scholarly journals Minimally Invasive Parafascicular Surgery (MIPS) for Spontaneous Intracerebral Hemorrhage Compared to Medical Management: A Case Series Comparison for a Single Institution

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Victoria L. Phillips ◽  
Anil K. Roy ◽  
Jonathan Ratcliff ◽  
Gustavo Pradilla
Keyword(s):  
Minimally Invasive ◽  
Medical Management ◽  
Case Series ◽  
Safety Net ◽  
Inpatient Mortality ◽  
Management Group ◽  
Safety Net Hospital ◽  
Chi Squared ◽  
Frontline Treatment ◽  
Discharge Status

Objective. We compared the safety and effectiveness of minimally invasive parafascicular surgery (MIPS) as a frontline treatment for spontaneous supratentorial ICH to medical management. Patients. The sample consisted of 17 patients who underwent MIPS from January 2014 to December 2016 and a comparison group of 23 patients who were medically managed from June 2012 to December 2013. All had an International Classification of Disease (ICD) diagnosis of 431 and were treated at Grady Memorial Hospital, an urban, public, safety-net hospital. Methods. The primary endpoint was risk of inpatient mortality. Secondary endpoints were rates of inpatient infection and favorable discharge status, defined as discharge to home or rehabilitation facility. Demographics and pre- and postclinical outcomes were compared using t-tests, the Mann–Whitney test, and chi-squared tests for continuous, ordinal and categorical measures, respectively. Cox proportional hazard models were used to estimate the time to inpatient death. Logistic regression analyses were used to determine treatment effects on secondary outcomes. We also conducted exploratory subgroup analyses which compared MIPS to two medical management subgroups: those who had surgery during their hospitalization and those that did not. Results. Two patients (12%) died in the MIPS group compared to three (12%) in the medical management group. MIPS did not increase the risk of inpatient mortality relative to medical management. Rates of inpatient infection did not differ significantly between the two groups; eight MIPS patients (47%) and 13 medically managed patients (50%) contracted infections. MIPS significantly increased the likelihood of favorable discharge status (odds ratio (OR) 1.77; 95% CI, 1.12–21.9) compared to medical management. No outcome measures were significantly different between MIPS and the medical management subgroup without surgery, while rates of favorable discharge were higher among the MIPS patients compared to the medical management group with surgery. Conclusions. These data suggest that MIPS, as a frontline treatment for spontaneous ICH, versus medical management for spontaneous ICH warrants further investigation.

scholarly journals Acute Esophageal Necrosis: A Case Series From a Safety Net Hospital

Cureus ◽  
2020 ◽  
Author(s):  
Ishaan Vohra ◽  
Parth Desai ◽  
Kapil Thapa Chhetri ◽  
Hassam Shah ◽  
Anas Almoghrabi
Keyword(s):  
Case Series ◽  
Safety Net ◽  
Acute Esophageal Necrosis ◽  
Esophageal Necrosis ◽  
Safety Net Hospital

scholarly journals Massive Soft Tissue Haemophilic Pseudotumor in Limbs: Lessons Learnt from an Extremely Rare Problem

2021 ◽  
pp. 1-4
Author(s):  
C F Munson ◽  
C F Munson ◽  
A N Morritt
Keyword(s):  
Soft Tissue ◽  
Minimally Invasive ◽  
Medical Management ◽  
Case Reports ◽  
Case Series ◽  
Lessons Learnt ◽  
The World ◽  
The Future ◽  
Extensive Surgery ◽  
Future Management

Haemophilic pseudotumors are very rare, encapsulated haematomas forms as a result of repetitive bleeding, forming a mass of clotted blood and necrosed tissue. Reported experience in the literature is limited to case reports and case series from around the world, reporting on smaller and medium sized pseudotumors. Conflicting opinion exists following failed medical management, which includes minimally invasive interventions through extensive surgery. We present our experience with the management of two of the largest soft tissue pseudotumors reported in the literature. We also provide some guidance, based on our experiences, for the future management of massive haemophilic pseudotumors.

scholarly journals Toxoplasmosis Encephalitis: A Cross-Sectional Analysis at a U.S. Safety-Net Hospital in the Late cART Era

2021 ◽  
Vol 20 ◽  
pp. 232595822110438
Author(s):  
Abby Lau ◽  
Mamta Khandelwal Jain ◽  
Jeremy Yan-Shun Chow ◽  
Ellen Kitchell ◽  
Susana Lazarte ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Complete Response ◽  
Safety Net ◽  
Clinical Severity ◽  
People Living With Hiv ◽  
Coordinated Care ◽  
Cross Sectional ◽  
Safety Net Hospital ◽  
Chi Squared ◽  
New Diagnosis

