scholarly journals Closing the loop in child TB contact management: completion of TB preventive therapy outcomes in western Kenya

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e040993
Author(s):  
James A Amisi ◽  
E Jane Carter ◽  
Enos Masini ◽  
Daria Szkwarko
Keyword(s):  
High Risk ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Monitoring And Evaluation ◽  
Preventive Therapy ◽  
Therapy Outcomes ◽  
Western Kenya ◽  
Care Cascade ◽  
Closing The Loop ◽  
Project Data

SettingChildren especially those <5 years of age exposed to pulmonary tuberculosis (TB) are at a high risk of severe TB disease and death. Isoniazid preventive therapy (IPT) has been shown to decrease disease progression by up to 90%. Kenya, a high TB burden country experiences numerous operational challenges that limit implementation of TB preventive services. IPT completion in child contacts is not routinely reported in Kenya.ObjectiveThis study aims to review the child contact management (CCM) cascade and present IPT outcomes across 10 clinics in western Kenya.DesignA retrospective chart review of programmatic data of a TB Reach-funded active, clinic-based CCM strategy.ResultsOf 553 child contacts screened, 231 (42%) were reported symptomatic. 74 (13%) of the child contacts were diagnosed with active TB disease. Of those eligible for IPT, 427 (90%) initiated IPT according to TB REACH project data while 249 (58%) were recorded in the IPT register with 49 (11%) recorded as a transfer to other facilities. Of the 249 recorded in the IPT register, 205 (82%) were documented to complete therapy (48% of project initiation children).ConclusionOur evaluation shows gaps in the routine CCM care cascade related to completeness of documentation that require further programmatic monitoring and evaluation to improve CCM outcomes.

scholarly journals Correction to: Treatment patterns in patients with osteoporosis at high risk of fracture in Japan: retrospective chart review

2018 ◽  
Vol 13 (1) ◽  
Author(s):  
Saeko Fujiwara ◽  
Akimitsu Miyauchi ◽  
Etsuro Hamaya ◽  
Rebecca Jayne Nicholls ◽  
Adele Weston ◽  
...  
Keyword(s):  
High Risk ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Treatment Patterns ◽  
Risk Of Fracture

scholarly journals Growth of young HIV-infected and HIV-exposed children in western Kenya: A retrospective chart review

PLoS ONE ◽  
2019 ◽  
Vol 14 (12) ◽  
pp. e0224295
Author(s):  
Megan S. McHenry ◽  
Edith Apondi ◽  
Samuel O. Ayaya ◽  
Ziyi Yang ◽  
Wenfang Li ◽  
...  
Keyword(s):  
Chart Review ◽  
Retrospective Chart Review ◽  
Western Kenya ◽  
Hiv Exposed

Systematic urine drug testing for detecting and managing opioid misuse among chronic noncancer pain patients in primary care—The HARMS Program: A retrospective chart review of 77 patients

2020 ◽  
Vol 16 (4) ◽  
pp. 277-282
Author(s):  
Niharika Shahi, HBSc ◽  
Ryan Patchett-Marble, BSc, MD, CCFP(AM)
Keyword(s):  
Primary Care ◽  
High Risk ◽  
Drug Testing ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Opioid Misuse ◽  
Chronic Noncancer Pain ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
Noncancer Pain

The prevalence of opioid abuse has reached an epidemic level. National guidelines recommend safer opioid prescribing practices, including potentially monitoring patients with urine drug testing (UDT). There is limited research evidence surrounding the use of UDT in the context of chronic noncancer pain (CNCP). We evaluated the efficacy of systematic, randomized UDT to detect and manage opioid misuse among patients with CNCP in primary care. The Marathon Family Health Team (MFHT) designed and implemented a clinic-wide, randomized UDT program called the HARMS (High-yield Approach to Risk Mitigation and Safety) Program. This retrospective chart review includes 77 CNCP patients being prescribed opioids, who were initially stratified by their prescriber as “low-risk.” Each month, 10 percent of patients were selected for a random UDT with double testing (immunoassay and liquid chromatography-mass spectrometry). The primary outcome measure was UDT leading to a change in management plan. Of the 77 patients in the study, 55 (71 percent) completed at least one UDT during the 12-month study period. Overall, 22 patients had aberrant results. UDT led directly to changes in management in 15 of those patients. Four of those 15 patients were escalated to an addictions program, two were tapered from opioids with informed discussion, and nine were escalated to the high-risk monitoring stream. The results of this study show that in low-risk CNCP patients prescribed opioids, applying systematic UDT in a primary care setting is effective for detecting high risk behaviors and addiction, and altering management. Further research is needed with larger numbers using a prospective study design.

