scholarly journals Protocol-driven intensive outpatient management of pregnant patients with symptomatic COVID-19

2020 ◽  
Author(s):  
M D Soffer ◽  
L L Shook ◽  
K James ◽  
M R Sawyer ◽  
A Ciaranello ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Acute Care ◽  
Medical Center ◽  
Academic Medical Center ◽  
Ventilatory Support ◽  
Outpatient Setting ◽  
Viral Clearance ◽  
Rt Pcr ◽  
Duration Of Symptoms ◽  
Presenting Symptoms

Abstract Background Reports of SARS-CoV2 infection have focused on pregnant women hospitalized due to moderate to severe COVID-19 disease or asymptomatic women diagnosed through universal screening at the time of obstetric admission. Many pregnant women who have symptomatic SARS-CoV2 infection may not meet criteria for hospitalization; however, whether and how these women can be managed safely in outpatient setting is not well described. Objective We sought to describe the time to symptom and viral clearance and to identify predictors of hospitalization in order to better understand the safety of monitoring pregnant patients with symptomatic COVID-19 in the outpatient setting. Study Design We performed a retrospective cohort study of pregnant patients with symptomatic, confirmed COVID-19 illness at a large academic medical center. Patients had systematic telehealth follow up by a clinician team to assess for symptoms, provide virtual prenatal care, and arrange in-person visits when appropriate in a dedicated outpatient center. Data was collected via chart abstraction. Results Of 180 pregnant patients presenting with symptoms and undergoing RT-PCR testing, 67 patients with confirmed COVID-19 infection were identified during the study period. Nineteen (28%) required acute care given worsening of COVID-19 symptoms, and 95% of these were directed to this acute care setting due to symptom severity telehealth evaluation. Nine women (13%) were admitted to the hospital given worsening symptoms, 3 required ICU care, 2 required ventilatory support, and 2 required delivery. Women with the presenting symptoms of fever, cough, shortness of breath, chest pain, or nausea and vomiting were more likely to require admission. The median duration from initial positive test to RT-PCR viral clearance was 26 days. Disease progression, time to viral clearance and duration of symptoms did not vary significantly by trimester of infection. Conclusions Management of the majority of pregnant women with symptomatic COVID-19 illness can be accomplished in the outpatient setting with intensive and protocol-driven monitoring for symptom progression.

scholarly journals Pre-test symptom duration and cycle threshold values for SARS-CoV-2 reverse transcription-PCR (RT-PCR) predict COVID-19 mortality

2021 ◽  
Author(s):  
Emily Happy Miller ◽  
Jason Zucker ◽  
Delivette Castor ◽  
Medini K Annavajhala ◽  
Jorge L Sepulveda ◽  
...  
Keyword(s):  
Viral Load ◽  
Symptom Onset ◽  
Medical Center ◽  
Strong Predictor ◽  
Academic Medical Center ◽  
Patient Characteristics ◽  
Symptom Duration ◽  
Rt Pcr ◽  
Duration Of Symptoms ◽  
The Impact

Abstract Background The relationship between SARS-CoV-2 viral load and patient symptom duration in both in- and outpatients, and the impact of these factors on patient outcomes, are currently unknown. Understanding these associations is important to clinicians caring for patients with COVID-19. Methods We conducted an observational study between March 10–May 30, 2020 at a large quaternary academic medical center in New York City. Patient characteristics, laboratory values, and clinical outcomes were abstracted from the electronic medical records. Of all patients tested for SARS-CoV-2 during this time (N=16,384), there were 5,467 patients with positive tests, of which 4,254 had available Ct values and were included in further analysis. Univariable and multivariable logistic regression models were used to test associations between Ct values, duration of symptoms prior to testing, patient characteristics and mortality. The primary outcome is defined as death or discharge to hospice. Results Lower Ct values at diagnosis (i.e. higher viral load) were associated with significantly higher mortality among both in- and out-patients. Interestingly, patients with a shorter time since the onset of symptoms to testing had a worse prognosis, with those presenting less than three days from symptom onset having 2-fold increased odds of death. After adjusting for time since symptom onset and other clinical covariates, Ct values remained a strong predictor of mortality. Conclusions SARS-CoV-2 RT-PCR Ct value and duration of symptoms are strongly associated with mortality. These two factors add useful information for clinicians to risk stratify patients presenting with COVID-19.

