scholarly journals Patient Complications after Interscalene Block: A Retrospective Comparison of Liposomal Bupivacaine to Nonliposomal Bupivacaine

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Jacob L. Hutchins ◽  
Jason Habeck ◽  
Zac Novaczyk ◽  
Richard Campbell ◽  
Christopher Creedon ◽  
...  
Keyword(s):  
Emergency Room ◽  
Surgical Procedure ◽  
Interscalene Block ◽  
Emergency Room Visits ◽  
University Of Minnesota ◽  
Phone Calls ◽  
Number Of Patients ◽  
Significant Difference ◽  
Liposome Bupivacaine ◽  
Anesthetic Complications

Background. The purpose of this study was to investigate if the addition of liposome bupivacaine (LB) to an interscalene block (ISB) had an effect on the number of patients with surgical- or block-related complications. Methods. This was a single-center retrospective chart view performed by identifying patients who received an ISB from January 1, 2014, through April 26, 2018, at the University of Minnesota. 1,518 patients were identified who received an ISB (LB = 784, nonliposomal bupivacaine = 734). Patients were divided into two groups those who did receive liposome bupivacaine in their ISB and those who did not receive liposome bupivacaine in their ISB. Medical records were individually reviewed for surgical procedure, block medications, complications related to the block or surgical procedure, phone calls to the healthcare system for issues related to opioids or pain within 3 and within 30 days, readmissions within 30 days, and emergency room visits for complications within 3 and 30 days. Results. There was no significant difference in the number of patients with surgical or anesthetic complications. Only phone calls for pain within 3 days were significantly different. The LB group had 3.2% of patients call compared to 5.6% in the nonliposomal bupivacaine group (aOR = 1.71 (95% CI: 1.04–2.87), p=0.036). We found no significant difference in any of the other secondary outcomes. Conclusions. The use of LB in an ISB demonstrated no significant difference compared to nonliposomal bupivacaine in numbers of complications, emergency room visits, and readmissions.

scholarly journals Patient Complications After Interscalene Block: A Retrospective Comparison of Liposomal Bupivacaine to Non-Liposomal Bupivacaine.

2019 ◽  
Author(s):  
jacob hutchins ◽  
Jason Habeck ◽  
Zac Novaczyk ◽  
Richard Campbell ◽  
Christopher Creedon ◽  
...  
Keyword(s):  
Emergency Room ◽  
Surgical Procedure ◽  
Interscalene Block ◽  
Emergency Room Visits ◽  
Liposomal Bupivacaine ◽  
Phone Calls ◽  
Number Of Patients ◽  
Significant Difference ◽  
Liposome Bupivacaine ◽  
Anesthetic Complications

Abstract Background The purpose of this study was to investigate if the addition of liposome bupivacaine (LB) to an interscalene block (ISB) had an effect on the number of patients with surgical or block related complications.Methods This was a single-center retrospective chart view was performed identifying patients who received an ISB from January 1, 2014 through April 26, 2018 at the University of Minnestoa. 1,518 patients were identified who received an ISB (LB =784, non-liposomal bupivacaine =734). Patients were divided into two groups those who did receive liposome bupivacaine in their ISB and those who did not receive liposome bupivacaine in their ISB. Medical records were individually reviewed for surgical procedure, block medications, complications related to the block or surgical procedure, phone calls to the healthcare system for issues related to opioids or pain within 3 and within 30 days, readmissions within 30 days, and emergency room visits for complications within 3 and 30 days.Results There was no significant difference in the number of patients with surgical or anesthetic complications. Only phone calls for pain within 3 days was significantly different. The LB group had 3.2% of patients call compared to 5.6% in the non-liposomal bupivacaine group (aOR=1.71 [95% CI: 1.04-2.87], p=0.036). We found no significant difference in any of the other secondary outcomes.Conclusions The use of LB in an ISB demonstrated no significant difference compared to non-liposomal bupivacaine in numbers of complications, emergency room visits, and readmissions.

