scholarly journals Bleb-Related Endophthalmitis: A 15-Year Review

2018 ◽  
Vol 3 (1) ◽  
pp. 21-27
Author(s):  
Lekha K. Mukkamala ◽  
Tian Xia ◽  
Rana Mady ◽  
Lisa Athwal ◽  
Marco A. Zarbin ◽  
...  
Keyword(s):  
Open Angle Glaucoma ◽  
Tertiary Care ◽  
Care Facility ◽  
Retrospective Chart Review ◽  
Glaucoma Surgery ◽  
Patient Characteristics ◽  
Light Perception ◽  
Hand Motion ◽  
Tertiary Care Facility ◽  
Systemic Antibiotics

Purpose: The purpose of this study is to describe the patient characteristics, management, and outcomes of bleb-related endophthalmitis (BRE). Methods: A retrospective chart review was conducted of patients who presented to a tertiary care facility from 2001 to 2016 with BRE. Collected data included demographics, medical and ocular history, visual acuity (VA), intraocular pressure (IOP), presence of hypopyon, treatment, microbiology, visual outcomes particularly of VA and IOP, and complications. Results: Thirty-six eyes (36 patients: 21 females, mean 66.8 years old, 78% with primary open-angle glaucoma) presented an average of 4.5 years (range, 2 days-33 years) after glaucoma surgery (30 trabeculectomies with mitomycin C, 6 tube shunts) with endophthalmitis. Mean VA and IOP at presentation were hand motion (HM; logMAR 2.1) and 19.9 mmHg, respectively, with 82% displaying hypopyon and 87% with purulent blebitis. Eighteen (50%) eyes (mean VA HM) underwent vitreous tap and injection (T/I) of intravitreal antibiotics (vancomycin 1 mg/0.1 cc and ceftazidime 2.25 mg/0.1 cc), and 18 (50%) eyes (mean VA HM) underwent pars plana vitrectomy (PPV) with intravitreal antibiotic injection. Eight (45%) eyes initially treated with T/I required a subsequent PPV, and 5 (28%) eyes treated initially with PPV underwent a second PPV. All patients also received systemic antibiotics (33 intravenous [IV] and 3 oral) and topical medications. Average time to documented resolution was 15 days, with mean VA of HM and IOP of 13.6 mmHg. Thirty-one (86%) eyes had vision worse than 20/200 at resolution, and those presenting with light perception or no light perception (NLP) vision (n = 6) had worse vision final VA (logMAR 2.6) than those with initial vision of HM or better (final VA logMAR 1.7). Three (8.6%) eyes were enucleated, with 4 worsening to NLP during the course of the infection. Conclusions: BRE is a visually devastating infection requiring prompt diagnosis and management. Despite aggressive treatment with antibiotics, visual prognosis is poor.

Review of a Home-Based Palliative Care Program for Children with Malignant and Non-Malignant Diseases

1997 ◽  
Vol 13 (4) ◽  
pp. 28-33 ◽  
Author(s):  
Ernest A. Kopecky ◽  
Sheila Jacobson ◽  
Prashant Joshi ◽  
Maria Martin ◽  
Gideon Koren
Keyword(s):  
Palliative Care ◽  
Tertiary Care ◽  
Care Facility ◽  
Retrospective Chart Review ◽  
Care Program ◽  
Patient Characteristics ◽  
Palliative Care Program ◽  
Tertiary Care Facility ◽  
Home Based ◽  
At Home

This retrospective chart review presents the patient characteristics and utilization of the home-based palliative care program at The Hospital for Sick Children in Toronto. A total of 126 children dying from a broad spectrum of diseases was admitted during the period 1986–1994, referred from neurosurgery, genetic/metabolic, neurology, neonatology, nephrology, cardiology, general pediatrics, general surgery, and pulmonology. At the time of review, 15 patients remained alive and 18 had been discharged from the program. Mean age at the time of referral was 4.8 ± 0.51 years and mean age at death was 5.3 ± 0.55 years. The mean number of days in hospital was 26.5 ± 14.6 while days spent at home averaged 98.4 ± 15.2; thus 80% of the children's remaining time was spent at home. The average number of parent-team contacts was 3.5 ± 0.9 by pager and 24.0 ± 2.9 by telephone. Of the 93 patients who died in the program, 53% died at home, 18% died in community hospitals, and 29% died in a tertiary care facility. Analgesic medications were administered to 54% of the patients; 56% of these then required opioid analgesia for pain and symptom management. Home-based palliative care appeared to be an effective program for many children with a variety of terminal illnesses after adequate supports for the child and family had been established.

