scholarly journals 763. 30 Day Readmission Outcomes in Patients Over 80 Years of Age Enrolled in an Outpatient Parenteral Antibiotic Therapy (OPAT) Program

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S339-S340
Author(s):  
Kathleen R Sheridan ◽  
Joshua Wingfield ◽  
Lauren McKibben ◽  
Natalie Clouse
Keyword(s):  
Readmission Rate ◽  
Chart Review ◽  
Age Groups ◽  
Retrospective Chart Review ◽  
Model Of Care ◽  
Readmission Rates ◽  
Parenteral Antibiotic ◽  
Patient Demographics

Abstract Background OPAT is a well-established model of care for the monitoring of patients requiring long-term IV antibiotics1. We have previously reported a reduction in the 30-day readmission rate to our facility for patients managed in our OPAT program. However, little has been published to date regarding outcomes in OPAT patients over 80 years of age 2–3. Our OPAT program was established in 2013. Patients can be discharged to a facility or home to complete their course of antibiotics. Methods We conducted a retrospective chart review of all OPAT patients discharged from our facility from 2015 to 2018. Patients were divided into two groups based on age, <80 (n = 4618) and >80 (n = 562). Results Patient demographics are listed in Table 1. The overall 30-day readmission rate for patients older than 80 was 27.8%. For patients over 80 that had a follow-up ID clinic appointment, the 30-day readmission rate decreased to 15.7%. For patients younger than 80, the 30-day readmission rate was 36.0% with a decrease to 16.2% if patients were evaluated in the outpatient clinic. Figure 1. Staphylococcus Aureus was the predominant organism in both age categories. Vancomycin was the most common antibiotic used in both age groups followed by β lactams. Conclusion In general, patients aged over 80 years were more likely to be discharged to a facility to complete their antibiotic course than younger patients. These patients also were more likely to have other comorbidities. The 30-day readmission rate in each age group was relatively similar. OPAT in patients over age 80 can have similar 30-day readmission rates as for patients less than 80 years of age Disclosures All authors: No reported disclosures.

Surgical treatment for intramedullary spinal cord melanocytomas

2008 ◽  
Vol 9 (1) ◽  
pp. 48-54 ◽  
Author(s):  
Eric M. Horn ◽  
Peter Nakaji ◽  
Stephen W. Coons ◽  
Curtis A. Dickman
Keyword(s):  
Spinal Cord ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Complete Resection ◽  
Intramedullary Spinal Cord ◽  
Local Infiltration ◽  
Patients Âgés ◽  
Patient Demographics

Spinal meningeal melanocytomas are rare lesions that are histologically benign and can behave aggressively, with local infiltration. The authors present their experience with intramedullary spinal cord melanocytomas consisting of 3 cases, which represents the second largest series in the literature. A retrospective chart review was performed following identification of all spinal melanocytomas treated at the author's institution, based on information obtained from a neuropathology database. The charts were reviewed for patient demographics, surgical procedure, clinical outcome, and long-term tumor progression. Three patients were identified in whom spinal melanocytoma had been diagnosed between 1989 and 2006. The patients' ages were 37, 37, and 48 years, and the location of their tumor was C1–3, T9–10, and T-12, respectively. All 3 had complete resection with no adjuvant radiotherapy during follow-up periods of 16, 38, and 185 months, respectively. One patient demonstrated a recurrence 29 months after resection and the other 2 patients have demonstrated asymptomatic recurrences on imaging studies obtained at 16 and 38 months following resection. With these cases added to the available literature, the evidence strongly suggests that complete resection is the treatment of choice for spinal melanocytomas. Even with complete resection, recurrences are common and close follow-up is needed for the long term in these patients. Radiation therapy should be reserved for those cases in which complete resection is not possible or in which there is recurrence.

