Role of Montgomery salivary stent placement during pharyngolaryngectomy, to prevent pharyngocutaneous fistula in high-risk patients

AbstractObjective:To evaluate the incidence of pharyngocutaneous fistula after pharyngolaryngectomy with and without a Montgomery salivary stent.Design:Retrospective analysis of patients with factors that predispose to the development of pharyngocutaneous fistula (i.e. disease extending to the supraglottic region, base of the tongue or pyriform sinuses, and/or radiochemotherapy).Subjects:Between 2002 and 2008, 85 pharyngolaryngectomies were performed in our clinic. Of these patients, 31 were at increased risk of fistula development, of whom 45 per cent developed fistulas post-operatively. This subgroup of 31 patients was compared with a second subgroup of 22 patients at high risk of fistula development, treated between 2009 and 2011 with pharyngolaryngectomy and with a Montgomery salivary stent placed in advance during closure of the neopharynx.Results:Statistical analysis showed a significant reduction in the rate of fistula development, from 45 to 9 per cent (p < 0.01), with application of the salivary stent.Conclusion:These data confirm the preventive effect of a salivary stent placed during pharyngolaryngectomy, for patients at high risk of fistula development.

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Evaluation of role of remdesivir in covid-19 patients outcome: A retrospective analysis

Indian Journal of Clinical Anaesthesia ◽

10.18231/j.ijca.2021.097 ◽

2021 ◽

Vol 8 (4) ◽

pp. 5-9

Author(s):

Vengamamba Tummala ◽

Chilamakuri Kalyani ◽

Saikrupa Vadlapudi ◽

Nagalaxmi Jangiti ◽

Beri Abhilash Sai ◽

...

Keyword(s):

High Risk ◽

Retrospective Analysis ◽

Antiviral Agent ◽

Supplemental Oxygen ◽

Progression Of Disease ◽

Risk Patients ◽

Group 2 ◽

Oxygen Group ◽

Group 1

Coronavirus disease 2019 (COVID-19) is a contagious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Remdesivir, a broad spectrum antiviral agent, is currently the only drug that is approved by the Food and Drug Administration for the treatment of COVID-19. It is recommended for use in hospitalized patients who require supplemental oxygen. There are insufficient data either for or against to recommend for routine use of Remdesivir in high risk patients who doesn’t require supplemental oxygen. To evaluate the efficacy of Remdesivir in covid positive patients. A retrospective analysis of 300 patients was done, out of which 150 patients belong to Group 1 and 150 patients belong to Group 2. Group 1-Elderly patients with comorbidities who doesn’t require supplemental oxygen Group 2- Patients requiring oxygen supplementation (SpO2 88% to 94% on room air).Group 1 patients were discharged earlier than Group 2 patients.Elective use of Remdesivir has a definitive role in prevention of progression of disease especially in high risk susceptible individuals.

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Faculty Opinions recommendation of Increased risk of general anesthesia for high-risk patients undergoing magnetic resonance imaging.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1159714.621114 ◽

2009 ◽

Author(s):

Roy Schwartz ◽

Pravin Taneja

Keyword(s):

Magnetic Resonance Imaging ◽

High Risk ◽

Magnetic Resonance ◽

General Anesthesia ◽

Resonance Imaging ◽

High Risk Patients ◽

Increased Risk ◽

Risk Patients

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No increased risk of VTE in high-risk patients continuing their dose of 75 mg aspirin compared to healthier patients given LMWH

The Journal of Arthroplasty ◽

10.1016/j.arth.2021.06.001 ◽

2021 ◽

Author(s):

Oystein Hovik ◽

Einar J. Amlie ◽

Kjersti Kaul Jenssen

Keyword(s):

High Risk ◽

High Risk Patients ◽

Increased Risk ◽

Risk Patients

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Inflammation as a determinant of healing response after coronary stent implantation

The International Journal of Cardiovascular Imaging ◽

10.1007/s10554-020-02073-3 ◽

2021 ◽

Author(s):

Dorota Ochijewicz ◽

Mariusz Tomaniak ◽

Grzegorz Opolski ◽

Janusz Kochman

Keyword(s):

Cardiovascular Disease ◽

High Risk ◽

Inflammatory Response ◽

Percutaneous Coronary Interventions ◽

Coronary Stent Implantation ◽

Percutaneous Coronary ◽

Prevention And Treatment ◽

Risk Patients ◽

Excessive Inflammatory Response

AbstractCardiovascular disease remains the leading cause of death and morbidity worldwide. Inflammation plays an important role in the development of atherosclerosis and is associated with adverse clinical outcomes in patients after percutaneous coronary interventions. Data on stent elements that lead to excessive inflammatory response, proper identification of high–risk patients, prevention and treatment targeting residual inflammatory risk are limited. This review aims to present the role of inflammation in the context of evolving stent technologies and appraise the potential imaging modalities in detection of inflammatory response and anti-inflammatory therapies.

