scholarly journals Changing Pattern of Clinical Illness in Children with Group A Streptococcal Bacteremia

1993 ◽  
Vol 4 (6) ◽  
pp. 341-346 ◽  
Author(s):  
Kim J Burrows ◽  
Scott A Halperin ◽  
Margaret Swift ◽  
Robert Bortolussi
Keyword(s):  
Chart Review ◽  
Tertiary Care ◽  
Length Of Hospital Stay ◽  
Clinical Syndrome ◽  
Deep Tissue ◽  
The Past ◽  
Recent Group ◽  
Group A ◽  
Clinical Illness ◽  
Seriously Ill

Objective: To test the hypothesis that bacteremia caused by group A streptococci (gas) has become more common and the presentation of the infection more severe in the Izaak Walton Killam Hospital for Children during the past decade.Design: Retrospective analysis by laboratory log and chart review.Setting: A pediatric teaching hospital providing primary and tertiary care.Results: There was no difference in the frequency of detection ofgasbacteremia between the two periods studied (1980 to 1988 and 1988 to 1991). However, severegasinfection with deep tissue invasion was more common in the last three-year period (77% versus 11%, P=0.01). Severity, as measured by length of hospital stay, was also greater in the recent group (17.9 days versus 3.3 days, P=0.03). A recent group of four children was identified with a unique clinical syndrome of rash, severe myalgias, hyperesthesia, and refusal to bear weight.Conclusion: The number of cases of severegasdisease has increased in the past several years, andgasinfection should be included in the differential diagnosis of seriously ill children,gasinfection must be managed aggressively with vigilance for additional deep tissue involvement, even while on appropriate antimicrobial therapy.

scholarly journals Mapping Pediatric Tetanus Cases in Central Pennsylvania and Analyzing Hospital Costs Associated with Treatment

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S323-S323
Author(s):  
Bilaal Ahmed ◽  
Michael Beck ◽  
Parvathi Kumar
Keyword(s):  
Chart Review ◽  
Care Center ◽  
Tertiary Care ◽  
Hospital Costs ◽  
Population Level ◽  
Microsoft Excel ◽  
Vaccine Preventable Diseases ◽  
The Past ◽  
Central Pennsylvania ◽  
Preventable Infection

Abstract Background Pennsylvania is home to Amish and Mennonite communities with an estimated combined population of over 90,000 people. Under-immunization is common with vaccine preventable diseases, including tetanus, periodically presenting among children from these communities. Nearly 20% of nationally reported pediatric tetanus cases in the past 10 years were treated at our institution, the tertiary care center which serves these unique populations. We characterize demographics and costs of treating this rare, but largely preventable infection. Methods Chart review based on ICD-9 codes for tetanus infection in patients aged 0–17 years treated for clinically diagnosed tetanus infection between January 2006 and December 2015. Cost data were extracted from Horizon Business Insight software and analyzed in Microsoft Excel. Cases were mapped using UDS Mapper. Results Four cases of pediatric tetanus infection were identified with 100% occurring in unimmunized patients and 3 of 4 (75%) in Amish individuals. Treatment costs amounted to $121,170 with estimated payment of $80,664 resulting in a net loss to the hospital of $40,506 over the course of 10 years. Each case treated resulted in a median loss of $4,402 to the hospital. Conclusion The costs of treating this vaccine preventable disease for both hospitals and under-immunized Amish and Mennonite communities, who tend to pay out-of-pocket, should be emphasized in targeted outreach and education programs at the population level. Disclosures All authors: No reported disclosures.

