scholarly journals The impact of polymerase chain reaction (PCR) on diagnosis and management of infectious uveitis at a tertiary care facility

2022 ◽  
Vol 12 (1) ◽  
Author(s):  
Julia Fallon ◽  
Swati Narayan ◽  
Jun Lin ◽  
Jodi Sassoon ◽  
Stephanie Llop
Keyword(s):  
Tertiary Care ◽  
Care Facility ◽  
Clinical Suspicion ◽  
Chain Reaction ◽  
Treatment Change ◽  
Tertiary Care Facility ◽  
High Clinical Suspicion ◽  
Infectious Uveitis ◽  
Polymerase Chain ◽  
The Impact

Abstract Background Polymerase Chain Reaction (PCR) is a well-accepted adjunct in the management of infectious uveitis. In turn, few reports in the literature have evaluated how PCR then impacts patient care. This study aims to evaluate the impact of PCR sampling on diagnosis and treatment of infectious uveitidies at a large tertiary care facility. Main body This is a retrospective, observational study of patients with aqueous and vitreous PCR samples obtained from 2014 to 2019. The study was undertaken at a single institution. At least one follow up visit following results of PCR testing was required for inclusion. If a patient had multiple PCR samples taken, only the first sample was included. The patients were divided into three categories based on pre-sampling diagnosis. A chi-square test was used to analyze the data. 108 cases were available for analysis. PCR did not change diagnosis or management in any of the cases where pre-sampling diagnosis carried a high clinical suspicion for negative PCR. Overall, the results of PCR testing had a more significant impact on diagnosis in those cases where pre-sampling diagnosis was unknown versus those where it was confirmatory in nature, thus presumed to be related to an infectious entity tested by PCR (74% vs. 29%, p = 0.00006). The rate of treatment change based on PCR was similar between those cases where there was a high clinical suspicion for positive PCR and those where pre-sampling diagnosis was unknown (32% vs. 33%, p = 0.95). Further analyzing specimens separately depending on source of sample, this pattern persisted for aqueous samples, with PCR showing a more significant impact on diagnosis in those cases where the diagnosis was unknown versus those where sampling was confirmatory (86% vs. 31%, p = 0.00004). The rate of change in treatment between the two groups was similar (35% vs. 31%, p = 0.79). Vitreous samples followed a similar pattern with a higher rate of diagnosis change for those cases where pre-sampling diagnosis was unknown and a similar rate in treatment change between the two groups, however this did not reach statistical signifigance (44% vs. 25%, p = 0.28; 27% vs. 33%, p = 0.74). Conclusion There is no well-defined algorithm as to when to employ PCR testing in uveitis. As expected, in our experience, it has the largest impact on diagnosis when the diagnosis is unknown, however even when confirmatory in nature, it continues to impact patient management.

scholarly journals An Assessment of Emergency Department Throughput and Provider Satisfaction after the Implementation of a Scribe Program

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Brandon Allen ◽  
Ben Banapoor ◽  
Emily C. Weeks ◽  
Thomas Payton
Keyword(s):  
Emergency Department ◽  
Program Implementation ◽  
Tertiary Care ◽  
Care Facility ◽  
Workplace Satisfaction ◽  
Electronic Survey ◽  
Left Without Being Seen ◽  
Tertiary Care Facility ◽  
Discharged Patients ◽  
The Impact

Objectives. To assess the impact of a scribe program on an academic, tertiary care facility. Methods. A retrospective analysis of emergency department (ED) data, prior to and after scribe program implementation, was used to quantitatively assess the impact of the scribe program on measures of ED throughput. An electronic survey was distributed to all emergency medicine residents and advanced practice providers to qualitatively assess the impact of the scribe program on providers. Results. Several throughput time measures were significantly lower in the postscribe group, compared to prescribe implementation, including time to disposition. The left without being seen (LWBS) decrease was not statistically significant. A total of 30 providers responded to the survey. 100% of providers indicated scribes are a valuable addition to the department and they enjoy working with scribes. 90% of providers indicated scribes increase their workplace satisfaction and quality of life. Conclusions. Through evaluation of prescribe and postscribe implementation, the postscribe time period reflects many throughput improvements not present before scribes began. Scribe Program implementation led to improved ED throughput for discharged patients with further system-wide challenges needing to be addressed for admitted patients.

