scholarly journals Pneumomediastinum in marijuana users: a retrospective review of 14 cases

2019 ◽  
Vol 6 (1) ◽  
pp. e000391 ◽  
Author(s):  
Zoe Freeman Weiss ◽  
Sara Gore ◽  
Andrew Foderaro
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Marijuana Use ◽  
Pulmonary Injury ◽  
Air Leakage ◽  
Male Predominance ◽  
Free Air ◽  
Closed Glottis

IntroductionInhaled marijuana has been infrequently identified as a potential risk factor for the development of spontaneous pneumomediastinum (SPM), a rare finding of free air in the mediastinum likely caused by barotrauma during breathing manoeuvres. The mechanism of inhalation drug use is often not ascertained by physicians, thus little is known about how different smoking techniques precipitate pulmonary injury. We aimed to evaluate the frequency of marijuana use in patients with non-traumatic pneumomediastinum over a 12-month period, identifying additional relevant clinical features or risk factors, and determining the extent to which clinicians record smoking techniques.MethodsWe performed a retrospective chart review over a 1-year period, identifying patients presenting to the hospital with a diagnosis of pneumomediastinum in the absence of trauma, malignancy or iatrogenic cause.ResultsWe identified 21 cases, 14 of which (66.7%) were associated with marijuana use, average age was 22.5 years (range 18–30), with male predominance (64.2%). Daily or more use was reported in 50% of cases. Concurrent risk factors including vomiting (57.1%) and coughing (42.9%) were commonly present. The mechanism of smoking was described in only two cases (14.3%).DiscussionInhaled marijuana may be an underappreciated risk factor for the development of SPM, caused by air leakage around the bronchovascular sheaths during successive inhalation through a high-resistance smoking apparatus or forced exhalation against a closed glottis. Physicians should be aware of this association in order to provide appropriate counselling. Further research is needed to direct the safe use of smoking devices and techniques.

scholarly journals Demographic and Risk Factor Differences between Children with “One-Time” and “Repeat” Visits to the Emergency Department for Asthma

2021 ◽  
Vol 18 (2) ◽  
pp. 486
Author(s):  
Pavani Rangachari ◽  
Jie Chen ◽  
Nishtha Ahuja ◽  
Anjeli Patel ◽  
Renuka Mehta
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Risk Factor ◽  
Childhood Asthma ◽  
Medical Center ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Primary Research ◽  
Ed Visits ◽  
The Individual

This retrospective study examines demographic and risk factor differences between children who visited the emergency department (ED) for asthma once (“one-time”) and more than once (“repeat”) over an 18-month period at an academic medical center. The purpose is to contribute to the literature on ED utilization for asthma and provide a foundation for future primary research on self-management effectiveness (SME) of childhood asthma. For the first round of analysis, an 18-month retrospective chart review was conducted on 252 children (0–17 years) who visited the ED for asthma in 2019–2020, to obtain data on demographics, risk factors, and ED visits for each child. Of these, 160 (63%) were “one-time” and 92 (37%) were “repeat” ED patients. Demographic and risk factor differences between “one-time” and “repeat” ED patients were assessed using contingency table and logistic regression analyses. A second round of analysis was conducted on patients in the age-group 8–17 years to match another retrospective asthma study recently completed in the outpatient clinics at the same (study) institution. The first-round analysis indicated that except age, none of the individual demographic or risk factors were statistically significant in predicting of “repeat” ED visits. More unequivocally, the second-round analysis revealed that none of the individual factors examined (including age, race, gender, insurance, and asthma severity, among others) were statistically significant in predicting “repeat” ED visits for childhood asthma. A key implication of the results therefore is that something other than the factors examined is driving “repeat” ED visits in children with asthma. In addition to contributing to the ED utilization literature, the results serve to corroborate findings from the recent outpatient study and bolster the impetus for future primary research on SME of childhood asthma.

scholarly journals Biofilm Formation by and Antifungal Susceptibility of Candida Isolates from Urine

