Endaural Atticotomy for pars flaccida Cholesteatoma

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P55-P55
Author(s):  
John P Leonetti ◽  
Sam J Marzo ◽  
Matthew L Kircher
Keyword(s):  
Clinical Symptoms ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Long Term Results ◽  
Pars Flaccida ◽  
Academic Medical

Objective To present our long-term results using an endaural atticotomy approach for the management of 361 cases of pars flaccida cholesteatoma. Methods This is a retrospective chart review of 361 cases of attic cholesteatoma that were surgically managed at our tertiary care, academic medical center between 7/88 – 7/07. Results 361 of the 2068 cholesteatomas treated at our institution were surgically managed with an endaural atticotomy approach. There were 201 females and 160 males who ranged in age from 17–77 years. The most common clinical symptoms were aural fullness, hearing loss, and otorrhea. Ossiculoplasty was necessary in 170 of 361 or 47% of the patients. Hearing levels were maintained or improved in 297 patients or 82%. Cholesteatoma recurred in 29 of 361 patients (8%) and 24 of these 29 patients failed to return for otoscopic evaluation and PE tube replacement. The mean follow-up was 7.7 years. Conclusions The endaural approach for pars flaccida cholesteatoma is an option for limited retraction cholesteatomas in patients who will reliably be seen for ventilation tube replacement.

Factors Affecting Compliance With Myringotomy Tube Follow-up Care

2022 ◽  
pp. 000348942110722
Author(s):  
Helen H. Soh ◽  
Katherine R. Keefe ◽  
Madhav Sambhu ◽  
Tithi D. Baul ◽  
Dillon B. Karst ◽  
...  
Keyword(s):  
Medical Center ◽  
Private Insurance ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Safety Net ◽  
Tube Placement ◽  
Factors Affecting ◽  
Urban Safety

Objective: Myringotomy and tube insertion is a commonly practiced procedure within pediatric otolaryngology. Though relatively safe, follow-up appointments are critical in preventing further complications and monitoring for improvement. This study sought to evaluate the factors associated with compliance of post-myringotomy follow-up visits in an urban safety-net tertiary care setting. Methods: This study is a retrospective chart review conducted in outpatient otolaryngology clinic at an urban, safety-net, tertiary-care, academic medical center. All patients from ages 0 to 18 who received myringotomy and tube placement between February 3, 2012, to May 30, 2018 at the aforementioned clinic were included. Results: A total of 806 patients had myringotomy tubes placed during this period; 190 patients were excluded due to no visits being scheduled within 1 and 6 month visit windows post-operatively, leaving 616 patients included for analysis. Of 616 patients, 574 patients were seen for the 1-month visit, (42 patients did not have follow-up visits within the 1-month window), and 356 patients were examined for the 6-month visit (260 patients did not schedule follow-up visits within the 6-month window). For the 1-month follow-up visits post-procedure, only race/ethnicity type “Other” was associated with lower no-show rates (OR = 0.330, 95% CI: 0.093-0.968). With the 6-month follow-up visits, having private insurance (OR = 0.446, 95% CI: 0.229-0.867) and not having a 1-month visit scheduled (OR = 0.404, 95% CI: 0.174-0.937) predicted lower no-show rates. Conclusion: No meaningful factors studied were significantly associated with compliance of short-term, 1-month visits post-myringotomy. Compliance of longer-term, 6-month post-operative visits was associated with insurance type and previous visit status.

scholarly journals Efficacy of Fluoroscopically Guided Steroid Injections in the Management of Coccydynia

2007 ◽  
Vol 6;10 (6;11) ◽  
pp. 775-778
Author(s):  
Raj Mitra
Keyword(s):  
Acute Pain ◽  
Medical Center ◽  
Statistical Significance ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Stepwise Logistic Regression ◽  
Exact Test ◽  
Steroid Injections ◽  
Academic Medical

Background: Coccydynia is a rare but painful disorder characterized by axial coccygeal pain which is typically exacerbated by pressure. Management includes physical therapy/rectal manipulation, use of anti-inflammatory medications, modality use, coccygectomy, and fluoroscopically guided steroid injections. There are no studies documenting the efficacy of fluoroscopically guided coccygeal steroid injections in patients with coccydynia. Methods: Retrospective chart review was used to collect data on 14 consecutive patients diagnosed with coccydynia who underwent a fluoroscopically guided coccygeal injection of 80 mg triamcinolone acetate and 2mg of 1% lidocaine over a 3-year period at a tertiary care academic medical center. Results: Using stepwise logistic regression, acute pain was determined to be the best predictor of relief. Fisher’s exact test showed that those patients with pain lasting less then 6 months were significantly more likely to have greater than 50% relief (P=0.055). Patients with chronic pain longer than 6 months were not found to have pain relief of >50% to any statistical significance, but every patient with acute pain showed improvement. Conclusion: Patients with acute pain (less then 6 months) are more likely to respond to fluoroscopically guided coccygeal steroid injections. Key words: Coccydynia, steroid injection, fluroscopy.