Predictors of Mortality in Necrotizing Soft Tissue Infection

2014 ◽  
Vol 80 (10) ◽  
pp. 989-993 ◽  
Author(s):  
Jessica Keeley ◽  
Amy Kaji ◽  
Dennis Kim ◽  
Huan Yan ◽  
Brant A. Putnam ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Medical Center ◽  
Academic Medical Center ◽  
Regression Tree ◽  
Classification And Regression Tree ◽  
Duration Of Symptoms ◽  
Predictors Of Mortality ◽  
Presenting Symptoms ◽  
Necrotizing Soft Tissue Infections ◽  
Elevated Creatinine

Necrotizing soft tissue infections (NSTIs) are a major source of morbidity and mortality, yet predictors of mortality for these critically ill patients remain poorly characterized. The aim of this study was to identify risk factors for mortality in patients with NSTI. We performed a retrospective review of all patients presenting with an NSTI to our county-funded, academic medical center between 2008 and 2013. Admission characteristics, comorbidities, laboratory values, time to operation, and perioperative cultures were assessed to identify predictors of mortality. During the 5-year study period, 138 patients were admitted with a NSTI; 20 (14.5%) of the patients died. Univariate predictors of mortality included bandemia, elevated creatinine, low bicarbonate, elevated lactate, a lower admission temperature, and shorter duration of presenting symptoms. Using Classification And Regression Tree analysis and subsequent logistic regression, bands greater than 25 per cent (odds ratio [OR], 8.0; 95% confidence interval [CI], 2.7 to 24.1; P = 0.0002), duration of symptoms less than 3.5 days (OR, 4.0; 95% CI, 1.2 to 13.9; P = 0.03), and temperature 37°C or less (OR, 3.6; 95% CI, 1.1 to 11.8; P = 0.03) were found to be independent predictors of mortality. Awareness of these predictors should prompt aggressive management of this at-risk population.

scholarly journals COVID-19 Admission Screening, and Assessment of Infectiousness at an Academic Medical Center, Iowa 2020

2021 ◽  
pp. 1-19
Author(s):  
Mohammed Alsuhaibani ◽  
Takaaki Kobayashi ◽  
Alexandra Trannel ◽  
Stephanie Holley ◽  
Oluchi J. Abosi ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Clinical History ◽  
Rt Pcr ◽  
University Of Iowa ◽  
Past Infection ◽  
Admission Screening ◽  
Academic Medical ◽  
The University ◽  
Positive Results

Abstract Objective: Patients admitted to the hospital may unknowingly carry SARS-CoV-2 and hospitals have implemented SARS-CoV-2 admission screening. However, because SARS-CoV-2 RT-PCR may remain positive for months after infection, positive results may represent active or past infection. We determined the prevalence and infectiousness of patients who were admitted for reasons unrelated to COVID-19 but tested positive on admission screening. Methods: We conducted an observational study at the University of Iowa Hospitals & Clinics from July 7 to October 25, 2020. All patients admitted without suspicion of COVID-19 infection were included and medical records of those with a positive admission screening test were reviewed. Infectiousness was determined using patient history, PCR cycle threshold (Ct) value, and serology. Results: A total of 5,913 patients were screened and admitted for reasons unrelated to COVID-19. Of these, 101 had positive admission RT-PCR results. Thirty-six patient were excluded because they had respiratory signs/symptoms on admission on chart review. Sixty-five patients (1.1%) did not have respiratory symptoms. A total of 55 patients had Ct values available and were included in this analysis. The median age was 56 years, and (51%) were male. Our assessment revealed that 23 patients (42%) were likely infectious. The median duration of in-hospital isolation was five days for those likely infectious and two days for those deemed non-infectious. Conclusions: COVID-19 infection was infrequent among patients admitted for reasons unrelated to COVID-19. An assessment of the likelihood of infectiousness using clinical history, RT-PCR Ct values, and serology may help discontinue isolation and conserve resources.

Retrospective Analysis of Patients With Acute Invasive Fungal Rhinosinusitis in a Single Tertiary Academic Medical Center: A 10-Year Experience

2019 ◽  
Vol 34 (3) ◽  
pp. 324-330
Author(s):  
Gennadiy Vengerovich ◽  
Kristen A. Echanique ◽  
Ki Wan Park ◽  
Christine Wells ◽  
Jeffrey D. Suh ◽  
...  
Keyword(s):  
Medical Management ◽  
Medical Center ◽  
Academic Medical Center ◽  
Sinus Surgery ◽  
Open Approach ◽  
Presenting Symptoms ◽  
Fungal Rhinosinusitis ◽  
Acute Invasive Fungal Rhinosinusitis ◽  
Academic Medical ◽  
Invasive Fungal Rhinosinusitis