2007 ◽  
Vol 73 (6) ◽  
pp. 1697-1703 ◽  
Author(s):  
N. Jain ◽  
R. Kohli ◽  
E. Cook ◽  
P. Gialanella ◽  
T. Chang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Growth Medium ◽  
Biofilm Formation ◽  
Chart Review ◽  
Antifungal Susceptibility ◽  
Retrospective Chart Review ◽  
Urine Samples ◽  
Rpmi Medium

ABSTRACT Biofilm formation (BF) in the setting of candiduria has not been well studied. We determined BF and MIC to antifungals in Candida spp. isolates grown from urine samples of patients and performed a retrospective chart review to examine the correlation with risk factors. A total of 67 Candida spp. isolates were grown from urine samples from 55 patients. The species distribution was C. albicans (54%), C. glabrata (36%), and C. tropicalis (10%). BF varied greatly among individual Candida isolates but was stable in sequential isolates during chronic infection. BF also depended on the growth medium and especially in C. albicans was significantly enhanced in artificial urine (AU) compared to RPMI medium. In nine of the C. albicans strains BF was 4- to 10-fold higher in AU, whereas in three of the C. albicans strains and two of the C. glabrata strains higher BF was measured in RPMI medium than in AU. Determination of the MICs showed that planktonic cells of all strains were susceptible to amphotericin B (AMB) and caspofungin (CASPO) and that three of the C. glabrata strains and two of the C. albicans strains were resistant to fluconazole (FLU). In contrast, all biofilm-associated adherent cells were resistant to CASPO and FLU. The biofilms of 14 strains (28%) were sensitive to AMB (MIC50 of <1 μg/ml). Correlation between degree of BF and MIC of AMB was not seen in RPMI grown biofilms but was present when grown in AU. A retrospective chart review demonstrated no correlation of known risk factors of candiduria with BF in AU or RPMI. We conclude that BF is a stable characteristic of Candida strains that varies greatly among clinical strains and is dependent on the growth medium. Resistance to AMB is associated with higher BF in AU, which may represent the more physiologic medium to test BF. Future studies should address whether in vitro BF can predict treatment failure in vivo.

Documentation of medical marijuana use in cancer patients

2019 ◽  
Vol 26 (5) ◽  
pp. 1117-1127 ◽  
Author(s):  
Jessica N LeClair ◽  
Kevin W Chamberlin ◽  
Jessica Clement ◽  
Lisa M Holle
Keyword(s):  
Quality Improvement ◽  
Cancer Patients ◽  
Chart Review ◽  
Medical Marijuana ◽  
Retrospective Chart Review ◽  
Marijuana Use ◽  
Cancer Center ◽  
Medication List ◽  
Post Test ◽  
Medical Marijuana Use

Purpose Medical marijuana is often used as adjuvant therapy in cancer patients for symptom management, although limited evidence-based studies evaluating its efficacy or safety exist. Similar to over-the-counter medications, supplements, or herbal products, documentation of medical marijuana is important to monitor efficacy, potential adverse effects, or interactions. The objective of this quality improvement study was to improve the consistency of medical marijuana documentation in cancer patients by assessing current practices; educating healthcare team members about the importance of documentation and newly established documentation process; and evaluating the new documentation process. Methods This three-part quality improvement study was approved by the Institutional Review Board. In part I, a voluntary survey was sent via email to Cancer Center healthcare personnel to assess the current documentation process of medical marijuana. In part II, a best practice process for documenting medical marijuana in the electronic medical record was established. Medical marijuana was to be listed as a historical medication in the medication list. In-person and electronic education sessions were offered to Cancer Center clinical staff. The education emphasized the importance of documenting medical marijuana use and provided a detailed process for electronic medical record documentation. A pre- and post-test to assess understanding was also included. Part III was a retrospective chart review to evaluate documentation practices of certified medical marijuana users in the Cancer Center. Patients included in the study were greater than 18 years old and certified for medical marijuana use on or after 1 January 2018. Department of Corrections patients were excluded. Descriptive statistics were used for data analysis. Results The survey results in part I demonstrated a lack of consistency in the documentation of medical marijuana in the Cancer Center. The pre- and post-test scores measured in part II showed a significant improvement in understanding after education was provided. The average pre-test score was a 61 and post-test score was 88, indicating an average increase of 27 points. A larger increase in test scores was observed in those attending the in-person education than the online sessions ( p < 0.002). The results of the retrospective chart review in part III revealed 56 patients who met inclusion criteria, but only 39 patients were alive and evaluated at the time of the retrospective chart review. Of the 39 patients, 22 never completed the patient registration process and therefore, would never have been able to obtain medical marijuana. Seven patients had medical marijuana properly documented in their medication list and 10 patients were missing documentation in the medication list, showing room for improvement in documentation practices. Conclusions This quality improvement study led to the implementation of medical marijuana documentation in the medication list. Education increased healthcare team members understanding of medical marijuana utilization and the importance of documentation.

