Management Landscape of Pediatric Hidradenitis Suppurativa

2021 ◽  
pp. 1-4
Author(s):  
Justine R. Seivright ◽  
Erin Collier ◽  
Tristan Grogan ◽  
Terri Shih ◽  
Marcia Hogeling ◽  
...  
Keyword(s):  
Primary Care ◽  
Hidradenitis Suppurativa ◽  
Chart Review ◽  
Age Of Onset ◽  
Severe Disease ◽  
Retrospective Chart Review ◽  
Primary Care Providers ◽  
Care Providers ◽  
Delay In Diagnosis ◽  
Mean Delay

<b><i>Introduction:</i></b> Pediatric hidradenitis suppurativa (HS) is an understudied condition, and the literature describing the provider landscape for this disease is limited. We aim to characterize healthcare utilization in a cohort of pediatric HS patients at an academic institution. <b><i>Methods:</i></b> Patients diagnosed with HS before age 18 were identified via retrospective chart review using ICD-9/10 codes for HS. Data on demographics and HS providers were collected. <b><i>Results:</i></b> We found that half of the pediatric HS patients first presented to primary care with their HS symptoms. There was a mean delay in diagnosis of 2 years. Dermatologists and pediatricians were the principal HS care providers, and dermatologists most frequently prescribed treatment or procedures (63%). We also found a low rate of utilization of the HS specialty clinic (11%). Females, patients with more severe disease, and patients with earlier age of onset were more likely to be seen by a dermatologist. <b><i>Conclusions:</i></b> Dermatologists play a pivotal role in pediatric HS management as principal care providers for patients. Increasing HS awareness among primary care providers, including pediatricians, is critical for early diagnosis and initiation of treatment.

Combination Therapies for Hidradenitis Suppurativa: A Retrospective Chart Review of 31 Patients

2019 ◽  
Vol 23 (3) ◽  
pp. 270-276 ◽  
Author(s):  
Meghan L. McPhie ◽  
Alanna C. Bridgman ◽  
Mark G. Kirchhof
Keyword(s):  
Disease Severity ◽  
Hidradenitis Suppurativa ◽  
Chart Review ◽  
Small Sample Size ◽  
Demographic Data ◽  
Severe Disease ◽  
Treatment Protocol ◽  
Retrospective Chart Review ◽  
Small Sample ◽  
Combination Therapies

Background: Although a variety of medical and surgical interventions exist for the treatment of hidradenitis suppurativa (HS), it remains a challenging disease to manage because of its variable presentation and unpredictable clinical course. Apart from the combination of clindamycin and rifampin, the success of other combination therapies is largely unknown. Objectives: The goal of our study was to examine the clinical utility of various combination therapies for the treatment of HS. Methods: We conducted a qualitative retrospective chart review of 31 patients with dermatologist-diagnosed HS who were seen at an academic teaching hospital between 2014 and 2018. Demographic data, disease location, disease severity, and treatment protocol were retrieved for analysis. Hurley stage was used to classify disease severity on initial presentation, and the International Hidradenitis Suppurativa Severity Score System (IHS4) was used to track changes across visits. Results: Of the 31 patients (Mage = 37.7 years; 67.7% female) included in the study, 6 (19.4%), 11 (35.5%), and 14 (45.2%) patients were classified as Hurley stages I, II, and III, respectively. Although no statistical results are provided because of the small sample size, we have identified several drug combinations that show promising clinical response for patients with HS based on their IHS4 score, such as isotretinoin/spironolactone for mild disease, isotretinoin or doxycycline with adalimumab for moderate disease, and cyclosporine/adalimumab for severe disease. Conclusions: This preliminary work demonstrates that HS treatment with combination therapy appears to be a promising method of disease management.

scholarly journals 323. Fragility Fracture Risk in HIV: Awareness Among Primary Care Providers

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S171-S171
Author(s):  
Anne Abbate ◽  
Lisa Chirch ◽  
Michael Christopher. Thompson ◽  
Dorothy Wakefield ◽  
Faryal Mirza ◽  
...  
Keyword(s):  
Primary Care ◽  
Logistic Regression ◽  
Fracture Risk ◽  
Fragility Fracture ◽  
Chart Review ◽  
Assessment Tool ◽  
Primary Care Providers ◽  
Care Providers ◽  
Post Intervention ◽  
Hiv Patients