scholarly journals Decreasing High Risk Exposures for Healthcare-workers through Universal Masking and Universal SARS-CoV-2 Testing upon entry to a Tertiary Care Facility

2020 ◽  
Author(s):  
Jeremey Walker ◽  
Molly E Fleece ◽  
Russell L Griffin ◽  
Sixto M Leal ◽  
Jorge A Alsip ◽  
...  
Keyword(s):  
High Risk ◽  
Healthcare Workers ◽  
Tertiary Care ◽  
Care Facility ◽  
Universal Testing ◽  
Tertiary Care Facility ◽  
The Impact

Abstract We describe the impact of universal masking and universal testing at admission on high risk exposures to SARS-CoV-2 for healthcare workers. Universal masking decreased the rate per patient day of high risk exposures by 68%, and universal testing further decreased those exposures by 77%.

scholarly journals Impact of the Novel Coronavirus 2019 (COVID-19) Pandemic on Head and Neck Cancer Care

2021 ◽  
pp. 019459982110045
Author(s):  
Joshua Adam Thompson ◽  
Joshua E. Lubek ◽  
Neha Amin ◽  
Reju Joy ◽  
Donita Dyalram ◽  
...  
Keyword(s):  
Head And Neck ◽  
Tertiary Care ◽  
Care Facility ◽  
Cross Sectional Study ◽  
Tumor Board ◽  
Secondary Outcome ◽  
Cross Sectional ◽  
Tertiary Care Facility ◽  
Procedural Volume ◽  
The Impact

Objective The study aimed to assess the impact of the coronavirus disease 2019 (COVID-19) pandemic on head and neck oncologic care at a tertiary care facility. Study Design This was a cross-sectional study conducted between March 18, 2020, and May 20, 2020. The primary planned outcome was the rate of treatment modifications during the study period. Secondary outcome measures were tumor conference volume, operative volume, and outpatient patient procedure and clinic volumes. Setting This single-center study was conducted at a tertiary care academic hospital in a large metropolitan area. Methods The study included a consecutive sample of adult subjects who were presented at a head and neck interdepartmental tumor conference during the study period. Patients were compared to historical controls based on review of operative data, outpatient procedures, and clinic volumes. Results In total, 117 patients were presented during the review period in 2020, compared to 69 in 2019. There was an 8.4% treatment modification rate among cases presented at the tumor conference. There was a 61.3% (347 from 898) reduction in outpatient clinic visits and a 63.4% (84 from 230) reduction in procedural volume compared to the prior year. Similarly, the operative volume decreased by 27.0% (224 from 307) compared to the previous year. Conclusion Restrictions related to the COVID-19 pandemic resulted in limited treatment modifications. Transition to virtual tumor board format observed an increase in case presentations. While there were reductions in operative volume, there was a larger proportion of surgical cases for malignancy, reflecting the prioritization of oncologic care during the pandemic.

scholarly journals The Impact of COVID-19 Pandemic on Cancer Care in a Tertiary Care Facility

2021 ◽  
Vol 10 (01) ◽  
pp. 32-35
Author(s):  
Pradeep Kumar Reddy K. ◽  
Jyosthna Elagandula ◽  
Shivani Patel ◽  
Rajesh Patidar ◽  
Vikas Asati ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Active Treatment ◽  
Lymphoblastic Leukemia ◽  
Tertiary Care ◽  
Care Facility ◽  
Cancer Type ◽  
Cancer Management ◽  
Tertiary Care Facility ◽  
Anticancer Treatment ◽  
The Impact

