Placement of Labcor Pulmonary Conduit Results in a High Incidence of Postoperative Fever

2021 ◽  
Vol 12 (1) ◽  
pp. 55-60
Author(s):  
Rouba Shaker ◽  
Mariam Arabi ◽  
Sarah Khafaja ◽  
Danielle Fayad ◽  
Aia Assaf Casals ◽  
...  
Keyword(s):  
Medical Center ◽  
Data Entry ◽  
Antibiotic Use ◽  
International Classification Of Diseases ◽  
Cardiac Patients ◽  
P Value ◽  
Postoperative Fever ◽  
American University ◽  
Prolonged Fever ◽  
Pulmonary Conduit

Background: Fever in the postoperative period in cardiac patients is common. The purpose of this study is to recognize the risk factors for prolonged postoperative fever in cardiac patients with pulmonary conduit insertion. Methods: Patients were identified retrospectively by looking at the International Classification of Diseases, Ninth Revision, Clinical Modification procedure code for pulmonary conduit insertion between June 2009 and December 2015 at the American University of Beirut Medical Center. Data about preoperative, perioperative, and postoperative variables were collected. Data entry and analysis were performed using SPSS version 22. Results: The study identified 59 patients. The most common type of pulmonary conduit used was the Contegra type (57.6%) (n = 34), followed by the Labcor type (20.3%; n = 12). Postoperative fever occurred in 61% of patients (n = 36). Fourteen patients (38.8%) had a prolonged fever that lasted for more than seven days. Prolonged postoperative fever was significantly associated with the Labcor pulmonary conduit ( P value < .001) and a longer duration of pacing wires ( P value: .039). Significantly prolonged fever that lasted for more than 21 days occurred in five patients who all had inserted the Labcor pulmonary conduit. Conclusions: The Labcor pulmonary conduit type is a risk factor for prolonged postoperative fever. The protracted use of pacing wires could be a consequence of the prolonged fever rather than a cause. In the absence of a demonstrable infectious etiology for prolonged postoperative fever in cardiac patients with pulmonary conduit insertion, the Labcor pulmonary conduit could be the underlying cause. Alternative management of such cases may lead to decreased antibiotic use and morbidity.

Characteristics and risk factors associated with stroke subtypes among adult patients admitted to stroke unit of JUMC

2019 ◽  
Vol 15 ◽  
Author(s):  
Bekalu Getachew Gebreegziabher ◽  
Tesema Etefa Birhanu ◽  
Diriba Dereje Olana ◽  
Behailu Terefe Tesfaye
Keyword(s):  
Risk Factors ◽  
Stroke Unit ◽  
Medical Center ◽  
Data Entry ◽  
Public Health Problem ◽  
Cross Sectional Study ◽  
Chi Square ◽  
Cross Sectional ◽  
Factors Associated ◽  
Stroke Subtypes

Background: Stroke is a great public health problem in Ethiopia. According to reports, in-hospital stroke mortality was estimated to be 14.7% in Ethiopia. Despite this, in this country researches done on factors associated with stroke sub-types were inadequate. Objective: To assess the Characteristics and risk factors associated with stroke sub-types among patients admitted to JUMC. Methods and materials: A retrospective cross sectional study was conducted from May 2017 to May 2018 in stroke unit of Jimma University Medical Center. A total of 106 medical charts of patients diagnosed with stroke were reviewed. Checklist comprising of relevant variables was used to collect data. SPSS version 21 was employed for data entry and analysis. Chi-square test was used to point-out association and difference among stroke sub-types. The data was presented using text, tables and figures. Result: From a total of 106 patients, 67(63.2%) were men. The mean ± SD of age was 52.67±12.46 years, and no significant association was found. Of all the patients, 59(55.6%) had ischemic strokes and 47(44.4%) had hemorrhagic strokes. The most common risk factor in the patients was alcohol use with a prevalence of 69.9%. Of all the risk factors, only sex, cigarettes smoking and dyslipidemia were significantly associated to sub-types of stroke. Conclusion: Ischemic stroke was the most common subtype of stroke. Sex of patient, cigarette smoking and dyslipidemia are significantly associated with the two stroke subtypes.

