scholarly journals INNV-38. COVID-19 INDUCED TELEMEDICINE LESSONS FOR CLINICIANS CARING FOR PATIENTS WITH PRIMARY BRAIN TUMORS

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi113-vi114
Author(s):  
Edina Komlodi-Pasztor ◽  
Amy Brady ◽  
Stuart Grossman
Keyword(s):  
Medical Records ◽  
Laboratory Data ◽  
Full Time ◽  
Infection Rates ◽  
Patient Demographics ◽  
Neurological Exam ◽  
Mri Scans ◽  
Time Away ◽  
Time Faculty

Abstract BACKGROUND The COVID-19 pandemic triggered a rapid conversion from in-person to video-visits for new patient consultations and follow-up visits. Now with available vaccines and declining case rates efforts are underway to return to in-person visits as they provide more revenue and are viewed as best for patients and clinicians. This abstract reviews these assumptions. METHODS Electronic medical records from seven full-time faculty neuro-oncologists at Johns Hopkins Hospitals were retrospectively reviewed from 4/1/20 to 3/31/21 to examine the use of video visits over time and their patient demographics. RESULTS From 4/1/20 to 3/31/21, 279 new patients were seen (57% video-visits) with a median age of 52 years for both video and in-person visits. Patients came from 15 states for video and 17 states for in-person visits. There were also 2247 follow-up visits (85% video-visits) with a median age of 47 yrs for video and 50 yrs for in-person visits. Patients came from 28 states for video and 14 for in-person visits. No show visits were more frequent for in-person visits. During early months of the pandemic, few patients were seen in the clinics. Thereafter, video-visits rose sharply comprising 93% of follow-up visits in June 2020 and 62% of new patient consultations in September 2020. These rates have remained high (in March 2021, 72% of all follow-up visits and 59% of new patient consultations). CONCLUSIONS Despite reductions in COVID-19 infection rates, our neuro-oncologists continue to favor video-visits for new patient consultations and follow-up visits. Video-visits save patients and caregivers travel time, parking costs, and time away from work. They also allow an acceptable history and neurological exam, participation by many family members, easy sharing of MRI scans and laboratory data, and discussions unencumbered by face masks and shields. These advantages to video-visits remain significant even as the pandemic recedes.

scholarly journals Prognostic Role of Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio in the Survival of Patients with Esophageal Cancer

2021 ◽  
Author(s):  
Maryam Tajik ◽  
Mohammad Shirkhoda ◽  
Maryam Hadji ◽  
Monireh Sadat Seyyed- salehi ◽  
Elnaz Saeidi ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Medical Records ◽  
Total Bilirubin ◽  
Laboratory Data ◽  
Neutrophil To Lymphocyte Ratio ◽  
Poor Survival ◽  
Platelet To Lymphocyte Ratio ◽  
Lymphocyte Ratio

Background: Different factors can affect the future of a person with cancer. The patient’s systemic inflammatory response is an important factor. Several inflammatory markers have been evaluated for measuring the patient’s response to cancer. We evaluated neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) as prognostic factors for survival in patients with pathologically proven esophageal cancer. Methods: In this retrospective cohort study, patients with pathologically approved esophageal cancer, who underwent surgical treatment in the cancer institute of Iran, were included. Demographic, pathological, and laboratory data of patients were obtained from the archive of medical records. Results: In this study, 135 patients with esophageal cancer with a mean age of 60 were studied. The median time of the follow-up period was 21 months. Mean NLR and PLR were 7.05 and 898, respectively. Patients’ survival had a significant relationship with their age, gender, tumor differentiation, receiving chemotherapy, absolute neutrophil count, total bilirubin, direct bilirubin, and NLR. Conclusion: According to the results, in a multivariable investigation, it was demonstrated that a high NLR has a direct effect on patients’ poor survival.

