scholarly journals The impact of COVID-19 on adolescents with eating disorders: a cohort study

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Wendy Spettigue ◽  
Nicole Obeid ◽  
Madison Erbach ◽  
Stephen Feder ◽  
Natalie Finner ◽  
...  
Keyword(s):  
Eating Disorders ◽  
Chart Review ◽  
Clinical Course ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Time Frame ◽  
Lower Percentage ◽  
Average Percentage ◽  
Psychological Measures ◽  
The Impact

Abstract Background There is a noticeable lack of evidence regarding the impact of COVID-19 and the associated lockdown on young people with eating disorders. The goals of this study were 1) to examine characteristics of adolescents presenting for eating disorder (ED) assessment since the onset of the COVID-19 pandemic; 2) to compare adolescents presenting for ED assessment since the onset of the COVID-19 pandemic to those that presented for assessment 1 year previously; 3) to examine implications of the pandemic on the system of care. Methods A retrospective chart review was completed on all patients assessed at a pediatric tertiary care ED program during the pandemic between April 1 and October 31, 2020, and on youth assessed during the same time frame 1 year previously. Data including body measurements and results of psychological measures was extracted from patients’ charts. Clinician reports were utilized for accounts of ED symptoms. Referrals to our program were also compared for the two time periods. Results Of the 48 youth assessed between April and October 2020, average age was 14.6 years and average percentage of treatment goal weight was 77.7%. 40% cited the pandemic as a trigger for their ED; of these youth, 78.9% were medically unstable compared to 55.2% of those whose ED was not triggered by the pandemic. When comparing the 2020 cohort to those assessed in 2019, youth who presented for assessment during the pandemic trended towards having lower percentage of goal weights and higher rates of self-reported impairment, and were significantly more likely to be medically unstable (p = 0.005) and to require hospitalization (p = 0.005). Higher rates of inpatient admissions, emergency room consultation requests and outpatient referrals deemed “urgent” were likewise associated with the pandemic period. Conclusions During the COVID-19 pandemic, youth assessed for an ED presented with high rates of medical instability and need for hospitalization. Caring for these youth may be more challenging during the pandemic, when access to services may be limited. Further research is required to better understand the impact of the pandemic on the clinical course and outcomes of EDs in adolescents.

scholarly journals The Impact of COVID-19 on Adolescents with Eating Disorders: A Cohort Study

2021 ◽  
Author(s):  
Wendy Spettigue ◽  
Nicole Obeid ◽  
Madison Erbach ◽  
Stephen Feder ◽  
Natalie Finner ◽  
...  
Keyword(s):  
Eating Disorders ◽  
Chart Review ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Time Frame ◽  
Lower Percentage ◽  
Average Percentage ◽  
Psychological Measures ◽  
One Year ◽  
The Impact

Abstract Background: There is a noticeable lack of evidence regarding the impact of COVID-19 and the associated lockdown on young people with eating disorders. The goals of this study were 1) to examine characteristics of adolescents presenting for eating disorder (ED) assessment since the onset of the COVID-19 pandemic; 2) to compare adolescents presenting for ED assessment since the onset of the COVID-19 pandemic to those that presented for assessment one year previously; 3) to examine implications of the pandemic on the system of care. Methods: A retrospective chart review was completed on all patients assessed at a pediatric tertiary care ED program during the pandemic between April 1 and October 31, 2020, and on youth assessed during the same time frame one year previously. Data including body measurements and results of psychological measures was extracted from patients’ charts. Clinician reports were utilized for accounts of ED symptoms. Referrals to our program were also compared for the two time periods.Results: Of the 48 youth assessed between April and October 2020, average age was 14.6 years and average percentage of treatment goal weight was 77.7%. 40% cited the pandemic as a trigger for their ED; of these youth, 78.9% were medically unstable compared to 55.2% of those whose ED was not triggered by the pandemic. When comparing the 2020 cohort to those assessed in 2019, youth who presented for assessment during the pandemic trended towards having lower percentage of goal weights and higher rates of self-reported impairment, and were significantly more likely to be medically unstable and to require hospitalization. Higher rates of inpatient admissions, emergency room consultation requests and outpatient referrals deemed “urgent” were likewise associated with the pandemic period.

