scholarly journals 596. The ID Physician Is Out: Are Remote ID E-Consults an Effective Substitute?

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S401-S402
Author(s):  
Sui Kwong Li ◽  
Carolyn Fernandes ◽  
Sowmya Nanjappa ◽  
Sarah Burgdorf ◽  
Vidya Jagadeesan ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Mortality Rate ◽  
Patient Outcomes ◽  
Tertiary Care Hospital ◽  
Immunosuppressive Agents ◽  
Tertiary Care ◽  
Published Data ◽  
Care Hospital ◽  
Material Support ◽  
Phone Calls

Abstract Background Telemedicine (TM) can provide specialty ID care for remote and underserved areas; however, the need for dedicated audio-visual equipment, secure and stable internet connectivity, and local staff to assist with the consultation has limited wider implementation of synchronous TM. ID e-consults (ID electronic consultations or asynchronous™) are an alternative but data are limited on their effectiveness, especially patient outcomes. Methods In the setting of the COVID-19 pandemic and ID physician outage, we were asked to perform ID e-consults at a 380-bed tertiary care hospital located in Blair County, PA. We performed retrospective chart reviews of 121 patients initially evaluated by ID e-consults between April 2020 and July 2020. Follow-up visits were also conducted via e-consults with or without direct phone calls with the patient. Key patient outcomes assessed were length of stay (LOS), disposition after hospitalization, 30-day mortality from initial ID e-consult and 30-day readmission post-discharge. Results The majority of patients were white males and non-ICU (Table 1). The most common ID diagnosis was bacteremia (27.3%, 33/121), followed by skin and soft tissue infections (15.7%, 19/121) and bone/joint infections (14.9%, 18/121) (Figure 1). Table 2 shows patient outcomes. Average total LOS was 11 days and 7 days post-initial ID e-consult. 48.7% (59/121) of patients were discharged home and 37.2% (45/121) to a post-acute rehabilitation facility. 2.5% (3/121) of patients required transfer to a higher level of care facility; none of which were to obtain in-person ID care. The index mortality rate was 3.3% (4/121), which appears to be lower than published data for in-person ID care. The 30-day mortality rate was 4.1% (5/121), which is also comparable to previously reported for ID e-consults. 25.6% (31/121) of patients required readmission within 30 days but only 14.0% (17/121) were related to the initial infection. Table 1. Demographics *Immunosuppressive agents include: Apremilast, Dasatinib, Etanercept, Remicade, Rituximab, and Prednisone >10 mg/day Figure 1. Variety of ID Diagnoses made by e-consults Table 2. Outcomes Conclusion We believe that this is the first report of the implementation of ID e-consults at a tertiary care hospital. Mortality rates appear to be comparable to in-person ID care. In the absence of in-person ID physicians, ID e-consults can be a reasonable substitute. Further study is required to compare performance of ID e-consults to in-person ID consults. Disclosures John Mellors, MD, Abound Bio, Inc. (Shareholder)Accelevir (Consultant)Co-Crystal Pharma, Inc. (Other Financial or Material Support, Share Options)Gilead Sciences, Inc. (Advisor or Review Panel member, Research Grant or Support)Infectious DIseases Connect (Other Financial or Material Support, Share Options)Janssen (Consultant)Merck (Consultant) Rima Abdel-Massih, MD, Infectious Disease Connect (Employee, Director of Clinical Operations) Rima Abdel-Massih, MD, Infectious Disease Connect (Individual(s) Involved: Self): Chief Medical Officer, Other Financial or Material Support, Other Financial or Material Support, Shareholder

scholarly journals Epidemiology, species distribution, and outcome of nosocomial Candida spp. bloodstream infection in Shanghai: an 11-year retrospective analysis in a tertiary care hospital

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Yan-Jun Zheng ◽  
Ting Xie ◽  
Lin Wu ◽  
Xiao-Ying Liu ◽  
Ling Zhu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mortality Rate ◽  
Antifungal Therapy ◽  
Species Distribution ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Clinical Severity ◽  
Severe Neutropenia ◽  
Care Hospital ◽  
The Impact

