scholarly journals Characterizing telemedicine use in clinical immunology and allergy in Canada before the COVID-19 pandemic

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Erika Yue Lee ◽  
Christine Song ◽  
Peter Vadas ◽  
Matthew Morgan ◽  
Stephen Betschel
Keyword(s):  
Rural Communities ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Population Based ◽  
Administrative Database ◽  
Single Centre ◽  
Remote Communities ◽  
Common Diagnosis ◽  
Average Potential

Abstract Rationale There exists a geographic barrier to access CIA care for patients who live in rural communities; telemedicine may bridge this gap in care. Herein we characterized the use of telemedicine in CIA at a population-based level and single centre. Methods Before the COVID-19 pandemic, telemedicine care was provided via the Ontario Telemedicine Network (OTN) in Ontario, Canada. Descriptive data were collected from the OTN administrative database and from electronic medical records at a single academic centre during 2014 to 2019. The potential distance travelled and time saved by telemedicine visits were calculated using postal codes. Results A total of 1298 telemedicine visits was conducted over OTN, with an average of 216 visits per year. Only 11% of the allergists/immunologists used telemedicine to provide care before the COVID-19 pandemic. In the single centre that provided the majority of the telemedicine care, 66% patients were female and the overall mean age was 46. The most common diagnosis was immunodeficiency (40%), followed by asthma (13%) and urticaria (11%). Most patients required at least one follow-up via telemedicine. The average potential two-way distance travelled per visit was 718 km and the average potential time travelled in total was 6.6 h. Conclusion Telemedicine was not widely used by allergists/immunologists in Ontario, Canada before the COVID-19 pandemic. It could offer a unique opportunity to connect patients who live in remote communities and allergists/immunologists who practice in urban centres in Canada. Independent of the current pandemic, our study further highlights the need for more physicians to adopt and continue telemedicine use as well as for healthcare agencies to support its use as a strategic priority once the pandemic is over.

Spontaneous resolution rates in congenital nasolacrimal duct obstruction managed with massage or topical antibiotics compared with observation alone

2021 ◽  
pp. bjophthalmol-2021-318853
Author(s):  
Brian G Mohney ◽  
Saraniya Sathiamoorthi ◽  
Ryan D Frank
Keyword(s):  
Medical Records ◽  
Population Based ◽  
Nasolacrimal Duct ◽  
Spontaneous Resolution ◽  
Nasolacrimal Duct Obstruction ◽  
Olmsted County ◽  
Congenital Nasolacrimal Duct Obstruction ◽  
Duct Obstruction ◽  
Topical Antibiotics

Background/aimsTo determine if nasolacrimal massage or topical antibiotics are associated with higher rates of resolution compared with observation alone in a population-based cohort of infants with congenital nasolacrimal duct obstruction (CNLDO).MethodsThe medical records of all children <5 years diagnosed with CNLDO while residing in Olmsted County, Minnesota from 1 January 1995 through 31 December 2004 were retrospectively reviewed for type of management and non-surgical resolution of tearing.ResultsAmong 1958 infants diagnosed and followed for CNLDO, 516 (26.4%) were merely observed, 506 (25.8%) were prescribed massage alone, 485 (24.8%) were prescribed at least one course of topical antibiotics, 397 (20.3%) were prescribed both topical antibiotics and massage, and 54 (2.8%) had no documented therapy. Non-surgical resolution, occurring in 1669 (85.2%) during a median follow-up of 3.1 months (range: 1 week–248 months), was 74.6% for the merely observed, 89.7% for those prescribed digital massage, 87.0% for those prescribed antibiotics and 90.7% for those treated with both. This comparison was significant in unadjusted (p<0.001) and multivariable comparisons (p<0.001).ConclusionPrescribing topical antibiotics or digital massage for infants with CNLDO in this cohort, individually or in combination, was associated with a higher rate of spontaneous resolution than observation alone.

Microcannula Utilization for Injectable Facial Fillers: Standard of Care?

2018 ◽  
Vol 35 (4) ◽  
pp. 189-197 ◽  
Author(s):  
Kian Karimi ◽  
Chester F. Griffiths ◽  
Alex Reivitis ◽  
Austin Davis-Hunter ◽  
Elizabeth Zhang ◽  
...  
Keyword(s):  
Adverse Events ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Standard Of Care ◽  
Dermal Filler ◽  
Popular Method ◽  
Patient Reported ◽  
Clinical Series ◽  
Filler Injections

