Biopsy forceps disruption paired with bougie dilation of esophageal strictures lengthens time to repeat intervention

2020 ◽  
Author(s):  
Tricia Hengehold ◽  
Benjamin D Rogers ◽  
Farhan Quader ◽  
C Prakash Gyawali
Keyword(s):  
Electronic Medical Records ◽  
Medical Records ◽  
Care Center ◽  
Tertiary Care ◽  
Balloon Dilation ◽  
Biopsy Forceps ◽  
Kaplan Meier ◽  
Esophageal Strictures ◽  
Foregut Surgery

Summary Esophageal strictures commonly cause dysphagia and require treatment with endoscopic dilation using balloons or bougies. We aimed to determine whether biopsy forceps disruption of strictures at time of dilation increases time to repeat intervention or duration of intervention-free follow-up. We performed a retrospective analysis of 289 adults (age 61.0 ± 0.8 years, 66.4% female) who underwent dilation of an esophageal stricture at our tertiary care center between 2014 and 2016. Exclusions consisted of endoscopic intervention within the preceding 6 months, prior foregut neoplasia, achalasia, radiofrequency ablation, endoscopic mucosal resection, endoscopic submucosal dissection, or foregut surgery. Demographics, clinical presentation, dilation technique, and follow-up were abstracted from electronic medical records. We compared time to repeat dilation and duration of intervention-free follow-up between treatment subgroups. Balloon dilation was performed more often than bougie dilation (76.8 vs. 17.6%); biopsy forceps disruption was performed in 23.2%. Over a median follow-up of 52.9 months, 135 patients (46.7%) underwent repeat dilation. Age, body mass index, gender, and use of antisecretory medications did not influence need for repeat dilation (P = ns for each). Bougie dilation with biopsy forceps disruption prolonged time to repeat dilation in all patients (P ≤ 0.02), particularly in those with gastroesophageal reflux disease (P ≤ 0.03), compared with bougie dilation alone and balloon dilation with or without disruption. On Kaplan–Meier analysis, bougie dilation with biopsy forceps resulted in longer intervention-free follow-up compared with dilation alone (P = 0.03). We conclude that stricture disruption with biopsy forceps increases time to repeat intervention with bougie but not balloon dilation.

Renal Toxicity of Long-Term Therapy With Tenofovir in HIV-Infected Patients

2012 ◽  
Vol 25 (5) ◽  
pp. 552-559 ◽  
Author(s):  
Maricelle O. Monteagudo-Chu ◽  
Mei H. Chang ◽  
Horatio B. Fung ◽  
Norbert Bräu
Keyword(s):  
Renal Toxicity ◽  
Care Center ◽  
Tertiary Care ◽  
Term Therapy ◽  
Kaplan Meier ◽  
Ckd Stage ◽  
Advanced Stages ◽  
Long Term Therapy

Data are sparse on long-term renal toxicity of tenofovir as measured by estimated glomerular filtration rate (eGFR) and progression to advanced stages of chronic kidney disease (CKD). The objective of the study is to determine the incidence of renal impairment associated with the use of tenofovir in HIV-infected patients, using abacavir as a control. In a single tertiary care center, all HIV-infected patients with baseline CKD stage 0 or 1 (CKD-1), who were started on either tenofovir or abacavir from 1998 to 2008 and had at least 1 follow-up eGFR measure on therapy, were included in this retrospective analysis. Progression to CKD stages 2 to 5 was compared using Kaplan-Meier analysis. Progression to CKD-2 and CKD-3 occurred more frequently in patients who received tenofovir than those receiving abacavir (CKD-2, 2-year actuarial frequency, 48.8% vs 23.7%; P < .001, log rank; CKD-3, 5.8% vs 0.0%; P = .028). Only 1 patient in the tenofovir group progressed to CKD-4 and none to CKD-5. Treatment with tenofovir was the only independent factor associated with progression to CKD-2 (hazard ratio [HR], 2.12; 95% confidence interval [CI]: 1.41-3.18; P < .001) and to CKD-3 (HR, 4.91; 95% CI, 1.02-23.7; P = .048). In HIV-infected patients, long-term therapy with tenofovir is associated with mild-to-moderate nephrotoxicity which is significantly higher than in abacavir-treated patients.

