scholarly journals Effectiveness of minimum retesting intervals in managing repetitive laboratory testing: experience from a Croatian university hospital

2019 ◽  
Vol 29 (3) ◽  
pp. 531-558 ◽  
Author(s):  
Ivana Lapić ◽  
Dunja Rogić ◽  
Mirjana Fuček ◽  
Ružica Galović
Keyword(s):  
Complete Blood Count ◽  
Cost Savings ◽  
High Volume ◽  
University Hospital ◽  
Reactive Protein ◽  
Limited Effectiveness ◽  
Reagent Cost ◽  
Mri Protocol ◽  
One Year ◽  
The One

Introduction: Inappropriate laboratory retesting can be addressed by implementing minimum retesting intervals (MRI). The aim of our study was to assess the effectiveness of the implemented MRI protocol for inpatients. Materials and methods: Minimum retesting intervals were applied for 53 laboratory tests. The overall reduction of test requests, reduction in charges and reagent cost savings, frequency of MRI alert appearance as well as the rate of MRI acceptance and ignorance were calculated for a one-year period. Reasons for violating the MRI rule, hospital departments that contributed mostly to MRI rule violation, and the frequency of MRI violations between routine and emergency laboratory were evaluated. Results: During the one-year period, 106,780 requests violated the MRI rule, which corresponds to 14.8% of all requests received. 13,843 requests were cancelled, yielding a 1.9% reduction of requested tests. High-volume tests, namely complete blood count, C-reactive protein, alanine aminotransferase, gamma-glutamyltransferase and total bilirubin, accounted for 65% of all generated alerts and had the highest alert ignorance (>85%). The highest cancellation rate was observed for tumor markers and autoimmunity tests, for most being at least 50%. Annual charge reduction was 62,641 EUR while reagent cost savings were 11,408 EUR. Tests performed in the emergency laboratory had a higher alert appearance than the same routine tests. The most common reason for MRI violation was clinical justification based on the patient’s condition. Most frequently ignored MRI alerts were in the intensive care unit. Conclusion: MRI implementation showed limited effectiveness in reducing testing repetition and achieving financial savings, yet provided the basis for future improvements.

P2754Streptococcal infective endocarditis: distribution of species and their prognosis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Chamat ◽  
A Dahl ◽  
C Hassager ◽  
M Arpi ◽  
L Oestergaard ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Electronic Device ◽  
Species Level ◽  
University Hospital ◽  
Heart Valve Disease ◽  
Significant Difference ◽  
Streptococcal Species ◽  
Species Groups ◽  
One Year ◽  
The One

Abstract Background Infective endocarditis (IE) is frequently caused by streptococcal species. However, there is limited knowledge about the relationship between different streptococcal species and IE, and their associated outcomes. Purpose To examine the prevalence of streptococci at species level in IE, and to relate these different species to outcomes. Methods From 2002–2012 we prospectively collected consecutive patients with IE admitted to two tertiary heart centres covering a catchment area of 2.4 million people. The registry comprises 915 IE patients, 366 (40%) with streptococcal IE. Based on phylogenetic relationship, streptococcal species were classified into seven main groups: Mitis, Bovis, Mutans, Anginosus, Salivarius, Pyogenic and Nutritionally Variant Streptococcus (NVS). Classification at species level was not possible in 51 patients, who were excluded. Complications and prognosis of streptococcal IE were compared between the subgroups, and at species level. Results We included 315 patients with streptococcal IE. Mean age was 63 (IQR 52–76) years, and most were men (67%). A total of 115 patients (37%) had a previous heart valve disease, 58 (18%) had a prosthetic valve, 22 (7%) had previously had IE and 29 (9%) had a cardiac electronic device. With 148 episodes (47%) the Mitis group was the most common cause of IE. Other frequent groups were the Pyogenic group and the Bovis group, accounting for 66 (21%) and 51 (16%) of the cases, respectively. Surgery was carried out in 55% (n=173) of all cases. Patients infected with S. pneumoniae or S. agalactiae had a significantly higher rate of surgery, 72.2% (n=13) and 71.9% (n=23) respectively, whereas the Bovis group had a significantly lower rate, 35.5% (n=18) (p=0.048). The aortic valve was infected in 137 patients (43.5%), mitral valve in 105 patients (33.3%) and both valves were infected in 53 patients (16.8%). Twenty patients (6.3%) had right-sided IE, including pacemaker lead IE. There was no significant difference between the species subgroups regarding type of infected valve. Embolization and osteitis were observed in 76 (24.1%) and 30 (9.5%) patients, respectively. There was no significant difference between the species groups, as was the case with mortality: 23 patients (7.3%) died in-hospital and the one-year mortality was 16% (n=50). Distribution of streptococcal IE Conclusion Species of the Mitis group were the most frequent Streptococci causing IE. Patients infected with S. pneumonia or S. agalactiae had significantly higher rate of surgery, and patients infected with S. bovis group had lower rate of surgery. There was no significant difference in rate of complications such as abscesses, embolization, osteitis or mortality between the streptococcal species. Acknowledgement/Funding Supported by grants from Herlev-Gentofte University Hospital Research Foundation