scholarly journals Estimating risk and cost: An analysis of patients with risk factors for Type 2 Diabetes in rural Jalisco, Mexico

2019 ◽  
Vol 10 (3) ◽  
pp. 98
Author(s):  
Katie Morales ◽  
Emily Hall ◽  
Ella Harris ◽  
Alden Blair ◽  
Sharon Rose ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Risk Factor ◽  
Health Care Systems ◽  
Retrospective Chart Review ◽  
Health Clinic ◽  
Middle Income ◽  
Borderline Hypertension ◽  
Life Years

The global age standardized prevalence of type 2 diabetes (T2DM) has doubled (4.7% to 8.5%) over the last three decades and is increasing more rapidly in low and middle-income countries (LMICs). The global economic burden of diabetes affects individuals and health care systems and is estimated to cost $825 billion USD a year. Within Mexico, T2DM is the second leading cause of mortality and the leading cause of morbidity using disability associated life years (DALYs). A retrospective chart review and cost analysis, analyzing those at risk of diabetes, was conducted at a rural community health clinic in Jalisco, Mexico. The goal was to project the cost of providing an appropriate scope of care and plan prevention-based population health programs. The results demonstrated that out of 264 charts reviewed, 218 (83%) had one or more diabetic risk factor. The estimated per patient per visit cost is $127.22 MP (Mexican Peso, 2018) and as the number of diabetes risk factors increases for an individual patient, the mean cost of their care to the system increases (p < .001). Those with at least one risk factor comprise the majority in both males and females with a median age of 36 and median BMI of 28, and this group also has the highest percentage of borderline hypertension (46%). This data demonstrates an opportunity to intervene in a group of young adults (ages 27-46) with a cluster of high-risk borderline risk factors and preventing them from developing obesity, hypertension and diabetes later in life.

Risk factors for poor outcomes of early rehabilitation after total en bloc spondylectomy: a retrospective chart review of 140 patients

Spinal Cord ◽  
2020 ◽  
Vol 58 (8) ◽  
pp. 900-907
Author(s):  
Yuki Kurokawa ◽  
Hideki Murakami ◽  
Satoru Demura ◽  
Satoshi Kato ◽  
Noriaki Yokogawa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Early Rehabilitation ◽  
En Bloc ◽  
Total En Bloc Spondylectomy ◽  
En Bloc Spondylectomy ◽  
Bloc Spondylectomy ◽  
Poor Outcomes

Exposure to risk factors for cervical and anal dysplasia in transgender men and women: A retrospective chart review

2017 ◽  
Vol 145 ◽  
pp. 72 ◽  
Author(s):  
L.A. Fein ◽  
L. Abern ◽  
J. Seay ◽  
C.A. Medina ◽  
C.J. Salgado ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Men And Women ◽  
Anal Dysplasia ◽  
Transgender Men

scholarly journals High Prevalence of Hypertension in Ethiopian and Non-Ethiopian HIV-Infected Adults