Rituximab Does Not Prevent Relapse in Patients with Thrombotic Thrombocytopenic Purpura

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3318-3318
Author(s):  
Goyal Jatinder ◽  
Jose L. O. Lima ◽  
Jill Adamski ◽  
Marisa Marques
Keyword(s):  
Thrombotic Thrombocytopenic Purpura ◽  
Medical Records ◽  
Conflicts Of Interest ◽  
Univariate Analysis ◽  
Laboratory Data ◽  
Delayed Response ◽  
Thrombocytopenic Purpura ◽  
Group 2 ◽  
Group 1

Abstract Abstract 3318 Objective: In the last decade, rituximab has been added to therapeutic plasma exchange (TPE) to treat patients with thrombotic thrombocytopenic purpura (TTP) who appear resistant to TPE. We sought to determine first if rituximab prevented TTP relapse. In addition, if relapse has occurred, we compared the rates of relapse of patients treated with TPE alone with those treated with a combination of TPE and rituximab. Methods: We retrospectively reviewed the medical records of all adult patients treated for TTP between 2003 and 2008 at our institution. TTP was defined as thrombocytopenia, hemolytic anemia and ADAMTS13 activity less than 10% due to an inhibitor. None of the patients had congenital TTP. Patient demographics, laboratory data, treatment characteristics and follow up details were collected from their electronic and apheresis' medical records. Kaplan-Meier curves were drawn for survival and Cox proportional hazards models were applied to look for independent predictors of relapse-free survival (RFS). Results: A total of 20 patients underwent TPE only (Group 1) as compared to 18 patients who also received rituximab during admission with TTP (Group 2). Table 1 shows that both groups were balanced at baseline for demographic and laboratory data. However, patients in group 2 had longer duration of hospital stay (p<0.0001), underwent more TPE procedures (p<0.0001) and took longer to achieve remission (p<0.0001). The mean follow up in group 1 was 77.5 (±22.4) months and in group 2 was 68.6 (±28.5) months. At follow-up, 5 patients from group 1 relapsed (25%) as compared with 6 patients from group 2 (35%) (p=0.50). The 1-year, 3-year and 5-year RFS rates were 95%, 85% and 74% for group 1, and 94%, 76% and 71%, respectively, for group 2 (p=0.53 using log rank test). On univariate analysis, only age at the time of treatment (p=0.05) and duration of follow-up after treatment (p=0.03) were predictors of relapse. However, on multivariate analysis, no independent predictors of relapse were identified. Conclusion: Rituximab does not prevent or reduce rates of relapse when used with TPE in patients with TTP. Since rituximab was added to patients later in their TPE course due to delayed response to treatment, it may yet have a role in decreasing the number of TPEs needed to achieve a response if it were started earlier during hospitalization for TTP. Disclosures: No relevant conflicts of interest to declare.

Can an Oncology Information System Improve Radiation Therapy Safety and Patient Confidence?

2011 ◽  
Vol 07 (03) ◽  
pp. 165
Author(s):  
Laura Francis ◽  
Keyword(s):  
Radiation Therapy ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Treatment Technique ◽  
Image Management ◽  
Computing Power ◽  
Patient Demographics ◽  
Advanced Computing ◽  
Patient Confidence

Radiation therapy has become one of the safest and most effective methods for treating cancer. Over half of all cancer patients undergo radiotherapy, either as the sole treatment technique or combined with other therapies. As technologies evolve and improve, radiotherapy techniques become increasingly sophisticated, requiring more time and skill to ensure delivery as prescribed. Such is the increasing complexity of treatments that technology providers are trying to keep up with demand for more and more advanced computing power to manage the need for immensely precise and powerful tools. Today the need for oncology information systems and electronic medical records is paramount in providing the tools for image management, data and workflow control supporting individual patient demographics, treatment planning, delivery and follow-up.

scholarly journals Equestrian Injury Presentations to a Regional Trauma Centre in Ireland

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
A. Abdulkarim ◽  
A. Juhdi ◽  
P. Coffey ◽  
Lily Edelson
Keyword(s):  
Emergency Department ◽  
Tertiary Care ◽  
Trauma Centre ◽  
Full Time ◽  
Patient Demographics ◽  
Populations At Risk ◽  
Radiological Abnormality ◽  
Results Management ◽  
One Year