Abstract Background The incidence of Candida bloodstream infections (BSIs), has increased over time. In this study, we aimed to describe the current epidemiology of Candida BSI in a large tertiary care hospital in Shanghai and to determine the risk factors of 28-day mortality and the impact of antifungal therapy on clinical outcomes. Methods All consecutive adult inpatients with Candida BSI at Ruijin Hospital between January 1, 2008, and December 31, 2018, were enrolled. Underlying diseases, clinical severity, species distribution, antifungal therapy, and their impact on the outcomes were analyzed. Results Among the 370 inpatients with 393 consecutive episodes of Candida BSI, the incidence of nosocomial Candida BSI was 0.39 episodes/1000 hospitalized patients. Of the 393 cases, 299 (76.1%) were treated with antifungal therapy (247 and 52 were treated with early appropriate and targeted antifungal therapy, respectively). The overall 28-day mortality rate was 28.5%, which was significantly lower in those who received early appropriate (25.5%) or targeted (23.1%) antifungal therapy than in those who did not (39.4%; P = 0.012 and P = 0.046, respectively). In multivariate Cox regression analysis, age, chronic renal failure, mechanical ventilation, and severe neutropenia were found to be independent risk factors of the 28-day mortality rate. Patients who received antifungal therapy had a lower mortality risk than did those who did not. Conclusions The incidence of Candida BSI has increased steadily in the past 11 years at our tertiary care hospital in Shanghai. Antifungal therapy influenced short-term survival, but no significant difference in mortality was observed between patients who received early appropriate and targeted antifungal therapy.

scholarly journals FREQUENCY AND CAUSES OF PERINATAL MORTALITY IN A TERTIARY CARE HOSPITAL IN PESHAWAR, PAKISTAN

2018 ◽  
Vol 16 (1) ◽  
pp. 15-19
Author(s):  
Maimoona Qadir ◽  
Sohail Amir ◽  
Samina Jadoon ◽  
Muhammad Marwat
Keyword(s):  
Mortality Rate ◽  
Perinatal Mortality ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Age Groups ◽  
Mortality Data ◽  
Care Hospital ◽  
Cross Sectional ◽  
Medical Disorders ◽  
Perinatal Mortality Rate

Background: Perinatal mortality rate indicates quality of care provided during pregnancy and delivery to the mother and to the neonate in its early neonatal period. The objective of this study was to determine the frequency and causes of perinatal mortality in a tertiary care hospital in Peshawar, Pakistan. Materials & Methods: This cross-sectional study was conducted at Department of Gynaecology & Obstetrics, Khyber Teaching Hospital, Peshawar, Pakistan from 1st January 2016 to 31st December 2016. The inclusion criteria was all singleton gestation with gestational age of at least 24 weeks presenting with perinatal mortality. Data was collected for the following variables; age groups (up to 20 years, 21-30 years, 31-40 years and > 40 years), booking status (yes/ no), period of gestation (24-31+6, 32-36+6, 37-39+6 and > 40 weeks), Foetal weight ( 3.5 kg) and cause of perinatal mortality. Results: Out of 4508 deliveries there were 288 perinatal deaths, including 228 stillbirths and 60 neonatal deaths, so perinatal mortality rate was 63.8/1000 births. 90.28% women were unbooked. Most common cause was hypertensive disorders of pregnancy (27.78%) followed by antepartum haemorrhage (25.71%) and then mechanical causes (13.88%). Congenital anomalies comprised 11.8% cases, neonatal problems 10.07% and maternal medical disorders for 4.16% cases. Cause of 4.16% cases remained unexplained. Conclusion: Appropriate strategies like control of identifiable causes, proper antenatal and postnatal care, healthy delivery practices and availability of emergency neonatal care facilities can bring down perinatal mortality rates.