scholarly journals Clinical Team Distribution and Antibiotic Use Patterns at a Tertiary-Care Academic Medical Center

2020 ◽  
Vol 41 (S1) ◽  
pp. s168-s169
Author(s):  
Rebecca Choudhury ◽  
Ronald Beaulieu ◽  
Thomas Talbot ◽  
George Nelson
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Antibiotic Use ◽  
Care Hospital ◽  
Hospital Units ◽  
Antibiotic Utilization ◽  
Academic Medical ◽  
Level Data ◽  
Utilization Data

Background: As more US hospitals report antibiotic utilization to the CDC, standardized antimicrobial administration ratios (SAARs) derived from patient care unit-based antibiotic utilization data will increasingly be used to guide local antibiotic stewardship interventions. Location-based antibiotic utilization surveillance data are often utilized given the relative ease of ascertainment. However, aggregating antibiotic use data on a unit basis may have variable effects depending on the number of clinical teams providing care. In this study, we examined antibiotic utilization from units at a tertiary-care hospital to illustrate the potential challenges of using unit-based antibiotic utilization to change individual prescribing. Methods: We used inpatient pharmacy antibiotic use administration records at an adult tertiary-care academic medical center over a 6-month period from January 2019 through June 2019 to describe the geographic footprints and AU of medical, surgical, and critical care teams. All teams accounting for at least 1 patient day present on each unit during the study period were included in the analysis, as were all teams prescribing at least 1 antibiotic day of therapy (DOT). Results: The study population consisted of 24 units: 6 ICUs (25%) and 18 non-ICUs (75%). Over the study period, the average numbers of teams caring for patients in ICU and non-ICU wards were 10.2 (range, 3.2–16.9) and 13.7 (range, 10.4–18.9), respectively. Units were divided into 3 categories by the number of teams, accounting for ≥70% of total patient days present (Fig. 1): “homogenous” (≤3), “pauciteam” (4–7 teams), and “heterogeneous” (>7 teams). In total, 12 (50%) units were “pauciteam”; 7 (29%) were “homogeneous”; and 5 (21%) were “heterogeneous.” Units could also be classified as “homogenous,” “pauciteam,” or “heterogeneous” based on team-level antibiotic utilization or DOT for specific antibiotics. Different patterns emerged based on antibiotic restriction status. Classifying units based on vancomycin DOT (unrestricted) exhibited fewer “heterogeneous” units, whereas using meropenem DOT (restricted) revealed no “heterogeneous” units. Furthermore, the average number of units where individual clinical teams prescribed an antibiotic varied widely (range, 1.4–12.3 units per team). Conclusions: Unit-based antibiotic utilization data may encounter limitations in affecting prescriber behavior, particularly on units where a large number of clinical teams contribute to antibiotic utilization. Additionally, some services prescribing antibiotics across many hospital units may be minimally influenced by unit-level data. Team-based antibiotic utilization may allow for a more targeted metric to drive individual team prescribing.Funding: NoneDisclosures: None

scholarly journals 180. Leveraging the Electronic Medical Record as a Method of Antibiotic Stewardship

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S97-S97
Author(s):  
Christina M Kaul ◽  
Eric Molina ◽  
Donna Armellino ◽  
Mary Ellen Schilling ◽  
Mark Jarrett
Keyword(s):  
Medical Record ◽  
Electronic Medical Record ◽  
Antibiotic Stewardship ◽  
Antibiotic Use ◽  
Antibiotic Usage ◽  
P Value ◽  
Inpatient Setting ◽  
Post Intervention ◽  
Paired Samples ◽  
Viable Method