Using Electronic Medical Records of Nursing Care to Characterize Constipation in Patients with Intracerebral Hemorrhage

2021 ◽  
pp. 1-8
Author(s):  
Wei Chen ◽  
Jieyi Zhao ◽  
Xiangkui Li ◽  
Xiaoyu Wang ◽  
Jing Chen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Intracerebral Hemorrhage ◽  
Hospital Mortality ◽  
Electronic Medical Records ◽  
Nursing Care ◽  
Medical Records ◽  
Care Center ◽  
Tertiary Care

<b><i>Introduction:</i></b> Constipation is one of the common poststroke complications that directly affect the patients’ quality of life in patients with intracerebral hemorrhage (ICH), which has not been paid enough attention. <b><i>Objective:</i></b> This study investigates constipation’s clinical characteristics and its risk factors in ICH patients driven by the electronic medical records of nursing care. <b><i>Methods:</i></b> This retrospective chart review investigated patients with acute spontaneous ICH admitted at a tertiary care center from October 2010 to December 2018. Poststroke constipation was defined as a first stool passage occurring after 3 days postadmission and the use of enemas or laxatives after ICH. The associations between constipation present and potential factors were evaluated. <b><i>Results:</i></b> Of 1,748 patients, 408 (70.3% men, mean age 58 ± 14 years) patients with poststroke constipation were identified. After adjusting for potential confounding variables, the risk factors independently associated with poststroke constipation are admission Glasgow Coma Scale score (odds ratio [OR] 0.62, 95% confidence interval [CI] 0.44–0.88; <i>p</i> = 0.007), use of mechanical ventilation (OR 3.74, 95% CI 2.37–5.89, <i>p</i> &#x3c; 0.001), enteral nutrition (OR 2.82, 95% CI 1.85–4.30, <i>p</i> &#x3c; 0.001), hematoma evacuation (OR 2.10, 95% CI 1.40–3.16; <i>p</i> &#x3c; 0.001), opioid analgesics (OR 1.86, 95% CI 1.32–2.62; <i>p</i> &#x3c; 0.001), sedation (OR 1.83, 95% CI 1.20–2.77; <i>p</i> = 0.005), and vasopressors (OR 1.81, 95% CI 1.26–2.61; <i>p</i> = 0.001) in order. Similar associations were observed in the prespecified length of the stay subgroup. Patients with constipation were associated with a longer hospital stay length (2.24 days, 95% CI 1.43–3.05, <i>p</i> &#x3c; 0.001) but not with in-hospital mortality (OR 1.05, 95% CI 0.58–1.90, <i>p</i> = 0.871). <b><i>Conclusions:</i></b> Our findings suggested that risk factors influence the absence of constipation after ICH with the synergy of different weights. The occurrence of constipation likely affects a longer length of stay, but not in-hospital mortality. Future prospective investigations are warranted to validate our findings and identify the optimal management of constipation that may improve the quality of life in patients with ICH.

scholarly journals Benefit, tolerance, and safety of hybrid argon plasma coagulation for treatment of Barrett's esophagus: US pilot study

2021 ◽  
Vol 09 (12) ◽  
pp. E1870-E1876
Author(s):  
Toshitaka Shimizu ◽  
Jason B. Samarasena ◽  
Kyle J. Fortinsky ◽  
Rintaro Hashimoto ◽  
Nabil El Hage Chehade ◽  
...  
Keyword(s):  
Pilot Study ◽  
Barrett’S Esophagus ◽  
Barrett's Esophagus ◽  
Argon Plasma Coagulation ◽  
Care Center ◽  
Tertiary Care ◽  
Balloon Dilation ◽  
Argon Plasma ◽  
Low Grade

Abstract Background and study aims A novel technique for Barrett’s esophagus (BE) ablation, termed hybrid APC, has recently been developed. The aims of this US pilot study were to evaluate the efficacy, tolerance and safety of hybrid APC for the treatment of BE. Patients and methods Patients with biopsy-proven BE referred to our tertiary care center over a 12-month period for mucosal ablation were eligible for this study. Efficacy of ablation was measured on follow-up endoscopy by demonstrating either a reduction of visible BE or biopsies proving complete resolution of intestinal metaplasia (CRIM). To evaluate tolerance and safety, patients were called on post-procedure days 1 and 7. Results Twenty-two patients with BE (4.5 % intramucosal carcinoma, 31.8 % high-grade dysplasia, 18.1 % low-grade dysplasia, 36.3 % non-dysplastic, 9.1 % indefinite for dysplasia) underwent 40 treatments with hybrid APC. All patients had endoscopic improvement of BE disease and 19 of 22 patients (86.4 %) achieved CRIM. With regard to tolerance, average pain scores (0 to 10 scale) on follow-up were 2.65 and 0.62 on days 1 and 7, respectively. With regards to safety, there were two treatment-related strictures (9.1 %) that required a single balloon dilation. Conclusions Hybrid APC appears to be promising in the treatment of BE. The ablation protocol used in this study demonstrated efficacy, tolerability, and a safety profile similar to radiofrequency ablation. Given the significant price difference between hybrid APC and other modalities for Barrett’s ablation, this modality may be more cost-effective. These results warrant further study in a large prospective multicenter trial.