scholarly journals Long-term results of microvascular free-tissue transfer reanimation of the paralyzed face: Three cases

2008 ◽  
Vol 87 (4) ◽  
pp. 226-233
Author(s):  
John P. Leonetti ◽  
Chad A. Zender ◽  
Daryl Vandevender ◽  
Sam J. Marzo
Keyword(s):  
Facial Nerve ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Free Tissue Transfer ◽  
Long Term Results ◽  
Wide Field ◽  
Facial Movement ◽  
Tissue Transfer ◽  
Facial Reanimation

We conducted a retrospective case review at our tertiary care academic medical center to assess the long-term results of microvascular free-tissue transfer to achieve facial reanimation in 3 patients. These patients had undergone wide-field parotidectomy with facial nerve resection. Upper facial reanimation was accomplished with a proximal facial nerve–sural nerve graft, and lower facial movement was achieved through proximal facial nerve–long thoracic (serratus muscle) nerve anastomosis. Outcomes were determined by grading postoperative facial nerve function according to the House-Brackmann system. All 3 patients were able to close their eyes independent of lower facial movement, and all 3 had achieved House-Brackmann grade III function. We conclude that reanimating the paralyzed face with microvascular free-tissue transfer provides anatomic coverage and mimetic function after wide-field parotidectomy. Synkinesis is reduced by separating upper-and lower-division reanimation.

scholarly journals Clinical Team Distribution and Antibiotic Use Patterns at a Tertiary-Care Academic Medical Center

2020 ◽  
Vol 41 (S1) ◽  
pp. s168-s169
Author(s):  
Rebecca Choudhury ◽  
Ronald Beaulieu ◽  
Thomas Talbot ◽  
George Nelson
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Antibiotic Use ◽  
Care Hospital ◽  
Hospital Units ◽  
Antibiotic Utilization ◽  
Academic Medical ◽  
Level Data ◽  
Utilization Data

Background: As more US hospitals report antibiotic utilization to the CDC, standardized antimicrobial administration ratios (SAARs) derived from patient care unit-based antibiotic utilization data will increasingly be used to guide local antibiotic stewardship interventions. Location-based antibiotic utilization surveillance data are often utilized given the relative ease of ascertainment. However, aggregating antibiotic use data on a unit basis may have variable effects depending on the number of clinical teams providing care. In this study, we examined antibiotic utilization from units at a tertiary-care hospital to illustrate the potential challenges of using unit-based antibiotic utilization to change individual prescribing. Methods: We used inpatient pharmacy antibiotic use administration records at an adult tertiary-care academic medical center over a 6-month period from January 2019 through June 2019 to describe the geographic footprints and AU of medical, surgical, and critical care teams. All teams accounting for at least 1 patient day present on each unit during the study period were included in the analysis, as were all teams prescribing at least 1 antibiotic day of therapy (DOT). Results: The study population consisted of 24 units: 6 ICUs (25%) and 18 non-ICUs (75%). Over the study period, the average numbers of teams caring for patients in ICU and non-ICU wards were 10.2 (range, 3.2–16.9) and 13.7 (range, 10.4–18.9), respectively. Units were divided into 3 categories by the number of teams, accounting for ≥70% of total patient days present (Fig. 1): “homogenous” (≤3), “pauciteam” (4–7 teams), and “heterogeneous” (>7 teams). In total, 12 (50%) units were “pauciteam”; 7 (29%) were “homogeneous”; and 5 (21%) were “heterogeneous.” Units could also be classified as “homogenous,” “pauciteam,” or “heterogeneous” based on team-level antibiotic utilization or DOT for specific antibiotics. Different patterns emerged based on antibiotic restriction status. Classifying units based on vancomycin DOT (unrestricted) exhibited fewer “heterogeneous” units, whereas using meropenem DOT (restricted) revealed no “heterogeneous” units. Furthermore, the average number of units where individual clinical teams prescribed an antibiotic varied widely (range, 1.4–12.3 units per team). Conclusions: Unit-based antibiotic utilization data may encounter limitations in affecting prescriber behavior, particularly on units where a large number of clinical teams contribute to antibiotic utilization. Additionally, some services prescribing antibiotics across many hospital units may be minimally influenced by unit-level data. Team-based antibiotic utilization may allow for a more targeted metric to drive individual team prescribing.Funding: NoneDisclosures: None

scholarly journals 1310. Implementation of AUC:MIC Pharmacy to Dose in an Academic Medical Center: A Pilot Study