Abstract Background Recommendations on screening HIV-infected (+) patients for bone disease exist. We sought to characterize awareness of and adherence to HIV-specific recommendations and assess risk factors for fracture in this population. Methods Primary care provider (PCP) and ID specialist awareness of screening recommendations was assessed using an anonymous electronic survey. We conducted interviews of 45 HIV+ patients and chart review. We calculated risk using the fracture risk assessment tool (FRAX). Email notifications were sent if an indication dual-energy x-ray absorptiometry (DXA) scans was identified. Chart review was repeated 12 months later to assess response. Statistical methods included chi-square and Fisher’s exact test for categorical data, and t-tests or Wilcoxon rank-sum tests for continuous data. A multivariate logistic regression examined the relationship between adult fragility fractures and covariates. Results No immunologic or virologic factors or exposure to specific antiretroviral therapies (ART) were associated with FFX (Table 1). FRAX score (hip, major osteoporotic fracture) successfully predicted FFX history (P = 0.002, P = 0.001, respectively). Overall, 35 (78%) patients qualified for DXA; 23 (66%) were men, only 8 (23%) had a previous DXA. Following provider notification, an additional 5 patients had DXA ordered. DXA was recommended for all patients with FFX, compared with 68% without a fracture (P = 0.02). In logistic regression modeling, increasing age, male sex, and months of ART therapy were associated with FFX (Table 2). Twenty-seven providers responded to the pre-intervention survey, of whom only 35% were aware of screening recommendations for HIV+ patients. Of the 18 providers who responded post-intervention, 63% were aware of these recommendations (Table 3). Conclusion A brief educational intervention resulted in increased awareness of HIV-specific screening recommendations, but this translated into adherence to a lesser extent. HIV+ men were more likely to have a history of fragility fracture compared with females. No specific ART or immunologic marker predicted fracture risk or history. Fostering a greater understanding of unique characteristics and risks in this population is crucial to ensure appropriate preventive care. Disclosures All authors: No reported disclosures.

Barriers To Diagnosis In Myeloproliferative Neoplasms

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 5248-5248
Author(s):  
Raymond H L Yip ◽  
Lynda M Foltz
Keyword(s):  
Primary Care ◽  
Median Time ◽  
Primary Care Physicians ◽  
Myeloproliferative Neoplasms ◽  
Diagnostic Testing ◽  
Primary Care Providers ◽  
Care Providers ◽  
Average Delay ◽  
Delay In Diagnosis ◽  
Hemorrhagic Complications

