scholarly journals A Retrospective Review of Thiazolidinediones with Development of a Troglitazone Conversion Protocol

2003 ◽  
Vol 3 ◽  
pp. 477-483 ◽  
Author(s):  
Cameron Lindsey ◽  
Maqual Graham ◽  
Julie McMurphy
Keyword(s):  
Retrospective Review ◽  
Chart Review ◽  
Medical Center ◽  
Retrospective Chart Review ◽  
Veterans Affairs ◽  
Effective Management ◽  
Adherence To Guidelines ◽  
Full Compliance ◽  
Lost To Follow Up

The objective of this paper was (1) to assess compliance with the National Veterans Affairs Guidelines for the use of troglitazone and rosiglitazone and (2) to develop and implement a conversion protocol that allows effective management of patients receiving troglitazone. A retrospective chart review was conducted to assess adherence to guidelines for all patients receiving troglitazone and rosiglitazone at the medical center. Appropriateness of therapy through indication evaluation, safety through alanine aminotransferase (ALT) monitoring compliance, and efficacy through hemoglobin A1c(HbA1c) changes were used to assess adherence. According to National Veterans Affairs (VA) Guidelines, 68% of troglitazone and 63% of rosiglitazone patients had an appropriate indication for the use of these agents. Baseline ALT levels were obtained in 40% of troglitazone and 71% of rosiglitazone patients. Full compliance with continual ALT monitoring was seen in 6 and 54% of patients, respectively. Goal HbA1cwas achieved in 57 and 29% of patients, respectively. Of the 33 patients receiving troglitazone, 19 were converted to rosiglitazone therapy; 11 were maintained on current regimens without troglitazone, and 3 were lost to follow up. Adherence to guidelines needs to be reinforced, in particular, compliance with ALT monitoring. However, there were no reported cases of hepatotoxicity in the patients reviewed. Many patients did not achieve a HbA1c

scholarly journals Treatment of Advanced Oropharyngeal Cancers with Chemotherapy and Radiation

2003 ◽  
Vol 82 (5) ◽  
pp. 367-370 ◽  
Author(s):  
Maria M. LoTempio ◽  
Marilene B. Wang ◽  
Ahmad Sadeghi
Keyword(s):  
Los Angeles ◽  
Primary Tumor ◽  
Chart Review ◽  
Medical Center ◽  
Retrospective Chart Review ◽  
Concomitant Chemotherapy ◽  
Small Series ◽  
Lost To Follow Up ◽  
Base Of The Tongue

We conducted a retrospective chart review of treatment outcomes in 17 adults who had been selected to undergo concomitant chemotherapy and radiation (chemo/XRT) for late-stage oropharyngeal cancers. All patients had been treated at the West Los Angeles VA Medical Center between March 1, 1998, and Sept. 30, 2000. Nine patients had a primary tumor at the base of the tongue, five had a primary tumor in the tonsillar area, and three had a tumor that affected both sites. Of this group, 15 patients completed one to three cycles of chemo/XRT, and the remaining two died during therapy. At the most recent follow-up, 9 of the 17 patients (52.9%) were documented to still be alive; seven patients had earlier died as a result of their primary tumor or a distant metastasis, and one patient had been lost to follow-up after completing treatment. At study's end, the duration of post-treatment survival ranged from 2 to 36 months (mean: 12.5). Based on the results of our small series, we conclude that chemo/XRT is a valid alternative to surgery with postoperative radiation and to radiation alone. Chemo/XRT yields acceptable rates of local control and allows for organ preservation with tolerable side effects.

S244 – Intraoperative ABR after Myringotomy and Tube Placement

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P157-P157
Author(s):  
Nanette Sturgill ◽  
Joshua G Yorgason ◽  
Albert H Park
Keyword(s):  
Middle Ear ◽  
Chart Review ◽  
Medical Center ◽  
Hearing Threshold ◽  
Retrospective Chart Review ◽  
Tube Placement ◽  
Threshold Levels ◽  
Time Of Surgery ◽  
The Difference