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S667-S668
Author(s):  
Ann-Marie Idusuyi ◽  
Maureen Campion ◽  
Kathleen Belusko
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Area Under The Curve ◽  
Kidney Injury ◽  
Retrospective Chart Review ◽  
Total Daily Dose ◽  
Therapeutic Goals ◽  
Academic Medical ◽  
Progress Notes ◽  
Implementation Period

Abstract Background The new ASHP/IDSA consensus guidelines recommend area under the curve (AUC) monitoring to optimize vancomycin therapy. Little is known about the ability to implement this recommendation in a real-world setting. At UMass Memorial Medical Center (UMMMC), an AUC pharmacy to dose protocol was created to manage infectious diseases (ID) consult patients on vancomycin. The service was piloted by the pharmacy residents and 2 clinical pharmacists. The purpose of this study was to determine if a pharmacy to dose AUC protocol can safely and effectively be implemented. Methods A first-order kinetics calculator was built into the electronic medical record and live education was provided to pharmacists. Pharmacists ordered levels, wrote progress notes, and communicated to teams regarding dose adjustments. Patients were included based upon ID consult and need for vancomycin. After a 3-month implementation period, a retrospective chart review was completed. Patients in the pre-implementation group were admitted 3 months prior to AUC pharmacy to dose, had an ID consult and were monitored by trough (TR) levels. The AUC group was monitored with a steady state peak and trough level to calculate AUC. The primary outcome evaluated time to goal AUC vs. time to goal TR. Secondary outcomes included number of dose adjustments made, total daily dose of vancomycin, and incidence of nephrotoxicity. Results A total of 64 patients met inclusion criteria, with 37 patients monitored by TR and 27 patients monitored by AUC. Baseline characteristics were similar except for weight in kilograms (TR 80.0 ±25.4 vs AUC 92.0 ±26.7; p=0.049). The average time to goal AUC was 4.13 (±2.08) days, and the average time to goal TR was 4.19 (±2.30) days (p=0.982). More dose adjustments occurred in the TR group compared to the AUC (1 vs 2; p=0.037). There was no difference between the two groups in dosing (TR 15.8 mg/kg vs AUC 16.4 mg/kg; p=0.788). Acute kidney injury occurred in 5 patients in the AUC group and 11 patients in the TR group (p=0.765). Conclusion Fewer dose adjustments and less nephrotoxicity was seen utilizing an AUC based protocol. Our small pilot has shown that AUC pharmacy to dose can be safely implemented. Larger studies are needed to evaluate reduction in time to therapeutic goals. Disclosures All Authors: No reported disclosures

Abstract 208: Effects of Gender and BMI on Comorbidities in Patients With Non Hemorrhagic Stroke

2016 ◽  
Vol 36 (suppl_1) ◽  
Author(s):  
Michael Ashamalla ◽  
Justin Pieper ◽  
Daniel Sedhom ◽  
Neil Yager ◽  
Mikhail Torosoff
Keyword(s):  
Hemorrhagic Stroke ◽  
Medical Center ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Obesity Paradox ◽  
Morbidly Obese ◽  
Academic Medical ◽  
Conflicting Evidence ◽  
Stage Renal Disease ◽  
End Stage

Background: There is conflicting evidence concerning the obesity paradox in stroke patients. We sought to examine the relationship between gender, BMI, and prevalence of comorbidities in patients with non-hemorrhagic stroke. Materials and Methods: Retrospective chart review was performed in 996 consecutive patients treated for non-hemorrhagic stroke at a single academic medical center. Patients were divided according to gender and specific BMI groups according to the National Institute of Health. This study was approved by the institutional IRB. Results: Patients with BMI from 0-18.5 and 18.5-24.9 were more likely to be female (63.2% and 58.4% p<.05). Whereas patients with BMI over 25-30 and 30-35 were more likely to be male (60.82% and 59.2% p<.05). Morbidly obese patients (BMI>35) were equally likely to be men or women. In men higher BMI correlated with presentation at younger age. Diabetes was most prevalent in patients with BMI over 35 (40% males, 44% females, p<.05). In females, HTN was associated with BMI 30-34.5 and 35+ (80.5% and 73.3%, P<.05). Males showed a similar though non-significant trend. The prevalence of end stage renal disease, systemic atherosclerosis, and PVD was not significantly correlated with BMI in either gender. Conclusion: Gender and BMI significantly affect associated comorbidities in patients with non-hemorrhagic stroke, possibly suggestive of unique gender specific disease mechanisms. Additional studies investigating the effect of gender and BMI on diagnostic evaluation and treatment of patients with non-hemorrhagic stroke are warranted.