The microcannula technique has become an increasingly popular method for injecting cosmetic fillers. Previous studies have illustrated that the microcannula technique allows filler to be injected with less pain, swelling, and essentially no bruising. This study is a retrospective clinical series examining 247 patients who have undergone dermal filler injections using the microcannula technique from 2011 to 2016 with a single injector, Kian Karimi. The purpose of this study is to assess the frequency of adverse events associated with injections such as bruising and swelling. All 666 recorded patient visits from 2011 to 2016 were analyzed using electronic medical records based on the criteria that the patients had cosmetic filler using the microcannula technique by the surgeon investigator. Of the 666 filler treatments using the microcannula technique, 3 treatments (0.5%) produced adverse events on the day of service, and 32 treatments (4.8%) produced adverse events at 2-week follow-up. In total, 5.4% of treatments produced adverse events. At the 2-week follow-up, 5.7% of treatments using the 25-gauge microcannula produced adverse events ( P = .830); 3.9% of treatments using the 27-gauge microcannula produced adverse events ( P = .612]). Only 3 patients were treated with the 30-gauge microcannula, and 1 patient reported adverse events on the day of service. None of the treatments using the 30-gauge microcannula produced adverse events at the 2-week follow-up ( P = .160). The data support that the microcannula technique is a safe and effective alternative to hypodermic needles for the injection of dermal filler to minimize common adverse events.

scholarly journals Midterm Safety of Carbon Dioxide Insufflation of the Knee During Arthroscopic Cartilage–Based Procedures

2021 ◽  
Vol 9 (10) ◽  
pp. 232596712110354
Author(s):  
Judson L. Penton ◽  
Travis R. Flick ◽  
Felix H. Savoie ◽  
Wendell M. Heard ◽  
William F. Sherman
Keyword(s):  
Carbon Dioxide ◽  
Clinical Outcomes ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Knee Arthroscopy ◽  
Case Series ◽  
Osteochondral Allograft ◽  
Systemic Complications ◽  
Allograft Transplantation

Background: When compared with fluid arthroscopy, carbon dioxide (CO2) insufflation offers an increased scope of view and a more natural-appearing joint cavity, and it eliminates floating debris that may obscure the surgeon’s view. Despite the advantages of CO2 insufflation during knee arthroscopy and no reported cases of air emboli, the technique is not widely used because of concerns of hematogenous gas leakage and a lack of case series demonstrating safety. Purpose/Hypothesis: To investigate the safety profile of CO2 insufflation during arthroscopic osteochondral allograft transplantation of the knee and report the midterm clinical outcomes using this technique. We hypothesized that patients undergoing CO2 insufflation of the knee joint would have minimal systemic complications, allowing arthroscopic cartilage work in a dry field. Study Design: Case series; level of evidence, 4. Methods: A retrospective chart review was performed of electronic medical records for patients who underwent arthroscopic osteochondral allograft transplantation of the knee with the use of CO2 insufflation. Included were patients aged 18 to 65 years who underwent knee arthroscopy with CO2 insufflation from January 1, 2015, to January 1, 2021, and who had a minimum follow-up of 24 months. All procedures were performed by a single, fellowship-trained and board-certified sports medicine surgeon. The patients’ electronic medical records were reviewed in their entirety for relevant demographic and clinical outcomes. Results: We evaluated 27 patients (14 women and 13 men) with a mean age of 38 and a mean follow-up of 39.2 months. CO2 insufflation was used in 100% of cases during the placement of the osteochondral allograft. None of the patients sustained any systemic complications, including signs or symptoms of gas embolism or persistent subcutaneous emphysema. Conclusion: The results of this case series suggest CO2 insufflation during knee arthroscopy can be performed safely with minimal systemic complications and provide an alternative environment for treating osteochondral defects requiring a dry field in the knee.

Predicting chronic pain after major traumatic injury

2019 ◽  
Vol 19 (3) ◽  
pp. 453-464 ◽  
Author(s):  
Elisabeth B. Powelson ◽  
Brianna Mills ◽  
William Henderson-Drager ◽  
Millie Boyd ◽  
Monica S. Vavilala ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Traumatic Injury ◽  
Opioid Use ◽  
Post Injury ◽  
Regional Analgesia ◽  
Final Model ◽  
Opioid Medications