A 10-Year Review of Necrotizing Fasciitis in the Pediatric Population: Delays to Diagnosis and Management

2016 ◽  
Vol 56 (7) ◽  
pp. 627-633 ◽  
Author(s):  
Heather VanderMeulen ◽  
Jeffrey M. Pernica ◽  
Madan Roy ◽  
April J. Kam
Keyword(s):  
Necrotizing Fasciitis ◽  
Chart Review ◽  
Pediatric Population ◽  
Care Center ◽  
Tertiary Care ◽  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
Causative Organism ◽  
Antibiotic Administration ◽  
Large Variability

Objective. To assess the promptness and appropriateness of management in pediatric cases of necrotizing fasciitis (NF). Methods. A retrospective chart review examined cases of pediatric NF treated at a pediatric tertiary care center over a 10-year period. Results. Twelve patients were identified over the 10-year period. The median (25th to 75th centile) times to appropriate antibiotic administration, infectious disease consults, surgical consults and debridement surgeries were 2.6 (2.1-3.2), 7.7 (3.4-24.4), 4.6 (1.7-21.0), and 22.1 (10.3-28.4) hours following assessment at triage. The initial antibiotic(s) administered covered the causative organism in 9 of 12 cases. The median (25th to 75th centile) length of hospital stay was 21 (14.0-35.5) days. Conclusions. The large variability in the care of these patients speaks to the range of their presenting symptomatology. The lack of a standardized approach to the pediatric patient with suspected NF results in delays in management and suboptimal antibiotic choice.

scholarly journals Inter-Rater Reliability of the Retrospectively Assigned Clinical Frailty Scale Score in a Geriatric Outreach Population

2018 ◽  
Vol 21 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Jasmine Davies ◽  
Jennifer Whitlock ◽  
Iris Gutmanis ◽  
Sheri-Lynn Kane
Keyword(s):  
Scale Score ◽  
Daily Living ◽  
Chart Review ◽  
Tertiary Care ◽  
Clinical Syndrome ◽  
Clinical Frailty Scale ◽  
Rater Reliability ◽  
Outreach Service ◽  
Increased Risk ◽  
Nurse Clinician

BackgroundFrailty, a common clinical syndrome in older adults associated with increased risk of poor health outcomes, has been retrospectively calculated in previous publications; however, the reliability of retrospectively assigned frailty scores has not been established. The aim of this study was to see if frailty scores, based on chart review data, agreed with clinician-determined scores based on a comprehensive geriatric assessment.MethodsPer standard practice, all patients seen by one nurse clinician (JW) from the Southwestern Ontario Regional Geriatric Program, a tertiary care-based outreach service, between August 15, 2013 and December 31, 2015 received a comprehensive geriatric assessment which included the assignment of an interview-based Clinical Frailty Scale score (CFS-I). Subsequently, a medical student researcher (JD), blinded to the CFS-I, assigned each consenting patient a frailty score based on chart review data (CFS-C). The inter-rater reliability of the CFS-I and CFS-C was then determined.ResultsOf the 41 consented patients, 39 had both a CFS-I and CFSC score. The median CFS score was 6, indicating patients were moderately frail and required assistance for some basic activities of daily living. Cohen’s kappa coefficient was 0.64, indicating substantial agreement.ConclusionCFS scores can be reliably assigned retrospectively, thereby strengthening the utility of this measure.

scholarly journals Pattern of blood requisition and utilization in a tertiary care hospital: a chart review study

2021 ◽  
Vol 8 (4) ◽  
pp. 1991
Author(s):  
Mohammed Rafique ◽  
Laisangbam Tarakishwor Singh ◽  
N. Ranabrata Meetei ◽  
Shantibala Konjengbam ◽  
Brogen Singh Akoijam
Keyword(s):  
Blood Group ◽  
Chart Review ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
High Rate ◽  
Care Hospital ◽  
Medicine Department ◽  
Inappropriate Use ◽  
Group A ◽  
Abstract Data