Background. The Irish Equestrian industry provides over 12,500 full time job equivalents contributing in excess of €454 million to the Irish economy annually. For such an important industry there is a paucity of information relating to equestrian injuries.Aims. The aim of this study was to determine the demographics, characteristics, and outcomes of equestrian related injuries presenting to the emergency department of a regional trauma centre in Ireland over the course of one year.Methods. Retrospective analysis of all 30,700 presentations to the emergency department (ED) of the Midland Regional Hospital (MRH) Tullamore in 2013 was performed to identify equestrian related presentations. Patient demographics, mechanism of injury, radiology results, management, and follow-up data were collected and analysed using Microsoft Excel software.Results. A total of 149 equestrian related presentations were identified during the study period. There were significantly more females involved in equestrian injuries than males (58% versus 42%). Falling from a horse contributed to significantly more presentations and admissions than any other cause. 36% of presentations were associated with a radiological abnormality. Types of injuries identified included skeletal fractures (27.5%), joint dislocation/subluxation (5%), concussion (12.5%), and splenic laceration/intraperitoneal haemorrhage (1%). Admission or transfer to tertiary care was required for 18% of equestrian injuries. Only 43% of presentations were discharged back to primary care from the emergency department.Conclusion. This study identifies a high incidence of morbidities associated with equestrian presentations. In addition we recognised populations at risk of specific injuries and described high-risk mechanisms of injury.

20 Armoured Infantry Brigade downgrade study: epidemiology of principal conditions and plugging leaks in the rehabilitation pipeline

2019 ◽  
Vol 166 (5) ◽  
pp. 312-317
Author(s):  
James Papworth ◽  
L Osborne ◽  
M A Shimmings ◽  
C C S Roberts
Keyword(s):  
Case Management ◽  
Medical Records ◽  
Medical Information ◽  
Musculoskeletal Injury ◽  
Adjustment Disorders ◽  
Full Time ◽  
Primary Condition ◽  
Active Case ◽  
Lost To Follow Up

IntroductionIn April 2017, 22% of Army Full-time Trade Trained Strength was downgraded, reducing fully deployable strength to 60 546, against a target of 82 000. In June 2017, Commander 20 Armoured Infantry Brigade (20 AI Bde) initiated a study to look at the principal conditions causing medical downgrading, as a stepping stone to finding ways of reducing injury, enhancing rehabilitation and improving deployability.MethodThe Defence Medical Information Capability Programme medical records for every downgraded soldier in 20 AI Bde and supporting units were scrutinised to identify their Medical Deployment Standard and the primary condition causing downgrading.ResultsA total of 842 downgraded soldiers were identified from a held strength of 3827 personnel. Sixty-five per cent of these downgrades were due to musculoskeletal injury (MSKI). Of this 65%, the majority were due to knee (31%), spine (28%) and foot/ankle (23%). Of the remaining 35%, the majority were due to noise-induced hearing loss (NIHL) (22%), adjustment disorders (19%) and non-freezing cold injury (NFCI) (13%).Several factors that slowed an individual’s recovery pathway were identified. They mainly relate to soldiers being lost to follow-up through lack of active case management.ConclusionsMSKI is responsible for most downgraded personnel at Brigade level. The distribution of principal conditions is similar to previous studies looking at recruits and individual units.The creation of a rehabilitation troop, delivering active case management, can reduce the number of soldiers leaking out of the rehabilitation pipeline.

J 5 — A Data Processing System for Medical Information

1967 ◽  
Vol 06 (01) ◽  
pp. 1-6
Author(s):  
P. Hall ◽  
Ch. Mellner ◽  
T. Danielsson
Keyword(s):  
Medical Records ◽  
Medical Information ◽  
Health Care Systems ◽  
Processing System ◽  
Linear Pattern ◽  
Flexible Form ◽  
Care Systems ◽  
Pattern Recognition Analysis ◽  
Numeric Information

A system for medical information has been developed. The system is a general and flexible one which without reprogramming or new programs can accept any alphabetic and/or numeric information. Coded concepts and natural language can be read, stored, decoded and written out. Medical records or parts of records (diagnosis, operations, therapy, laboratory tests, symptoms etc.) can be retrieved and selected. The system can process simple statistics but even make linear pattern recognition analysis.The system described has been used for in-patients, outpatients and individuals in health examinations.The use of computers in hospitals, health examinations or health care systems is a problem of storing information in a general and flexible form. This problem has been solved, and now it is possible to add new routines like booking and follow-up-systems.