Impact of 24/7/365 Attending Radiologist Coverage on the Turnaround Time in an Emergency and Trauma Radiology Department

2020 ◽  
pp. 084653711989932
Author(s):  
Sabeena Jalal ◽  
Hugue Ouellette ◽  
Zharmaine Ante ◽  
Peter Munk ◽  
Faisal Khosa ◽  
...  
Keyword(s):  
Chart Review ◽  
Emergency Radiology ◽  
Care Center ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Turnaround Time ◽  
Radiology Department ◽  
Tertiary Care Center ◽  
Imaging Studies ◽  
The Impact

Objective: To study the impact of 24/7/365 attending radiologist coverage on the turnaround time (TAT) of trauma and nontrauma cases in an emergency and trauma radiology department. Patients and Methods: This was a retrospective chart review in which TAT of patients coming to the emergency department between 2 periods: (1) December 1, 2012, to September 30, 2013, and (2) January 1, 2017, to January 30, 2018, and whose reports were read by an attending emergency and trauma radiologist was noted. Results: The 24/7/365 radiology coverage was associated with a significant reduction in TAT of computed tomography reports, and the time reduction was comparable between trauma and nontrauma cases. In adjusted models, the extension of radiology coverage was associated with an average of 7.83 hours reduction in overall TAT (95% confidence interval [CI]: 7.44-8.22) for reports related to trauma, in which 2.73 hours were due to reduction in completion to transcription time (TC; 95% CI: 2.53-2.93), and 5.10 hours were due to reduction in transcription to finalization time (TF; 95% CI: 4.75-5.44). For reports related to nontrauma cases, 24/7/365 coverage was associated with an average of 6.07 hours reduction in overall TAT (95% CI: 3.54-8.59), 2.91 hours reduction in TC (95% CI: 1.55-4.26), and 3.16 hours reduction in TF (95% CI: 0.90-5.42). Conclusion: Our pilot study demonstrates that the implementation of on-site 24/7/365 attending emergency radiology coverage at a tertiary care center was associated with a reduced TAT for trauma and nontrauma patients imaging studies. Although the magnitude and precision of estimates were slightly higher for trauma cases as compared to nontrauma cases. Trauma examinations stand to benefit the most from 24/7/365 attending level radiology coverage.

Comparative Morbidity Profile of Elective vs Therapeutic Neck Dissection

2021 ◽  
pp. 019459982110089
Author(s):  
Quinn Dunlap ◽  
James Reed Gardner ◽  
Amanda Ederle ◽  
Deanne King ◽  
Maya Merriweather ◽  
...  
Keyword(s):  
Neck Dissection ◽  
Surgical Complications ◽  
Chart Review ◽  
Care Center ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Neck Surgery ◽  
Continuous Variables ◽  
Significant Difference ◽  
History Of

Objective Neck dissection (ND) is one of the most commonly performed procedures in head and neck surgery. We sought to compare the morbidity of elective ND (END) versus therapeutic ND (TND). Study Design Retrospective chart review. Setting Academic tertiary care center. Methods Retrospective chart review of 373 NDs performed from January 2015 to December 2018. Patients with radical ND or inadequate chart documentation were excluded. Demographics, clinicopathologic data, complications, and sacrificed structures during ND were retrieved. Statistical analysis was performed with χ2 and analysis of variance for comparison of categorical and continuous variables, respectively, with statistical alpha set a 0.05. Results Patients examined consisted of 224 males (60%) with a mean age of 60 years. TND accounted for 79% (n = 296) as compared with 21% (n = 77) for END. Other than a significantly higher history of radiation (37% vs 7%, P < .001) and endocrine pathology (34% vs 2.6%, P < .001) in the TND group, no significant differences in demographics were found between the therapeutic and elective groups. A significantly higher rate of structure sacrifice and extranodal extension within the TND group was noted to hold in overall and subgroup comparisons. No significant difference in rate of surgical complications was appreciated between groups in overall or subgroup analysis. Conclusion While the significantly higher rate of structure sacrifice among the TND population represents an increased morbidity profile in these patients, no significant difference was found in the rate of surgical complications between groups. The significant difference seen between groups regarding history of radiation and endocrine pathology likely represents selection bias.

scholarly journals 59. Persistence of Respiratory and Non-respiratory Symptoms Among COVID-19 Patients Seeking Care at an Ambulatory COVID-19 Center