scholarly journals Prosthetic-joint Infections: Mortality Over The Last 10 Years

2019 ◽  
Vol 4 (4) ◽  
pp. 198-202 ◽  
Author(s):  
Arnaud Fischbacher ◽  
Olivier Borens
Keyword(s):  
Surgical Treatment ◽  
University Hospital ◽  
Cumulative Mortality ◽  
Risk Of Death ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
Significant Difference ◽  
One Year ◽  
The One

Abstract. Background: There is a constant increase of joint arthroplasties to improve the quality of life of an ever-aging population. Although prosthetic-joint infections are rare, with an incidence of 1-2%, they represent a serious complication in terms of morbidity and mortality. Infection related mortality is known to be approaching 8% at one year. The aim of this retrospective study is to reassess the one and two-year mortality over the last ten years.Methods: Patients treated for prosthetic joint infection at the University Hospital of Lausanne (Switzerland) between 2006 and 2016 were included. The one and two-year cumulative mortality depending on sex, age, type of prosthesis, infecting organism and type of surgical treatment were computed.Results: 363 patients (60% hips, 40% knees) were identified with a median age of 70 years. The one-year cumulative mortality was 5.5% and it was 7.3% after two years. No difference was seen between hip and knee prostheses, but the mortality was higher in men than in women and increased with age. Furthermore, there was a significant difference depending of the germ with enterococci infections associated with a higher risk of death. Finally, patients treated with a one-stage or two-stage exchange had a lower mortality than those treated with debridement and retention.Conclusion: The mortality is still high and differs according to sex, age, infecting organism and type of surgical treatment. There is a need of studies to improve the management of patients at risk of increased mortality.

Acceptance, Prevalence and Indications for Robot-Assisted Laparoscopy - Results of a Survey Among Urologists in Germany, Austria and Switzerland

2015 ◽  
Vol 95 (3) ◽  
pp. 336-345 ◽  
Author(s):  
Florian Imkamp ◽  
Thomas R.W. Herrmann ◽  
Yuri Tolkach ◽  
Sebastian Dziuba ◽  
Jens U. Stolzenburg ◽  
...  
Keyword(s):  
Practice Patterns ◽  
Response Rate ◽  
Tertiary Care ◽  
High Volume ◽  
Robotic Systems ◽  
Survey Results ◽  
One Year ◽  
The One ◽  
Insight Into ◽  
Robotic Assisted Laparoscopy