Comparative effectiveness and persistence of TNFi and non-TNFi in juvenile idiopathic arthritis: a large pediatric rheumatology center in US

Rheumatology ◽  
2020 ◽  
Author(s):  
Xiaomeng Yue ◽  
Bin Huang ◽  
Ana L Hincapie ◽  
Patricia R Wigle ◽  
Yuxiang Li ◽  
...  
Keyword(s):  
Electronic Medical Records ◽  
Medical Records ◽  
Treatment Effectiveness ◽  
Biologic Treatment ◽  
Off Label ◽  
Kaplan Meier ◽  
Level Data ◽  
Necrosis Factor ◽  
Rheumatic Drug

Abstract Objective To evaluate the persistence and effectiveness of tumor necrosis factor inhibitors (TNFi) vs non-TNFi among newly diagnosed JIA patients after initiation of biologic disease-modifying anti-rheumatic drug (bDMARD). Methods Using longitudinal patient-level data extracted from electronic medical records (EMR) in a large Midwestern pediatric hospital from 2009–2018, we identified JIA patients initiating TNFi and non-TNFi. Treatment effectiveness was assessed based on disease activity. Inverse probability of treatment weighting (IPTW) of propensity score was used to estimate the treatment effectiveness and Kaplan–Meier analysis were conducted to assess persistence. Results Of 667 JIA patients, most (92.0%) were prescribed one of the class of TNFi as their initial biologic treatment. Etanercept was the most frequently prescribed (67.1%) treatment, followed by adalimumab (27.5%). Only around 5% of patients were prescribed off-label bDMARDs as their first-course treatment; however, &gt;20% were prescribed off-label biologics as their second-course therapy. 7.3% of patients received four or more bDMARDs. The median persistence of the first-course bDMARD is 320 days, with TNFi being significantly longer than the non-TNFi (395 vs 320 days, p= 0.010). The cJADAS reduction was significant greater of TNFi users (6.6, 95% CI 5.7–7.5) compare to non-TNFi users (3.0, 95% CI 1.5–4.6, p&lt; 0.0001) at 6-month follow-up visit. Conclusion Persistence was significantly longer among patients initiating TNFi as their first biologic therapy than those receiving non-TNFi. Patients with TNF therapy had significant greater reduction of cJADAS at the 6-month follow-up visit compared with patient in non-TNF cohort.

scholarly journals Genetic Modifiers of Hereditary Neuromuscular Disorders and Cardiomyopathy

Cells ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. 349
Author(s):  
Sholeh Bazrafshan ◽  
Hani Kushlaf ◽  
Mashhood Kakroo ◽  
John Quinlan ◽  
Richard C. Becker ◽  
...  
Keyword(s):  
Muscular Dystrophy ◽  
Electronic Medical Records ◽  
Cardiac Disease ◽  
Medical Records ◽  
Care Center ◽  
Neuromuscular Disorders ◽  
Next Generation Sequencing Data ◽  
Comparative Genomic ◽  
Genetic Modifiers ◽  
Cardiac Phenotype

Novel genetic variants exist in patients with hereditary neuromuscular disorders (NMD), including muscular dystrophy. These patients also develop cardiac manifestations. However, the association between these gene variants and cardiac abnormalities is understudied. To determine genetic modifiers and features of cardiac disease in NMD patients, we have reviewed electronic medical records of 651 patients referred to the Muscular Dystrophy Association Care Center at the University of Cincinnati and characterized the clinical phenotype of 14 patients correlating with their next-generation sequencing data. The data were retrieved from the electronic medical records of the 14 patients included in the current study and comprised neurologic and cardiac phenotype and genetic reports which included comparative genomic hybridization array and NGS. Novel associations were uncovered in the following eight patients diagnosed with Limb-girdle Muscular Dystrophy, Bethlem Myopathy, Necrotizing Myopathy, Charcot-Marie-Tooth Disease, Peripheral Polyneuropathy, and Valosin-containing Protein-related Myopathy. Mutations in COL6A1, COL6A3, SGCA, SYNE1, FKTN, PLEKHG5, ANO5, and SMCHD1 genes were the most common, and the associated cardiac features included bundle branch blocks, ventricular chamber dilation, septal thickening, and increased outflow track gradients. Our observations suggest that features of cardiac disease and modifying gene mutations in patients with NMD require further investigation to better characterize genotype–phenotype relationships.