Background Acute invasive fungal rhinosinusitis (AIFRS) is an aggressive, potentially fatal disease that can spread rapidly to the orbit and intracranial structures causing significant mortality and morbidity. Objective In this study, we present a 10-year experience from a tertiary academic medical center of patients presenting with AIFRS. Data on presentation, mortality rate, comorbidities, surgical, and medical management were analyzed. Methods A retrospective chart review was performed in a tertiary academic medical center of patients with AIFRS from January 2009 through February 2019. Data collected included demographics, presenting symptoms, comorbidities, immunosuppression status, endoscopic and imaging findings, orbital and intracranial complications, surgical and medical management, as well as outcomes and mortality. Results A total of 34 patients were identified. In our series, mortality was noted to be 61.8%, excluding patients who were lost to follow-up. The most common presenting symptoms included facial pain, ophthalmologic complaints, headaches, and proptosis. Only 4 of the 34 patients did not undergo surgical intervention, as they were not deemed surgical candidates; they all succumbed to their disease. Twenty-six of the 30 surgical patients (86.7%) underwent endoscopic sinus surgery, 8 underwent an open approach (26.7%), while 7 patients underwent orbital exenteration (23.3%). All patients had surgical pathology consistent with AIFRS. Fungal species isolated from culture included Aspergillus, Mucor/ Rhizopus, Candida, Cunninghamella Scedosporium boydii, Paecilomyces, and Scopulariopsis. Medical therapies included intravenous amphotericin B, caspofungin, posaconazole, voriconazole, isavuconazole, and micafungin. Conclusion AIFRS was associated with 61.8% mortality in our series of 34 patients over the past 10 years. Early diagnosis, as well as rapid and aggressive surgical and medical management, is necessary for optimal outcomes in this devastating disease.

Securing discharge follow-up appointments in a women’s cancer program.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 81-81
Author(s):  
Carole Dalby ◽  
Susana M. Campos ◽  
Lisa Doverspike ◽  
Melissa Spinks ◽  
Joseph O. Jacobson
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Outpatient Setting ◽  
Outpatient Services ◽  
Post Discharge ◽  
Post Intervention ◽  
Discharge Data ◽  
Patient Dissatisfaction ◽  
Hospital Readmission Rates

81 Background: Ensuring patients have a follow-up appointment scheduled prior to discharge is one of several key interventions shown to reduce hospital readmission rates (Hansen L.O., Young R.S., Hinami K., et al. [2011, October]. Interventions to reduce 30-day rehospitalization: a systematic review. Annals of Internal Medicine, 155[8], 520-528). Lack of follow-up diminishes continuity between the inpatient and outpatient setting, can lead to patient dissatisfaction, as well as delays in proposed therapy. Methods: A three-month review of discharge data highlighted 49% of Women’s Cancer Gynecologic patients at an academic medical center were discharged from the hospital without securing a follow-up appointment. A multidisciplinary team involved in the scheduling process was assembled and determined failure to schedule appointments was attributed to a lack of communication between the inpatient and outpatient services, a complicated scheduling process, as well as ambiguity regarding when patient’s should return. Several rapid PDSA cycles were implemented over a three month period of time. The intervention created a standardized electronic template, including the establishment of standard time frames for follow-up appointments post discharge (7 to 10 days). The template details all required scheduling elements such as services requested, required laboratory studies, and patient preferences. Within the electronic template is the ability to directly email essential staff through a centralized email address embedded within the form. Staff engaged through reviewing of data, identification of the importance of securing a follow-up appointment, and weekly huddles. Results: Post intervention, the rate of compliance of scheduled discharge follow-up appointments rose from 49% to 87%. Staff reported high satisfaction with the new process, highlighting its simplicity and efficiency. Conclusions: Securing a follow-up appointment prior to discharge is feasible as evidence by increased compliance from baseline 49% to 87%. Future endeavors will implement this process across other disease programs in hopes of obtaining similar results.

Interactive iBook-Based Patient Education in a NeuroTrauma Clinic

Neurosurgery ◽  
2017 ◽  
Vol 81 (5) ◽  
pp. 787-794 ◽  
Author(s):  
Ronald Sahyouni ◽  
Amin Mahmoodi ◽  
Amir Mahmoodi ◽  
Ramin R Rajaii ◽  
Bima J Hasjim ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Educational Interventions ◽  
The United States ◽  
Outpatient Setting ◽  
Educational Material ◽  
Patient Knowledge ◽  
Academic Medical ◽  
Baseline Knowledge

