scholarly journals 1523. Clinical Epidemiology of Children with Orbital Cellulitis

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S554-S555
Author(s):  
Meghna Sharma ◽  
Alexandra Espinel ◽  
Emily Ansusinha ◽  
Rana F Hamdy
Keyword(s):  
Clinical Epidemiology ◽  
Medical Center ◽  
Orbital Cellulitis ◽  
Surgical Drainage ◽  
Medical Problems ◽  
Duration Of Symptoms ◽  
National Medical ◽  
Intracranial Complications ◽  
Almost All ◽  
Viridans Group Streptococci

Abstract Background The microbiology of pathogens causing orbital cellulitis in children is evolving over time, with studies from around 10 years ago describing MRSA as responsible for anywhere from 0 to 13% of cases of orbital cellulitis. However, the prevalence of community-acquired MRSA infections has declined over the past decade. A current understanding of the bacteria most commonly found to be responsible for orbital cellulitis would be important to inform the empiric antibiotic regimens for cases of orbital cellulitis in which no microbiologic data are available. Methods This is a single-center retrospective cohort study of children ≤18 years hospitalized with orbital cellulitis at Children’s National Medical Center between January 1, 2017 and July 31, 2018. We excluded children with immunocompromising conditions, cystic fibrosis, underlying craniofacial abnormality, or recent craniofacial or otolaryngologic surgery. Baseline clinical characteristics, microbiologic data, clinical outcomes, and antibiotic treatment data were abstracted through structured chart review and summarized with descriptive statistics. Results We identified 68 children that met inclusion criteria, with an average age of 8.2 years; 66.2% were male, 48.5% were African American, and 14.7% were Hispanic. Most (67.6%) had no underlying medical problems, 14.7% had asthma, and 22.1% had allergic rhinitis. The median duration of symptoms prior to presentation was 4 days. An abscess or phlegmon was identified in 41 of the 68 (60.3%). Three patients (4.4%) developed intracranial complications. About one-quarter (27.9%) of all patients in the cohort underwent surgical drainage. The most commonly identified pathogens were viridans group streptococci (7/19, 36.8%), followed by Staphylococcus aureus (4/19, 21.1%). Anti-MRSA therapy was provided empirically in almost all (95.6%) of patients. Conclusion One-quarter of all patients hospitalized for orbital cellulitis underwent surgical drainage, and viridans group streptococci and S. aureus were the most commonly isolated pathogens. While MRSA was isolated in only one patient (5.2%), almost all received empiric anti-MRSA therapy. Disclosures All authors: No reported disclosures.

Intracranial Complications of Sinusitis in Childhood

1995 ◽  
Vol 104 (4) ◽  
pp. 288-293 ◽  
Author(s):  
Don N. Lerner ◽  
George H. Zalzal ◽  
Sukgi S. Choi ◽  
Dennis L. Johnson
Keyword(s):  
Medical Center ◽  
Abscess Formation ◽  
Intracranial Extension ◽  
Washington Dc ◽  
Surgical Drainage ◽  
Intracranial Abscess ◽  
National Medical ◽  
Management Protocol ◽  
Similar Disease ◽  
Intracranial Complications

Complications of sinusitis in children, such as intracranial abscess formation, are uncommon and are often clinically unremarkable in comparison to similar disease processes in adults. Between 1983 and 1991, 443 children were admitted to Children's National Medical Center in Washington, DC, for treatment of sinusitis. Fourteen of these children presented with intracranial extension of the infection and abscess formation. A retrospective review of these patients revealed that the risk of developing an intracranial abscess secondary to sinusitis was 3%. The management of these patients included surgical drainage of the infected sinuses and intracranial surgical exploration. Cranialization and exenteration of the frontal sinus proved to be effective single-stage procedures. While not indicated in all patients, these procedures eliminated the sinus as a source of continued or potential infection and obviated the need for a second obliterative procedure. Combined antimicrobial therapy and surgical drainage should be the management protocol.