Abstract Background Coronavirus disease 2019 (COVID-19) pandemic had an overwhelming impact on health care worldwide. Cancer patients represent a subgroup that is vulnerable and is under high risk. It is, therefore, necessary to analyze factors that predict outcomes in these patients so that they can be triaged accordingly to mitigate the effects of COVID-19 on cancer management. To date, the impact of COVID-19 on cancer patients remain largely unknown. Methods Data of 291 cancer patients undergoing active treatment from March 23 to August 15, 2020 were retrospectively reviewed; the incidence, demographic and clinical characteristics, treatment, and outcomes of cancer patients infected by COVID-19 were included in the analysis. Discussion During the index period (March 23–August 15, 2020), 4,494 confirmed cases of COVID-19 were admitted at our institute. In the department of medical oncology out of 578 patients presented to outpatient department, 291 patients were admitted for active treatment. Considering the cancer patients, infection rate was 7.9% (23/291) and mortality 13% (3/23). Median age was 40 years and the majority of patients were male (60%). The most common cancer type was acute lymphoblastic leukemia presented at various stages of treatment. Twenty patients (86.9%) were discharged after full clinical recovery and negative real-time polymerase chain reaction on a nasopharyngeal swab. Anticancer treatment was modified according to the type of cancer under intensive surveillance. Conclusion Although mortality rate in COVID-19 cancer patients is elevated, our results support the feasibility and safety of continuing anticancer treatment during pandemic by endorsing consistent preventive measures, but however should be modified based on the type and prognosis of cancer.

scholarly journals 748. The Impact of a Positive Respiratory Viral Panel Among Hospitalized Adult Patients with Negative Rapid Influenza Testing at an Academic Tertiary Care Facility: A-matched Cohort Study

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S268-S268
Author(s):  
Emily Ciccone ◽  
Alan Kinlaw ◽  
Vahini Chundi ◽  
Melissa Miller ◽  
David Weber ◽  
...  
Keyword(s):  
Clinical Management ◽  
Tertiary Care ◽  
Care Facility ◽  
Respiratory Illness ◽  
Adult Patients ◽  
Nucleic Acid Amplification ◽  
Matched Cohort ◽  
Research Support ◽  
Tertiary Care Facility ◽  
The Impact

Abstract Background Multiplex nucleic acid amplification assays (NAATs) are increasingly used to evaluate respiratory illnesses. Viral diagnosis has the potential to change clinical management and, specifically, decrease antibiotic use. However, the assays are expensive, and their effect on clinical management is unknown. This study evaluated the incremental impact of a multiplex respiratory viral panel after negative rapid influenza testing. Methods We completed a retrospective review of all adult patients with respiratory viral panel (RVP; GenMark) and/or rapid influenza or RSV/influenza PCR tests (PCR; Cepheid Xpert) collected within 48 hours of admission to non-ICU, inpatient units from September 1, 2015 to April 15, 2016. We matched hospitalizations with a positive RVP simultaneously with or following negative PCR testing (PCR−RVP+) 1:1 with patient encounters with negative rapid PCR testing only (PCR−). Matching of the referent PCR-group occurred without replacement based on age (±10 years), sex, race, season of testing (±50 days), and any respiratory viral test in the prior 30 days. The primary outcome was a change in management, defined as antimicrobial de-escalation (discontinuation, switch from intravenous to oral administration, and/or narrowing of spectrum), antiviral initiation, and/or change in isolation precautions. Results During the study period, there were 153 PCR−RVP+ patient encounters and 524 with PCR− testing only from which we identified 134 matched pairs. In the matched cohort, the median age was 60 years (IQR: 41–71), 47.8% were female, and 34.3% were non-White. Respiratory viral testing was associated with management change in 3.7% of PCR− and 23.9% of PCR−RVP+ patients (risk difference 20.1%; 95% CI 12.2–28.0%). Antimicrobial de-escalation did not occur after testing for any PCR- patients but did occur for 15.7% of PCR−RVP+ patients (95% CI 9.5–21.8%). Conclusion Among patients with negative rapid influenza testing, a subsequent or simultaneous positive RVP was associated with a higher frequency of antibiotic de-escalation. This suggests multiplex NAATs could play a role in improving antimicrobial stewardship in the setting of respiratory illness. Disclosures M. Miller, GenMark: Investigator, Research support. R. Jhaveri, GenMark: Investigator, Research support.