Abstract BACKGROUND Traumatic brain injury (TBI) is a leading cause of death and disability in the United States. Educational interventions may alleviate the burden of TBI for patients and their families. Interactive modalities that involve engagement with the educational material may enhance patient knowledge acquisition when compared to static text-based educational material. OBJECTIVE To determine the effects of educational interventions in the outpatient setting on self-reported patient knowledge, with a focus on iPad-based (Apple, Cupertino, California) interactive modules. METHODS Patients and family members presenting to a NeuroTrauma clinic at a tertiary care academic medical center completed a presurvey assessing baseline knowledge of TBI or concussion, depending on the diagnosis. Subjects then received either an interactive iBook (Apple) on TBI or concussion, or an informative pamphlet with identical information in text format. Subjects then completed a postsurvey prior to seeing the neurosurgeon. RESULTS All subjects (n = 152) significantly improved on self-reported knowledge measures following administration of either an iBook (Apple) or pamphlet (P < .01, 95% confidence interval [CI]). Subjects receiving the iBook (n = 122) performed significantly better on the postsurvey (P < .01, 95% CI), despite equivalent presurvey scores, when compared to those receiving pamphlets (n = 30). Lastly, patients preferred the iBook to pamphlets (P < .01, 95% CI). CONCLUSION Educational interventions in the outpatient NeuroTrauma setting led to significant improvement in self-reported measures of patient and family knowledge. This improved understanding may increase compliance with the neurosurgeon's recommendations and may help reduce the potential anxiety and complications that arise following a TBI.

scholarly journals A Prospective Study of Feto-Maternal Outcome Among Covid-19 Positive Women Delivered in a Level III Covid Hospital at Moradabad, Western UP

2021 ◽  
Author(s):  
Nupur Nandi ◽  
Ritika Agarwal ◽  
Garima Bajpai
Keyword(s):  
Pregnant Women ◽  
Vertical Transmission ◽  
Ventilatory Support ◽  
Late Pregnancy ◽  
Maternal Outcome ◽  
Data Availability ◽  
Research Centre ◽  
Care Hospital ◽  
Rt Pcr ◽  
Pcr Test

Abstract Background: The ongoing pandemic situation by a highly infective Covid-19 virus is a global health threat. Pregnancy related physiological changes of cardio- respiratory system and relative immunosuppression might cause more infectivity and worsening complications of this novel respiratory virus infection. Limited data availability on feto -maternal outcome of Covid 19 positive pregnant women necessitates the current study.Methodology: A prospective cohort study was conducted in a government designated level III Covid care hospital at Teerthankar Mahaveer Medical College & Research Centre to assess the feto-maternal outcome in Covid 19 RT- PCR test positive pregnant women delivered between April 2020 to September 2020. Mothers were evaluated in terms of asymptomatic status or predominant symptoms (fever, cough, sore throat, and breathlessness), complication if any including need for ventilatory support for extensive pneumonia, or mortality. Neonates were tested for presence of infection by RT-PCR test on day 2 & 5 of delivery, and also looked for any symptoms of the disease or it’s complication.Results: Total 33 women with Covid19 positivity delivered at term pregnancy in the said period of 6 months. The most frequent (45.45%) age group was 26 to 30 years. Asymptomatic Covid 19 positive cases were more (57.58%) prevailing over symptomatic patients. Fever was most frequent (33.33%) physical symptom. Emotional quotient was significantly affected by presence of anxiety amongst 36.36%. Caesarean delivery conducted maintaining all protocol in 60.6% women, but all were indicated for other obstetric reason. None of the mother had developed significant pneumonia or other complication. One case of maternal mortality noted, but was not related to Covid 19 infection. Vertical transmission was nil in our study and no neonate was affected by any complication.Conclusion: Course of disease was not different in pregnant women infected by Covid 19 virus in late pregnancy in comparison to non-pregnant adults. No case of vertical transmission noted, neither any neonatal morbidity nor mortality in present study, shows the importance of following optimum protocol. All pregnant women should be screened for Covid 19 infection in current scenario.

scholarly journals 41. Impact of Discharge Antimicrobial Stewardship at an Academic Medical Center

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S142-S142
Author(s):  
Katie A Parsels ◽  
Wesley D Kufel ◽  
Jeni Burgess ◽  
Robert Seabury ◽  
Rahul Mahapatra ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Treatment Duration ◽  
Medical Center ◽  
Academic Medical Center ◽  
Panel Member ◽  
Outpatient Setting ◽  
Acceptance Rate ◽  
Inpatient Setting ◽  
Dose Selection ◽  
Research Grant