Objectives Understand the utility of intraoperative ABR testing after myringotomy and tube placement. Methods We performed a retrospective chart review of 27 patients (mean age 23 months) who underwent intraoperative ABR (ioABR) after myringotomy and tube placement at Primary Childrens Medical Center from 2004 to 2007. Paired t-tests were perfomed to analyze the difference in threshold levels from the ioABR to follow up behavioral audiometry at 1kHz and 4kHz frequencies, accounting for the presence or absence of fluid at the time of surgery. Results 15 patients (29 ears) showed a mean improvement of 10 dB at the 1 kHz frequency (p=0.007), and 16 patients (31 ears) improved by 5 dB at 4kHz (p=0.83). An improvement of at least 15 dB was seen in 45% of patients (13/29 ears) at 1 kHz and in 26% (8/31 ears) at 4 kHz; 5 patients improved by as much as 35–50 dB. Of the patients whose thresholds improved by at least 15 dB, 77% at 1 kHz and 83% at 4 kHz showed evidence of fluid at the time of the ioABR Conclusions Patients who undergo ioABR testing show a significant improvement of dB level on follow-up behavioral audiometry. Many patients whose hearing threshold improved by at least 15 dB had fluid at the time of myringotomy. Therefore, the presence of middle ear pathology may lead to an overestimation of ioABR thresholds. Consequently, ioABR results should be interpreted with caution in isolation, and subsequent audiometric testing should always be performed to validate prior results.

scholarly journals Clinical Characteristics and Treatment Outcome of Pediatric Rhabdomyosarcoma; Retrospective Review

2021 ◽  
Vol 7 (2) ◽  
Author(s):  
Zunaira Shaukat ◽  
Raheela Mansoor ◽  
Najma Shaheen ◽  
Saliha Sarfraz ◽  
Komal Seher
Keyword(s):  
Treatment Outcome ◽  
Clinical Characteristics ◽  
Chart Review ◽  
Treatment Plan ◽  
Retrospective Chart Review ◽  
Group Classification ◽  
Primary Tumor Site ◽  
Lost To Follow Up ◽  
Late Stages

Introduction: Rhabdomyosarcoma is the most common soft tissue sarcoma in children. This paper aimed to assess the stage, site, and treatment outcome among rhabdomyosarcoma (RMS) patients. Materials and Methods: A retrospective chart review was completed from January 2011 to December 2017 of patients that presented to the Department of Pediatric Oncology, Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan, for the management of RMS. Data collection included clinical characteristics, staging, grouping, risk stratification, treatment plan, radiotherapy doses, and treatment outcome. Results: Among 24 subjects, there were a total of 13 (54.2%) males and 11 (45.8%) females. The median age at the time of diagnosis was 2.5 years (range: 0.75 - 17 years). The majority of the subjects (91.7%) were less than 10 years of age. The median follow-up time was 0.6 years. According to the Children's Oncology Group Classification, 4 (16.7%) subjects were classified as low risk, 14 (58.3%) subjects were rated as intermediate risk, and 6 (0.25%) subjects were stratified as high risk. The most common primary tumor site were genitourinary (62.5%) and abdomen/retroperitoneal (20.8%) regions. At the time of analysis, nine (37.5%) subjects had died because of the disease, twelve (50%) were alive with no evidence of disease, and one subject had a recurrence of disease and was alive. One subject had abandoned the therapy, and another was lost to follow-up. Conclusion: Patients with Rhabdomyosarcoma presented at the late stages of the disease, and it most frequently affected genitourinary and abdomen or retroperitoneal areas. Overall, Rhabdomyosarcoma was found to have a poor outcome to therapy.

scholarly journals Time to Reach Glycemic Goal on an Outpatient Academic Endocrinology Clinic

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A479-A480
Author(s):  
Leopoldo M Cobos Salinas ◽  
Fernando Reyes San Martin ◽  
Merri Pendergrass ◽  
Dinkar Rupakula
Keyword(s):  
Chart Review ◽  
Insurance Coverage ◽  
Retrospective Chart Review ◽  
Initial Visit ◽  
Acute Hyperglycemia ◽  
The Us ◽  
New Diagnosis ◽  
Lost To Follow Up ◽  
Endocrinology Clinic