Background: There is a tendency to order more units of blood than what are actually needed. As blood being finite and recognition of a high rate of inappropriate use, there is a need to monitor and regulate it. It can be done by the analysis of blood requisitions. This study was done to analyze the pattern of blood requisition and utilization in a tertiary care hospital considering the lack of such studies conducted.Methods: A chart review was conducted during April to May, 2020 to analyse 5601 blood requisitions made during April 2019 to March 2020 in the Department of Transfusion Medicine, RIMS Imphal. Data abstraction form was used to abstract data and it was analyzed in IBM Statistical package for social sciences (SPSS) version 21.Results: Out of total 5601 blood requisitions, 52.8% were made for female. Nearly one-fifth (18.4%) of the requisitions were for 50-59 years. Of the blood group, A+ (33.4%) was the commonest. Nearly one-third (32.4%) of blood units requested were from the Medicine Department. Anemia (71.6%) was the most common indication. Out of total 5601 requisitions, 4727 (84.4%) were made for packed RBC, 258 (4.6%) for FFP, 232 (4.1%) for platelets and 44 (0.8%) for whole blood. Majority (14.1%) of requisitions were made during the month of July. Replacement was the commonest mode of issue of blood.Conclusions: Predominant blood requisitions were made for A+ blood group. PRBC constitute majority of the blood requisition. Majority of the requisitions were made from medicine department.

Nasal Mucormycosis: Our experience with 24 cases

2020 ◽  
Vol 74 (4) ◽  
pp. 37-40
Author(s):  
Satvinder Singh Bakshi ◽  
Soumyajit Das ◽  
Seepana Ramesh ◽  
Suriyanarayanan Gopalakrishnan
Keyword(s):  
Liposomal Amphotericin ◽  
Chart Review ◽  
Hematologic Malignancy ◽  
Care Center ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
First Line ◽  
The Past ◽  
Increased Risk ◽  
Shed Light

<b>Background:</b> Mucormycosis is a rare fungal infection affecting people with impaired immunity. The aim of this study is to shed light on the epidemiology, incidence, and outcome of patients with mucormycosis hospitalized at a tertiary care center in Pondicherry. <br><b>Methods:</b> We conducted a retrospective chart review between January 2008 and January 2018. All patients with proven or probable mucormycosis were included. <br><b>Results:</b> A total of 24 patients were included. Their median age was 49 years and the majority were males. Comorbidities included mainly hematologic malignancy and diabetes mellitus. A liposomal amphotericin B formulation alone or in combination with other antifungals was used as a first line agent in all patients. <br><b>Conclusion:</b> The incidence of mucormycosis has significantly increased over the past 10 years at our institution, most likely due to increased risk factors.

COMPARISON OF EFFECTIVENESS OF MOBILIZATION AND SELF-EXERCISES IN ADHESIVE CAPSULITIS OF SHOULDER

2018 ◽  
Vol 7 (1) ◽  
pp. 35-41
Author(s):  
Muhammad Usman Khan ◽  
Ghazala Noor Nizami ◽  
Ali Farhad
Keyword(s):  
Pain Intensity ◽  
Adhesive Capsulitis ◽  
Descriptive Analysis ◽  
Tertiary Care ◽  
Sampling Technique ◽  
Simple Random Sampling ◽  
T Test ◽  
P Value ◽  
Group A ◽  
Group B

OBJECTIVE To compare the effectiveness of mobilization and self-exercises in the management of adhesive capsulitis of shoulder STUDY DESIGN Randomized Control Trial SAMPLE SELECTION 30 patients of adhesive capsulitis of shoulder from physiotherapy department of tertiary care hospitals of Karachi were selected through simple random sampling technique. PROCEDURE Treatment was continued for 5 days per week for the period of 3 weeks followed by assessment. Patients were randomly divided into two equal groups. Group A was treated with midrange mobilization while group B performed self-exercises. Both groups received TENS and hot pack prior to the exercises. Mean ± SD, frequencies and percentages were used for descriptive analysis. ROM via goniometry and pain intensity through VAS was analyzed by paired t-test within the groups and by independent t-test between the groups, using SPSS. P-value of less than 0.05 was considered significant. RESULTS 60% were females (n=18) and 40% were males (n=12) with mean age of 50.17±6.37 years. Significant improvement (p-value <0.05) in pain and shoulder ROM was observed among patients of Group A as compared to Group B. Pain intensity was decreased to 1.67 ± 0.62 in group A, whereas ROMs in these patients were also better than other group.