Background: Robotic-assisted laparoscopy (RAL) is being widely accepted in the field of urology as a replacement for conventional laparoscopy (CL). Nevertheless, the process of its integration in clinical routines has been rather spontaneous. Objective: To determine the prevalence of robotic systems (RS) in urological clinics in Germany, Austria and Switzerland, the acceptance of RAL among urologists as a replacement for CL and its current use for 25 different urological indications. Materials and Methods: To elucidate the practice patterns of RAL, a survey at hospitals in Germany, Austria and Switzerland was conducted. All surgically active urology departments in Germany (303), Austria (37) and Switzerland (84) received a questionnaire with questions related to the one-year period prior to the survey. Results: The response rate was 63%. Among the participants, 43% were universities, 45% were tertiary care centres, and 8% were secondary care hospitals. A total of 60 RS (Germany 35, Austria 8, Switzerland 17) were available, and the majority (68%) were operated under public ownership. The perception of RAL and the anticipated superiority of RAL significantly differed between robotic and non-robotic surgeons. For only two urologic indications were more than 50% of the procedures performed using RAL: pyeloplasty (58%) and transperitoneal radical prostatectomy (75%). On average, 35% of robotic surgeons and only 14% of non-robotic surgeons anticipated RAL superiority in some of the 25 indications. Conclusions: This survey provides a detailed insight into RAL implementation in Germany, Austria and Switzerland. RAL is currently limited to a few urological indications with a small number of high-volume robotic centres. These results might suggest that a saturation of clinics using RS has been achieved but that the existing robotic capacities are being utilized ineffectively. The possible reasons for this finding are discussed, and certain strategies to solve these problems are offered.

scholarly journals Clinical and microbiological profile of adult inpatients with community acquired pneumonia in Ilorin, North Central, Nigeria

2020 ◽  
Vol 20 (4) ◽  
pp. 1655-68
Author(s):  
Olutobi Babatope Ojuawo ◽  
Olufemi Olumuyiwa Desalu ◽  
Ademola Emmanuel Fawibe ◽  
Ayotade Boluwatife Ojuawo ◽  
Adeniyi Olatunji Aladesanmi ◽  
...  
Keyword(s):  
Complete Blood Count ◽  
Community Acquired Pneumonia ◽  
Systemic Hypertension ◽  
Viral Pathogens ◽  
North Central ◽  
Microbiological Profile ◽  
Predominant Pathogen ◽  
One Year ◽  
The One ◽  
Significant Disease

Background: The optimal management of community acquired pneumonia (CAP) depends on the clinical and microbio- logical profile in the locality. Objectives: To determine the clinical and microbiological profile of patients admitted with CAP in Ilorin, Nigeria. Methods: One hundred and two consenting consecutively selected patients with clinical and radiologic confirmation of CAP were recruited in 12 months. The socio-demographic, physical examination and laboratory/radiologic parameters were documented in a questionnaire. Microbiological evaluation of their sputum was done and blood samples were taken for complete blood count, culture, serum urea and serological evaluation for atypical bacteria and some viral pathogens. Results: CAP constituted 5.9% of the total medical admissions during the one-year study period. The mean age of the pa- tients was 49 ± 22 years with the largest frequency in those aged 65 years and above. The commonest symptoms were short- ness of breath (96.1%) and cough (94.1%), with a median duration of 3 days from symptom onset to admission. Systemic hypertension was the commonest comorbid illness (25/102; 24.5%). Klebsiella pneumoniae was the predominant pathogen iso- lated (20/102; 28.1%). The susceptible antibiotics were Imipenem, Ceftazidime and Ceftriaxone. Intra-hospital mortality was 17.6%. CURB – 65 score of ≥ 2 and the presence of complications of CAP were the independent predictors of mortality. Conclusion: CAP constitutes a significant disease burden in Ilorin, Nigeria. Typical bacteria accounted for over half of the pathogens isolated from the patients with gram negative agents predominating. This highlights a possible shift in the micro- biological profile which could guide empirical treatment. Keywords: Community acquired pneumonia; microbiological profile; Nigeria.

scholarly journals Relation between ultra-sensitive C-reactive protein, diabetes and periodontal disease in patients with and without myocardial infarction