Abstract Background Timely diagnosis of patients (pts) with polycythemia vera (PV) and essential thrombocythemia (ET) is important given the risks of thrombotic and hemorrhagic complications, disease progression and associated symptoms.  Pts often present initially to primary care physicians, who may have limited previous experience with PV/ET given the low prevalence.  Little is known about the timeliness of referral or diagnostic testing after identification of abnormal blood test results or if delays in diagnosis affect patient outcomes. Objectives To determine the time from initial lab abnormality to referral, diagnosis and treatment of pts with PV and ET. Methods Pts at a single Canadian academic institution newly diagnosed with PV or ET from Jan 2010 to May 2013 were identified.  Retrospective data was collected including demographics, lab values, diagnostic testing and treatments. Results Demographics: 26 pts with PV and 34 with ET were identified.  Median age was 67.5 (44-89) y for PV and 66.5 (34-92) y for ET. Delay in Referral and Diagnosis: 98% of pts were referred directly to a hematologist by their primary care physician.  69% of PV pts were referred within 30 days and 92% within 90 days of initial lab abnormality.  Median time from referral to diagnosis was 98 (0-221) days.  41% of ET pts were referred within 30 days and 56% within 90 days of initial lab abnormality.  Median time from referral to diagnosis was 121 (8-638) days.  PV pts were referred sooner, median 20 (0-187) days, than ET pts, median 67 (0-3743) days (p=0.01).  The median delay from referral until hematology assessment was 51 days for PV compared to 78 days for ET (p=0.08).  After assessment by the hematologist, it required a median of 35 days to make a diagnosis of PV and 25 days for a diagnosis of ET (p=0.31). Referrals by platelet (plt) count: There was a trend to earlier referral of ET pts with higher platelet (plt) counts.  15/20 (75%) ET pts with plt count >600 were referred within 90 days of initial lab abnormality whereas only 4/14 (29%) of pts with plt count 450-600 were referred within 90 days (p=0.056). Treatment of PV pts: 22/26 (85%) pts received phlebotomy at or after referral at the direction of a hematologist.  Average delay in referral (and phlebotomy initiation) for patients treated with phlebotomy was 32 days.  13/26 (50%) pts were initiated on treatment with hydroxyurea within 2 months of diagnosis.  Average delay in diagnosis (and hydroxyurea initiation) in this subgroup was 142 days.   11/26 (42%) pts were receiving ASA prior to the initial hematological consultation.  12/26 (46%) were initiated on ASA at or shortly after hematological consultation.  Average delay to hematology consultation (and ASA initiation) was 90 days in this subgroup. Treatment of ET pts: 8/34 (24%) pts were initiated on treatment with hydroxyurea within 2 months of diagnosis.  Average delay in diagnosis (and hydroxyurea initiation) in this subgroup was 790 days. 17/34 (50%) pts were receiving ASA prior to the initial hematological consultation.  15/34 (44%) were initiated on ASA at or shortly after hematological consultation.  Average delay to hematology consultation (and ASA initiation) was 355 days in this subgroup. No thrombotic or major hemorrhagic complications occurred in any PV/ET pts between the time of initial lab abnormality and diagnosis. Discussion This study demonstrates the marked variability in time from lab abnormality to referral and diagnosis for PV/ET pts.  Primary care providers were more likely to promptly refer PV pts than ET pts, and particularly tended to overlook referral and investigation of pts with modestly elevated plt counts of 450-600.  This is a concern, as risk of thrombosis in ET pts is independent of plt count.  Delays were also apparent in wait times for hematology appointments and subsequent diagnostic tests.   The delay in diagnosis led to a delay in initiation of therapy to reduce risk of thrombosis in both PV and ET pts.  Possible strategies to expedite diagnosis include targeted education of primary care physicians focusing on identification of lab features of PV/ET.  Directive comments on lab reports by community hematopathologists may also facilitate prompt referral and investigation. Disclosures: No relevant conflicts of interest to declare.

Inpatient infusion treatments of headache in patients with chronic migraine and a reported history of head trauma and endocrine co-morbidities

Neurology ◽  
2020 ◽  
Vol 95 (20 Supplement 1) ◽  
pp. S14.2-S14
Author(s):  
Nina Yakovlevna Riggins ◽  
Henna Sawhney ◽  
Annika Ehrlich ◽  
Mira Parekh ◽  
Morris Levin
Keyword(s):  
Primary Care ◽  
Chronic Migraine ◽  
Head Trauma ◽  
Retrospective Chart Review ◽  
Primary Care Providers ◽  
Infusion Therapy ◽  
Case Conference ◽  
Care Providers ◽  
Lifestyle Modifications ◽  
History Of

ObjectiveTo evaluate if inpatient infusion treatments for patients with chronic migraine (CM) and history of head trauma and endocrine abnormalities can lead to headache improvement.BackgroundMany patients with CM and history of head trauma have endocrine co-morbidities that can interfere with successful management of headache. In this study, we evaluated if inpatient infusion treatments improved headache outcomes for this patient population.Design/MethodsRetrospective chart review of patients admitted and treated with 4–5 days of intravenous (IV) Dihydroergotamine (DHE), Chlorpromazine, or Valproate for headache. All cases were presented at the Headache Center Case Conference before admission, and plans for addressing co-morbidities were discussed with appropriate specialists and primary care providers. Co-morbidities addressed included diabetes mellitus, pituitary and thyroid dysfunction and endometriosis. During admission, vital signs and appropriate lab work such as serum glucose, thyroid, liver and renal function were monitored. Lifestyle recommendations provided during admission and appropriate follow ups after discharge were arranged with Headache Clinic, primary care, and specialists, when applicable.Results53 patients with CM were included in the analysis. 12 (22.6%) of the 53 patients had both reported history of head trauma and endocrine comorbidity. Of these 12 patients, 8 (66.7%) had improvement in headache up to 6 weeks after admission. Of the 8 that improved, 6 (75%) received DHE and 2 (25%) received Chlorpromazine.ConclusionsInpatient infusion treatments for patients who have CM with history of head trauma and endocrine abnormalities can lead to headache improvement, potentially due to IV infusion therapy along with holistic approaches which include addressing co-morbidities and education on lifestyle modifications. Future studies are needed to evaluate if specific endocrine system dysfunction can predict outcomes from repetitive infusion therapy for persistent headache in patients with CM and a reported history of head trauma.