Late endoscopic evaluation of the ostium size after external dacryocystorhinostomy

2020 ◽  
pp. 112067212097604
Author(s):  
Reem R Al Huthail ◽  
Yasser H Al-Faky
Keyword(s):  
Chart Review ◽  
Retrospective Chart Review ◽  
Tertiary Hospital ◽  
Nasal Endoscope ◽  
Long Term Follow Up ◽  
Mean Size ◽  
External Dacryocystorhinostomy ◽  
The Mean

Objective: To evaluate the effect of chronicity on the size of the ostium after external dacryocystorhinostomy (DCR) with intubation. Methods: Design: A retrospective chart review of patients who underwent external DCR with intubation over 10 years from January 2003 at a tertiary hospital. All patients were recruited and examined with rigid nasal endoscope. Results: A total number of 66 (85 eyes) patients were included. The mean age at the time of evaluation was 53.1 years with gender distribution of 54 females (81.8 %). The mean duration ±SD between the date of surgery and the date of evaluation was 33.2 ± 33.6 (6–118 months). Our study showed an overall anatomical and functional success of 98.8% and 95.3%, respectively. The mean size of the ostium (±SD) was 23.0 (±15.7) mm2 (ranging from 1 to 80.4 mm2). The size of the ostium was not a significant factor for failure ( p = 0.907). No statistically significant correlation was found between the long-term duration after surgery and the size of the ostium ( R: 0.025, p = 0.157). Conclusions: Nasal endoscopy after DCR is valuable in evaluating the ostium with no observed potential correlation between the long-term follow-up after surgery and the size of the ostium.

scholarly journals Trajectory Modelling to Assess Trends in Long-Term Readmission Rate among Abdominal Aortic Aneurysm Patients

2018 ◽  
Vol 2018 ◽  
pp. 1-10
Author(s):  
Ahsan Rao ◽  
Alex Bottle ◽  
Collin Bicknell ◽  
Ara Darzi ◽  
Paul Aylin
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Readmission Rate ◽  
High Impact ◽  
Short Term ◽  
Readmission Rates ◽  
Abdominal Aortic ◽  
High Readmission Rate ◽  
Trajectory Modelling

Introduction. The aim of the study was to use trajectory analysis to categorise high-impact users based on their long-term readmission rate and identify their predictors following AAA (abdominal aortic aneurysm) repair. Methods. In this retrospective cohort study, group-based trajectory modelling (GBTM) was performed on the patient cohort (2006-2009) identified through national administrative data from all NHS English hospitals. Proc Traj software was used in SAS program to conduct GBTM, which classified patient population into groups based on their annual readmission rates during a 5-year period following primary AAA repair. Based on the trends of readmission rates, patients were classified into low- and high-impact users. The high-impact group had a higher annual readmission rate throughout 5-year follow-up. Short-term high-impact users had initial high readmission rate followed by rapid decline, whereas chronic high-impact users continued to have high readmission rate. Results. Based on the trends in readmission rates, GBTM classified elective AAA repair (n=16,973) patients into 2 groups: low impact (82.0%) and high impact (18.0%). High-impact users were significantly associated with female sex (P=0.001) undergoing other vascular procedures (P=0.003), poor socioeconomic status index (P<0.001), older age (P<0.001), and higher comorbidity score (P<0.001). The AUC for c-statistics was 0.84. Patients with ruptured AAA repair (n=4144) had 3 groups: low impact (82.7%), short-term high impact (7.2%), and chronic high impact (10.1%). Chronic high impact users were significantly associated with renal failure (P<0.001), heart failure (P = 0.01), peripheral vascular disease (P<0.001), female sex (P = 0.02), open repair (P<0.001), and undergoing other related procedures (P=0.05). The AUC for c-statistics was 0.71. Conclusion. Patients with persistent high readmission rates exist among AAA population; however, their readmissions and mortality are not related to AAA repair. They may benefit from optimization of their medical management of comorbidities perioperatively and during their follow-up.