2014 ◽  
Vol 58 (4) ◽  
pp. 362-368 ◽  
Author(s):  
Francina Escobar Arregoces ◽  
Catalina Latorre Uriza ◽  
Juliana Velosa Porras ◽  
Maria Beatriz Ferro Camargo ◽  
Alvaro Ruiz Morales
Keyword(s):  
Myocardial Infarction ◽  
Periodontal Disease ◽  
Complete Blood Count ◽  
Inflammatory Marker ◽  
University Hospital ◽  
Control Group ◽  
Case Group ◽  
Diabetic Patients ◽  
Reactive Protein ◽  
The Impact

Objective: The purpose of this study was to evaluate the impact of diabetes and periodontal disease in us-CRP, an inflammatory marker in patients with and without acute myocardial infarction (AMI). Subjects and methods: A case-control study was conducted in 401 subjects aged between 30 and 75 years, living in Bogotá D.C. (Colombia). Patients arriving at the emergency room of the San Ignacio University Hospital with AMI were included into the case group. The control group was defined as those subjects without AMI. The following blood tests were performed: complete blood count (CBC), glycemia, total cholesterol, triglycerides, cHDL, cLDL, and us-CRP. Patients with infections or antibiotic treatment within the last three months, who had received periodontal treatment within the six months prior to the study entry, had oral ulcerations, or less than seven teeth were excluded from the study. Periodontal disease was diagnosed based on the 1999 Armitage’s classification. Results: The mean us-CRP value found in diabetic patients with severe chronic periodontitis was 5.31 mg/L (SD 6.82), and 2.38 mg/L (SD 4.42) in non-diabetic patients, being statistically significant (p = 0.000). Conclusion: Diabetes had an impact in periodontal disease and us-CRP. In patients with AMI, DM and PD considerably increased the us-CRP.

scholarly journals Delirium: Prevalence and outcome in the very old in 27 medical departments during a one-year prospective study

2021 ◽  
pp. 1-6
Author(s):  
Justus Marquetand ◽  
Leonie Bode ◽  
Simon Fuchs ◽  
Jutta Ernst ◽  
Roland von Känel ◽  
...  
Keyword(s):  
Intensive Care ◽  
Assisted Living ◽  
University Hospital ◽  
Assisted Living Facilities ◽  
Prevalence Rates ◽  
Term Care ◽  
Very Old ◽  
One Year ◽  
The One ◽  
Simple Logistic

Abstract Objective The prevalence and effects of delirium in very old individuals aged ≥80 years have not yet been systematically evaluated. Therefore, this large single-center study of the one-year prevalence of delirium in 3,076 patients in 27 medical departments of the University Hospital of Zurich was conducted. Methods Patient scores on the Delirium Observation Screening scale, Intensive Care Delirium Screening Checklist, Diagnostic and Statistical Manual, 5th edition, and electronic Patient Assessment–Acute Care (nursing tool) resulted in the inclusion of 3,076 individuals in 27 departments. The prevalence rates were determined by simple logistic regressions, odds ratios (ORs), and confidence intervals. Results Of the 3,076 patients, 1,285 (41.8%) developed delirium. The prevalence rates in the 27 departments ranged from 15% in rheumatology (OR = 0.30) to 73% in intensive care (OR = 5.25). Delirious patients were more likely to have been admitted from long-term care facilities (OR = 2.26) or because of emergencies (OR = 2.24). The length of their hospital stay was twice as long as that for other patients. Some died before discharge (OR = 24.88), and others were discharged to nursing homes (OR = 2.96) or assisted living facilities (OR = 2.2). Conclusion This is the largest study to date regarding the prevalence of delirium in patients aged ≥80 years and the medical characteristics of these patients. Almost two out of five patients developed delirium, with a high risk of loss of independence and mortality.