scholarly journals Assessing the utility of screening electrocardiograms in pediatric patients following COVID-19

2021 ◽  
pp. 1-19
Author(s):  
Ari J. Gartenberg ◽  
Travus J. White ◽  
Khoi Dang ◽  
Maully Shah ◽  
Stephen M. Paridon ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Stress Test ◽  
Severe Disease ◽  
Retrospective Chart Review ◽  
Exercise Stress Test ◽  
Primary Care Providers ◽  
Exercise Stress ◽  
Care Providers ◽  
Premature Ventricular Contractions ◽  
Small Cohort

Abstract Objective: To determine the utility of screening electrocardiograms after SARS-CoV-2 infection among pediatric patients in detecting myocarditis related to COVID-19. Study Design: A retrospective chart review was performed at a large pediatric academic institution to identify patients with prior SARS-CoV-2 infection who received a screening electrocardiogram by their primary care providers and were subsequently referred for outpatient cardiology consultation due to an abnormal electrocardiogram. The outcomes were the results from their cardiology evaluations, including testing and final diagnoses. Results: Among 46 patients, during their preceding COVID-19 illness, the majority had mild symptoms, four were asymptomatic, and one had moderate symptoms. The median length of time from positive SARS-CoV-2 test to screening electrocardiogram was 22 days, and many electrocardiogram findings that prompted cardiology consultation were normal variants in asymptomatic adolescent athletes. Patients underwent frequent additional testing at their cardiology appointments: repeat electrocardiogram (72%), echocardiogram (59%), Holter monitor (11%), exercise stress test (7%), and cardiac MRI (2%). Five patients were incidentally diagnosed with congenital heart disease or structural cardiac abnormalities, and three patients had conduction abnormalities (premature atrial contractions, premature ventricular contractions, borderline prolonged QTc), although potentially incidental to COVID-19. No patients were diagnosed with myocarditis or ventricular dysfunction. Conclusion: In a small cohort of pediatric patients with prior COVID-19, who were primarily either asymptomatic or mildly symptomatic, subsequent screening electrocardiograms identified various potential abnormalities prompting cardiology consultation, but no patient was diagnosed with myocarditis. Larger multi-center studies are necessary to confirm these results and to evaluate those with more severe disease.

Analysis of Teledermatology Consults in a County Hospital Setting (Preprint)

2021 ◽  
Author(s):  
Colton Funkhouser ◽  
Martha E Funkhouser ◽  
Jay E Wolverton ◽  
Stephen E Wolverton ◽  
Toby Maurer
Keyword(s):  
Primary Care ◽  
Chart Review ◽  
Hospital Setting ◽  
Primary Care Providers ◽  
County Hospital ◽  
Care Providers ◽  
Seborrheic Keratosis ◽  
Non Melanoma Skin Cancer ◽  
Skin Conditions ◽  
Melanoma Skin

BACKGROUND Teledermatology consults are increasingly used by primary care providers for diagnosis and triage of skin conditions. However, there are few studies that analyze which conditions are most commonly sent for teledermatology consultation and which of those are most often referred for an in-person visit. OBJECTIVE We aim to examine teledermatology consults sent from primary care providers at a county hospital to identify common diagnoses that prompted use of the teledermatology system and determine which diagnoses required an in-person visit after teledermatology evaluation. METHODS A retrospective analysis was conducted based on 450 teledermatology consults from primary care providers at a county health system. Chart review was performed to identify the diagnoses made by the teledermatologist for each consult and which diagnoses prompted an in-person visit after teledermatology evaluation. RESULTS Our analysis captured 471 diagnoses. Seborrheic keratosis was the most frequent diagnosis (10.2%) prompting teledermatology consultation. Some diagnoses, such as non-melanoma skin cancer, actinic keratosis, and alopecia areata required an in-person visit after each teledermatology consult. Others, such as atopic dermatitis and lentigo, did not require an in-person visit and were able to be managed by teledermatology each time. Overall, 39.9% of diagnoses seen via teledermatology were referred for an in-person visit. CONCLUSIONS Teledermatology is valuable in managing many dermatologic conditions that present to primary care, while serving as an effective triage tool for more complex conditions or concern for malignancy. Conditions that required procedural management or involved the scalp also frequently required an in-person referral after TD evaluation. The lowest proportion of referrals for an in-person visit occurred in banal conditions without concern for malignancy.