Dosage Changes in Long-Term Botox Use for Laryngeal Dystonia

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P49-P49
Author(s):  
Hakan Birkent ◽  
Nicole C Maronian ◽  
Patricia F. Waugh ◽  
Albert L Merati ◽  
David Perkel ◽  
...  
Keyword(s):  
Total Dose ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Duration Of Effect ◽  
Laryngeal Dystonia ◽  
Patient Reported ◽  
Number Of Treatment ◽  
Over Time

Objective Botulinum toxin (BTX) injections continue to be the mainstay of treatment for laryngeal dystonia (LD). Many patients are entering their 2nd and 3rd decade of treatment. In this study, the dosage consistency of BTX injections over time was examined in patients with long-term BTX use for LD. Methods Retrospective chart review, 1990–2007. Patients with adductor-type LD who had received at least 20 injections to the thyroarytenoid (TA) muscles were included in the study. The change of total dose and patient-reported effective weeks were investigated; data of the first 5 injections were excluded to eliminate initial dose searching. Results 55 patients (11 male, 44 female, mean age 60.6) with a mean follow-up period of 149.9 ± 43.7 months (range 44 to 211 months) were identified. Total number of treatment episodes was 1825 with a mean of 33.18 ± 10.37 (range 20 to 58) and a mean interval of 19.1 ± 1.3 (range 2 to 118) weeks. The average total dose of BTX for each treatment episode was 2.15 ± 0.37 U (range 0.125 to 10.00 U). The total dose trended downward over time; this trend became statistically significant at 13th injection. The overall mean duration of effect was 15.5 ± 1.1 (range 1 to 58) weeks and did not show a significant change over time. Conclusions The BTX dose needed for a constant response in the treatment of LD decreases over time, raising the concern that neural recovery from repeated BTX is not infinite.

scholarly journals Therapeutic Challenges for Elderly Patients with Primary Hyperparathyroidism

2019 ◽  
Vol 2019 ◽  
pp. 1-3 ◽  
Author(s):  
Kenneth Sluis ◽  
Hyon Kim ◽  
Yuling He ◽  
Beatrice Wong ◽  
Xiangbing Wang
Keyword(s):  
Primary Hyperparathyroidism ◽  
Chart Review ◽  
Treatment Options ◽  
Case Series ◽  
Retrospective Chart Review ◽  
Long Term Stability ◽  
Feasible Option ◽  
One Year

Primary hyperparathyroidism (PHPT) predominantly affects older adults, and parathyroidectomy can achieve definitive cure in symptomatic PHPT and asymptomatic meeting surgical criteria. As the population continues to age, the treatment of PHPT in octogenarians and nonagenarians presents a clinical conundrum. This case series presents the management of eight patients 85 years of age and older diagnosed with PHPT. A retrospective chart review of patients diagnosed with primary hyperparathyroidism were identified in a single institution. Those patients 85 years of age and older who were followed up for over one year were included in this case series. The literature on treatment options for this age group was also reviewed. Eight cases of PHPT patients aged 88 ± 2.5 years old with a follow-up average of 5.6 ± 4.4 years were reported in our case series. Six PHPT patients were medically managed and two PHPT patients underwent parathyroid resection. Most of the medically managed PHPT patients except for one had long-term stability of disease for over five years. The treatment of PHPT diagnosed in patients over 85 years of age presents a clinical challenge for which there is no clear consensus guideline. Our case series supports that medical therapy is a feasible option for PHPT patients over 85 years old.