Abstract Background: The achievement of the A1C goals in the US did not improve in 2017 compared to 2014. Guidelines for which patients with T2DM to refer to an endocrinologist are not well defined. Furthermore, there is no consensus about how long patients should be followed by an endocrinologist. Experts have recommended referral to an endocrinologist for new diagnosis, acute hyperglycemia, A1C > 7.0, > 8.0 for 6 months, or A1C 1.4 times the upper limit of normal. However, with the current number of board-certified endocrinologists in the US, it would be impossible for patients with those criteria to be seen even once. To determine which patients should be followed by an endocrinologist, it would help to know which patients are most likely to achieve ongoing benefit. To focus on patients that have a higher chance of improvement, it is important to know the average time it would take to reach an individualized A1C goal and focus on patients more likely to improve. Objective: We performed this quality improvement assessment to 1) determine the percentage of patients with T2DM who achieved their individualized A1C goals (Age 18–55: 7.0% +/- .5%, 55–75: 7.5% +/- .5%, >75: 9.0% +/- .5%) at 12 months after their initial endocrinologist visit and 2) compare characteristics of patients who achieved A1C goals by 12 months versus those who did not achieve goals. Material and Methods: We performed a retrospective chart review of patients with T2DM who had an initial visit at an academic endocrinology clinic between 10/1/2017 and 05/31/2018 (N= 48, 52% female, baseline 9.6%, 48% male, baseline [BL] HbA1c 9.9%). Data for 12 months following the initial visit were collected. Results: Following their initial visit, 21/48 (44%, BL A1c 10.3%) were lost to follow-up. Of those with at least one additional visit, 12/27 (44%, BL A1c 11.3%, P<0.05) achieved A1C goal by the 12-month period. Of those, 6/12 (50%, BL A1c 10.3%), 1/12 (8%, BL A1c 9.9%), 4/12 (25%, BL A1c 9.0%), 1/12 (8%, BL A1c 8.8%) achieved goals by 3, 6, 9, and 12 months respectively. Those who did achieve their goals were slightly older (52 +/- 25yrs) than those who did not (50 +/- 12yrs), p< 0.05. No significant differences between those who were lost to follow-up, achieved goals, or who did not achieve goals with respect to gender, insurance coverage, or regimen. However, those who did continued care had a worse A1c of 11.3%. Conclusion: Of patients with T2DM and uncontrolled hyperglycemia presenting to an academic endocrine clinic, nearly half are lost to follow-up after the initial visit. Future efforts should be made to better understand and potentially improve this. Of additional concern, only about half of patients with at least one additional visit achieved their A1C goal after 12 months, and 91% of those achieved their goals by 9 months. Further study will be needed to determine whether patients who are uncontrolled after 9–12 months will have any further benefit from endocrine follow-up.

Is there a role for referral of high-risk patients seen in preoperative medical consultation for postoperative inpatient follow-up?

2021 ◽  
pp. 175045892110310
Author(s):  
Jessica Evans ◽  
James Chan ◽  
Delvina H Saraqini ◽  
Ranjeeta Mallick
Keyword(s):  
High Risk ◽  
Chart Review ◽  
Hospital Admissions ◽  
Hospital Readmissions ◽  
Retrospective Chart Review ◽  
Medical Consultation ◽  
Medical Assessment ◽  
Risk Patients ◽  
Lost To Follow Up

The potential benefit of referring select high-risk surgical patients who are seen during a preoperative medical consultation for postoperative inpatient medical follow-up is uncertain. Over a seven-year period, our internal medicine perioperative clinic referred 5% of 4642 preoperative consults for postoperative follow-up. A retrospective chart review found that although reasons for referral were heterogeneous, those assessed by the medical consult team postoperatively were more comorbid, had more adverse medical complications and had longer hospital admissions compared to those not referred. Physicians were best able to predict adverse cardiac and diabetes-related complications. Half of the patients who were referred for postoperative assessment were lost to follow-up, and there was a trend towards increased hospital readmissions in this group. Further research is required to identify the subset of patients who might benefit from postoperative inpatient medical assessment.

scholarly journals Caudal Epidural Steroid Injections in the Setting of Remaining on Antithrombotics: A Retrospective Study

2021 ◽  
Vol 24 (6) ◽  
pp. E821-E828
Keyword(s):  
Chart Review ◽  
Medical Condition ◽  
Retrospective Chart Review ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Epidural Steroid ◽  
Antithrombotic Medication ◽  
Lost To Follow Up ◽  
Caudal Epidural