Abstract Background and aims Chronic pain after traumatic injury and surgery is highly prevalent, and associated with substantial psychosocial co-morbidities and prolonged opioid use. It is currently unclear whether predicting chronic post-injury pain is possible. If so, it is unclear if predicting chronic post-injury pain requires a comprehensive set of variables or can be achieved only with data available from the electronic medical records. In this prospective study, we examined models to predict pain at the site of injury 3–6 months after hospital discharge among adult patients after major traumatic injury requiring surgery. Two models were developed: one with a comprehensive set of predictors and one based only on variables available in the electronic medical records. Methods We examined pre-injury and post-injury clinical variables, and clinical management of pain. Patients were interviewed to assess chronic pain, defined as the presence of pain at the site of injury. Prediction models were developed using forward stepwise regression, using follow-up surveys at 3–6 months. Potential predictors identified a priori were: age; sex; presence of pre-existing chronic pain; intensity of post-operative pain at 6 h; in-hospital opioid consumption; injury severity score (ISS); location of trauma, defined as body region; use of regional analgesia intra- and/or post-operatively; pre-trauma PROMIS Depression, Physical Function, and Anxiety scores; in-hospital Widespread Pain Index and Symptom Severity Score; and number of post-operative non-opioid medications. After the final model was developed, a reduced model, based only on variables available in the electronic medical record was run to understand the “value add” of variables taken from study-specific instruments. Results Of 173 patients who completed the baseline interview, 112 completed the follow-up within 3–6 months. The prevalence of chronic pain was 66%. Opioid use increased from 16% pre-injury to 28% at 3–6 months. The final model included six variables, from an initial set of 24 potential predictors. The apparent area under the ROC curve (AUROC) of 0.78 for predicting pain 3–6 months was optimism-corrected to 0.73. The reduced final model, using only data available from the electronic health records, included post-surgical pain score at 6 h, presence of a head injury, use of regional analgesia, and the number of post-operative non-opioid medications used for pain relief. This reduced model had an apparent AUROC of 0.76, optimism-corrected to 0.72. Conclusions Pain 3–6 months after trauma and surgery is highly prevalent and associated with an increase in opioid use. Chronic pain at the site of injury at 3–6 months after trauma and surgery may be predicted during hospitalization by using routinely collected clinical data. Implications If our model is validated in other populations, it would provide a tool that can be easily implemented by any provider with access to medical records. Patients at risk of developing chronic pain could be selected for studies on preventive strategies, thereby concentrating the interventions to patients who are most likely to transition to chronic pain.

Perspectives on Electronic Prescribing and Terminologies

2013 ◽  
pp. e370-e373
Author(s):  
David Liebovitz
Keyword(s):  
Patient Safety ◽  
Electronic Medical Records ◽  
Medical Records ◽  
International Classification Of Diseases ◽  
Population Based ◽  
Electronic Prescribing ◽  
Medication History ◽  
Diagnosis Codes ◽  
Classification Of Diseases ◽  
Potential Benefits

Electronic medical records provide potential benefits and also drawbacks. Potential benefits include increased patient safety and efficiency. Potential drawbacks include newly introduced errors and diminished workflow efficiency. In the patient safety context, medication errors account for significant patient harm. Electronic prescribing (e-prescribing) offers the promise of automated drug interaction and dosage verification. In addition, the process of enabling e-prescriptions also provides access to an often unrecognized benefit, that of viewing the dispensed medication history. This information is often critical to understanding patient symptoms. Obtaining significant value from electronic medical records requires use of standardized terminology for both targeted decision support and population-based management. Further, generating documentation for a billable encounter requires usage of proper codes. The emergence of International Classification of Diseases (ICD)-10 holds promise in facilitating identification of a more precise patient code while also presenting drawbacks given its complexity. This article will focus on elements of e-prescribing and use of structured chart content, including diagnosis codes as they relate to physician office practices.

Bilateral inferior petrosal sinus sampling: experience in 327 patients

2016 ◽  
Vol 9 (2) ◽  
pp. 196-199 ◽  
Author(s):  
Amy Deipolyi ◽  
Alexander Bailin ◽  
Joshua A Hirsch ◽  
T Gregory Walker ◽  
Rahmi Oklu
Keyword(s):  
Electronic Medical Records ◽  
Medical Records ◽  
Inferior Petrosal Sinus ◽  
Technical Success ◽  
Cushing Disease ◽  
Inferior Petrosal Sinus Sampling ◽  
Technical Success Rate ◽  
Technical Failures ◽  
Groin Hematoma

ObjectiveTo describe findings and outcomes of 331 bilateral inferior petrosal sinus sampling (BIPSS) procedures performed in 327 patients evaluated for Cushing disease (CD).Materials and methodsThe radiology department's electronic database was searched to identify all BIPSS procedures (1990–2013). Electronic medical records were used to identify demographics, laboratory, procedural, surgical and pathologic findings.ResultsA total of 331 BIPSS procedures were performed in 327 patients (254 F, 73 M), mean age 41 (range 7–81) years. The overall technical success rate was 88% for bilateral cannulation, though nearly two-thirds of the technical failures had unilateral sampling that diagnosed CD. Of the 331 BIPSS procedures, 40 were performed without, and 291 with stimulation by Acthrel or desmopressin. Sensitivity was 89–94% for unstimulated BIPSS, 96% for stimulated BIPSS, and 77% for MRI. BIPSS lateralization was accurate in about half of patients, compared with 75% accuracy for MRI. Mean inferior petrosal sinus (IPS):peripheral adrenocorticotropic hormone ratio was 17.3 (SE 1.8) at baseline, and 99.2 (SE 14.8) at 3 min, with decreasing values over time. All patients with follow-up after surgical resection for centralizing BIPSS were reported to be cured, with cortisol levels significantly decreased from 19 to 4 μg/dL (p<0.0001). Complications from BIPSS were rare, including groin hematoma (2.5%), but no thromboembolic complications were seen.ConclusionsBIPSS remains the ‘gold standard’ for diagnosing CD. Stimulation with Acthrel or desmopressin is key to increasing specificity. When only one IPS can be successfully cannulated, results may still be diagnostic. BIPSS findings cannot be used to accurately lateralize lesions within the pituitary.