Health Characteristics of Elderly North Korean Defectors: 2006-2016 at National Medical Center

2019 ◽  
Vol 20 (1) ◽  
pp. 31-37
Author(s):  
Jong Yun Lee ◽  
Im Seok Koh ◽  
So Hee Lee ◽  
Sung Soo Eun
Keyword(s):  
Medical Center ◽  
National Medical ◽  
North Korean Defectors

scholarly journals NURSING HOME TELEED INTERVENTION: ADVANCING NEW CARE MODELS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S337-S338
Author(s):  
Charlene C Quinn ◽  
Anthony Roggio ◽  
Barr Erik ◽  
Ann Gruber-Baldini
Keyword(s):  
Medical Center ◽  
Business Case ◽  
Admission Policy ◽  
Care Utilization ◽  
Future Research ◽  
Technical Equipment ◽  
Nursing Facilities ◽  
Medical Problems ◽  
Provider Satisfaction ◽  
Care Models

Abstract New reimbursement and managed care models demonstrate the need to reduce avoidable Emergency Department (ED) use and limit preventable inpatient admissions for older adults in Skilled Nursing Facilities (SNF). The objective was to develop an ED telemedicine consultation intervention for SNF residents with acute medical problems. Secondary objectives including evaluation of health care utilization, provider satisfaction. Demonstration evaluation in three urban SNFs, telemedicine linked to university medical center ED. Mobile telemedicine cart equipment assessed SNF residents for any change in condition. ED physicians used tablets with secure access to conduct the resident assessment. Provider satisfaction measures imbedded in EMRs were completed at consultation visit end. 460 patients had changes in condition, 327 resulted in 911 calls, 85 deemed eligible for telemedicine consult. Conducted 57 telehealth consults. Forty (70%) telemedicine consult residents remained in the SNF. Fourteen residents were transferred to the ED. Average satisfaction scores were 5.8/7 for SNF nurses (n=49) and 5.6 for ED physicians (n=45). Lower-rated items related to technical equipment problems. ED physicians reported residents transferred to ED after telehealth visit had better continuity of care. The intervention was effective in preventing or delaying transfer of acutely ill, medically complex SNF residents. Implementation of the intervention identified need for SNF admission policy and procedure changes; weekly telemedicine training; SNF clinical advocates; on-site tracking and linkage of EMRs across providers; HIPAA shared medical record concerns. Future research plans include analyses of detailed SNF resident characteristics and business case assessment for reduction of transfers, ED and hospital utilization.

Specific Antigens by Federal Entity in Patients at the Transplant Unit of Specialities Hospital, National Medical Center Twenty-First Century, Mexico

2016 ◽  
Vol 48 (2) ◽  
pp. 575-577 ◽  
Author(s):  
J.C.H. Hernández Rivera ◽  
A. Ibarra Villanueva ◽  
R. Espinoza Pérez ◽  
J.D. Cancino López ◽  
I.R. Silva Rueda ◽  
...  
Keyword(s):  
Medical Center ◽  
First Century ◽  
National Medical ◽  
Specific Antigens ◽  
Twenty First Century

Advertisements for Medicines in Leading Medical Journals in 18 Countries: A 12-Month Survey of Information Content and Standards

1993 ◽  
Vol 23 (1) ◽  
pp. 161-172 ◽  
Author(s):  
Andrew Herxheimer ◽  
Cecilia Stålsby Lundborg ◽  
Barbro Westerholm
Keyword(s):  
Information Content ◽  
Medical Information ◽  
Industrialized Countries ◽  
Brand Name ◽  
Negative Effects ◽  
Medical Journals ◽  
National Medical ◽  
Ethical Criteria ◽  
Almost All ◽  
Medicinal Drug