S210 – Asymmetric Sudden SNHL: Is All This Screening Necessary?

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P146-P146
Author(s):  
Selena E. Heman-Ackah ◽  
Dunn Ryan ◽  
Tina C. Huang
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Tertiary Care ◽  
Care Facility ◽  
Retrospective Chart Review ◽  
Sudden Sensorineural Hearing Loss ◽  
Sensorineural Hearing ◽  
Diagnostic Evaluation ◽  
Diagnostic Screening ◽  
Tertiary Care Facility

Objectives A number of factors have been identified that contribute to the presentation of asymmetric sudden sensorineural hearing loss (ASSNHL). Routinely patients presenting with ASSNHL undergo a battery of serologic testing and imaging in an attempt to determine a cause. The study will assess the utility of this diagnostic evaluation in elucidating a cause of an asymmetric sensorineural hearing loss. At the conclusion of this presentation, the participants should be able to: 1) Understand the utility of diagnostic screening in the management of ASSNHL. 2) Understand the cost-effectiveness of the diagnostic screening for ASSNHL. Methods The study design is a retrospective chart review. Charts from patients presenting to the otolaryngology clinic of a tertiary care facility between January 1, 2000, and November 30, 2007, with ASSNHL confirmed with audiometric evaluation were reviewed. Diagnostic tests included in the work-up of ASSNHL and test results were recorded. Percentage of positive tests was determined and compared to national data. Cost analysis of the diagnostic battery was performed. Results All patients presenting with sudden sensorineural hearing loss received 1 or more of the following serologic and radiographic tests: ANA, cholesterol, creatinine, DNA-ds, ESR, blood glucose, Lyme titer, rheumatoid factor, RPR, FTA-ABS, HSP, T3, TSH and MRI with gadolinium. The average cost associated with the full diagnostic evaluation is greater than $1,500. The positive rate for any of these tests was extremely low. Conclusions The utility of the comprehensive ASSNHL evaluation should be reconsidered. The choice of diagnostic evaluation should be directed by patient risk factors and exposures.

Understanding the Role of the Otolaryngology Hospitalist: Tracheostomies and Tracheostomy Care

2021 ◽  
pp. 000348942110457
Author(s):  
Mohamad Issa ◽  
Nadeem El-Kouri ◽  
Sara Mater ◽  
Jonathan Y. Lee ◽  
Carl Snyderman ◽  
...  
Keyword(s):  
Medical Center ◽  
Tertiary Care ◽  
Care Facility ◽  
Retrospective Chart Review ◽  
Wait Time ◽  
High Volume ◽  
Care Team ◽  
Consulting Services ◽  
Tertiary Care Facility

Introduction: The concept of a hospitalist has been well established. This model has been associated with reduced length of stay contributing to reduction in healthcare costs. Minimal literature is available assessing the effects of an otolaryngology (ENT) hospitalist at a tertiary medical center. The aim of this study is to assess the role of an ENT hospitalist on (1) performing tracheostomies and (2) providing care as part of the tracheostomy care team (TCT). Methods: Retrospective chart review of all tracheostomies performed by the ENT service over 2 years (July 2015-June 2017), and prospective data collection of all tracheostomy care consults over 1 year (July 2016-June 2017). In year 1 (from July 2015 to June 2016), no ENT hospitalist was employed, and in year 2 (from July 2016 to June 2017), an ENT hospitalist was employed. Results: Compared to other Ear, Nose, and Throat (ENT) surgeons, the ENT hospitalist performed tracheostomies with shorter patient wait times, and performed a greater proportion of percutaneous tracheostomies at the bedside versus open tracheostomies in the operating room. The tracheostomy care team (TCT) received 91 consults over the course of 1 year with an average of 1.1 billable procedures generated per consult. Conclusion: In this study, an ENT hospitalist was decreased patient wait time to tracheostomy and increased bedside percutaneous tracheostomies, which has positive implications for resource utilization and healthcare cost. The average wait time to receive a tracheostomy was reduced when calculated across the entire department due to the availability of the ENT hospitalist to see and perform tracheostomies. The TCT generated many billable bedside procedures in addition to encouraged decannulation of patients. This study highlights the fact that the ENT hospitalist contributes to providing expedient tracheostomies and provides valuable consulting services as part of a TCT at a high-volume tertiary care facility.