scholarly journals Evaluation of provider response to positive depression screenings and physician attitudes on integrating psychiatric pharmacist services in primary care settings

2018 ◽  
Vol 8 (1) ◽  
pp. 28-32 ◽  
Author(s):  
Brittany H. Denson ◽  
Rory E. Kim
Keyword(s):  
Primary Care ◽  
Los Angeles ◽  
Suicide Ideation ◽  
Retrospective Chart Review ◽  
Primary Care Providers ◽  
Physician Attitudes ◽  
Care Providers ◽  
Primary Care Clinics ◽  
Primary Care Settings ◽  
Provider Survey

Abstract Introduction: The aim of this study was to identify potential gaps in the management of depression and assess the perceptions of primary care providers (PCPs) toward integrating psychiatric pharmacists into primary care settings. Method: This was a retrospective chart review of patients ≥18 years of age seen in primary care clinics in Los Angeles County with a documented annual health screening (AHS) between January 1, 2015, through December 31, 2015. Primary outcomes were number and percentage of patients screened for depression with patient health questionnaire (PHQ) assessments, positive depression screenings, and interventions made for positive depression screenings. Secondary outcomes were PCPs' perceptions on management of depression, use of AHS, and roles for psychiatric pharmacists through evaluation of provider survey. Results: Of the patients who received an AHS (n = 6797), 63% received PHQ assessments. Of 145 individuals with a positive PHQ-2, 69% had a positive PHQ-9. Greater than 50% of individuals with a positive PHQ-9 had no preexisting depression diagnosis. Seventy-six percent of individuals with a positive PHQ-9 and 78% with reported suicide ideation had no documented intervention. The majority of providers reported there is a role for psychiatric pharmacists in primary care. Discussion: Gaps in the management of depression were identified. Although depression screenings were performed for the majority of individuals receiving an AHS, no documented interventions were made for most of those individuals who screened positive for depression. Primary care clinics could benefit from psychiatric pharmacist involvement in depression screening and follow-up processes.

The Perspective of Older Men With Depression on Suicide and Its Prevention in Primary Care

Crisis ◽  
2018 ◽  
Vol 39 (5) ◽  
pp. 397-405 ◽  
Author(s):  
Steven Vannoy ◽  
Mijung Park ◽  
Meredith R. Maroney ◽  
Jürgen Unützer ◽  
Ester Carolina Apesoa-Varano ◽  
...  
Keyword(s):  
Primary Care ◽  
Low Socioeconomic Status ◽  
Thematic Analysis ◽  
Older Men ◽  
Primary Care Providers ◽  
Depression Treatment ◽  
Care Providers ◽  
Low Socioeconomic ◽  
Self Image ◽  
The Impact

Abstract. Background: Suicide rates in older men are higher than in the general population, yet their utilization of mental health services is lower. Aims: This study aimed to describe: (a) what primary care providers (PCPs) can do to prevent late-life suicide, and (b) older men's attitudes toward discussing suicide with a PCP. Method: Thematic analysis of interviews focused on depression and suicide with 77 depressed, low-socioeconomic status, older men of Mexican origin, or US-born non-Hispanic whites recruited from primary care. Results: Several themes inhibiting suicide emerged: it is a problematic solution, due to religious prohibition, conflicts with self-image, the impact on others; and, lack of means/capacity. Three approaches to preventing suicide emerged: talking with them about depression, talking about the impact of their suicide on others, and encouraging them to be active. The vast majority, 98%, were open to such conversations. An unexpected theme spontaneously arose: "What prevents men from acting on suicidal thoughts?" Conclusion: Suicide is rarely discussed in primary care encounters in the context of depression treatment. Our study suggests that older men are likely to be open to discussing suicide with their PCP. We have identified several pragmatic approaches to assist clinicians in reducing older men's distress and preventing suicide.

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