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Outcomes and Role of Urgent Endoscopy in High-Risk Patients With Acute Nonvariceal Gastrointestinal Bleeding

Clinical Gastroenterology and Hepatology ◽

10.1016/j.cgh.2017.06.029 ◽

2018 ◽

Vol 16 (3) ◽

pp. 370-377 ◽

Cited By ~ 24

Author(s):

Soo-Han Cho ◽

Yoon-Seon Lee ◽

Youn-Jung Kim ◽

Chang Hwan Sohn ◽

Shin Ahn ◽

...

Keyword(s):

High Risk ◽

Gastrointestinal Bleeding ◽

High Risk Patients ◽

Risk Patients

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Abstract 14782: Sex Comparisons in Anticoagulation Treatment for Atrial Fibrillation in a Large Rural Healthcare System

Circulation ◽

10.1161/circ.142.suppl_3.14782 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Macaela N Rudeck ◽

Catherine P Benziger

Keyword(s):

Atrial Fibrillation ◽

High Risk ◽

Atrial Flutter ◽

Electronic Medical Record System ◽

Record System ◽

High Risk Patients ◽

Occlusion Device ◽

Increased Risk ◽

Medical Record System ◽

Risk Patients

Introduction: Atrial fibrillation (AF) and flutter lead to increased risk of thromboembolism (TE). The CHA 2 DS 2 -VASc score is used to determine the risk of TE. Objective: We aim to evaluate the anticoagulation use across CHA 2 DS 2 -VASc scores calculated using a validated automatic calculator. Methods: An AF registry was created for patients with AF or atrial flutter who had seen a primary care or cardiology provider within the past 2 years (5/28/2018-5/28/2020). An automatic CHA 2 DS 2 -VASc calculator was integrated into the electronic medical record system at Essentia Health on 10/1/2019. High-risk of TE was defined as a score of ≥3 for females and a score of ≥2 for males. AF registry included demographics, anticoagulation prescription, CHA 2 DS 2 -VASc and ATRIA bleed score, contraindications, and presence of left atrial appendage (LAA) occlusion device. Results: A total of 10992 patients with AF or atrial flutter were included in the registry (74.8 ±11.8 years, 41.7% female). A total of 6703 (61.0%) had a CHA 2 DS 2 -VASc score calculated (mean score 3.9 ± 1.5). Mean ATRIA bleed score was 3.0 ± 2.0. Within these patients, 90.7% of males and 93.0% of females were at high-risk of TE. Of these high-risk patients, anticoagulation use was 82.7% for females and 83.5% for males and increased with increasing score (p<0.01 for males, p<0.01 for females) (Figure 1). Overall, 36.9% were prescribed NOAC, 47.0% warfarin, and 0.8% heparin. There was no sex difference in the prescription of NOAC (37.7% male vs. 35.9% female, p=0.1). Fewer than 1% had WATCHMAN LAA device (0.3% male vs. 0.4% female, p=0.5). Conclusion: Four out of 5 patients at increased risk of TE are prescribed an anticoagulant. Interventions to improve anticoagulation use in high-risk patients are needed. Figure 1. Anticoagulation prescription use in atrial fibrillation patients by CHA 2 DS 2 -VASc score and sex between 5/28/2018-5/28/2020 at Essentia Health (N=6703).