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S161-S161
Author(s):  
Aditi Ramakrishnan ◽  
Jennifer Zreloff ◽  
Miranda Moore ◽  
Sharon H Bergquist ◽  
Michele Cellai ◽  
...  
Keyword(s):  
Respiratory Symptoms ◽  
Chart Review ◽  
Clinical Course ◽  
Retrospective Chart Review ◽  
Illness Onset ◽  
Persistent Symptoms ◽  
Emory University ◽  
Ambulatory Patients ◽  
Three Stages ◽  
Taste Alteration

Abstract Background While hospitalized COVID-19 patients are well described in the literature, studies of the natural history and ambulatory cases are limited. We aim to describe the symptoms and clinical course of COVID-19 among ambulatory patients seen at the Emory University multidisciplinary Acute Respiratory Clinic (ARC) developed to care for patients with confirmed or suspected COVID-19. Methods PCR-confirmed COVID-19 cases seen at ARC from 4/3–5/16/2020 were included in a retrospective chart review. Encounters were classified as acute, subacute, or convalescent depending on the duration since illness onset (&lt; 1, 1–4, or &gt;4 weeks, respectively). Demographic, clinical, physical exam, diagnostic test, and disposition data were abstracted and analyzed with standard descriptive statistics. Results Among 404 visits at ARC, 127 (31.4%) were for confirmed COVID-19 illness (107 unique patients with 1–4 visits). The majority (75.7%) of patients were female, and the median age was 55 years (range 24–89). Patients presented during acute, subacute, and convalescent phases of illness (15.7%, 58.3%, and 26.0%, respectively; Table). Prevalent co-morbidities included hypertension (39.3%), obesity (27.1%), diabetes (20.6%), and asthma (21.5%). While measured or subjective fever was reported in the majority of acute visits (60.0%), it was less common in subacute and convalescent encounters (27.0% and 30.3%). Cough was commonly reported in acute, subacute, and convalescent visits (70.0%, 79.7%, 66.7%), as were dyspnea on exertion (45.0%, 70.3%, 66.7%) and chest tightness (40.0%, 40.5%, 60.6%). Although smell or taste alteration was present in almost half of acute and subacute patients, it was only reported in a quarter of convalescent patients. Among the three stages of illness, transfers from ARC to the ED or direct hospitalizations occurred in 15.0%, 23.0%, and 12.1% of acute, subacute and convalescent visits, respectively. Table Timecourse of Symptoms among COVID-19 Patients in the Ambulatory Context Conclusion Following acute illness, COVID-19 patients can experience persistent symptoms, primarily respiratory symptoms, which can be severe enough to warrant hospitalization. Clinics evaluating recovering patients should prepare to manage these symptoms. Further study of the pathophysiology and treatment of persistent pulmonary symptoms in COVID-19 is needed. Disclosures All Authors: No reported disclosures

Abstract P305: Post-Stroke Aphasia as a Predictor of 30-Day Readmission Associated With Infection: A Retrospective Chart Review

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Emma M Loebel ◽  
Mary Rojas ◽  
Connor Mensching ◽  
Danielle Wheelwright ◽  
Laura K Stein
Keyword(s):  
Chart Review ◽  
Retrospective Chart Review ◽  
Mount Sinai Hospital ◽  
Index Admission ◽  
Negative Consequences ◽  
Medical Comorbidities ◽  
Post Stroke ◽  
Increased Risk ◽  
Adjusted Model ◽  
The Impact