One-year all-cause mortality for 338 patients admitted with epistaxis in a large tertiary ENT centre

2019 ◽  
Vol 133 (06) ◽  
pp. 487-493 ◽  
Author(s):  
M J Corr ◽  
T Tikka ◽  
C M Douglas ◽  
J Marshall
Keyword(s):  
Risk Factors ◽  
Rating Scale ◽  
Performance Status ◽  
University Hospital ◽  
Retrospective Case ◽  
Large Teaching Hospital ◽  
All Cause Mortality ◽  
One Year ◽  
The One ◽  
Overall Mortality

AbstractObjectiveEpistaxis is the most common ENT emergency. This study aimed to assess one-year mortality rates in patients admitted to a large teaching hospital.MethodThis study was a retrospective case note analysis of all patients admitted to the Queen Elizabeth University Hospital in Glasgow with epistaxis over a 12-month period.ResultsThe one-year overall mortality for a patient admitted with epistaxis was 9.8 per cent. The patients who died were older (mean age 77.2 vs 68.8 years; p = 0.002), had a higher Cumulative Illness Rating Scale-Geriatric score (9.9 vs 6.7; p < 0.001) and had a higher performance status score (2 or higher vs less than 2; p < 0.001). Other risk factors were a low admission haemoglobin level (less than 128 g/dl vs 128 g/dl or higher; p = 0.025), abnormal coagulation (p = 0.004), low albumin (less than 36 g/l vs more than 36 g/l; p < 0.001) and longer length of stay (p = 0.046).ConclusionThere are a number of risk factors associated with increased mortality after admission with epistaxis. This information could help with risk stratification of patients at admission and enable the appropriate patient support to be arranged.

Leflunomide and Azathioprine Combination in Refractory Adult-Onset Still's Disease

2005 ◽  
Vol 39 (4) ◽  
pp. 764-767 ◽  
Author(s):  
Ayse Cefle
Keyword(s):  
Adult Onset Still’S Disease ◽  
Adult Onset ◽  
Still’S Disease ◽  
Reactive Protein ◽  
Still's Disease ◽  
Normal Erythrocyte Sedimentation Rate ◽  
One Year ◽  
The One ◽  
Adult Onset Still's Disease

OBJECTIVE: To present a case of Adult-onset Still's disease (ASD) in a patient who was successfully treated with leflunomide and azathioprine. CASE SUMMARY: A 24-year-old woman with ASD was initially treated with indomethacin, corticosteroids, and hydroxychloroquine; there was no clinical improvement. Methotrexate was added to the regimen, followed by azathioprine. The patient still experienced disease flares with this treatment, and cyclophosphamide was started. However, because of persisting disease activity, leflunomide combined with azathioprine was given. Only on this regimen was complete disease control achieved, with a normal erythrocyte sedimentation rate as well as normal C-reactive protein and ferritin levels. No recurrences or adverse effects attributable to leflunomide or azathioprine were observed at the one-year follow-up. DISCUSSION: Clinical experience concerning leflunomide and azathioprine combination in ASD is limited. This combination may be modifying the clinical expression of ASD through its effects on T lymphocyte clonal expansion and production of proinflammatory cytokines. CONCLUSIONS: Leflunomide combined with azathioprine appears to be an effective and safe treatment of ASD.

P2656Real-world Outcomes for STEMI in octogenarians and nonagenarians: A 5-year review from an Irish primary PCI centre

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R Kumar ◽  
C E Homer ◽  
A Buckley ◽  
J Kumar ◽  
C O'conner ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Statistical Significance ◽  
Coronary Intervention ◽  
Nursing Home Care ◽  
University Hospital ◽  
Very Old ◽  
Level Data ◽  
Poor Outcomes ◽  
One Year ◽  
The One

