cognitive as well as emotional and existential concerns. Information related to diagnosis and surgery should be adapted in relation to the loneliness and the existential seriousness of the situation. Care and support for patients with pituitary tumours should preferably be organised based on continuity and an unbroken care pathway from the first pre-operative evaluation through to postoperative care and the start of a life-long endocrine treatment and tumour surveillance.

Abstract TP366: Significant Reduction in Readmission Using Transitions Nurse

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Kiersten Espaillat ◽  
Paula Buckner
Keyword(s):  
Hospital Discharge ◽  
Transitional Care ◽  
Medical Center ◽  
Hospital Readmissions ◽  
Primary Diagnosis ◽  
Adult Patients ◽  
Care Coordinator ◽  
Readmission Rates ◽  
Before And After

In an effort to reduce early hospital readmissions, Vanderbilt University Medical Center (VUMC) implemented a transitional care coordinator (TCC) to provide careful coordinated follow up care for stroke patients after hospital discharge. The aim of this study is to compare all cause thirty- day readmission rates of adult patients with a primary diagnosis of stroke before and after the implementation of a stroke services TCC. All adult patients admitted to VUMC with a primary diagnosis of stroke; ischemic, hemorrhagic, and TIA; and readmitted within the first thirty days following hospital discharge between January-June of 2015, 2016, 2017, & 2018 were analyzed. Readmission data from 2015 & 2016, prior to the implementation of the TCC was compared to readmission data from 2017 & 2018, after the TCC was implemented. A total of 1911 charts were reviewed for the timeframe January-June of 2015-2018. In 2015 there were 369 stroke admissions and 120 (33%) were readmitted and in 2016 there were 474 stroke admissions and 112 (24%) readmissions, before the TCC role was implemented. In 2017 there were 540 stroke admissions and 62 (11%) were readmitted and in 2018 there were 528 stroke admissions and 74 (14%) readmissions, after the TCC role was implemented. Hospital readmissions were reduced significantly after implementing a TCC.

STUDY OF PREVALENCE OF LOWER URINARY TRACT SYMPTOMS IN PATIENTS UNDERGOING INGUINAL HERNIA REPAIR AT SKMCH, MUZAFFARPUR, BIHAR

2021 ◽  
pp. 51-53
Author(s):  
Sanjay Kumar ◽  
Kumar Vikram ◽  
Manoj Kumar ◽  
Debarshi Jana
Keyword(s):  
Inguinal Hernia ◽  
Urinary Tract ◽  
Hernia Repair ◽  
Inguinal Hernia Repair ◽  
Lower Urinary Tract Symptoms ◽  
Lower Urinary Tract ◽  
Urinary Symptoms ◽  
Number Of Patients ◽  
Urinary Tract Symptoms ◽  
Lower Urinary

Background: Lower urinary tract symptoms (LUTS) are frequently associated with inguinal hernias. It is important to recognise and treat bladder outlet obstruction in patients before inguinal hernia repair to prevent recurrence of hernia. Methods: This prospective study was conducted at Department of Surgery, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar. Hundred patients who presented with inguinal hernia repair were evaluated for LUTS using AUA scoring for urinary symptoms, uroowmetry (Qmax) and post voidal residual urine using ultrasonography along with urine routine microscopic examination and urine culture and sensitivity. Results: Eleven patients out of 100 who came for hernia repair had clinically signicant LUTS due to benign enlargement of prostate (BEP) and required treatment for BEP but none of these 11 patients had urinary symptoms as primary complaint. Ten patients were found to have urinary tract infection without any urinary symptom. Three patients had urethral stricture out of which 2 had Qmax of <10 ml/second. Conclusions: Signicant number of patients (14 percent) with inguinal hernia had lower urinary tract symptoms. An effort should be made to identify LUTS in patients presenting with inguinal hernia before surgery and treat the cause of LUTS. Ten percent of patients had asymptomatic UTI with AUA score less than 8 but Qmax on uroowmetry was in between 10-15 ml/second.

Is the Correct Anatomical Placement of the Electrocardiogram (ECG) Electrodes Essential to Diagnosis in the Clinical Setting A Systematic Review

2020 ◽  
Author(s):  
Alexandros Stavros Hadjiantoni
Keyword(s):  
Clinical Diagnosis ◽  
Clinical Setting ◽  
Critical Appraisal ◽  
Care Pathway ◽  
Meta Analysis ◽  
Relevant Literature ◽  
Anatomical Landmarks ◽  
Critical Appraisal Skills ◽  
Electrocardiogram Ecg ◽  
Ecg Morphology

Abstract Background: Anatomical misplacement of the Electrocardiogram (ECG) electrode(s) is common, with significant impact on clinical diagnosis. Reasons are multi-faceted, with this review examining the consequential effects of misplacement to ECG morphology, diagnosis, prognosis, patient outcomes, and potential impact to patient care pathway. Objectives: This review examined the significance of misplacement, its’ commonality and ensuing effect on patient safety, accurate ECG acquisition and diagnosis, with evaluation of reasons for such misplacement.Methodology: Review of available literature was conducted using electronic databases. In-line with the Preferred Reporting Items for Systematic reviews and Meta – analysis protocols (PRISMA) 2015 checklist, this review was conducted with search criteria, search terms, eligibility for inclusion/ exclusion criteria, extraction and data analysis predetermined by the authors. Keywords were arranged according to grouping of terms surrounding ECG, anatomical placement, and diagnosis. The search strategy was conducted during September/October 2019. Scoping searches were conducted alongside reference lists of included studies hand searched (Snowballing) for further relevant studies. The Critical Appraisal Skills Programme (CASP) was used to methodically appraise papers (CASP, 2019). Screening of titles and abstracts of identified citations was performed by a single reviewer. Eligible articles then full text screened independently by two reviewers. Disagreements were discussed and resolved by a third reviewer. In instances of unclear reporting, authors were contacted to provide further information and clarity. Assessment of relevant literature and critical appraisal of primary research, pertaining to the clinical diagnosis and effects of anatomical misplacement of ECG electrodes, formulate the thematic discussion drawn by this review. Results: This review identified a plethora of causes, ranging from: operator error; lack of anatomical awareness; inaccurate assessment of anatomical landmarks; obesity; differences in anatomy/gender; levels of undress and lack of appreciation of consequences of misplacement, both modifiable and non-modifiable attributable to electrode misplacement. Clinical diagnosis can be altered owing to erroneous placement of electrodes. ECG morphology is altered due to incorrect anatomical misplacement, culminating substandard practice, a missed diagnosis or misdiagnosis and potential harm. Conclusion: Correct anatomical placement of ECG electrodes is essential to diagnosis in the clinical setting. Peer-led educational intervention with mandatory training is essential to improve practice. PROSPERO Registration Number: CRD42019152461

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