Effect of an Alcohol Withdrawal Protocol on Patient Outcomes at a Tertiary Care Hospital

2013 ◽  
Vol 62 (4) ◽  
pp. S124
Author(s):  
P. Sud ◽  
R.A. Medairos ◽  
M. Wu ◽  
Y. Goltser ◽  
M.F. Ward ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Alcohol Withdrawal ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital

scholarly journals The impact of infectious disease consultation in candidemia in a tertiary care hospital in Japan over 12 years

PLoS ONE ◽  
2019 ◽  
Vol 14 (4) ◽  
pp. e0215996 ◽  
Author(s):  
Masahiro Ishikane ◽  
Kayoko Hayakawa ◽  
Satoshi Kutsuna ◽  
Nozomi Takeshita ◽  
Norio Ohmagari
Keyword(s):  
Infectious Disease ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Infectious Disease Consultation ◽  
The Impact

scholarly journals Profile of Diabetic Foot Ulcer Patients at Tertiary Care Hospital in Surabaya, Indonesia

2021 ◽  
Vol 9 (3) ◽  
pp. 293
Author(s):  
Arisvia Sukma Hariftyani ◽  
Hermina Novida ◽  
Mouli Edward
Keyword(s):  
Mortality Rate ◽  
Diabetic Foot ◽  
Tertiary Care Hospital ◽  
Demographic Data ◽  
Tertiary Care ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Care Hospital ◽  
Precipitating Factors ◽  
Medical Histories

Background: Diabetic Foot Ulcer (DFU) has been associated with a high mortality rate of Diabetes Mellitus (DM) patients. Both behavioral and biological factors cause predisposition to DFU. Purpose: This research describes the profile of hospitalized DFU patients at a tertiary care hospital in Surabaya. Methods: A retrospective descriptive study that analyzed medical records of hospitalized T2DM patients with DFU in Dr. Soetomo General Hospital. Sampled respondents were patients ≥ 21 years old who were hospitalized between 2016–2018. Demographic data, clinical characteristics, medical histories, length of hospital stay, laboratory results, precipitating factors, microorganism culture results, treatment, and outcome were analyzed. Descriptive analysis is presented in the form of narratives, tables, and diagrams. Results: 9.08% of hospitalized Type 2 DM (T2DM) cases were related to foot ulcers. The average patient age was 57.00 ± 9.83 years with no gender predominance. DM was poorly controlled (Mean HbA1C 9.78±2.83%; RBG 251.83 ± 158.15 mg/dL). The majority of patients had sepsis (68.26%) and renal function impairment (62.72%). Ulcers with Wagner grades of 4–5 were frequent (41.31%). The highest percentage of sepsis (80.49%) and the average leukocyte level (22.60±11.95 x109/L) were found in gangrenous feet. Anemia was more predominant and severe in ulcers with higher Wagner grades. Trauma and Escherichia coli were the most common precipitating factors and microorganisms isolated, respectively. Amputation was performed for 82.36% of patients who were admitted to hospital with gangrene. The Lower Extremity Amputation (LEA) and mortality rates were 14.11% and 40.93%, respectively. Conclusion: DFUs were found to have a relatively high prevalence among T2DM patients, and must never be neglected due to the high associated mortality rate.

scholarly journals Pattern of admissions, clinical course and short term outcome of patients admitted to an obstetric ICU of a tertiary care hospital of north India: a retrospective study

2018 ◽  
Vol 7 (5) ◽  
pp. 1749
Author(s):  
Waseeqa Nigeen ◽  
Saima Salam ◽  
Samina Ashraf ◽  
Abdus Sami Bhat
Keyword(s):  
Mortality Rate ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Spectrum Management ◽  
North India ◽  
Care Hospital ◽  
Care Giving ◽  
Obstetric Haemorrhage ◽  
Number Of Patients ◽  
The World

Background: Obstetric ICUs have become an important part of any tertiary care obstetric hospital. There have been studies in different parts of the world including India to determine the clinical spectrum, management and outcome of the patients admitted to these units. There have been a few studies on the subject from our part of the country, so we tried to carry out the said study. Our objective was to study indications of admissions, the pattern of complications, interventions required, and the maternal and fetal /neonatal outcome of the patients admitted in an obstetric ICU of our hospital.Methods: A retrospective descriptive study carried out at Lalla Ded hospital Srinagar, a tertiary care hospital of north India, between January 2017 and June 2017.Results: Fifty patients among 4890 obstetric admissions required ICU care giving an admission rate of 1.02%. Most of the patients fell in the age group of 26-30years (52%) followed by 31-35 years (24%).The most frequent indication for admission to ICU was pregnancy induced hypertension related eclampsia and preeclampsia which constituted about 44% (n=22) of the admissions. Obstetric haemorrhage was a close second and accounted for 34% (n=17) of the admissions. Mean ICU stay was 2.5±1 days. Four patients died giving a maternal mortality rate of 8% in this ICU. There were eleven fetal and neonatal deaths excluding ectopic pregnancy giving a fetal /neonatal mortality rate of 22%.Conclusions: Obstetric ICUs have become an important part of any tertiary care obstetric hospital. Significant number of patients get admitted and treated in these ICUs. In our part of the world majority of ICU admissions are because of eclampsia/preeclampsia and obstetric haemorrhage. Although a large number of mothers and their neonates get benefitted by way of admission to ICUs, a significant proportion of these mothers and their neonates die. There is a lot of scope of improvement in maternal and perinatal mortality. In addition to the importance of setting up of state of the art obstetric ICUs, the need for supervision of pregnancies, institutional deliveries, early detection of complications and early referral cannot be overemphasized. 