Farm Accidents

PEDIATRICS ◽  
1986 ◽  
Vol 77 (5) ◽  
pp. 784-785
Author(s):  
THOMAS H. COGBILL ◽  
HENRY M. BUSCH ◽  
GARY R. STIERS
Keyword(s):  
Rural Population ◽  
Chart Review ◽  
Retrospective Chart Review

In Reply.— We appreciate the interest and comments by Dr Paulson relative to our paper (Pediatrics 1985;76:562-566). In our series of 105 children injured in farm accidents, we reported one mortality (1%) and one child (1%) with major long-term disability. Follow-up ranged from 2 to 80 months based upon review of complete outpatient records in this stable rural population. Serious neurologic and physiologic sequelae were accurately recorded. We agree with Dr Paulson that a retrospective chart review will underestimate the number of minor disabilities including subtle neurologic, orthopedic, and pulmonary sequelae.

scholarly journals Salami-Tactics: when is it time for a major cut after multiple minor amputations?

2021 ◽  
Author(s):  
Martin C. Berli ◽  
Zoran Rancic ◽  
Madlaina Schöni ◽  
Tobias Götschi ◽  
Pascal Schenk ◽  
...  
Keyword(s):  
Chart Review ◽  
Cox Regression ◽  
Retrospective Chart Review ◽  
Major Amputation ◽  
Level Of Evidence ◽  
Cox Regression Analysis ◽  
Patient Demographics ◽  
Minor Amputation ◽  
Retrospective Comparative Study

Abstract Introduction Repetitive minor amputations carry the concomitant risks of multiple surgical procedures, major amputations have physical and economical major drawbacks. The aim of this study was to evaluate whether there is a distinct number of minor amputations predicting a major amputation in the same leg and to determine risk factors for major amputation in multiple minor amputations. Materials and methods A retrospective chart review including 429 patients with 534 index minor amputations between 07/1984 and 06/2019 was conducted. Patient demographics and clinical data including number and level of re-amputations were extracted from medical records and statistically analyzed. Results 290 legs (54.3%) had one or multiple re-amputations after index minor amputation. 89 (16.7%) legs needed major amputation during follow up. Major amputation was performed at a mean of 32.5 (range 0 – 275.2) months after index minor amputation. No particular re-amputation demonstrated statistically significant elevated odds ratio (a.) to be a major amputation compared to the preceding amputation and (b.) to lead to a major amputation at any point during follow up. Stepwise multivariate Cox regression analysis revealed minor re-amputation within 90 days (HR 3.8, 95% CI 2.0-7.3, p <0.001) as the only risk factor for major amputation if at least one re-amputation had to be performed. Conclusions There is no distinct number of prior minor amputations in one leg that would justify a major amputation on its own. If a re-amputation has to be done, the timepoint needs to be considered as re-amputations within 90 days carry a fourfold risk for major amputation. Level of evidence Retrospective comparative study (Level III).

scholarly journals F.09 Neurosurgical Outcomes in patients with Multiple Sclerosis related Trigeminal Neuralgia

2016 ◽  
Vol 43 (S2) ◽  
pp. S20-S20
Author(s):  
S Krishnan ◽  
AM Kaufmann
Keyword(s):  
Multiple Sclerosis ◽  
Trigeminal Neuralgia ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Time Interval ◽  
Recurrent Pain ◽  
Kaplan Meier ◽  
Glycerol Injection

Background: The aim of this study was to assess the outcomes of surgery for multiple sclerosis-related trigeminal neuralgia (MS-TN). Methods: All Manitobans undergoing first surgery for medically refractory MS-TN between 2000 and 2014 were identified. The time interval until additional surgeries were required for recurrent pain, defined as the time to fail (TTF), was determined from a retrospective chart review. Kaplan-Meier analyses were performed and outcomes compared. Results: Twenty-one patients (26 sides) underwent first rhizotomy by GammaKnife (GK, 13), glycerol injection (PGR, 10) or balloon compression (BCR, 3). Second procedures were required in 88% at 15±13 months, including GK (24), PGR (19), BCR (25), microvascular decompression (2) and open surgical partial rhizotomy (Dandy, 4) for an overall total of 99 surgeries (1-12 per side). The additional GK, PGR, and BCR eventually failed and required further surgeries in 40%, 60% and 70% at 1, 2, and 3 years respectively with a trend to longer TTF compared to first surgeries (ns). Follow up of Dandy procedures, however, identified no pain recurrence at 4 to 110 months. Conclusions: The minimally invasive rhizotomies for MS-TN were associated with high rates of recurrence and reoperation. Long term pain relief was best achieved with a Dandy procedure, even after multiple prior rhizotomies.