scholarly journals Health seeking behaviour, delayed presentation and its impact among oral cancer patients in Pakistan: a retrospective qualitative study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Sarah Basharat ◽  
Babar Tasneem Shaikh ◽  
Haroon Ur Rashid ◽  
Mamoon Rashid
Keyword(s):  
Oral Cancer ◽  
Financial Burden ◽  
Behavioural Change ◽  
Tertiary Care ◽  
Care Facility ◽  
Delayed Presentation ◽  
Health Seeking Behaviour ◽  
Health Seeking ◽  
Tertiary Care Facility ◽  
The Impact

Abstract Background Delayed diagnosis of Oral Cancer (OC) can mean a difference in quality and expectancy of life for the patient. This delay could be from the healthcare side, or more importantly from the patient’s side. Globally, there are studies enumerating the causes for delays from the patients’ side in seeking healthcare for Oral Cancer; however, no similar research is found in the context of Pakistan. This study endeavoured to understand the health seeking behaviour, reasons for delay in consultation and the impact on OC patients’ lives. Methods In-depth interviews were conducted with randomly selected OC patients at a private sector tertiary care facility in Islamabad (who met the inclusion criteria of having successfully been treated for Oral Cancer) which caters to the most diverse population for the treatment of Oral Cancer. Theoretical saturation was achieved at 14 interviews. All participants gave verbal consent for participation, which was recorded prior to the interviews. Results Patients (age range 43–68 years) had received the surgical treatment and radiation. The reported delay before seeking a proper medical advice ranged from 1 month to 2 years. Lack of awareness about OC risk factors, symptoms, and whom to approach for treatment were the main reasons. Most respondents relied on self-treatment considering the non-healing wound/ulcer to be a minor issue until they were advised a consultation with a specialist. Treatment started within 1–3 months after a confirmed diagnosis on biopsy. The reported average expenditure on treatment was US$5000-10,000, mostly covered through a private health insurance and others borrowed the money. Conclusion A socio-behavioural change campaign for the general population can result in earlier presentation of the OC, minimizing the financial burden on the patient as well as the health system, and improving the quality of life of the patients.

Assessing Acute St-Elevation Myocardial Infarction With Prognostic Significance Of The Hyponatramia

2020 ◽  
Vol 11 (3) ◽  
pp. 3251-3260
Author(s):  
Makrand B Mane
Keyword(s):  
Myocardial Infarction ◽  
Ejection Fraction ◽  
Tertiary Care ◽  
Prognostic Significance ◽  
Care Facility ◽  
Early Death ◽  
Public Health Issue ◽  
Care Hospital ◽  
Tertiary Care Facility ◽  
Significant Public Health

Acute Myocardial Infarction (AMI) has become a significant public health issue in developed and developing nations, following extensive diagnostic and management research over recent decades. The study intended to research the prognostic values of inexplicable Hyponatremia in patients with severe STelevation of myocardial infarction, in 100 consecutive patients admitted to Tertiary care hospital. In the analysis, identified patients on admission were diagnosed with or produced Hyponatremia within 72 hours—a lower ejection fraction than those with usual amounts of sodium. The research aimed to evaluate the prognosis significance of Hyponatremia for the estimation of early death in acute ST-elevated myocardial infarction. One hundred straight patients admitted in the Coronary Centre Tertiary Care Facility with severe STelevated myocardial infarction were studied. The data of the study on various risk factors in association with the development of Hyponatremia like as age, sex, use of tobacco, diabetes, hypertension, ejection fraction etc. were analyzed. Thus, the researchers reported that in patients diagnosed with severe ST section escalation, Hyponatremia showed the initial emergence of hyponatremia myocardial infarctions. This condition correlates with the severity of LV dysfunction (in term of LVEF) and can be considered as an individual early death indicator as well as a prediction exacerbates with hyponatremia frequency.

scholarly journals Clinical features and outcomes of infective endocarditis in Egypt: an 11-year experience at a tertiary care facility