scholarly journals Financial Impact of Tertiary Care in an Academic Medical Center

2000 ◽  
Vol 231 (6) ◽  
pp. 860-868 ◽  
Author(s):  
Thomas S. Huber ◽  
Lori M. Carlton ◽  
Donna G. O’Hern ◽  
Nancy S. Hardt ◽  
C. Keith Ozaki ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Financial Impact ◽  
Academic Medical

scholarly journals 421. Effect of SARs-Cov-2 mRNA Vaccination in Healthcare Workers with Household COVID Exposure

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S311-S311
Author(s):  
Laura Selby ◽  
Richard Starlin
Keyword(s):  
Healthcare Workers ◽  
Screening Program ◽  
Medical Center ◽  
Severe Disease ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Limited Data ◽  
Viral Shedding ◽  
Academic Medical ◽  
Significant Burden

Abstract Background Healthcare workers have experienced a significant burden of COVID-19 disease. COVID mRNA vaccines have shown great efficacy in prevention of severe disease and hospitalization due to COVID infection, but limited data is available about acquisition of infection and asymptomatic viral shedding. Methods Fully vaccinated healthcare workers at a tertiary-care academic medical center in Omaha Nebraska who reported a household exposure to COVID-19 infection are eligible for a screening program in which they are serially screened with PCR but allowed to work if negative on initial test and asymptomatic. Serial screening by NP swab was completed every 5-7 days, and workers became excluded from work if testing was positive or became symptomatic. Results Of the 94 employees who were fully vaccinated at the time of the household exposure to COVID-19 infection, 78 completed serial testing and were negative. Sixteen were positive on initial or subsequent screening. Vaccine failure rate of 17.0% (16/94). Healthcare workers exposed to household COVID positive contact Conclusion High risk household exposures to COVID-19 infection remains a significant potential source of infections in healthcare workers even after workers are fully vaccinated with COVID mRNA vaccines especially those with contact to positive domestic partners. Disclosures All Authors: No reported disclosures

Abstract T P168: A Wake-up Call for Wake-up Strokes

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Josephine F Huang ◽  
Jennifer E Fugate ◽  
Alejandro A Rabinstein
Keyword(s):  
Ischemic Stroke ◽  
Medical Center ◽  
Academic Medical Center ◽  
Stroke Treatment ◽  
Good Outcome ◽  
Time Period ◽  
Academic Medical ◽  
Younger Age ◽  
Stroke Mechanism

INTRODUCTION: Studies suggest 8%-28% of ischemic strokes present as wake-up strokes (WUS). The unknown time of symptom onset precludes these patients from approved treatments for acute ischemic stroke, but a substantial proportion of patients may be deemed candidates for treatment if other factors are considered. The aim of this study was to identify characteristics associated with clinical outcomes of WUS patients. METHODS: We retrospectively reviewed the medical record of patients with ischemic stroke admitted to a large academic medical center between January 2011 and May 2012. We identified patients with stroke symptoms upon awakening or those who were found with stroke symptoms with an unknown time of onset. Baseline demographics, stroke mechanism, presenting NIHSS, Alberta Stroke Program Early Computed Tomography Score (ASPECTS), and modified Rankin Scale (mRS) scores on discharge and at 3-month follow-up were obtained. A good outcome was defined as mRS 0-2. RESULTS: WUS patients comprised 22% (162/731) of all patients with ischemic stroke at our institution during this time period. Median age was 74 years (range 15-100), median presenting NIHSS was 5 (range 0-28), and median initial ASPECTS 10 (range 0-10). A cardioembolic mechanism was identified in 68 patients (42%). Predictors of good outcome at hospital discharge were lower initial NIHSS (3.5 versus 12.0, p<0.0001) and higher ASPECTS (9.8 versus 8.1, p=0.0002). The predictors of good outcomes at 3 months were younger age (69.1 versus 75.8, p=0.009), lower initial NIHSS (5.0 versus 12.6, p<0.0001), and higher ASPECTS (9.5 versus 8.1, p=0.0006). One hundred and eleven patients (68.5%) had initial ASPECTS of 10. Of those, 19 had NIHSS≥10 and 7 were treated with acute recanalization therapies. Four of the 7 treated patients had good outcomes, and 2 of the 12 untreated patients had good outcomes. CONCLUSIONS: Few patients with strokes of unknown onset and severe deficits have good outcomes without acute stroke treatment. Patients with NIHSS≥10 and ASPECTS 10 may be candidates for acute recanalization therapy.

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