BACKGROUND: The American Society of Regional Anesthesia currently recommends ceasing antithrombotic medications for all spinal epidural steroid injections, however there is a paucity of data on the true risk of spinal epidurals via various approaches versus the risk of cessation of an agent as it relates to the underlying medical condition. OBJECTIVE: This study evaluated the complication rate of caudal epidural steroid injections in patients who remain on antithrombotic medications. STUDY DESIGN: Retrospective chart review. SETTING: Physiatric Spine Clinic in Orthopedic Specialty Office and Surgical Center. METHODS: A retrospective chart review was performed identifying patients (n = 335) who received a caudal epidural steroid injection (n = 673) from June 2015 through April 2020. Patients were included if they had received the injection while taking an antithrombotic medication. Patients were excluded if they were not taking an antithrombotic. The patient’s age, indication for the injection including magnetic resonance imaging or computed tomography findings, antithrombotic medication, the medical condition requiring an antithrombotic, and any complications following the injection were collected via chart review. RESULTS: Of the 443 injections included in the study, 51 encounters were lost to follow-up. Of the other 392 injections, there were no reported complications, regardless of the patient’s imaging findings, age, the antithrombotic medication used, or the underlying medical condition for which an antithrombotic medication was indicated. LIMITATIONS: This is a retrospective study. Therefore, a prospective study may have yielded fewer encounters lost to follow-up. Patients were not contacted directly after the procedure and chart reviews were utilized to evaluate for complications, which was limited to a patient’s reporting of perceived complications without any imaging. CONCLUSIONS: We conclude that caudal epidural steroid injections can be performed safely in patients while taking antithrombotic medications. Catastrophic events have been observed in patients who have discontinued antithrombotic agents preceding procedures. Thus, discontinuing antithrombotic medications may pose a greater risk than benefit for patients on an antithrombotic medication who have painful lumbar radiculopathy. KEY WORDS: Epidural injection, caudal, antithrombotic, safety, steroids, anticoagulant, antiplatelet, epidural hematoma

scholarly journals 662. Tick Borne-Associated Thrombocytopenia Among United States Veterans in Long Island New York

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S239-S239
Author(s):  
Olga Kaplun ◽  
Beth Lemaitre ◽  
Zeena Lobo ◽  
George Psevdos
Keyword(s):  
New York ◽  
Chart Review ◽  
Medical Center ◽  
Long Island ◽  
Febrile Illness ◽  
Retrospective Chart Review ◽  
Veterans Affairs ◽  
Babesia Microti ◽  
The Past ◽  
History Of

Abstract Background Long Island, New York, is highly endemic for tick borne illnesses (TBI) with rising numbers of cases in the past years. Thrombocytopenia is a known complication of babesiosis caused by Babesia microti, anaplasmosis caused by Anaplasma phagocytophilum, and ehrlichiosis caused by Ehrlichia chaffeensis. We identified cases of thrombocytopenia attributed to TBI in our institution. Methods Retrospective chart review of patients diagnosed with babesiosis, anaplasmosis, and ehrlichiosis from 2000 to 2017 at Northport Veterans Affairs Medical Center. Demographics, method of diagnosis (PCR/serologies), CBC/chemistries, treatment choices, and outcomes were analyzed. Results Thirty-two veterans (VETS) were identified with the following TBI: Babesiosis 22, Ehrlichiosis 6, Anaplasmosis 4. The majority of cases (19) were from Suffolk County, Long Island. The median (MED) age of this group was 62 years (range 31–89). Ninety-one percent were Caucasian, 9% Black. 37.5% had history of tick bite. The MED temperature on presentation was 101.9°F (range 97.6–105.2°F). 56% had HTN, 6% DM, 37% HLD, 9% hepatitis C, 3% HIV. Laboratory studies: MED platelet count 88,000/µL (36,000–161,000); MED hemoglobin 12 gm/dL (5.6–15.6); MED ALT 41 IU/L (6–330); MED LDH 335 IU/L (193–1,322). Twelve VETS had positive C6 peptide. The peak MED B. microti parasitemia was 1.4% (0.1–3%). PCR tests were available in the later years of the study period: three were positive for E. chaffeensis, two for A. phagocytophilum, and 14 for B. microti. The majority of the cases (19) were observed after year 2010. Morulae were seen in only one case. Haptoglobin in eight VETS was undetectable. One veteran with history of splenectomy and babesiosis with 3% parasitemia required exchange transfusion with 12 units of PRBCs. Two other babesiosis cases required regular transfusion of PRBCs. 20 babesiosis cases were treated with azithromycin-atovaquone and two with clindamycin-primaquine. Doxycycline was used in the other cases. One patient developed NSTEMI and required coronary stent placement. Platelet counts returned to baseline levels with treatment. No deaths occurred. Conclusion The incidence of TBI in Long Island, New York is rising. PCR testing for TBI can be utilized in our VETS presenting with febrile illness and thrombocytopenia to help identify the possible tick borne pathogen during the months of high tick activity. Disclosures All authors: No reported disclosures.