2019 ◽  
Vol 71 (1) ◽  
Author(s):  
Hussein Hassan Rizk ◽  
Ahmed Adel Elamragy ◽  
Ghada Sayed Youssef ◽  
Marwa Sayed Meshaal ◽  
Ahmad Samir ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Hospital Mortality ◽  
Tertiary Care ◽  
Care Facility ◽  
Period 2 ◽  
Peripheral Embolization ◽  
Tertiary Care Facility ◽  
Few Data ◽  
Healthcare Associated ◽  
Complications And Mortality

Abstract Background Few data are available on the characteristics of infective endocarditis (IE) cases in Egypt. The aim of this work is to describe the characteristics and outcomes of IE patients and evaluate the temporal changes in IE diagnostic and therapeutic aspects over 11 years. Results The IE registry included 398 patients referred to the Endocarditis Unit of a tertiary care facility with the diagnosis of possible or definite IE. Patients were recruited over two periods; period 1 (n = 237, 59.5%) from February 2005 to December 2011 and period 2 (n = 161, 40.5%) from January 2012 to September 2016. An electronic database was constructed to include information on patients’ clinical and microbiological characteristics as well as complications and mortality. The median age was 30 years and rheumatic valvular heart disease was the commonest underlying cardiac disease (34.7%). Healthcare-associated IE affected 185 patients (46.5%) and 275 patients (69.1%) had negative blood cultures. The most common complications were heart failure (n = 148, 37.2%), peripheral embolization (n = 133, 33.4%), and severe sepsis (n = 100, 25.1%). In-hospital mortality occurred in 108 patients (27.1%). Period 2 was characterized by a higher prevalence of injection drug use-associated IE (15.5% vs. 7.2%, p = 0.008), a higher staphylococcal IE (50.0% vs. 35.7%, p = 0.038), lower complications (31.1% vs. 45.1%, p = 0.005), and a lower in-hospital mortality (19.9% vs. 32.1%, p = 0.007). Conclusion This Egyptian registry showed high rates of culture-negative IE, complications, and in-hospital mortality in a largely young population of patients. Improvements were noted in the rates of complications and mortality in the second half of the reporting period.

scholarly journals Characteristics of Critically Ill Patients with COVID-19 Compared to Patients with Influenza—A Single Center Experience

2021 ◽  
Vol 10 (10) ◽  
pp. 2056
Author(s):  
Frank Herbstreit ◽  
Marvin Overbeck ◽  
Marc Moritz Berger ◽  
Annabell Skarabis ◽  
Thorsten Brenner ◽  
...  
Keyword(s):  
Influenza A ◽  
Health Care Systems ◽  
Severe Disease ◽  
Tertiary Care ◽  
Care Facility ◽  
High Volume ◽  
Single Center Experience ◽  
Severe Influenza ◽  
Tertiary Care Facility ◽  
Care Systems

Infections with SARS-CoV-2 spread worldwide early in 2020. In previous winters, we had been treating patients with seasonal influenza. While creating a larger impact on the health care systems, comparisons regarding the intensive care unit (ICU) courses of both diseases are lacking. We compared patients with influenza and SARS-CoV-2 infections treated at a tertiary care facility offering treatment for acute respiratory distress syndrome (ARDS) and being a high-volume facility for extracorporeal membrane oxygenation (ECMO). Patients with COVID-19 during the first wave of the pandemic (n = 64) were compared to 64 patients with severe influenza from 2016 to 2020 at our ICU. All patients were treated using a standardized protocol. ECMO was used in cases of severe ARDS. Both groups had similar comorbidities. Time in ICU and mortality were not significantly different, yet mortality with ECMO was high amongst COVID-19 patients with approximately two-thirds not surviving. This is in contrast to a mortality of less than 40% in influenza patients with ECMO. Mortality was higher than estimated by SAPSII score on admission in both groups. Patients with COVID-19 were more likely to be male and non-smokers than those with influenza. The outcomes for patients with severe disease were similar. The study helps to understand similarities and differences between patients treated for severe influenza infections and COVID-19.

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