Abstract Background Progress made by modern healthcare has led to improved life expectancy across the globe. This progress, however, also means that individuals are living with more chronic illnesses and co-morbidities than in previous generations. Due to this aging population, we can expect increasing rates of STEMI in octogenarians and nonagenarians in the future. The challenge of older patients with STEMI is that they are particularly high-risk for complications. At present, very little is known about the outcomes of STEMI in the very old population because they were under-represented in previous studies. Many cardiologists around the world have been hesitant in performing primary percutaneous coronary intervention (PPCI) in octogenarians and nonagenarians due to fear of complications and poor outcomes. Purpose To review the trend of octogenarians and nonagenarians presenting with STEMI and to assess the 30-day and 1-year mortality rates. Methods A single-centre retrospective observational study was conducted. All patients presenting with STEMI between January 2012 and December 2017 were reviewed. Individuals aged 80 years or older were included for the purpose of this analysis. Patient level data was collected by chart review and individuals were identified using the local STEMI database. Standard Bayesian statistics were employed for analysis. Results 1,268 patients presented with STEMI during this period. 172 (13.6%) were 80 years or older. Of this subgroup, 159/172 (92.4%) were true STEMI (figure 1). 124/159 (77.9%) patients were brought to the catheterization lab and 35/159 (22%) were managed medically on the ward.107/159 (67.29%) were treated with PPCI. Patients in the PPCI group had a 30-day mortality rate of 20.6% while those in the medically managed group had a mortality rate of 37.1%; with a trend towards statistical significance (p=0.07). The one-year mortality rate in patients treated with PPCI was 22.4% which was significantly lower than those who received medical management 48.6% (p=0.005). Conclusions This review demonstrates that there is a high mortality rate with STEMI in those aged 80 years or above, however, patients who are treated with PPCI tend to do better and have a significantly lower mortality rate at 1-year. The incidence of STEMI in the very old cohort is likely to continue to rise and this may prove challenging. PPCI remains the most feasible treatment approach towards STEMI and this should not be biased based on age, however, interventionists will need to take into account patient suitability on a case-by case basis. Octogenarians who undergo angiography and PPCI as required have 77.6% survival at 1 year (figure 1) with 92.4% likelihood of going home and don't require long term nursing home care. Acknowledgement/Funding University Hospital Limerick

scholarly journals P536 Effectiveness, safety and persistence of treatment with ustekinumab in a cohort of patients with moderate-to-severe refractory Crohn’s Disease

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S509-S510
Author(s):  
A I Morales Bermúdez ◽  
A M Bravo Aranda ◽  
M Martinez Burgos ◽  
R Olmedo Martín
Keyword(s):  
Clinical Remission ◽  
Real Life ◽  
Fecal Calprotectin ◽  
University Hospital ◽  
Reactive Protein ◽  
Kaplan Meier ◽  
Regional University ◽  
History Of ◽  
One Year

Abstract Background Ustekinumab has proved its efficacy and safety in moderate-to-severe Crohn′s disease (CD). However, the real practice setting differs from clinical trials. Our aim was to evaluate the effectiveness and safety of ustekinumab in a cohort of real-life practice patients with CD mostly refractory to anti-TNF α agents. Methods Observational retrospective single-center study. All patients undergoing treatment with ustekinumab at the Digestive Diseases Department of the Regional University Hospital of Málaga and at least 16 weeks of follow-up after induction were included. The primary outcome was steroid-free clinical remission (Harvey-Bradshaw Index ≤4) at 24 and 52 weeks. Secondary objectives were combined biological remission (fecal calprotectin levels <250 mcg/g and C-reactive protein <10 mg/dl), safety and persistence of ustekinumab during the follow-up period. Results A total of 89 patients with CD treated with ustekinumab (59,6% women; median disease duration 10 years) were included. The median follow-up was 60 weeks and 55 patients reached one year of follow-up. A 39,3% of the patients had history of previous abdominal surgery and 27% had been treated with 2 or more biologics. A 25,8% and 12,4% of the patients were on steroids and immunosupresants at the induction. The percentages of steroid-free clinical remission at 24 and 52 weeks were 42% and 54% respectively (Figure 1). Combined biological remission at 24 and 52 weeks was achieved in 33% and 45% of the patients respectively. Ustekinumab persistence was 88% at 12 months of follow-up (Figure 2). There were 14 suspensions mainly due to lack of response. Only 13 adverse events were documented in 9 patients (11.5%), none of them serious. Figure 1. Steroid-free clinical and biological remission percentages of ustekinumab at 16,24,52,76 and 104 weeks. Figure 2. Kaplan-Meier curve showing the durability of ustekinumab throughout the follow-up period. Conclusion Ustekinumab was effective and safe in a high proportion of patients with CD that were resistant to conventional immunosuppressant and antitumor necrosis factor drugs in this real-life practice cohort.

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