Abstract Background Overutilization of antibiotics remains an issue in the inpatient setting. What is more, many protocols geared toward curbing improper antibiotic use rely heavily on resource- and personnel-intensive interventions. Thus, the potential for using the EMR to facilitate antibiotic stewardship remains largely unexplored. Methods We implemented a novel change for ordering certain antibiotics in our EMR: ceftriaxone, daptomycin, ertapenem, imipenem, meropenem, and piperacillin-tazobactam. When ordering one of these antibiotics, providers had to note a usage indication, which assigned a usage duration as per our Antibiotic Stewardship Committee guidelines. Pre-intervention, manual discontinuation was required if a provider did not enter a duration. The intervention was enacted August 2019 in 13 hospitals. Data was collected from January 2018 to February 2020. Antibiotic usage was reported monthly as rate per 1000-patient days. Monthly pre- and post-intervention rates were averaged, respectively. Paired samples t-tests were used to compare pre- and post-intervention rates per unit type per hospital. A p-value of less than 0.05 was considered significant. Units with minimal usage, as defined by a pre- or post-intervention mean of 0, were excluded from analysis. Example of Ordering an Antibiotic Prior to Intervention Example of Ordering an Antibiotic After Intervention Results Ertapenem was noted to have a statistically significant decrease in utilization in seven units at three hospitals. Piperacillin-tazobactam was found to have a decrease in utilization in 19 units at eight hospitals. Daptomycin was found to have a decrease in utilization in one unit. Significant decreases in the utilization of ceftriaxone, imipenem, and meropenem were not noted. Example of Statistically Significant Decreased Utilization in Piperacillin-Tazobactam on a Medical-Surglcal Unit Conclusion Our study showed a statistically significant decrease in use of ertapenem, piperacillin-tazobactam and daptomycin using a simple built-in EMR prompt that curtails provider error. This should allow for an increased ease of integration, as the protocol does not require a host of resources for maintenance. Of note is decreased utilization of piperacillin-tazobactam and ertapenem across multiple hospitals, most notably on the medical and surgical wards. Thus, usage of the EMR without personnel-intensive protocols is a viable method for augmenting antibiotic stewardship in health systems. Disclosures All Authors: No reported disclosures

scholarly journals Perinatal Asphyxia Among Neonates Admitted Jimma Medical Center, Jimma, Ethiopia

2020 ◽  
Vol 7 ◽  
pp. 2333794X2098130
Author(s):  
Ebissa Bayana Kebede ◽  
Adugna Olani Akuma ◽  
Yonas Biratu Tarfa
Keyword(s):  
Gestational Age ◽  
Medical Center ◽  
Perinatal Asphyxia ◽  
Mode Of Delivery ◽  
Large For Gestational Age ◽  
Systematic Sampling ◽  
P Value ◽  
Health Extension Workers ◽  
Severe Problem ◽  
Prolonged Labor

Background: Perinatal asphyxia is a severe problem which causes serious problem in neonates in developing countries. This study is aimed to determine magnitude of perinatal asphyxia and its associated factors. Methods: A cross-sectional study design was conducted among neonates admitted over a period of 4 years on 740 samples. Systematic sampling method was employed to get required samples from log book. Epi-data 3.1 is used for data entry and the entered data was exported to SPSS Version 23 for analysis. Bivariable and multiple variable logistic regressions analysis were applied to see the association between dependent and independent variables. Finally, P-value <.05 at 95% CI was declared statistically significant. Results: The main significant factor associated to perinatal asphyxia were prolonged labor ( P = .04, AOR = 1.68 95%CI: [1.00, 2.80]), being primipara ( P = .003, AOR = 2.06, 95%CI: [1.28, 3.30]), Small for Gestational Age (SGA) ( P = .001, AOR = 4.35, 95%CI: [1.85, 10.19]), Large for Gestational Age ( P = .001, AOR = 16.75, 95%CI: [3.82, 73.33]) and mode of delivery. Conclusion: The magnitude of perinatal asphyxia was 18%. Prolonged labor, parity, birth size, mode of delivery, and APGAR score at 1st minute were significantly associated with perinatal asphyxia. So, Nurses, Midwives, Medical Doctors, and health extension workers have to engage and contribute to on how to decrease the magnitude of perinatal asphyxia.