Prevalence, Correlates and Management of Hyperglycemia in Diabetic Non-critically Ill Patients at a Tertiary Care Center in Lebanon

2019 ◽  
Vol 15 (2) ◽  
pp. 133-140 ◽  
Author(s):  
Ghada El Khoury ◽  
Hanine Mansour ◽  
Wissam K. Kabbara ◽  
Nibal Chamoun ◽  
Nadim Atallah ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Care Center ◽  
Descriptive Analysis ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
Diabetic Patients

Background: Diabetes Mellitus is a chronic metabolic disease that affects 387 million people around the world. Episodes of hyperglycemia in hospitalized diabetic patients are associated with poor clinical outcomes and increased morbidity and mortality. Therefore, prevention of hyperglycemia is critical to decrease the length of hospital stay and to reduce complications and readmissions. Objective: The study aims to examine the prevalence of hyperglycemia and assess the correlates and management of hyperglycemia in diabetic non-critically ill patients. Methods: The study was conducted on the medical wards of a tertiary care teaching hospital in Lebanon. A retrospective chart review was conducted from January 2014 until September 2015. Diabetic patients admitted to Internal Medicine floors were identified. Descriptive analysis was first carried out, followed by a multivariable analysis to study the correlates of hyperglycemia occurrence. Results: A total of 235 medical charts were reviewed. Seventy percent of participants suffered from hyperglycemia during their hospital stay. The identified significant positive correlates for inpatient hyperglycemia, were the use of insulin sliding scale alone (OR=16.438 ± 6.765-39.941, p=0.001) and the low frequency of glucose monitoring. Measuring glucose every 8 hours (OR= 3.583 ± 1.506-8.524, p=0.004) and/or every 12 hours (OR=7.647 ± 0.704-79.231, p=0.0095) was associated with hyperglycemia. The major factor perceived by nurses as a barrier to successful hyperglycemia management was the lack of knowledge about appropriate insulin use (87.5%). Conclusion: Considerable mismanagement of hyperglycemia in diabetic non-critically ill patients exists; indicating a compelling need for the development and implementation of protocol-driven insulin order forms a comprehensive education plan on the appropriate use of insulin.

scholarly journals A Study of Factors Affecting the Length of Hospital Stay of COVID-19 Patients by Cox-Proportional Hazard Model in a South Indian Tertiary Care Hospital

2021 ◽  
Vol 12 ◽  
pp. 215013272110002
Author(s):  
Gayathri Thiruvengadam ◽  
Marappa Lakshmi ◽  
Ravanan Ramanujam
Keyword(s):  
Hospital Stay ◽  
Tertiary Care ◽  
Length Of Hospital Stay ◽  
Hazard Model ◽  
Cox Proportional Hazard Model ◽  
Care Hospital ◽  
Proportional Hazard ◽  
Proportional Hazard Model ◽  
Cox Proportional Hazard ◽  
South Indian

Background: The objective of the study was to identify the factors that alter the length of hospital stay of COVID-19 patients so we have an estimate of the duration of hospitalization of patients. To achieve this, we used a time to event analysis to arrive at factors that could alter the length of hospital stay, aiding in planning additional beds for any future rise in cases. Methods: Information about COVID-19 patients was collected between June and August 2020. The response variable was the time from admission to discharge of patients. Cox proportional hazard model was used to identify the factors that were associated with the length of hospital stay. Results: A total of 730 COVID-19 patients were included, of which 675 (92.5%) recovered and 55 (7.5%) were considered to be right-censored, that is, the patient died or was discharged against medical advice. The median length of hospital stay of COVID-19 patients who were hospitalized was found to be 7 days by the Kaplan Meier curve. The covariates that prolonged the length of hospital stay were found to be abnormalities in oxygen saturation (HR = 0.446, P < .001), neutrophil-lymphocyte ratio (HR = 0.742, P = .003), levels of D-dimer (HR = 0.60, P = .002), lactate dehydrogenase (HR = 0.717, P = .002), and ferritin (HR = 0.763, P = .037). Also, patients who had more than 2 chronic diseases had a significantly longer length of stay (HR = 0.586, P = .008) compared to those with no comorbidities. Conclusion: Factors that are associated with prolonged length of hospital stay of patients need to be considered in planning bed strength on a contingency basis.

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