scholarly journals Characteristic of COVID-19 infection in pediatric patients: early findings from a tertiary care center, Nagercoil, Tamil Nadu, India

2020 ◽  
Vol 7 (10) ◽  
pp. 2048
Author(s):  
Babitha Rexlin G. ◽  
Suresh P. M.
Keyword(s):  
Tamil Nadu ◽  
Care Center ◽  
Tertiary Care ◽  
Care Facility ◽  
Retrospective Chart Review ◽  
Respiratory Illness ◽  
Family Welfare ◽  
P Value ◽  
Mild Disease ◽  
Tertiary Care Facility

Background: The planet faces a new challenge with COVID-19 disease caused by novel SARS-CoV2. Pediatric COVID-19 is considered to be mild. Methods: The study aim was to describe the clinical presentation, diagnostic findings and outcome of a cohort of paediatric patients according to Ministry of health and family welfare (MOHFW) criteria, at KKGMCH a tertiary care facility in Kanyakumari district. It’s a retrospective chart review including data of children aged 0 to 12 years with COVID-19 from 20 March to 19 July 2020. Results: Of the 137 children with COVID-19, 17 (12.45%) were infants, 65 (35%) were 1-5 years and 72 (52.55%) were 6-12 years. Age didn’t have influence on acquiring the illness as p value is 0.125. Age had no influence on severity too as p value is 0.28. 46.7% were female and 53.3% were male. There was an apparent male preponderance with (OR 1.63, 95% CI 1.00 to 2.21) but a non-significant p value of 0.54. of the 34 (24.8%) mild symptomatic, 22 (64.7%) were males and 12 (35.2%) were females. The p value is 0.086 stating gender non-influential on severity. 129 (94.1%) children had contact history. The contacts were parents or close relatives. No child with comorbidity presented during this period. Most common clinical features were fever (8.76%), cough (6.6%), rhinorrhoea (2.2%), vomiting (2.9%) and diarrhoea (1.5%). Children never progressed to severe respiratory illness requiring intensive care as per MOHFW criteria. 1 (0.7%) presented with focal consolidation in chest x-ray. All 137 (100%) children got cured.Conclusion: Study concludes pediatric COVID-19 is a mild disease without mortality at beginning of pandemic in Kanyakumari district. Factors like age and gender neither influenced the occurrence of the disease nor the severity.

scholarly journals Accurate Operative Time Prediction in Thyroid Surgery: A Rural Tertiary Care Facility Experience

2021 ◽  
pp. 014556132110167
Author(s):  
Kevin P. Stavrides ◽  
Timothy L. Lindemann ◽  
Evan J. Harlor ◽  
Thorsen W. Haugen ◽  
Nicholas Purdy
Keyword(s):  
Operative Time ◽  
Care Center ◽  
Tertiary Care ◽  
Care Facility ◽  
Time Estimation ◽  
Patient Characteristics ◽  
Endocrine Surgery ◽  
Time Averaging ◽  
Tertiary Care Facility ◽  
Mean Differences

Objective: To determine whether surgeons can estimate thyroid operative time more accurately than a system-generated average time estimate. Methods: Four otolaryngologists at a single institution with extensive endocrine surgery experience were asked to predict their operative times for all eligible thyroid surgeries. These estimates were compared to system-generated operative time predications based on averaging the surgeon’s previous 10 cases with the same Current Procedural Terminology code. The surgeon-generated estimations and system-generated estimations were then compared to each other and the actual operative time. Results: A final sample of 73 cases was used for all analyses. Average age was 51 years old and the majority of patients were female. Surgeon-generated operative time estimates were significantly more accurate than system-generated estimates based on time averaging ( P < .001). These findings were consistent across each surgeon individually and within each procedure type (hemithyroidectomy and total thyroidectomy). These findings had a power of over 99% based on mean differences. Conclusion: As the financial center of modern hospitals, an efficient operating room is integral to economic success. Improving the precision of operative time estimation reduces costly unplanned staff overtime, canceled cases, and underutilization. Our research at a rural tertiary care center shows that experienced thyroid surgeons can substantially reduce the error of estimating thyroid operative times by considering individual patient characteristics. Although no objective variables have so far been identified to correlate with thyroid operative time, surgeon-generated operative time estimation is significantly more accurate than a generic system approach of averaging previous operative times.