Sleeve gastrectomy is the most common cause of Gastro-esophageal Reflux Disease in comparison with other bariatric operations

2021 ◽  
Author(s):  
majdi abu sneineh ◽  
malek abu sneineh ◽  
Monther Abu Sneineh ◽  
mustafa abu sneineh ◽  
muneer abu snineh ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Medical Center ◽  
Bariatric Procedure ◽  
P Value ◽  
Significant Difference ◽  
Symptomatic Gerd ◽  
Swallow Study ◽  
Contrast Swallow ◽  
Gerd Symptoms

Abstract Introduction GERD is one of the complications of bariatric operations that might affect the quality of life. We aim to perform a retrospective cohort study to determine the incidence of symptomatic GERD following different types of bariatric surgery and which operations are considered a contraindication of GERD. Besides, we are attempting to identify the risk factors of GERD after bariatric surgery. Methods Medical records of 729 patients undergone bariatric operations between January 2010 and June 2019 at Shamir (Assaf Harofeh) Medical Center were reviewed. Results There was a significant difference between the type of bariatric procedure and the incidence of GERD symptoms after the operation. The incidence of symptomatic GERD in patients who underwent SG was 39.9% (p =0.0131). This was significantly higher compared to 16.4% following roux en y gastric bypass, 23.4% following LAGB, and 11% following OAGB. 113 patients out of 718 had a positive swallow test and of these patient 71 developed GERD symptoms post-operatively without correlation to the degree of reflux at the swallow test but with statistically significant correlation to the type of operation especially for SG (P-value <0.001) and to our knowledge this was never reported in the literature. Conclusion SG is a good bariatric procedure option but should be contraindicated in asymptomatic reflux contrast swallow study and symptomatic GERD patients preoperatively because of high levels of symptomatic GERD post-operatively. Asymptomatic reflux at contrast swallow study pre-operatively should be considered a risk factor for GERD after the operation.

Radiology of terror injuries: the American University of Beirut Medical Center experience

2008 ◽  
Vol 32 (2) ◽  
pp. 83-87 ◽  
Author(s):  
Maurice C. Haddad ◽  
Nabil J. Khoury ◽  
Mukbil H. Hourani
Keyword(s):  
Medical Center ◽  
American University ◽  
American University Of Beirut

Abstract 16199: Trend of Hypertensive Emergencies in Atrial Fibrillation Hospitalization; National Estimate

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Mae'n Al-Dabbas ◽  
Jay Shah ◽  
devina adalja ◽  
Archana Gundabolu ◽  
Ashish Kumar ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
International Classification Of Diseases ◽  
Primary Diagnosis ◽  
Hypertensive Emergency ◽  
P Value ◽  
National Inpatient Sample ◽  
Common Risk Factor ◽  
The Past ◽  
Classification Of Diseases

Introduction: Hypertension has been reported as one of the most common risk factor causing atrial fibrillation (AF). Also, hypertension is associated with more persistent AF. However the epidemiology for incidence of hypertensive emergency in AF hospitalization is not well documented. Hypothesis: We hypothesize that frequency of hypertensive emergency has been increasingly associated with Atrial fibrillation. Methods: National inpatient sample from 2005 -2015 was used for the present analysis. Patients over 18 years, with AF as the primary diagnosis were identified using International Classification of Diseases, Ninth Revision-Clinical Modification (ICD-9-CM) code, 427.31. Patients with hypertensive emergency were identified using ICD-9-CM code. 401.0, 402.0, 403.0, 404.0, 405.0. Results: A total of 4,988,269 AF patients over 18 years of age were included in the present analysis. Of these hospitalization 49,423 had hypertensive emergency during hospitalizations and the rest 4,938,846 had no hypertensive emergency. There was a monotonic increase in the trend of rates of hypertensive emergency per 1000 AF hospitalizations, from 2005 - 2015. (P value <0.001) [Figure 1]. Conclusion: There has been a significant increase in the rates of hypertensive emergency among AF hospitalization, over the past decade. Further research is needed to investigate the reason for this increased trend.

scholarly journals SUMMIT (Serially Unified Multicenter Multiple Sclerosis Investigation): creating a repository of deeply phenotyped contemporary multiple sclerosis cohorts