scholarly journals Endocrowns: a retrospective study among Riyadh Elm university dental clinics

2021 ◽  
Vol 8 (7) ◽  
pp. 3280
Author(s):  
Fatima Alotaiby ◽  
Jumana Aldulaijan ◽  
Mai Alotaibi ◽  
Huda Aldossari ◽  
Noura Alabdulaziz ◽  
...  
Keyword(s):  
Chart Review ◽  
Retrospective Chart Review ◽  
Radiographic Examination ◽  
Term Survival ◽  
Dental Clinics ◽  
Male Patients ◽  
Review Study ◽  
Larger Sample

Background: Endocrowns are created from mono-block porcelain containing the invaded coronal portion of the apical projection that fills the space of the pulp chamber, and probably the entrances of the root canal. This makes restoring endodontically extensive damaged teeth challenging and difficult.Methods: This is a retrospective chart review study essentially compiling and analyzing records from all patients consecutively treated with endocrowns which was performed by residents and students, carried out in Riyadh Elm university in Riyadh.Results: Out of 41 endo-crown cases 65.9% were successful according to follow up time and radiographic examination, and 34.1% is still under investigation. Furthermore, 51.2% were male patients while 70.7% were in the age group of 22 to 49 years. About 63.4% had treatment for the lower teeth and all the cases teeth were posterior. The period of longevity was 6 to 24 months in 51.2% of subjects.Conclusions: Additional scientific studies and clinical examination on a larger sample size are needed to assess the long-term efficacy of endocrown. However, it appears to be a conservative and an aesthetic treatment with long-term survival benefits.

scholarly journals Medial Rectus Tendon Elongation with Bovine Pericard (Tutopatch®) in Thyroid-Associated Orbitopathy: A Long-Term Follow-Up including Oculodynamic MRI

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Monika Wipf ◽  
Britt-Isabelle Berg ◽  
Anja Palmowski-Wolfe
Keyword(s):  
Chart Review ◽  
Retrospective Chart Review ◽  
Good Alternative ◽  
Dose Effect ◽  
Medial Rectus ◽  
Tendon Elongation ◽  
Long Term Follow Up ◽  
Binocular Single Vision

Introduction. To assess long-term efficacy of bimedial rectus tendon elongation with Tutopatch in thyroid-associated orbitopathy (TAO). Materials and Methods. Retrospective chart review of 5 patients with TAO undergoing bimedial rectus recession with Tutopatch tendon elongation between 2009 and 2015. We analyzed horizontal squint angles, motility, field of binocular single vision, dose effect of surgery, and when possible oculodynamic MRI (OD-MRI). Dose effect and motility were compared to 4 TAO patients with conventional bimedial recession. Results and Discussion. In the Tutopatch group, preoperative angles ranged from 14 to 120∆ (prism diopters) at distance and 12–120∆ at near. Mean dose effect was 3.63∆/mm for the distance and 3.43∆/mm for the near angle. All patients were orthotropic at final FU (ranging from 1 to 10 years). OD-MRI showed the elasticity of Tutopatch. In the conventional recession group, preoperative angles ranged between 18 and 35∆ at distance and 12–33∆ at near. At final FU, 2 patients had reverted to their underlying microesotropia <2∆, 1 patient was orthophor, and one was reoperated for a remaining esotropia of 14∆. Dose effect was 2.95∆/mm for the distance and 2.18∆/mm for the near angle. Motility improved in both groups even after 3 months. Conclusions. Dose effect for medial rectus recessions with Tutopatch in TAO was higher than previously reported, presenting a good alternative to treat large squint angles while preserving good motility.

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