scholarly journals Implementation of Electronic Medical Records for Service Delivery in Selected State Hospitals in Southwest Nigeria

2021 ◽  
Vol 5 (2) ◽  
pp. 75-94
Author(s):  
Stephen Adekunle Ajayi ◽  
Peter Wamae ◽  
Daniel Wambiri Muthee
Keyword(s):  
Electronic Medical Records ◽  
Medical Records ◽  
Health Workers ◽  
Poor Performance ◽  
Electronic Record ◽  
Treatment Area ◽  
Medical Records Systems ◽  
Southwest Nigeria ◽  
Statistical Analysis Method

Electronic Medical Records (EMR) is an important communications channel relating to patient health conditions. Unfortunately, many hospitals in Africa, including Nigeria, have not implemented EMR. The few Hospitals that have some level of EMR continues are still struggling with the use of paper and hybrid medical records, which has led to inadequate medical follow-up, medical error, and long waiting time for patients. A sample size of three hundred and ninety-seven (397) was determined using krejcie and morgan models, comprising of strategic managers, and the operational staff drawn from a population of 2889 in the selected hospitals. At the hospital level, purposive sampling was applied in picking strategic managers, while stratified random sampling was method was used to select operational health workers. Questionnaires were used for data collection. The study adopted a descriptive statistical analysis method to describe the existing medical records systems. The finding indicated that the systems in the hospitals are mainly paper-based. The hospitals are also using hybrid system with a few treatment areas having fully electronic medical records systems. In the area where EMR has been implemented, the finding indicates poor penetration of the EMR system, limited modules, staff readiness and poor performance in the treatment area, among others. The study concluded that hospitals that have implemented, EMR is not serving the classical purpose of medical record of supporting treatment and follow up. The study recommended that the selected hospitals should ensure there is the availability of fund, staff training, and technical infrastructures like electronic record managers, ICT support staff, and computer compatible medical devices, among others.

scholarly journals Exploring why patients with cancer consult GPs: a 1-year data extraction

BJGP Open ◽  
2019 ◽  
Vol 3 (4) ◽  
pp. bjgpopen19X101663 ◽  
Author(s):  
Heidi Lidal Fidjeland ◽  
Ingvild Vistad ◽  
Svein Gjelstad ◽  
Mette Brekke
Keyword(s):  
Electronic Medical Records ◽  
Medical Records ◽  
Data Extraction ◽  
Survival Rates ◽  
Main Diagnosis ◽  
Consultation Rate ◽  
Patients With Cancer ◽  
Explorative Study ◽  
The Mean

BackgroundSurvival rates of patients with cancer are increasing owing to improvements in diagnostics and therapies. The traditional hospital-based follow-up model faces challenges because of the consequent increasing workload, and it has been suggested that selected patients with cancer could be followed up by GPs.The hypothesis of the study was that, regardless of the hospital-based follow-up care, GPs see their patients with cancer both for cancer-related problems as well as for other reasons. Thus, a formalised follow-up by GPs would not mean too large a change in GPs’ workloads.AimTo explore to what extent patients with cancer consult their GPs, and for what reasons.Design & settingA 1-year explorative study was undertaken, based on data from 91 Norwegian GPs from 2016–2017.MethodThe data were electronically extracted from GPs' electronic medical records (EMR).ResultsData were collected from 91 GPs. There were 11 074 consultations in total, generated by 1932 patients with cancer. The mean consultation rate was higher among the patients with cancer compared with Norwegian patients in general. In one-third of the consultations, cancer was the main diagnosis. Apart from cancer, cardiovascular and musculoskeletal diagnoses were common. Patients with cancer who had multiple diagnoses or psychological diagnoses did not consult their GP significantly more often than patients with cancer without such comorbidity.ConclusionThis study confirms that patients with cancer consult their GP more often than other patients, both for cancer-related reasons and for various comorbidities. A formalised follow-up by GPs would probably be feasible, and GPs should prepare for this responsibility.

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