scholarly journals Evaluation of the Anxiety Level of Mothers of Children with Epilepsy during the COVID-19 Pandemic Period

2021 ◽  
pp. 1-8
Author(s):  
Halil Celik ◽  
Sadettin Burak Acikel ◽  
Fatih Mehmet Akif Ozdemir ◽  
Erhan Aksoy ◽  
Ulkuhan Oztoprak ◽  
...  
Keyword(s):  
Neurological Disease ◽  
Chronic Conditions ◽  
Care Center ◽  
Tertiary Care ◽  
Anxiety Level ◽  
Childhood And Adolescence ◽  
Routine Examination ◽  
Significant Difference ◽  
Anxiety Levels

<b><i>Background and Aim:</i></b> Although anyone can be affected by the COVID-19 pandemic, it may cause additional concern for people with chronic conditions. Epilepsy is the most common neurological disease in childhood and adolescence. The aim of this study was to determine anxiety levels among the mothers of children under follow-up for epilepsy in our clinic during the COVID-19 pandemic. <b><i>Methods:</i></b> The study group consisted of the mothers of epilepsy patients who were under follow-up in the pediatric neurology outpatient clinic of the tertiary care center and were scheduled for a routine examination during the COVID-19 pandemic. The mothers’ anxiety levels according to the Beck Anxiety Inventory and their opinions about COVID-19 in relation to their child were assessed and compared based on whether the mother/patient attended their appointments in person and whether the child had frequent or infrequent seizures. <b><i>Results:</i></b> There was no statistically significant difference in anxiety level between the mothers of 64 children with epilepsy who attended their appointment during the pandemic and those of the mothers of 52 who did not attend their appointment. However, the mothers of children with frequent seizures had significantly higher anxiety levels. <b><i>Conclusion:</i></b> Anxiety level of mothers whose children have frequent seizures was significantly higher compared to mothers whose children have infrequent seizures. It is important to be aware about this point and using telemedicine approach in suitable population and postpone routine outpatient follow-up appointments as much as possible.

scholarly journals Medical Trainee Continuity of Care Following Emergency Department Consultations in a Pediatric Hospital

2016 ◽  
Vol 8 (1) ◽  
pp. 33-38 ◽  
Author(s):  
Kim Bjorklund ◽  
Emily A. Eismann ◽  
Roger Cornwall
Keyword(s):  
Emergency Department ◽  
Continuity Of Care ◽  
Broad Spectrum ◽  
Medical Records ◽  
Care Center ◽  
Tertiary Care ◽  
Well Being ◽  
Tertiary Care Center ◽  
Pediatric Hospital ◽  
Medical Trainee

ABSTRACT Background The importance of continuity of care in training is widely recognized; however, a broad-spectrum assessment across all specialties has not been performed. Objective We assessed the continuity of care provided by trainees, following patient consultations in the emergency department (ED) across all specialties at a large pediatric tertiary care center. Methods Medical records were reviewed to identify patients seen in consultation by a resident or fellow trainee in the ED over a 1-year period, and to determine if the patient followed up with the same trainee for the same condition during the next 6 months. Results Resident and fellow trainees from 33 specialties participated in 3400 ED consultations. Approximately 50% (1718 of 3400) of the patients seen in consultation by a trainee in the ED followed up with the same specialty within 6 months, but only 4.1% (70 of 1718) followed up with the same trainee for the same condition. Trainee continuity of care ranged from 0% to 21% among specialties, where specialties with resident clinics (14.4%) have a greater continuity of care than specialties without resident clinics (2.7%, P &lt; .001). Continuity of care did not differ between fellows (4.2%) and residents (4.0%, P = .87), but did differ between postgraduate years for residents (P &lt; .001). Conclusions Trainee continuity of care for ED consultations was low across all specialties and levels of training. If continuity of care is important for patient well-being and trainee education, efforts to improve continuity for trainees must be undertaken.