Evaluation of an infectious disease consultation programme in a German tertiary care hospital

Infection ◽  
2013 ◽  
Vol 41 (6) ◽  
pp. 1121-1128 ◽  
Author(s):  
J. J. Vehreschild ◽  
G. Morgen ◽  
O. A. Cornely ◽  
P. Hartmann ◽  
S. Koch ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Infectious Disease Consultation

scholarly journals Melioidosis: a case series from coastal Karnataka, India

2019 ◽  
Vol 7 (10) ◽  
pp. 3920
Author(s):  
Shabari M. Shenoy ◽  
Ankith Vaidya ◽  
Chethan Subramanya
Keyword(s):  
Infectious Disease ◽  
South India ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Case Series ◽  
Gram Negative Bacteria ◽  
Care Hospital ◽  
Gram Negative ◽  
Coastal City ◽  
Sporadic Cases

Melioidosis is an infectious disease caused by gram negative bacteria B. pseudomallei. The disease is largely under diagnosed globally. Sporadic cases have been reported from India, distributed mostly in the coastal areas. Authors present a series of seven culture proven cases of Melioidosis treated at a tertiary care Hospital in the coastal city of Mangalore in South India.

scholarly journals Epidemiology, species distribution, and outcome of nosocomial Candida spp. bloodstream infection in Shanghai — An 11-year retrospective analysis in a tertiary care hospital

2021 ◽  
Author(s):  
Yanjun Zheng ◽  
Ting Xie ◽  
Lin Wu ◽  
Xiaoying Liu ◽  
Ling Zhu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mortality Rate ◽  
Antifungal Therapy ◽  
Species Distribution ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Clinical Severity ◽  
Severe Neutropenia ◽  
Care Hospital ◽  
The Impact

Abstract Background The incidence of Candida bloodstream infections (BSIs), has increased over time. In this study, we aimed to describe the current epidemiology of Candida BSI in a large tertiary care hospital in Shanghai and to determine the risk factors of 28-day mortality and the impact of antifungal therapy on clinical outcomes. Methods All consecutive adult inpatients with Candida BSI at Ruijin Hospital between January 1, 2008 and December 31, 2018 were enrolled. Underlying diseases, clinical severity, species distribution, antifungal therapy, and their impact on the outcomes were analyzed. Results Among the 370 inpatients with 393 consecutive episodes of Candida BSI, the incidence of nosocomial Candida BSI was 0.39 episodes/1000 hospitalized patients. Of the 393 cases, 299 (76.1%) were treated with antifungal therapy (247 and 52 were treated with early appropriate and targeted antifungal therapy, respectively). The overall 28-day mortality rate was 28.5%, which was significantly lower in those who received early appropriate (25.5%) or targeted (23.1%) antifungal therapy than in those who did not (39.4%; P=0.012 and P=0.046, respectively). In multivariate Cox regression analysis, age, chronic renal failure, mechanical ventilation, and severe neutropenia were found to be independent risk factors of 28-day mortality rate. Patients who received antifungal therapy had a lower mortality risk than did those who did not.Conclusions The incidence of Candida BSI has increased steadily in the past 11 years at our tertiary care hospital in Shanghai. Antifungal therapy influenced short-term survival, but no significant difference in mortality was observed between patients who received early appropriate and targeted antifungal therapy.

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