Evaluation of Cost-effectiveness and Clinical Value of Routine Histopathologic Examination of Septoplasty Specimens

2021 ◽  
pp. 019459982110129
Author(s):  
Randall S. Ruffner ◽  
Jessica W. Scordino
Keyword(s):  
Chart Review ◽  
Medical Center ◽  
Academic Medical Center ◽  
Cost Savings ◽  
Retrospective Chart Review ◽  
Clinical Value ◽  
Level Of Evidence ◽  
Significant Pathology ◽  
National Model ◽  
Routine Histopathologic Examination

Objectives During septoplasty, normal cartilage and bone are often sent for pathologic examination despite benign appearance. We explored pathology results following septoplasty from April 2016 to April 2018, examining clinical value and relevance, implications, and cost analysis. Study Design Retrospective chart review. Setting Single-institution academic medical center. Methods A retrospective chart review was compiled by using Current Procedural Terminology code 30520 for septoplasty for indication of nasal obstruction, deviated septum, and nasal deformity. Results A total of 236 consecutive cases were identified spanning a 2-year period. Septoplasty specimens were sent for pathology evaluation in 76 (31%). The decision to send a specimen for histopathology was largely physician dependent. No cases yielded unexpected or significant pathology that changed management. The average total charges for septoplasty were $10,200 at our institution, with 2.2% of procedural charges accounting for pathology preparation and review, averaging $225. Nationally, this results in an estimated charged cost of $58.5 million. The Centers for Medicare and Medicaid Services (CMS) reimbursement for septoplasty pathology charges was $46 in 2018, accounting for 1.3% of hospital-based reimbursements and 2.2% of ambulatory center reimbursements. With CMS as a national model for reimbursement, $11.8 million is spent yearly for septoplasty histopathology. Given that CMS reimbursement is significantly lower than private insurers, national total reimbursement is likely considerably higher. Conclusion Routine pathology review of routine septoplasty specimens is unnecessary, unremarkable, and wasteful. Correlation of the patient’s presentation and intraoperative findings should justify the need for pathology evaluation. This value-based approach can offer significant direct and indirect cost savings. Level of evidence 4.

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.

Cholecystectomy for Biliary Hyperkinesia

2019 ◽  
Vol 85 (2) ◽  
pp. 219-222 ◽  
Author(s):  
Joshua Gazzetta ◽  
Betty Fan ◽  
Paul Bonner ◽  
John Galante
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Chart Review ◽  
Gallbladder Disease ◽  
Retrospective Chart Review ◽  
Biliary Colic ◽  
Study Cohort ◽  
Final Pathology ◽  
Pathology Reports ◽  
Histologic Changes

Patients with classic biliary colic symptoms and documented gallbladder ejection fractions on the higher end of the spectrum on hepatobiliary iminoacetic acid scans with cholecystokinin stimulation are presently understudied and the benefits of cholecystectomy are unclear. To determine whether patients with biliary-type pain and biliary hyperkinesia (defined as a gallbladder ejection fractions of 80% or greater) benefit from laparoscopic cholecystectomy, a retrospective chart review encompassing five community hospitals was performed. Patients 16 years and older with diagnosed biliary hyperkinesia who underwent laparoscopic cholecystectomy between January 1, 2010 and May 31, 2015 were included. Pathology reports were reviewed for histologic changes indicating cholecystitis. Resolution of biliary colic symptoms was reviewed one to three weeks after surgery in their postoperative follow-up documentation. Within our study cohort, we found 97 patients who underwent laparoscopic cholecystectomy for biliary hyperkinesia. Within this population, 84.5 per cent of patients undergoing laparoscopic cholecystectomy for biliary hyper-kinesia had positive findings for gallbladder disease on final pathology. Of the 77 patients with data available from their first postoperative visit, 70 (90.9%) reported improvement or resolution of symptoms. Our findings suggest that symptomatic biliary hyperkinesia may be treated successfully with surgery.

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