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A COMPARATIVE OBSERVATIONAL STUDY OF PROGNOSTIC FACTOR SCORES TO PREDICT MORBIDITY AND MORTALITY IN PATIENTS OF PERFORATED PEPTIC ULCER

10.36106/ijsr/0100270 ◽

2021 ◽

pp. 4-8

Author(s):

Ananay Vishvakarma ◽

Subhasish Roychowdhury ◽

Anil Kumar Saha

Keyword(s):

Peptic Ulcer ◽

High Risk ◽

Prognostic Factor ◽

Sofa Score ◽

Adverse Outcome ◽

Perforated Peptic Ulcer ◽

Morbidity And Mortality ◽

Factor Scores ◽

Increased Risk ◽

Risk Patients

Background: Perforation is one of the common complication of peptic ulcer disease which is associated with signicant morbidity and mortality. It is a disease which needs emergent surgical intervention. Accurate and early identication of high-risk patients with Perforated Peptic Ulcer is important for risk stratication. Here, we calculate the three prognostic factor scores, (i) The Boey Score, (ii) The Peptic ulcer perforation (PULP) score, and (iii) The quick sequential organ failure assessment (q-SOFA) score, preoperatively to predict postoperative outcome. Aims & Objective: The aim of the study is to identify patients with an increased risk of adverse outcome, so that we can target the level of perioperative monitoring and treatment in high-risk patients. Also, to determine and compare the ability of three prognostic factor scores to predict morbidity and mortality in patients of Perforated Peptic Ulcer. Methods: Aprospective comparative observational study was conducted comprising of 92 patients with conrmed perforated peptic ulcer (PPU) attending the emergency ward of Department of General Surgery between February 2019 to July 2020. After conrmation of diagnosis, risk stratication according to the three prognostic factor scores (Boey score, PULP score, and q-SOFA score) was done. Acomparison was made between each score through calculation of positive predictive value (PPV) and negative predictive value (NPV). We used receiver operating characteristics (ROC) curve in my study to estimate the predictive ability of each scoring system. Results: The study include 92 patients. Female 41.3% and Male 58.7%. The mean age was 45.38 years. The most common site of PPU was the rst part of duodenum - D1 (64.1%). The most common operative procedure done was the Grahm's patch repair. The morbidity rate was 28.3%. Overall mortality rate was 10.9%. The AUROC for morbidity prediction was 0.791 for Boey score, 0.918 for PULP score, and 0.61 for q-SOFAscore. The AUROC for mortality prediction was 0.829 for Boey score, 0.865 for PULPscore, and 0.602 for q-SOFAscore. Conclusion:Boey score and PULP score helps in accurate and early identication of PPU patients with an increased risk of adverse outcome. q-SOFA score cannot signicantly predict morbidity and mortality in PPU patients. Overall, PULP score performs best but Boey score is crude and simple to calculate and is used to assess the patient rapidly

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Improving harm reduction with a naloxone intervention in primary care to prescribe and educate a support person

Journal of Opioid Management ◽

10.5055/jom.2021.0621 ◽

2021 ◽

Vol 17 (2) ◽

pp. 109-113

Author(s):

Julienne K. Kirk, PharmD, CDE, BCPS ◽

Matthew Q. Tran, PharmD ◽

Samantha Pelc, PharmD ◽

Katherine G. Moore, PharmD, BCPS, BCACP

Keyword(s):

Primary Care ◽

High Risk ◽

Family Medicine ◽

Quality Improvement Intervention ◽

Opioid Overdose ◽

Naloxone Administration ◽

Support Person ◽

High Risk Patients ◽

Increased Risk ◽

Risk Patients

Objective: To determine whether a pharmacist-led intervention would increase the number of naloxone prescriptions and naloxone administration education in a primary care family medicine setting.Design: Prospective quality improvement intervention in an academic family medicine clinic.Methods: We surveyed providers about naloxone knowledge, prescribing habits, and prescribing barriers. We identified patients on chronic opioid therapy, through electronic health records for the year 2019. Overdose risk categories based upon morphine milligram equivalent doses and concomitant benzodiazepine use were used to determine patients who met criteria for naloxone. Pharmacists phoned qualified patients to discuss overdose risk and naloxone benefits. Patients who accepted naloxone prescriptions used their local pharmacy through a department-approved standing order set.Results: From the survey results, there were 47 of 54 provider responses, and the majority noted that they do not routinely prescribe naloxone in high-risk patients. The predominant barriers were lack of time during visit and naloxone administration education. The population of patients from chart review included 93 high-risk patients with a mean age of 58 years. During the time of intervention, 71 patients remained eligible for naloxone coprescribing. Of the patients contacted, 29 (40 percent) accepted the intervention prescription, and subsequently, 22 picked up their prescription from the pharmacy. Sixteen received counseling with a support person. Twelve patients had naloxone already at home, and two received counseling with a support person.Conclusion: The naloxone prescribing intervention is achievable. The results of this intervention support identifying patients at increased risk of opioid overdose and offer education of a support person for naloxone in a large academic family medicine clinic.

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