Socioeconomic patient benefits of a pediatric neurosurgery telemedicine clinic

2020 ◽  
Vol 25 (2) ◽  
pp. 204-208 ◽  
Author(s):  
Kelsey Hayward ◽  
Sabrina H. Han ◽  
Alexander Simko ◽  
Hector E. James ◽  
Philipp R. Aldana
Keyword(s):  
Travel Time ◽  
Cost Savings ◽  
Transportation Cost ◽  
Pediatric Neurosurgery ◽  
University Of Florida ◽  
Remote Location ◽  
Socioeconomic Data ◽  
The University ◽  
Time Away

OBJECTIVEThe objective of this study was to examine the socioeconomic benefits to the patients and families attending a regional pediatric neurosurgery telemedicine clinic (PNTMC).METHODSA PNTMC was organized by the Division of Pediatric Neurosurgery of the University of Florida College of Medicine–Jacksonville based at Wolfson Children’s Hospital and by the Children’s Medical Services (CMS) to service the Southeast Georgia Health District. Monthly clinics are held with the CMS nursing personnel at the remote location. A retrospective review of the clinic population was performed, socioeconomic data were extracted, and cost savings were calculated.RESULTSClinic visits from August 2011 through January 2017 were reviewed. Fifty-five patients were seen in a total of 268 initial and follow-up PNTMC appointments. The average round-trip distance for a family from home to the University of Florida Pediatric Neurosurgery (Jacksonville) clinic location versus the PNTMC remote location was 190 versus 56 miles, respectively. The families saved an average of 2.5 hours of travel time and 134 miles of travel distance per visit. The average transportation cost savings for all visits per family and for all families was $180 and $9711, respectively. The average lost work cost savings for all visits per family and for all families was $43 and $2337, respectively. The combined transportation and work cost savings for all visits totaled $223 per family and $12,048 for all families. Average savings of $0.68/mile and $48.50/visit in utilizing the PNTMC were calculated.CONCLUSIONSManaging pediatric neurosurgery patients and their families via telemedicine is feasible and saves families substantial travel time, travel cost, and time away from work.

Adult outcome after treatment of pediatric posterior fossa ependymoma: long-term follow-up of a single consecutive institutional series of 22 patients with more than 5 years of survival

2020 ◽  
Vol 26 (1) ◽  
pp. 22-26 ◽  
Author(s):  
Tryggve Lundar ◽  
Bernt Johan Due-Tønnessen ◽  
Radek Frič ◽  
Petter Brandal ◽  
Paulina Due-Tønnessen
Keyword(s):  
Proton Beam ◽  
Posterior Fossa ◽  
Adjuvant Treatment ◽  
Tumor Control ◽  
Full Time ◽  
Time Work ◽  
Long Term Follow Up ◽  
Long Term Survivors

OBJECTIVEEpendymoma is the third most common posterior fossa tumor in children; however, there is a lack of long-term follow-up data on outcomes after surgical treatment of posterior fossa ependymoma (PFE) in pediatric patients. Therefore, the authors sought to investigate the long-term outcomes of children treated for PFE at their institution.METHODSThe authors performed a retrospective analysis of outcome data from children who underwent treatment for PFE and survived for at least 5 years.RESULTSThe authors identified 22 children (median age at the time of surgery 3 years, range 0–18 years) who underwent primary tumor resection of PFE during the period from 1945 to 2014 and who had at least 5 years of observed survival. None of these 22 patients were lost to follow-up, and they represent the long-term survivors (38%) from a total of 58 pediatric PFE patients treated. Nine (26%) of the 34 children treated during the pre-MRI era (1945–1986) were long-term survivors, while the observed 5-year survival rate in the children treated during the MRI era (1987–2014) was 13 (54%) of 24 patients. The majority of patients (n = 16) received adjuvant radiotherapy, and 4 of these received proton-beam irradiation. Six children had either no adjuvant treatment (n = 3) or only chemotherapy as adjuvant treatment (n = 3). Fourteen patients were alive at the time of this report. According to MRI findings, all of these patients were tumor free except 1 patient (age 78 years) with a known residual tumor after 65 years of event-free survival.Repeat resections for residual or recurrent tumor were performed in 9 patients, mostly for local residual disease with progressive clinical symptoms; 4 patients underwent only 1 repeated resection, whereas 5 patients each had 3 or more resections within 15 years after their initial surgery. At further follow-up, 5 of the patients who underwent a second surgery were found to be dead from the disease with or without undergoing additional resections, which were performed from 6 to 13 years after the second procedure. The other 4 patients, however, were tumor free on the latest follow-up MRI, performed from 6 to 27 years after the last resection. Hence, repeated surgery appears to increase the chance of tumor control in some patients, along with modern (proton-beam) radiotherapy. Six of 8 patients with more than 20 years of survival are in a good clinical condition, 5 of them in full-time work and 1 in part-time work.CONCLUSIONSPediatric PFE occurs mostly in young children, and there is marked risk for local recurrence among 5-year survivors even after gross-total resection and postoperative radiotherapy. Repeated resections are therefore an important part of treatment and may lead to persistent tumor control. Even though the majority of children with PFE die from their tumor disease, some patients survive for more than 50 years with excellent functional outcome and working capacity.