Conservative Non-surgical Management of High Risk IPMNs: A Retrospective Chart Review

2015 ◽  
Vol 110 ◽  
pp. S38
Author(s):  
Rabia Ali ◽  
Anjali Mone ◽  
Justin Ream ◽  
Alec Megibow ◽  
Mark Pochapin ◽  
...  
Keyword(s):  
High Risk ◽  
Surgical Management ◽  
Chart Review ◽  
Retrospective Chart Review

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.

Persistent Gaps in Appropriate Use of Empiric Acyclovir in Neonates

2016 ◽  
Vol 56 (5) ◽  
pp. 472-479 ◽  
Author(s):  
Peyton Wilson ◽  
Ashley G. Sutton ◽  
Christopher Nassef ◽  
Christopher Falato ◽  
Ravi Jhaveri
Keyword(s):  
High Risk ◽  
Chart Review ◽  
Diagnostic Testing ◽  
Retrospective Chart Review ◽  
Neonatal Herpes ◽  
Improvement Project ◽  
Survey Results ◽  
High Risk Infants ◽  
Neonatal Herpes Simplex ◽  
Simplex Virus

The use of empiric acyclovir for suspected neonatal herpes simplex virus (HSV) infection has been debated for years. To identify the gap in the decision to initiate empiric acyclovir, we performed a retrospective chart review and administered a survey to pediatricians to assess current practices regarding evaluation for possible HSV infection. Seventy infants received empiric acyclovir over a 1-year period; of these, 3 infants (4.3%) had positive HSV testing. Fourteen infants were identified as “high-risk” for HSV infection; of these, 13 infants had incomplete testing. Survey results revealed uncertainty in the decision to initiate acyclovir and in the composition of complete diagnostic testing. This study confirmed the clinical uncertainty in the decision to initiate empiric acyclovir. Using this chart review and survey as a baseline, future efforts will focus on a quality improvement project to reduce empiric acyclovir use in low-risk infants and to ensure complete diagnostic evaluation in high-risk infants.

scholarly journals Use of a Silicon Stoma Stent as an Interim Step in High-Risk Tracheostomy Decannulation

OTO Open ◽  
2019 ◽  
Vol 3 (1) ◽  
pp. 2473974X1983643
Author(s):  
Jacqueline Ross ◽  
Kristy McMurray ◽  
Tanis Cameron ◽  
Celia Lanteri
Keyword(s):  
High Risk ◽  
Adverse Events ◽  
Chart Review ◽  
Care Service ◽  
Health Care Service ◽  
Retrospective Chart Review ◽  
Airway Patency ◽  
Morbidity Burden ◽  
Airway Access ◽  
Reasons For Use

Objective To describe use of a stoma stent to facilitate high-risk decannulation. Methods Retrospective chart review of 14 consecutive patients who received a stent from March 2013 to December 2016 at a quaternary health care service. Primary outcome measures were decannulation outcome and adverse events. Results Decannulation outcome: 12 of 14 patients had their tracheostomy tube (TT) removal facilitated by stent use. Patients had the stent for a median of 6 days (interquartile range, 49). Reasons for use included medical instability, risk of sputum retention, uncertain airway patency, and the need for ongoing airway access. All patients survived to discharge. One patient residing in the community has retained a stoma stent. Adverse events: One patient removed the stent on the day of insertion, necessitating reinsertion of the TT. Granulation tissue at the stoma site was seen in 2 patients. Discussion A tracheostoma will normally close within 48 hours following decannulation, which is problematic if TT reinsertion is required. By using the stent, reversal of decannulation becomes a simple ward-based procedure. In comparison to a TT, which is secured with ties, the stoma stent proved unsuitable for use in an agitated patient. Implications for Practice Decreasing total cannulation time is of benefit as patients with tracheostomy are subject to high rates of complications and adverse events. A stoma stent poses little risk and a low morbidity burden to the patient in comparison to alternative management.

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