The impact of pharmacist telephone calls after discharge on satisfaction of oncology patients: A randomized controlled study

2017 ◽  
Vol 24 (5) ◽  
pp. 359-364 ◽  
Author(s):  
Sewar S Salmany ◽  
Lujeen Ratrout ◽  
Abdallah Amireh ◽  
Randa Agha ◽  
Noor Nassar ◽  
...  
Keyword(s):  
Emergency Room ◽  
Hospital Readmissions ◽  
Randomized Controlled Study ◽  
Controlled Study ◽  
Emergency Room Visits ◽  
Oncology Patients ◽  
Randomized Controlled ◽  
Significant Difference ◽  
The Impact

Purpose The aim of the study was to determine the impact of telephone follow-up calls on satisfaction in oncology patients after hospital discharge. Method A randomized controlled study, in which patients were randomized into two groups: The experimental group with the telephone follow-up (TFU) calls (intervention) and the control group (no intervention). The telephone follow-up call was conducted within 72 h after discharge. During the call, patients were asked about their medications, namely, whether they received them, understood how to take them, and whether they developed any medication-related adverse effect. Both groups were contacted by phone two weeks later to assess their satisfaction with the discharge medication instructions and the provided pharmaceutical services, using the 5-point Likert scale. In addition, hospital records were reviewed for emergency room visits and hospital readmissions within 30 days after discharge. Results There was no difference in the percentage of patients who reported being very satisfied between both the intervention and the control groups (45% intervention vs. 48% control, P = 0.68). The mean time of the intervention phone call was 3 ± 1.7 (SD) min. During the telephone follow-up call, medication-related problems were identified in 20% of the patients. There was no significant difference in emergency room visits and hospital readmissions in the intervention group vs. control (44% vs. 53%, P = 0.123) and (37% vs. 43%, P = 0.317), respectively. Conclusion Telephone follow-up calls conducted by a pharmacist to discharged oncology patients did not improve patients' satisfaction, emergency room visits or hospital readmissions; however, they helped to identify medication-related adverse effects in the oncology patients.

scholarly journals 112 Impact of the COVID-19 pandemic on emergency department visits at a university medical centre

2021 ◽  
Vol 26 (Supplement_1) ◽  
pp. e81-e82
Author(s):  
Viviane Mallette ◽  
Claude Cyr
Keyword(s):  
Emergency Department ◽  
Emergency Room ◽  
Emergency Department Visits ◽  
Medical Centre ◽  
Pediatric Care ◽  
Emergency Room Visits ◽  
Traumatic Injuries ◽  
Health Measures ◽  
Significant Difference ◽  
The Impact

Abstract Primary Subject area Emergency Medicine - Paediatric Background The new coronavirus, SARS-Cov-2, responsible for a global pandemic, led to the declaration of a health emergency and the implementation of large-scale public health measures by governments in 2020. Those measures, combined with the overlapping symptoms of COVID-19 disease and common viral infections in children, have led hospitals to prepare for possible changes in volume of emergency room visits by children. Objectives This study aims to determine the effect of the pandemic and governmental restrictions on the use of the emergency department by pediatric patients at a university medical centre, as well as to assess the impact on the severity of initial presentations. Design/Methods A single-centre study was conducted at a university hospital among children aged 0 to 17 who visited the emergency room. We used interrupted time series analysis to compare the average of pre-COVID-19 data (from January 1 2017, to December 31 2019) with data from the first wave of the COVID-19 pandemic (from January 1 to September 2020). Emergency room visits, initial triage codes, and admission and pediatric consultation rates were analyzed to assess whether there was a significant difference between periods. Results An important increase in total daily visits (+11.18, 95% CI [6.23-16.14]) was first observed with the emergence of COVID-19 cases in Canada. Then, during the strict confinement, which corresponds to an active period of COVID-19, we detected a significant drop in daily visits (-25.64, 95% CI [-30.4 to -20.66]), which continued while progressively loosening restrictions. The proportion of admissions and pediatric consultations rose slightly only throughout the time of intensive health measures (respectively +4.07% and +3.32%), but no changes in the severity of the triage codes at the emergency department were observed for all periods. Traumatic injuries also saw a significant decrease (p=0.018) when comparing data by groups of diagnosis. Conclusion These results show a significantly lower number of children’s visits to the emergency room of a university medical centre, and a transient increase in pediatric care with little impact on the immediate severity of the initial presentations during strict government health measures in the first wave of COVID-19. These measures also had a beneficial effect in reducing the number of traumatic injuries.

scholarly journals Does drug compliance change in asthmatic patients during pregnancy?