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Maya Korem ◽  
Tali Wallach ◽  
Michael Bursztyn ◽  
Shlomo Maayan ◽  
Karen Olshtain-Pops
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Chart Review ◽  
Pressure Rise ◽  
Retrospective Chart Review ◽  
Close Monitoring ◽  
Related Factors ◽  
The Metabolic Syndrome ◽  
High Prevalence ◽  
Study Population

Objectives. Prevalence of hypertension has not been studied in the Ethiopian HIV-infected population, which represents 60% of the patients in our AIDS unit. Our aim was to identify risk factors and characterize the prevalence of hypertension in the population monitored at our unit. Methods. A retrospective chart review categorized subjects according to their blood pressure levels. Hypertension prevalence was determined and stratified according to variables perceived to contribute to elevated blood pressure. Results. The prevalence of hypertension in our study population was significantly higher compared to the general population (53% versus 20%, P<0.0001) and was associated with known risk factors and not with patients’ viral load and CD4 levels. Ethiopian HIV-infected adults had a prominently higher rate of blood pressure rise over time as compared to non-Ethiopians (P=0.016). Conclusions. The high prevalence of hypertension in this cohort and the rapid increase in blood pressure in Ethiopians are alarming. We could not attribute high prevalence to HIV-related factors and we presume it is part of the metabolic syndrome. The lifelong cardiovascular risk associated with HIV infection mandates hypertension screening and close monitoring in this population.

Management of isolated calf vein thrombosis in cancer patients

Vascular ◽  
2015 ◽  
Vol 24 (1) ◽  
pp. 64-69
Author(s):  
Anand S Brahmandam ◽  
Kirstyn Brownson ◽  
Laura Skrip ◽  
Terri Parker ◽  
Jeffrey Indes ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cancer Patients ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Treatment Modalities ◽  
Vein Thrombosis ◽  
History Of ◽  
Calf Vein ◽  
History Of Cancer

The treatment of isolated calf vein thrombosis remains widely debated. This study highlights the characteristics of isolated calf vein thrombosis in cancer patients and compares to isolated calf vein thrombosis in patients without history of cancer. Between July 2013 and April 2014, a retrospective chart review of consecutive patients with isolated calf vein thrombosis was performed recording patient risk factors, ultrasound characteristics of the thrombus, treatment modalities, long-term recurrence of venous-thromboembolism, incidence of bleeding, and mortality. Of 131 patients with isolated calf vein thrombosis, 53 (40.1%) had history of cancer. Isolated calf vein thrombosis occurred at an older age in cancer patients (66.7 vs 58.5 years, p = 0.004). The anatomical characteristics of isolated calf vein thrombosis on ultrasound were comparable in both groups. Isolated calf vein thrombosis in cancer patients was less likely to be treated with anticoagulation (60.4% vs 80.8%, p = 0.018). However, a trend towards higher incidence of bleeding after initiation of anticoagulation for isolated calf vein thrombosis in cancer patients (11.3% vs 6.4%, p = 0.351) was noted. Mortality in cancer patients was higher (37.7% vs 9.00%, p < 0.001) but was unrelated to isolated calf vein thrombosis or its treatment. In conclusion, the risks of bleeding seem to exceed the benefits of anticoagulation in approximately 50% of cancer patients with isolated calf vein thrombosis. The management of isolated calf vein thrombosis does not seem to impact the survival of cancer patients.

scholarly journals Incidence and risk factors for complications after definitive skeletal fixation of lower extremity in multiple injury patients: a retrospective chart review

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 612 ◽  
Author(s):  
Thananit Sangkomkamhang ◽  
Wilaiphorn Thinkhamrop ◽  
Bandit Thinkhamrop ◽  
Wongsa Laohasiriwong
Keyword(s):  
Risk Factors ◽  
Lower Extremity ◽  
Early Treatment ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Multiple Injuries ◽  
Major Complications ◽  
Severity Of Injury ◽  
Initial Injury ◽  
The Mean