2017 ◽  
Vol 24 (11) ◽  
pp. 1485-1498 ◽  
Author(s):  
Riley Bove ◽  
Tanuja Chitnis ◽  
Bruce AC Cree ◽  
Mar Tintoré ◽  
Yvonne Naegelin ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
San Francisco ◽  
Medical Center ◽  
Clinically Isolated Syndrome ◽  
American University ◽  
American University Of Beirut ◽  
Longitudinal Investigation ◽  
American Academic

Background: There is a pressing need for robust longitudinal cohort studies in the modern treatment era of multiple sclerosis. Objective: Build a multiple sclerosis (MS) cohort repository to capture the variability of disability accumulation, as well as provide the depth of characterization (clinical, radiologic, genetic, biospecimens) required to adequately model and ultimately predict a patient’s course. Methods: Serially Unified Multicenter Multiple Sclerosis Investigation (SUMMIT) is an international multi-center, prospectively enrolled cohort with over a decade of comprehensive follow-up on more than 1000 patients from two large North American academic MS Centers (Brigham and Women’s Hospital (Comprehensive Longitudinal Investigation of Multiple Sclerosis at the Brigham and Women’s Hospital (CLIMB; BWH)) and University of California, San Francisco (Expression/genomics, Proteomics, Imaging, and Clinical (EPIC))). It is bringing online more than 2500 patients from additional international MS Centers (Basel (Universitätsspital Basel (UHB)), VU University Medical Center MS Center Amsterdam (MSCA), Multiple Sclerosis Center of Catalonia-Vall d’Hebron Hospital (Barcelona clinically isolated syndrome (CIS) cohort), and American University of Beirut Medical Center (AUBMC-Multiple Sclerosis Interdisciplinary Research (AMIR)). Results and conclusion: We provide evidence for harmonization of two of the initial cohorts in terms of the characterization of demographics, disease, and treatment-related variables; demonstrate several proof-of-principle analyses examining genetic and radiologic predictors of disease progression; and discuss the steps involved in expanding SUMMIT into a repository accessible to the broader scientific community.

scholarly journals Perception on Management of Nursing Education Institutes among Bachelors Students in Selected Nursing Colleges at Kathmandu

2020 ◽  
Vol 7 (1) ◽  
pp. 23-36
Author(s):  
Bhuwan Kumari Dangol ◽  
Narbada Thapa
Keyword(s):  
Nursing Education ◽  
Nursing Students ◽  
Statistical Significance ◽  
Data Entry ◽  
Education Institution ◽  
Cross Sectional Study ◽  
Current Status ◽  
P Value ◽  
Cross Sectional ◽  
Organizational Goals

Management is a process of planning, decision making, organizing, leading, motivating and controlling, and an effective utilization of the resources to reach the organizational goals efficiently and effectively. Management has a crucial role in quality of work and production in any institutions. Although a rapid increase of Nursing Education Institutions in Nepal since last decade which had been trained thousands of nursing cadres, the management aspects of these institutions are not studied adequately. Thus current study intended to explore the current status of Nursing Education Institution Management as experienced and perceived by the bachelors nursing students. A descriptive cross-sectional study was conducted among the nursing institutions in Kathmandu valley. Of the total 28 in the valley, 14 were selected purposively. From the selected institutions, all 377 eligible students currently in final year of study were selected. Among them, 208were from BSN and 169 were from B Sc program.  The data was collected through the self administered structured questioners after taking informed consent. Data entry and analysis was done in SPSS version 16 software. The findings of the study show that 70% students were satisfied in institutional management (mean59.62, SD ± 3.66). In academic management (78%), (mean139.82, SD ± 6.22), followed by human resources 67%, (mean43.54, SD ± 2.79) and were in physical resources management 75% students were satisfied (mean45.02, SD ± 3.08). Analysis of variations between group (administrators, faculties, students) found statistical significance (p value <0.05). So it is concluded the perception of students, faculties and administrator were different on managing the nursing education.

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