Despite decreasing incidence of toxoplasmosis encephalitis(TE) among people living with HIV(PLWH) in the late antiretroviral era, U.S. safety-net hospitals still see significant numbers of admissions for TE. Little is known about this population, their healthcare utilization and long-term outcomes. We conducted an 8-year retrospective review of PLWH with TE at a safety-net hospital. Demographics, clinical characteristics, treatments, readmissions, and outcomes were collected. We used chi-squared test to evaluate 6-month all-cause readmission and demographic/clinical characteristics. Of 38 patients identified, 79% and 40% had a new diagnosis of TE and HIV respectively. 59% had 6-month all-cause readmission. Social factors were associated with readmission (uninsured (p = 0.036), Spanish as primary language (p = 0.017), non-adherence (p = 0.030)) and not markers of clinical severity (ICU admission, steroid-use, concomitant infections, therapeutic adverse events). Despite high readmission rates, at follow-up, 60% had a complete response, 30% had a partial response. Improving TE outcomes requires focus on culturally competent, coordinated care.

Assessment of Oropharyngeal and Laryngeal Cancer Treatment Delay in a Private and Safety Net Hospital System

2018 ◽  
Vol 159 (3) ◽  
pp. 484-493 ◽  
Author(s):  
Haley K. Perlow ◽  
Stephen J. Ramey ◽  
Ben Silver ◽  
Deukwoo Kwon ◽  
Felix M. Chinea ◽  
...  
Keyword(s):  
Laryngeal Cancer ◽  
Multivariable Analysis ◽  
Case Series ◽  
Safety Net ◽  
Hospital Treatment ◽  
Academic Hospital ◽  
Retrospective Case ◽  
Hospital System ◽  
Safety Net Hospital ◽  
The Impact

Objective To examine the impact of treatment setting and demographic factors on oropharyngeal and laryngeal cancer time to treatment initiation (TTI). Study Design Retrospective case series. Setting Safety net hospital and adjacent private academic hospital. Subjects and Methods Demographic, staging, and treatment details were retrospectively collected for 239 patients treated from January 1, 2014, to June 30, 2016. TTI was defined as days between diagnostic biopsy and initiation of curative treatment (defined as first day of radiotherapy [RT], surgery, or chemotherapy). Results On multivariable analysis, safety net hospital treatment (vs private academic hospital treatment), initial diagnosis at outside hospital, and oropharyngeal cancer (vs laryngeal cancer) were all associated with increased TTI. Surgical treatment, severe comorbidity, and both N1 and N2 status were associated with decreased TTI. Conclusion Safety net hospital treatment was associated with increased TTI. No differences in TTI were found when language spoken and socioeconomic status were examined in the overall cohort.

1645 Same Day Discharge after Minimally Invasive Gynecologic Surgery at an Urban, Safety-Net Hospital

2019 ◽  
Vol 26 (7) ◽  
pp. S127-S128
Author(s):  
ML Fowler ◽  
S Delgado ◽  
P Hendessi ◽  
E Memmo ◽  
R Iverson ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Safety Net ◽  
Gynecologic Surgery ◽  
Same Day Discharge ◽  
Safety Net Hospital ◽  
Urban Safety

Mother–Infant Dyads with COVID-19 at an Urban, Safety-Net Hospital: Clinical Manifestations and Birth Outcomes

2021 ◽  
Author(s):  
Vishakha Sabharwal ◽  
Ruby Bartolome ◽  
Sacha Al Hassan ◽  
Bernadette M. Levesque ◽  
Ingrid Y. Camelo ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Pregnant Women ◽  
Cesarean Delivery ◽  
Birth Outcomes ◽  
Gestational Age ◽  
Clinical Manifestations ◽  
Case Series ◽  
Safety Net ◽  
Safety Net Hospital ◽  
Urban Safety