The information content of 6,710 advertisements for medicines in medical journals was surveyed to provide a baseline for monitoring the effect of WHO's Ethical Criteria for Medicinal Drug Promotion. The advertisements (ads) appeared during 12 months (1987–1988) in 23 leading national medical journals in 18 countries. Local participants, mostly doctors or pharmacists, examined them. The presence or absence in each ad of important information was noted. In most ads the generic name appeared in smaller type than the brand name. Indications were mentioned more often than the negative effects of medicines. The ads gave less pharmacological than medical information. However, important warnings and precautions were missing in half, and side effects and contraindications in about 40 percent. Prices tended to be given only in countries where a social security system pays for the medicines. The information content of ads in the developing countries differed surprisingly little from that in the industrialized countries. Almost all the ads (96 percent) included one or more pictures; 58 percent of these were considered irrelevant. The authors believe it is a mistake to regard ads as trivial. If they are not considered seriously they will influence the use of medicines as they are intended to do, but read critically they can provide useful information.

The Role of Clostridium septicum in Paraneoplastic Sepsis

2000 ◽  
Vol 124 (3) ◽  
pp. 353-356
Author(s):  
J. Peter R. Pelletier ◽  
Julie A. Plumbley ◽  
Elizabeth A. Rouse ◽  
Stephen J. Cina
Keyword(s):  
Medical Center ◽  
Case Series ◽  
Teaching Hospitals ◽  
Clostridium Septicum ◽  
Medical Problems ◽  
Exclusion Criteria ◽  
Cyclic Neutropenia ◽  
The Past ◽  
Associated Conditions

Abstract Context.—Clostridium septicum infections are rare but often associated with serious if not fatal outcomes. Clostridium septicum infection does not appear to be associated with a single specific defect in cellular or humoral immunity. It has been associated with multiple medical problems, including but not limited to leukemia, malignancy of the bowel, other solid tumors, cyclic neutropenia with enterocolitis, diabetes mellitus, and severe arteriosclerosis. Most cases of C septicum are associated with malignancy, and mortality approaches 100% if care is not rendered within 12 to 24 hours. Objectives.—To evaluate outcomes of patients with C septicum bacteremia, whether treated medically or surgically or both, and to note associated conditions. Design.—Retrospective evaluation of patients found to have C septicum bacteremia in the past 6 years. Setting.—Two teaching hospitals, Brooke Army Medical Center (250 beds) and Wilford Hall Medical Center (292 beds), were the source of our patients. Patients.—All patients found to have C septicum bacteremia during hospitalization or postmortem examination were included in the study. There were no exclusion criteria. Main Outcome Measure.—Mortality associated with C septicum infection. Results.—In our case series, mortality was 33%, which is slightly lower than reported in prior studies (43%–70%). Conclusion.—Presumptive identification based on Gram stain, awareness of C septicum infection as a paraneoplastic syndrome, and prompt, clear communication between laboratory personnel and clinicians are necessary for early diagnosis of C septicum infection. Early institution of antibiotic therapy improves prognosis.

SMOKING ISSUE IS HEATING UP CUSTODY SUITS

PEDIATRICS ◽  
1993 ◽  
Vol 92 (4) ◽  
pp. A78-A78
Author(s):  
B. H.
Keyword(s):  
Child Abuse ◽  
Cigarette Smoke ◽  
Secondhand Smoke ◽  
Healthy Children ◽  
Medical Problems ◽  
Parental Concern ◽  
Middle Ear Infection ◽  
Medical Reports ◽  
Almost All ◽  
Heating Up

Parental concern about secondhand smoke is adding a new wrinkle to some custody and divorce battles. Estranged spouses are taking an increasingly aggressive court stance when a child is exposed to cigarette smoke of one parent. Secondhand smoke has become a point of contention in custody cases in more than a dozen states, almost all involving children with respiratory ailments such as asthma and allergies. And smoking may become an issue in many more custody cases, according to some lawyers. Recent medical reports have cited the heightened likelihood of respiratory disease and middle-ear infection even in healthy children exposed to secondhand smoke. In at least one case a judge has been asked to rule that exposing a child with medical problems to cigarette smoke constitutes child abuse.

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