Paranasal Sinus Mucocele Clinical, imagistic and biochemical aspects

2018 ◽  
Vol 69 (8) ◽  
Author(s):  
Doina Vesa ◽  
Cristian Martu ◽  
Razvan Leata ◽  
Ludmila Lozneanu ◽  
luminita Radulescu ◽  
...  
Keyword(s):  
Facial Asymmetry ◽  
Retrospective Case ◽  
Mri Scans ◽  
The One ◽  
Ethmoid Sinuses ◽  
Retrospective Case Study ◽  
Cellular Components ◽  
Ct And Mri

Paranasal mucoceles are a type of cysts that evolve slowly and are asymptomatic; this poses a difficulty in diagnosing the patient because the symptoms can go unnoticed. The mucocele evolves unpredictably. On the one hand, it can become infected turning into pyoceles and on the other hand, it can invade important regions such as the orbital, cranial or genian regions, creating facial asymmetry. This is a retrospective case study of 37 patients diagnosed with sinus mucoceles, followed up by clinical examination and paraclinical tests such as CT and MRI scans. The biochemical components of the liquid from within the mucocele were analyzed and the following criteria were recorded: NaCl-, Cl-, Na+ and cholesterine as well as cellular components such as mastocytes, macrophages, hematocytes and leucocytes. In all cases, the treatment option was surgery with favorable post-operative and follow-up evaluation. The mucoceles that appeared post-operatively (maxillary and ethmoid sinuses) evolved more rapidly than the mucoceles that were induced byan external injury. Longer follow-up of operated patients permitted a more timely diagnosis of recurrences.

Understanding the Obstacles to Uptake of Intervention Programmes and Services for Persons with Dementia

2020 ◽  
Vol 17 (6) ◽  
pp. 526-533
Author(s):  
Ha N.H. Lien ◽  
Emily J. Koh ◽  
Philip L.K. Yap
Keyword(s):  
Medical Records ◽  
Cognitive Engagement ◽  
Functional Improvement ◽  
Related Factors ◽  
Related Services ◽  
Phone Calls ◽  
Information Session ◽  
Adequate Information ◽  
Care At Home

Background: Utilisation of intervention programmes and services for Persons with Dementia (PWD) has been generally modest despite the growing numbers. One reason has been the lack of knowledge about dementia and information on such services. Objective: We sought to close this gap by providing caregivers with an information session about dementia and the importance and availability of related services. We explored the uptake of intervention programmes and services and reasons for non-uptake thereafter. Methods: Two hundred and seventy-five PWD and caregiver dyads attended the Dyad Education and Empowerment Programme (DEEP). At the DEEP, while caregivers underwent an information session, PWD were assessed by a multidisciplinary team on their need and suitability for programmes and services such as daycare, cognitive engagement programmes and physical rehabilitation. The dyads then received individualized recommendations on the appropriate services, if any. Follow-up through medical records review and phone calls was conducted one month after DEEP to ascertain if the dyads had acted upon the recommendations and if not, what difficulties they encountered. Results: One hundred and eleven PWD received recommendations, of which 40 (36.0%) agreed and enrolled in the services while 71 (64%) declined. Thematic analysis of the reasons for non-uptake revealed 3 themes: PWD-related factors (e.g., refusal, functional improvement or decline), caregiverrelated factors (adequacy of care at home, other care arrangements), and service-related factors (e.g., cost, timing). Conclusion: Despite adequate information, there are other reasons for non-uptake of dementia- related services, some of which should be addressed to improve service updates and to provide better care for PWD.

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