Nephrocalcinosis, Renal Dysfunction, and Calculi in Patients With Primary Hypoparathyroidism on Long-Term Conventional Therapy

2020 ◽  
Vol 105 (4) ◽  
pp. e1215-e1224 ◽  
Author(s):  
Soma Saha ◽  
Devasenathipathy Kandasamy ◽  
Raju Sharma ◽  
Chandrasekhar Bal ◽  
Vishnubhatla Sreenivas ◽  
...  
Keyword(s):  
Renal Dysfunction ◽  
Conventional Therapy ◽  
Care Center ◽  
Tertiary Care ◽  
Fractional Excretion ◽  
Renal Calculi ◽  
Serum Total Calcium ◽  
Calcium Phosphorus

Abstract Context There are concerns about the long-term safety of conventional therapy on renal health in patients with hypoparathyroidism. Careful audit of these would help comparisons with upcoming parathyroid hormone therapy. Objective We investigated nephrocalcinosis, renal dysfunction, and calculi, their predictors and progression over long-term follow-up in patients with primary hypoparathyroidism (PH). Design and Setting An observational study at a tertiary care center was conducted. Participants and Methods A total of 165 PH patients receiving conventional therapy were evaluated by radiographs, ultrasonography, and computed tomography. Their glomerular filtration rate (GFR) was measured by Tc-99m-diethylenetriamine penta-acetic acid clearance. Clinical characteristics, serum total calcium, phosphorus, creatinine, hypercalciuria, and fractional excretion of phosphorus (FEPh) at presentation and during follow-up were analyzed as possible predictors of renal complications. Controls were 165 apparently healthy individuals. Results Nephrocalcinosis was present in 6.7% of PH patients but not in controls. Patients younger than 15 years at presentation and with higher serum calcium-phosphorus product were at higher risk. Nephrocalcinosis showed no significant association with cataract and intracranial calcification. Prevalence of renal calculi was comparable between hypoparathyroid patients and controls (5% vs 3.6%, P = .58). Fourteen percent of patients had a GFR less than 60 mL/min/1.73 m2. Increased FEPh during follow-up was the significant predictor of low GFR. Nephrocalcinosis developed in 9% of patients over 10 years of conventional therapy. Conclusion A total of 6.7% of PH patients had nephrocalcinosis, and 14% showed renal dysfunction. Prevalence of renal calculi was similar in patients and controls. Nine percent of patients developed nephrocalcinosis over 10 years of conventional therapy.

scholarly journals Postpartum follow up of gestational diabetes in a Tertiary Care Center

2018 ◽  
Vol 10 (1) ◽  
Author(s):  
C. A. Cabizuca ◽  
P. S. Rocha ◽  
J. V. Marques ◽  
T. F. L. R. Costa ◽  
A. S. N. Santos ◽  
...  
Keyword(s):  
Gestational Diabetes ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center

scholarly journals Effectiveness of Transjugular Intrahepatic Portosystemic Shunt in Variceal Bleeding: An Audit from a Tertiary Care Center in North India

2017 ◽  
Vol 01 (03) ◽  
pp. 150-155
Author(s):  
Arun Gupta ◽  
Ajay Mehta ◽  
Nitin Mishra ◽  
Rajendra Bansal ◽  
Ajit Yadav
Keyword(s):  
Variceal Bleeding ◽  
Patency Rate ◽  
Care Center ◽  
Tertiary Care ◽  
Portosystemic Shunt ◽  
North India ◽  
Related Complication ◽  
Variceal Bleed ◽  
Intrahepatic Portosystemic Shunt

AbstractVariceal bleeding is one of the most feared complications of cirrhosis and portal hypertension. Transjugular intrahepatic portosystemic shunt (TIPS) is an effective minimally invasive option to achieve adequate decompression of the portal system. The aim of the study was to assess the efficacy and complications of TIPS in patients presenting with variceal bleed. It was a retrospective study done in a tertiary care center in North India in cirrhotic patients with acute or recurrent variceal bleed who underwent TIPS from April 2010 to October 2013. All the patients were followed up till April 2014. We could successfully implant TIPS in 100% of our patients with 100% success rate in controlling variceal bleeding immediately and during the follow-up period. Our primary patency rate was 94.5% and overall patency rate was 100%. Major TIPS-related complication was hepatic encephalopathy in 20% of patients; 7 of 22 patients died during the follow-up period. TIPS is a safe and effective procedure for control of acute or recurrent variceal bleed. Emerging evidence in favor of early TIPS is further going to expand its indication in variceal bleed. Hepatic encephalopathy was the major procedure-related complication in our study consistent with previous literature reports.

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