2013 ◽  
Vol 8 ◽  
Author(s):  
Insu Yilmaz ◽  
Ferda Oner Erkekol ◽  
Sevki Celen ◽  
Mujdegul Zayifoglu Karaca ◽  
Omur Aydin ◽  
...  
Keyword(s):  
Emergency Room ◽  
Pregnant Women ◽  
Systemic Steroid ◽  
Emergency Room Visits ◽  
Behavioral Differences ◽  
Drug Compliance ◽  
Face To Face ◽  
Asthmatic Patients ◽  
Significant Difference ◽  
Symptomatic Asthma

Background: Pregnant women with asthma are recommended to maintain optimal therapeutic management during pregnancy. Uncontrolled, symptomatic asthma may increase the risk of adverse peri-natal outcomes; thus adequate regular anti-asthmatic treatment must be given to provide optimal asthma control during pregnancy. However, doubts about the safety of asthmatic drugs can affect pregnant asthmatic patients’ drug compliance. The aim of this study was to assess behavioral differences in drug compliance among pregnant asthmatic patients. Methods: Thirty two asthmatic and 121 healthy pregnant women were enrolled in the study. Structured face-to-face interviews were conducted after delivery. The interviews included disease characteristics, drug compliance and patients’ own perspective for asthma status prior to and during pregnancy. In addition, medical and pregnancy history, pregnancy complications and outcomes, and newborn characteristics were recorded. Results: In our study group the rates of hospitalization, emergency room visits and systemic steroid use in the year before pregnancy were 13%, 46.9% and 18.8%, respectively. The rate of regular asthma medication use was only 32% at that period and increased to 44% during pregnancy. However, hospitalization, emergency room visits, systemic steroid usage rates remained unchanged and according to patients’ own evaluations, 44% of asthmatics pointed out that their asthma had worsened during pregnancy. No statistically significant difference was detected in terms of pregnancy/labour complication between asthmatic and non-asthmatics. Conclusions: Contrary to some previous studies, in our study regular use of asthma drugs increased during pregnancy. The uncontrolled condition of their asthma before and during pregnancy and the idea that their asthma worsened during pregnancy might force the patients to use medication more regularly.

scholarly journals Perioperative mental status assessment of patients undergoing general surgical procedures

2018 ◽  
Vol 5 (8) ◽  
pp. 2788
Author(s):  
Prem Kumar A. ◽  
Raksha Nadig ◽  
Shashikala V. ◽  
Vikram Arunachalam
Keyword(s):  
Mental Status ◽  
Surgical Procedures ◽  
Surgical Procedure ◽  
Rating Scale ◽  
Psychological Status ◽  
Low Mood ◽  
Number Of Patients ◽  
Significant Difference ◽  
Psychiatric Rating ◽  
Psychiatric Rating Scale