Background: The management of multiple injuries is complex. Type and timing of treatment for lower extremity fractures is a controversial subject. Although many studies have demonstrated the safety and effectiveness of early treatment, others have suggested that early definitive stabilization may cause complications, especially with chest and head injuries. The aim of this study was to determine the complications and effects of timing of fixation, and investigate risk factors for complications in multiple injuries patients with lower extremity fractures. Methods: A Retrospective chart review from Khon Kaen Trauma Registry between 2008 and 2015 were collected. All major complications were identified and collected for example acute respiratory distress syndrome (ARDS), acute kidney injury (AKI) and sepsis.  The time to definitive skeletal fixation from initial injury was identified and analyzed with multiple logistic regression. Results: 1224 multiple injuries patients with lower extremity fractures were identified. The mean age was 34±19.5 years, 74.4% were male and 25.6% female. The mean time from initial injury to definitive operation was 55.7±53.9 hours. Complications occurred with 178 patients (14.5%), the most common of which were pneumonia, ARDS and AKI. After adjusting for sex, severity of injury, we found that the operation within 24-48 hours complication was 6.67 times less common than in the early treatment group (less than 24 hours) (95% CI: 3.03 to 10.00, P-value< 0.001). Conclusions: About 15% of the multiple injuries patients with lower extremity fracture had major complications. The optimal time for definitive fixation in lower extremity fractures to reduce complications was within 24-48 hours. We found that if we operated too early (before 24 hours) or more than 48 hours after the injury it could increase the morbidity and mortality.

scholarly journals An Ophthalmology Resident-Led Quality Improvement Initiative to Decrease the Incidence of Perioperative Corneal Injury

2019 ◽  
Vol 11 (02) ◽  
pp. e49-e53
Author(s):  
Amanda L. Ely ◽  
Mark Goerlitz-Jessen ◽  
Ingrid U. Scott ◽  
Erik Lehman ◽  
Tabassum Ali ◽  
...  
Keyword(s):  
Risk Factors ◽  
Quality Improvement ◽  
Chart Review ◽  
Medical Center ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Corneal Injury ◽  
Surgical Case ◽  
Anesthesia Providers ◽  
Academic Medical

Abstract Objective This article evaluates the effectiveness of an ophthalmology resident-led quality improvement (QI) initiative to decrease the incidence of perioperative corneal injury at an academic medical center Design Retrospective chart review. Methods A retrospective chart review was conducted of all surgical cases performed 6 months prior to, and 6 months after, implementation of an ophthalmology resident-led QI initiative at an academic medical center. The QI initiative (which focused on perioperative corneal injury awareness, understanding of risk factors, and presentation of an algorithm designed to prevent perioperative corneal injury) consisted of a lecture and distribution of educational materials to anesthesia providers. Data collected through the chart review included type of surgical case, presence of diabetes mellitus or thyroid disease, patient age and gender, patient positioning (supine, prone, or lateral), level of anesthesia provider training, length of surgical case, surgical service, type of anesthesia, and type (if any) of perioperative eye injury. The rates of perioperative corneal injury pre- versus post-initiative were compared. Results The rates of perioperative corneal injury pre- and post-initiative were 3.7 and 1.9 per 1,000, respectively (p = 0.012). Significant risk factors for perioperative corneal injury include longer duration of surgery (odds ratio [OR] 90–180 vs. < 90 minutes = 4.18, 95% confidence interval [CI] 1.43–12.18; OR > 180 vs. < 90 minutes = 8.56, 95% CI 3.01–24.32; OR > 180 vs. 90–180 = 2.05, 95% CI 1.17–3.58), patient position lateral > prone > supine (OR prone vs. lateral = 0.25, 95% CI 0.09–0.67; OR supine vs. lateral = 0.13, 95% CI 0.07–0.23), nonhead and neck surgeries (OR = 0.32, 95% CI 0.11–0.87), and surgery performed under the general surgery service (OR general surgery service vs. other subspecialty services = 6.50, 95% CI 2.39–24.76). Conclusions An ophthalmology resident-led QI initiative consisting of educating anesthesia providers was associated with a significant decrease in the rate of perioperative corneal injury.

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