scholarly journals Retrospective Review of Pediatric Thyroid Eye Disease Cases Referred to Nicklaus Children's Hospital

2018 ◽  
Vol 17 (3) ◽  
pp. 54-58
Author(s):  
Moises Enghelberg ◽  
Alice Wong ◽  
Zenia P. Aguilera ◽  
Roberto Warman
Keyword(s):  
Pediatric Population ◽  
Tertiary Care ◽  
Care Facility ◽  
Retrospective Chart Review ◽  
Thyroid Eye Disease ◽  
Eye Disease ◽  
Thyroid Peroxidase ◽  
Tertiary Care Facility ◽  
Thyroid Peroxidase Antibody ◽  
The Right

Purpose: We evaluate presenting features of pediatric thyroid eye disease, and discuss the morbidity and clinical course of this condition in the pediatric population.  Methods: A retrospective chart review of 11 patients referred for evaluation of thyroid eye disease at a pediatric tertiary care facility in Miami, Florida.Results: The average age at presentation was 12.7 years. The most common ocular complaint was mild irritation. Patients tended to be positive for thyroid stimulating immunoglobulin and thyroid peroxidase antibody. The average displacement on Hertel exophthalmometry was 21mm for the right eye, and 21.45mm for the left eye. Lower scleral show was the most common eyelid finding. Conclusion: In contrast to thyroid eye disease in adults, the condition tends to present with mild ocular findings in children. Pediatric patients presenting with thyroid eye disease respond very well to medical therapy aimed at enhancing the altered ocular surface.

scholarly journals 2790. Respiratory Viral Testing and Antimicrobial De-escalation Among Hospitalized Patients at a Tertiary Care Facility, 2015–2016: A Matched Cohort Study Series

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S986-S986
Author(s):  
Emily J Ciccone ◽  
Alan C Kinlaw ◽  
Melissa B Miller ◽  
David J Weber ◽  
Jonathan J Juliano ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Care Facility ◽  
Retrospective Chart Review ◽  
Treatment Decision ◽  
Clinical Effectiveness ◽  
Future Research ◽  
Matched Cohort ◽  
Tertiary Care Facility ◽  
Rapid Polymerase Chain Reaction ◽  
Syncytial Virus

Abstract Background The use of multiplex respiratory viral panels (RVP) is increasing. They have the potential to reduce unnecessary antibiotic use, but data are limited on their clinical effectiveness. Our objective was to estimate risk differences for antimicrobial de-escalation (discontinuation, intravenous to oral, or spectrum narrowing) between different sequences and results of RVP and rapid polymerase chain reaction (PCR) tests for influenza +/− respiratory syncytial virus. Methods We conducted a retrospective chart review of adults (age ≥18 years) admitted to a floor or stepdown unit at University of North Carolina Hospitals who had a respiratory viral test (RVT) within 48 hours of admission between September 2015 and April 2016. We estimated 3-day RDs for the relation between RVT and antimicrobial de-escalation. To control confounding and account for the 37-hour mean lag between PCR (faster) and RVP (slower) tests resulting, we leveraged the treatment decision design over a series of 1:1 matched cohort studies. Each targeted a clinically relevant scenario: (1) ordering RVP test (vs no RVP order) after learning PCR status; (2) learning RVP+ result (vs. no RVP result) after knowing PCR status; (3) learning RVP+ result (vs. RVP–) after knowing PCR–status; and (4) learning RVP+ result (vs. RVP–) given no prior PCR. For each subcohort, referent patients were matched to index patients by race, gender, RVT in prior month (y/n), age (±10 years), and season (±1.7 months). Results The overall cohort (n = 1,342) was 61% White, 29% African American, and 51% female. Median age was 56 years (IQR 39–69). Across all matched subcohorts (Figure 1), the matching success rate was 79–88% and referent frequency of antimicrobial de-escalation ranged 0.6%–1.9%. In scenario 1, ordering RVP results was associated with higher de-escalation (3-day RD 7.6%; 95% confidence intervals [CI] 3.2%, 12.1%). In scenarios 2–4, learning RVP+ results was associated with more frequent de-escalation (3-day RDs 14.8%, 13.8%, and 15.4%). Conclusion RVP testing and positive RVP results were associated with increased antimicrobial de-escalation, although de-escalation was overall infrequent. Future research should assess effect modification across subgroups and evaluate cost-effectiveness. Disclosures All authors: No reported disclosures.