Background: The past few decades have seen an enormous increase in the number of patients undergoing curative and palliative surgical procedures. The objective of the present study was to assess the mental status in a patient undergoing a general surgical procedure perioperatively.Methods: 105 patients admitted in a surgical ward, posted to undergo an elective surgical procedure were evaluated to assess their psychological status. Each patient was subjected to a Brief Psychiatric Rating Scale questionnaire twice, once preoperatively and postoperatively. Both sessions were conducted in a calm environment and the patient was administered adequate analgesia to eliminate bias due to pain. The preoperative and postoperative scores were calculated and compared.Results: BPRS is a psychiatric rating scale used in various psychiatric conditions. Using this scale, we were able to detect the presence of a baseline low mood in a patient undergoing a surgical procedure. The average score preoperatively was 35.84 and postoperatively was 32.68. These scores were higher in patients undergoing surgeries for malignant conditions and also in those with co-morbid conditions like diabetes mellitus. Although there was an improvement in the postoperative scores, there was no significant difference between the preoperative and postoperative scores.Conclusions: A surgical procedure puts a patient through immense psychological stress manifested as low mood and reduced motivation on the part of the patient to participate in their own rehabilitation programme. This affects the overall outcome of a surgical procedure and increases the morbidity. Knowledge of this on part of the operating surgeon and thus proper counselling of the patient, addressing both the psychological and surgical aspects of the disease process will help improve the overall surgical experience.

Assessment of Daily Burden and Factors for Overcrowded Emergency Department at Tertiary Care Hospital of Karachi

2021 ◽  
pp. 30-35
Author(s):  
Arsala Faridi ◽  
Farah Ahmad ◽  
Areej Zehra ◽  
Afreen Fazal
Keyword(s):  
Emergency Department ◽  
Emergency Room ◽  
Tertiary Care Hospital ◽  
Patient Flow ◽  
Tertiary Care ◽  
Care Hospital ◽  
Cross Sectional ◽  
Study Duration ◽  
Number Of Patients ◽  
Significant Difference

Background: When in emergency room there is no enough area left to serve or to admit the subsequent sick patients who may require urgent attention and observation the setting is called as the overcrowded emergency room. Due to overcrowded emergency department the quality of services provided by the staff and doctors is compromised ultimately patients with severe diseases are ignored and this may be one of the causes for causalities. Objective: To assess the daily burden and factors responsible for overcrowding at emergency department of tertiary care hospital of Karachi. Methodology: It was a cross sectional study conducted at tertiary care hospital of Karachi from October 2020 to January 2021. Data of patients coming to adult emergency department of either gender were collected.  Patients age <14 were excluded as these were referred to pediatric emergency department. Data collection was done according to Canadian emergency department triage and acuity scale (CTAS). Results: Total number (N) of patients who visited emergency department in study duration was 13434. The mean number of patients who visited ED was 141±13during our study duration. There was no any significant difference in presenting complaint. Delay in investigations was found to be a reason of prolong stay and overcrowding in ED in our setting. Conclusion: Overcrowding of patients in our ED of our setting was a common problem. The number of staff, doctors and beds were not matching the number of patient flow in the department. The main reason of prolong stay in ED was delay in investigations.

Abstract 103: Obesity Paradox in Heart failure- Are African Americans Affected?

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Minaba A Wariboko ◽  
Kimberli Taylor ◽  
Chimalum Okafor ◽  
Taopheeq Mustapha ◽  
Victor Nwazue ◽  
...  
Keyword(s):  
Heart Failure ◽  
African Americans ◽  
Ejection Fraction ◽  
Emergency Room ◽  
Left Ventricular Systolic Dysfunction ◽  
The United States ◽  
Left Ventricular ◽  
Small Sample ◽  
Emergency Room Visits ◽  
Significant Difference

Background - Obesity is a major risk factor for heart failure. However, many studies have shown that obesity is paradoxically associated with better outcomes in those with chronic heart failure (HF). Initially thought to occur only in those with left ventricular systolic dysfunction (LVSD), recent studies such as CHARM and I-PRESERVE have described the same phenomenon in those with HF with preserved ejection fraction (HFpEF). It is also known that minorities have the highest rates of obesity in the United States, yet no major studies have included a large enough sample (>10% minority representation) to study this relationship. Thus we propose to examine the relationship of different weight categories to HF outcomes in patients with LVSD (45%) utilizing a minority cohort. Methods - Outcomes (HF admissions & cardiac admissions, non-cardiac admissions, and emergency room visits) were assessed for162 HF patients with documentation of body mass index (BMI) and ejection fraction from the Meharry Heart Failure Registry (a registry composed of 80% African Americans and Hispanics). The cohort was evenly divided by EF into HFpEF versus LVSD. Utilizing the Center for Disease Control definitions, 5 categories for BMI were defined: 40.0. ANOVA was applied to test for possible differences among BMI groups and outcomes. Results - There was a trend towards a paradoxical relationship noted between BMI and outcome in males with HFpEF when looking at all-cause readmissions (p<0.0606). This same relationship was noted between BMI and outcome in women with HFpEF when looking at the all-cause emergency room visits (p<0.0677). However, we failed to find a significant difference across BMI categories and outcome for those with LVSD. Conclusion - Our study suggests that irrespective of race, there is a paradoxical relationship noted between BMI and outcome for both men and women with HFpEF. However, contrary to current literature, we failed to find the same relationship in minority patients with LVSD. This may be due to the small sample size hence a larger prospective study of this group is warranted.