Abstract Background The Centers for Disease Control and Prevention estimates approximately 30% of antimicrobials prescribed in the outpatient setting are unnecessary and up to 50% are inappropriate. Despite this, antimicrobial stewardship (AS) efforts mostly focus on the inpatient setting and limited data describe AS interventions at hospital discharge. Acknowledging the potential for discharge AS, we used our existing resources to review discharge antimicrobial prescriptions sent to our hospital-operated outpatient pharmacy to potentially optimize antimicrobial therapy. Methods Discharge antimicrobial prescriptions sent to our hospital-operated outpatient pharmacy, reviewed by an infectious disease (ID) pharmacist, and recorded into the REDCap® data collection tool from September 1, 2020 to February 28, 2021 were evaluated retrospectively. Both adult and pediatric patients were included. The primary outcome was to identify the frequency a DRP was identified by an ID pharmacist while reviewing discharge antimicrobial prescriptions. Secondary outcomes included DRP characterization, percentage of prescriptions with interventions, intervention acceptance rate, and the reduction in antimicrobial days dispensed at discharge when interventions to limit treatment duration were accepted. Results Of the 803 discharge antimicrobial prescriptions reviewed, at least one DRP was identified in 43.1% (346/803). The most frequently identified DRPs pertained to treatment duration, drug selection, and dose selection. The most common intervention categories included different antimicrobial duration, antimicrobial discontinuation, and different dose or frequency. At least one intervention was recommended in 42.8% (344/803) of prescriptions. In total, 438 interventions were made and the acceptance rate was 75.6% (331/438). When interventions to reduce the treatment duration were accepted, the median (interquartile range) number of antimicrobial days decreased from 8 (5 – 10) to 4 (0 – 5.5) days (P < 0.001). Conclusion ID pharmacist review of discharge antimicrobial prescriptions sent to our hospital-operated outpatient pharmacy resulted in identification of DRPs and subsequent interventions in a substantial number of prescriptions. Disclosures Wesley D. Kufel, PharmD, Melinta (Research Grant or Support)Merck (Research Grant or Support)Theratechnologies, Inc. (Advisor or Review Panel member)

scholarly journals Characterization and clinical course of 1000 patients with COVID-19 in New York: retrospective case series

2020 ◽  
Author(s):  
Michael G Argenziano ◽  
Samuel L Bruce ◽  
Cody L Slater ◽  
Jonathan R Tiao ◽  
Matthew R Baldwin ◽  
...  
Keyword(s):  
New York ◽  
Medical Record ◽  
Symptom Onset ◽  
Clinical Course ◽  
Medical Center ◽  
Academic Medical Center ◽  
Bimodal Distribution ◽  
Hospitalized Patients ◽  
Icu Patients ◽  
Presenting Symptoms

AbstractObjectiveTo characterize patients with coronavirus disease 2019 (COVID-19) in a large New York City (NYC) medical center and describe their clinical course across the emergency department (ED), inpatient wards, and intensive care units (ICUs).DesignRetrospective manual medical record review.SettingNewYork-Presbyterian/Columbia University Irving Medical Center (NYP/CUIMC), a quaternary care academic medical center in NYC.ParticipantsThe first 1000 consecutive patients with laboratory-confirmed COVID-19.MethodsWe identified the first 1000 consecutive patients with a positive RT-SARS-CoV-2 PCR test who first presented to the ED or were hospitalized at NYP/CUIMC between March 1 and April 5, 2020. Patient data was manually abstracted from the electronic medical record.Main outcome measuresWe describe patient characteristics including demographics, presenting symptoms, comorbidities on presentation, hospital course, time to intubation, complications, mortality, and disposition.ResultsAmong the first 1000 patients, 150 were ED patients, 614 were admitted without requiring ICU-level care, and 236 were admitted or transferred to the ICU. The most common presenting symptoms were cough (73.2%), fever (72.8%), and dyspnea (63.1%). Hospitalized patients, and ICU patients in particular, most commonly had baseline comorbidities including of hypertension, diabetes, and obesity. ICU patients were older, predominantly male (66.9%), and long lengths of stay (median 23 days; IQR 12 to 32 days); 78.0% developed AKI and 35.2% required dialysis. Notably, for patients who required mechanical ventilation, only 4.4% were first intubated more than 14 days after symptom onset. Time to intubation from symptom onset had a bimodal distribution, with modes at 3-4 and 9 days. As of April 30, 90 patients remained hospitalized and 211 had died in the hospital.ConclusionsHospitalized patients with COVID-19 illness at this medical center faced significant morbidity and mortality, with high rates of AKI, dialysis, and a bimodal distribution in time to intubation from symptom onset.

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