Does Use of Intraoperative Irrigation with Open or Laparoscopic Appendectomy Reduce Post-Operative Intra-abdominal Abscess?

2011 ◽  
Vol 77 (1) ◽  
pp. 78-80 ◽  
Author(s):  
Christopher B. Moore ◽  
R. Stephen Smith ◽  
Robert Herbertson ◽  
Christine Toevs
Keyword(s):  
Laparoscopic Appendectomy ◽  
Chart Review ◽  
Tertiary Care ◽  
Open Appendectomy ◽  
Care Facility ◽  
Retrospective Chart Review ◽  
Abscess Formation ◽  
Abdominal Abscess ◽  
Tertiary Care Facility

To date, no study shows a decrease in postoperative abscess with the use of irrigation during appendectomy. Postoperative abscess rate for laparoscopic and open appendectomy is 3.3 and 2.6 per cent. The purpose of this study is to determine if irrigation at appendectomy decreases the postoperative intra-abdominal abscess rate. Retrospective chart review of 176 consecutive appendectomies, open (39%) and laparoscopic (61%), at a university affiliated tertiary care facility from July 2007 to November 2008 for use of intraoperative irrigation was performed. Patients under age 18 were excluded. There were no differences between the irrigation groups in regards to age, sex, or weight. Perforation was observed in 28 per cent (50/176), of which 86 per cent (43/50) of patients received intraoperative irrigation. Eleven patients (9.6%) with irrigation developed postoperative abscess compared with two (3.3%) patients without irrigation ( P = 0.22). Our results do not show decrease in postoperative intra-abdominal abscess with use of intraoperative irrigation. Thirteen patients developed postoperative abscess: 11 with irrigation, two without irrigation. Ten of 13 patients who developed abscess were perforated; nine with irrigation and one without. These results suggest routine use of intraoperative irrigation for appendectomies does not prevent intra-abdominal abscess formation, adds extra costs, and may be avoided.

scholarly journals Neurocognitive Changes in Tertiary Neurosyphilis: A Retrospective Chart Review

2014 ◽  
Vol 41 (4) ◽  
pp. 452-458 ◽  
Author(s):  
Philippe Beauchemin ◽  
Robert Laforce
Keyword(s):  
Chart Review ◽  
Tertiary Care ◽  
Care Facility ◽  
Public Health Problem ◽  
Retrospective Chart Review ◽  
Quality Data ◽  
Major Public Health Problem ◽  
Tertiary Care Facility ◽  
Behavioral Impairments

Context:Since the beginning of the new millennium, prevalence of syphilis has re-increased and is once again, a major public health problem. Neurosyphilis is the extension of syphilitic infection to the nervous system. It is considered by many as a cause of reversible dementia, when treated early. However, scarce data exist on the evolution of cognitive and behavioral impairments in patients affected by tertiary neurosyphilis.Objectives:The aim of this study was to explore the cognitive and behavioral changes in a cohort of patients diagnosed with neurosyphilis.Design:A retrospective study based on systematized chart review between 2000 and 2012 in a large neurological tertiary care facility.Outcome measure:Clinical evaluations by treating physicians.Results:Eighteen patients were identified with tertiary neurosyphilis. Out of this group, only two had systematic neuropsychological follow-up despite physician reports of significant and persistent cognitive and psychiatric changes. For these two cases, only slight improvements were noted in memory and executive skills while improvements in attention were marked. None of our patients had previous psychiatric history yet a large proportion developed symptoms after the infection.Conclusion:Although neurosyphilis is traditionally considered a reversible form of dementia, we found limited support for this claim in our two patients with close follow-up. Quality data on the cognitive and psychiatric changes in the rest of our cohort was dramatically lacking, and this could not be explained by absence of symptoms at presentation. Given the recrudescence of syphilis, we propose a systematic approach to the evaluation and follow-up of this disorder.

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