ALLERGIST INFLUENCE IN ASTHMA CARE

PEDIATRICS ◽  
1994 ◽  
Vol 94 (2) ◽  
pp. 256-256
Author(s):  
Stanley P. Galant
Keyword(s):  
Intensive Care ◽  
Emergency Room ◽  
Peak Flow ◽  
Retrospective Chart Review ◽  
Patient Characteristics ◽  
Emergency Room Visits ◽  
Inhaled Steroids ◽  
Flow Monitoring ◽  
Significant Difference ◽  
Metered Dose

Purpose of the Study. To determine whether care by an allergist reduces the morbidity for asthma specifically by decreasing the need for hospitalizations and emergency room visits. Methods. This was a retrospective chart review of patients first seen between June 1985 and June 1986 and followed the second year either in an allergy clinic or in a general pediatric clinic. Charts were analyzed for demographic information; information regarding hospitalizalions, emergency room visits, and intensive care unit admissions; medications, including bronchodilators, systemic steroids and inhaled steroids, and home nebulizer; and home peak flow meters. There were 209 charts reviewed initially. Of these, 83 patients were then followed by allergists, 40 by non-allergists, and 86 were lost to followup. Findings. There was no statistically significant difference in patient characteristics of asthma at baseline, except that those followed by allergists had a significant increase in the use of oral steroids. There was a significant difference in favor of the allergy followup group for decrease in hospitalization rate and emergency room visits. In terms of medication, there was no significant difference in the use of theophylline, beta2-agonists, or home nebulizers, but there was a statistically significant increase in the use of cromolyn sodium and inhaled steroids, the use of spacers for the metered-dose inhalers, use of home peak flow monitoring, and a decreased incidence of intensive care admissions. Interestingly, there was no change in pets or smoking in the children's environment. Reviewer's Comments. This study suggests that the followup of asthmatics by an allergist is superior to the non-allergist.

Perbedaan sensitivitas tetes telinga antibiotik terhadap Pseudomonas aeruginosa pada otitis media supuratif kronik

2012 ◽  
Vol 42 (2) ◽  
Author(s):  
Anton Budhi Darmawan ◽  
Dwi Utami Anjarwati
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Otitis Media ◽  
Chronic Suppurative Otitis Media ◽  
Test Results ◽  
Sectional Study ◽  
Suppurative Otitis Media ◽  
Number Of Patients ◽  
Significant Difference ◽  
Cochran Test ◽  
Post Hoc