Objective This study aimed to describe maternal characteristics and clinical outcomes of infants born to mothers with positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) tests during pregnancy at an urban, safety-net hospital in Boston. Study Design We abstracted electronic chart data from 75 pregnant women with positive SARS-CoV-2 tests at any stage of gestation until 72 hours after birth who delivered consecutively between March 31 and August 6, 2020 at our center. We collected clinical data on maternal and infant characteristics, including testing, signs, and symptoms of coronavirus disease 2019 (COVID-19), delivery outcomes, newborn care practices (skin-to-skin care, location of care, and breastfeeding) and 30-day postdischarge infant emergency room visits and readmissions. We described categorical characteristics as percentages for this case series. Results Among 75 pregnant women, 47 (63%) were Hispanic, 10 (13%) had hypertension, 23 (30%) had prepregnancy obesity, and 57 (76%) had symptomatic SARS-CoV-2 infection. Regarding birth outcomes, 32 (41%) had cesarean delivery and 14 (19%) had preterm birth. Among 75 infants, 5 (7%) had positive SARS-CoV-2 polymerase chain reaction tests in the first week of life, all of whom were born to Hispanic mothers with symptomatic SARS-CoV-2 infection and had clinical courses consistent with gestational age. Six (8%) infants visited the emergency department within 30 days of discharge; one was admitted with a non-COVID-19 diagnosis. Conclusion At our urban, safety-net hospital among pregnant women with positive SARS-CoV-2 tests, 41% had a cesarean delivery and 19% had a preterm birth. Seven percent of infants had one or more positive SARS-CoV-2 tests and all infants had clinical courses expected for gestational age. Key Points

scholarly journals Non-insertive Acupuncture and Neonatal Abstinence Syndrome: a Case Series from an Inner-city Safety Net Hospital

2012 ◽  
Vol 1 (4) ◽  
pp. 48-52 ◽  
Author(s):  
Amanda C. Filippelli ◽  
Laura F. White ◽  
Lisa W. Spellman ◽  
Maria Broderick ◽  
Ellen Silver Highfield ◽  
...  
Keyword(s):  
Inner City ◽  
Case Series ◽  
Safety Net ◽  
Neonatal Abstinence Syndrome ◽  
Abstinence Syndrome ◽  
Safety Net Hospital

scholarly journals Exposure to and Use of Electronic Cigarettes: Does Language Matter?

2017 ◽  
Vol 27 (3) ◽  
pp. 217 ◽  
Author(s):  
Paul Wada ◽  
Chun Nok Lam ◽  
Elizabeth Burner ◽  
Sophie Terp ◽  
Michael Menchine ◽  
...  
Keyword(s):  
Los Angeles ◽  
Electronic Cigarettes ◽  
Native English Speakers ◽  
Safety Net ◽  
Cross Sectional Study ◽  
English Speakers ◽  
Foreign Born ◽  
Cross Sectional ◽  
Safety Net Hospital ◽  
Chi Squared

<p class="Pa5"><strong>Objectives: </strong>To determine whether patients who are English proficient become aware of e-cigarettes through different marketing tac­tics and have dissimilar patterns of use than patients who are non-English speaking.</p><p class="Pa5"><strong>Design: </strong>This was a cross-sectional study surveying adult English- and Spanish-speak­ing patients. ANOVA and chi-squared tests were used to examine differences between groups.</p><p class="Pa5"><strong>Setting: </strong>A large public, safety-net hospital in Los Angeles County, California.</p><p class="Pa5"><strong>Results: </strong>Respondents (N=1899) were predominately Hispanic (78%), foreign-born (68%), and reported Spanish as a primary language (64%). Native English speakers re­ported the highest use of e-cigarettes (26%), followed by non-native (13%) and non- English speakers (2%) (P&lt;.001). In terms of marketing, native and non-native English speakers were more likely to have friends and family as sources of e-cigarette informa­tion (P&lt;.001). Native speakers were more likely to see advertisements for e-cigarettes on storefronts (P=.004) and on billboards (P&lt;.001). Non-English speakers were most likely to learn about e-cigarettes on the news (P&lt;.001) and in advertisements on the television and radio (P=.002). Differ­ences in reasons for use were not significant between the three groups.</p><p><strong>Conclusions: </strong>Native and non-native English speakers become aware of e-cigarettes through different mechanisms and use e-cigarettes at a significantly higher rate than non-English speakers. These results highlight an opportunity for public health programs to concentrate on specific channels of com­munication that introduce patient popula­tions to e-cigarettes to slow the spread of e-cigarette usage.</p><p><em>Ethn Dis. </em>2017;27(3):217- 222; doi:10.18865/ed.27.3.217</p>

scholarly journals CASE SERIES OF PATIENTS WITH E-CIGARETTE OR VAPING PRODUCT-ASSOCIATED LUNG INJURY: INSIGHTS FROM A SAFETY NET HOSPITAL

CHEST Journal ◽  
2020 ◽  
Vol 158 (4) ◽  
pp. A2367
Author(s):  
Raghavendra Sanivarapu ◽  
Shiva Arjun ◽  
Hyfaa Mashaal ◽  
Alejandro Gutierrez ◽  
Daniel Meshoyrer ◽  
...  
Keyword(s):  
Lung Injury ◽  
Case Series ◽  
Safety Net ◽  
Safety Net Hospital
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