Background: Chronic suppurative otitis media (CSOM) is one infectious disease of the middle ear, most commonly caused by Pseudomonas aeruginosa. A high number of patients come to the ENT outpatient clinic with active benign type of CSOM. The bacteria Pseudomonas aeruginosa is capable of producing biofilm which protects itself from penetration of antibiotics, and therefore creates resistance towards antibiotics and difficult to eradicate. Objective: The aim of this study was to compare the sensitivity levels of chloramphenicol, polymyxin-neomycin, cyprofloxacin and ofloxacine against Pseudomonas aeruginosa in patients with active benign type CSOM in ENT clinic. Method: The method used was across sectional study on 25 patients, from August 2010 until December 2010. Samples were taken withear swab and then put on sensitivity test to chloramphenicol, polymyxin-neomycin, cyprofloxacin andofloxacine using the diffusion disc method. The analysis used in this study was Cochran test. Results: Results showed a significant difference in sensitivity among chloramphenicol (38,70%), polymyxinneomycin(83,87%),cyprofloxacin(90,32%)andofloxacin(58,06%)withp=0,000(p<0,05).PostHocanalysisusing the Mc Nemar indicated that there were significant differences in sensitivity betweenpolymyxin-neomycin to chloramphenicol with p=0,000 (p<0,05), ciprofloxacin to chloramphenicol andciprofloxacin to ofloxacine with p= 0,002, but there were no significant differences between cyprofloxacinto polymyxin-neomycin with p=0,687, polymyxin-neomycin to ofloxacin p=0.057 and ofloxacin tochloramphenicol p=0,109.   There were significant differences in antibiotic ear dropssensitivity to Pseudomonas aeruginosa in patients with active benign type of CSOM. Cyprofloxacin andpolymyxin-neomycin were more sensitive than ofloxacin and chloramphenicol. Keywords: Pseudomonas aeruginosa, active benign type of chronic suppurative otitis media, antibioticear drops.  Abstrak :  Latar belakang: Otitis media supuratif kronik (OMSK) merupakan penyakit infeksi kronik telinga tengah yang sering dijumpai di klinik THT. Penyebab tersering OMSK adalah bakteri Pseudomonasaeruginosa. Pseudomonas aeruginosa mempunyai kemampuan untuk membentuk biofilm yangmelindunginya dari penetrasi antibiotik sehingga menimbulkan resistensi terhadap antibiotik dan sulituntuk eradikasinya. Tujuan: Untuk mengetahui perbandingan tingkat sensitivitas kloramfenikol,polimiksin-neomisin, ciprofloksasin dan ofloksasin terhadap isolat Pseudomonas aeruginosa padapasien OMSK benigna aktif di klinik THT RSMS. Metode: Metode yang digunakan adalah crosssectional terhadap 29 pasien OMSK di klinik THT RSMS periode bulan Agustus 2010 - Desember2010. Pengambilan sampel dilakukan dengan swab telinga. Uji sensitivitas terhadap kloramfenikol,polimiksin-neomisin, ciprofloksasin dan ofloksasin dilakukan dengan metode cakram secara difusi.Analisis yang digunakan dalam penelitian ini adalah Cochran dan analisis post hoc. Hasil: Didapatkansensitivitas kloramfenikol sebesar 38,70%, polimiksin-neomisin sebesar 83,87%, ciprofloksasin sebesar90,32% dan ofloksasin sebesar 58,06% dengan p=0,01 (P<0,05), yang menunjukkan adanya perbedaansensitivitas yang bermakna antara kloramfenikol, polimiksin-neomisin, ciprofloksasin dan ofloksasinterhadap Pseudomonas aeruginosa. Analisis post hoc menggunakan Mc Nemar menunjukkan bahwaterdapat perbedaan sensitivitas yang bermakna antara tetes telinga polimiksin-neomisin terhadapkloramfenikol, dan ciprofloksasin terhadap kloramfenikol p=0,000 (p<0,05), serta terdapat perbedaanyang bermakna antara tetes telinga ciprofloksasin terhadap ofloksasin, p=0,002, tetapi tidak terdapatperbedaan yang bermakna antara ciprofloksasin terhadap polimiksin-neomisin, p=0,687, polimiksinneomisinterhadap ofloksasin p=0,057, dan kloramfenikol terhadap ofloksasin p=0,109. Kesimpulan:Terdapat perbedaan sensitivitas yang bermakna tetes telinga antibiotik terhadap Pseudomonas aeruginosa pada pasien OMSK benigna aktif. Ciprofloksasin dan polimiksin-neomisin tetes telinga mempunyai sensitivitas yang lebih baik dibanding ofloksasin dan kloramfenikol. Kata kunci: Pseudomonas aeruginosa, otitis media supuratif kronik, tetes telinga antibiotik 

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