Introduction: Studies have demonstrated that aphasia may negatively impact morbidity and mortality among ischemic stroke (IS) patients. However, the association between post-stroke aphasia and readmission with infection (RI) is poorly understood. We sought to assess the impact of aphasia on post-stroke RI. We hypothesized that aphasic patients are at increased risk of infection in the 30-day post-stroke period. Methods: We performed retrospective chart review of the Mount Sinai Hospital IS patients with 30-day all cause readmission from January 2016 - December 2019. All variables were abstracted from the index admission (IA) electronic medical records except for aspects related to the readmission (RA). Aphasia was present if a neurologist diagnosed the patient with acquired language dysfunction during IA. We performed chi square and logistic regression analyses to compare readmitted patients with and without aphasia at IA. Our fully adjusted model controlled for age, sex, medical comorbidities, NIHSS ≥ 8, IA LOS > 7, IA infection, discharge to facility. We completed all analyses with SPSS. Results: During IA, 36% (n=42) were diagnosed with aphasia. At IA, there were no significant differences in age (dichotomized at 65), sex, or medical comorbidities between aphasic and non-aphasic cohorts. However, more aphasic patients had admission NIHSS ≥ 8 (89% vs 35%, p<0.0001), LOS > 7 (76% vs 42%, p=0.0004), discharge to facility (79% vs 49%, p=0.0016), and RI (52% vs 19%, p=0.002). The presence of aphasia predicted RI in both unadjusted (OR=4.6, p<0.001) and adjusted (OR= 3.3, p=0.014) multivariate analyses. The Kappa inter-reliability ranged from 0.7-1.0 for the key variables included in our adjusted model. Conclusions: The adjusted odds of 30-day readmission with infection were significantly greater in those with diagnosis of aphasia at the time of index admission compared to those without. Our study provides preliminary evidence that the presence of aphasia may have negative consequences on a patient’s health beyond the language disturbance. Further study is needed to better understand the reasons and risk reduction strategies in this vulnerable population.

scholarly journals Post-operative fever in children undergoing mastoidectomy due to complicated acute mastoiditis

2021 ◽  
Author(s):  
Oren Ziv ◽  
Aviad Sapir ◽  
Eugene Leibowitz ◽  
Sofia Kordeluk ◽  
Daniel KAPLAN ◽  
...  
Keyword(s):  
Chart Review ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
University Hospital ◽  
Acute Mastoiditis ◽  
Benign Condition ◽  
Subperiosteal Abscess ◽  
Cortical Mastoidectomy ◽  
New Findings ◽  
Mastoid Surgery

Abstract Objectives: To determine the immediate post-operative course and outcome of pediatric patients with complicated acute mastoiditis (CAM) following surgical treatment. Study Design: A retrospective chart review of children diagnosed with CAM who underwent mastoid surgery during 2012-2019. Setting: Tertiary care university hospital. Participants: the study includes 33 patients, divided into two groups: 17 patients with subperiosteal abscess (SPA) alone - single complication group (SCG) and 16 patients with SPA and additional intracranial or intratemporal complications -multiple complications group (MCG). Main Outcome Measures: post-operative fever course and pattern (POF). Results :33 patients belong to the SCG 17(51%) and 16(49%) belonged to the MCG, respectively. 6/17(35.3%) SCG patients experienced POF vs. 12/16(75%) in the MCG (P=0.012). At post-operative day 2 (POD2), 10/13(77%) febrile patients belonged to MCG and 3/13(23%) to SCG (P=0.013). POF was recorded until POD6 in both groups. Seven patients, all from MCG with POF, underwent second imaging with no new findings. Conclusion: Following a cortical mastoidectomy for CAM, POF is not unusual in the first 6 days and seem to be benign condition. POF is more common, higher, and persistent for a longer duration in MCG compared with SCG. At POD 6, fever is expected to normalize in both groups, so if fever persists further evaluation should be considered.

scholarly journals The Administration of Prehospital Ketamine for Chemical Restraint does not Prolong On-Scene Times Compared to Haloperidol Based Sedation

2015 ◽  
Vol 12 (1) ◽  
Author(s):  
Aaron Burnett ◽  
Dolly Panchal ◽  
Bjorn Peterson ◽  
Eric Ernest ◽  
Kent Griffith ◽  
...  
Keyword(s):  
Emergency Medical Services ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
T Test ◽  
Medical Services ◽  
Demographic Differences ◽  
Chemical Restraint ◽  
Emergency Medical ◽  
Clinically Significant ◽  
The Impact

IntroductionAgitated patients who present a danger to themselves or emergency medical services (EMS) providers may require chemical restraints.  Haloperidol is employed for chemical restraint in many EMS services.  Recently, ketamine has been introduced as an alternate option for prehospital sedation.  On-scene time is a unique metric in prehospital medicine which has been linked to outcomes in multiple patient populations. When used for chemical restraint, the impact of ketamine relative to haloperidol on on-scene time is unknown.Objective: To evaluate whether the use of ketamine for chemical restraint was associated with a clinically significant (≥5 minute) increased on-scene time compared to a haloperidol based regimen.MethodsPatients who received haloperidol or ketamine for chemical restraint were identified by retrospective chart review.  On-scene time was compared between groups using an unadjusted Student t-test powered to 80% to detect a ≥5 minute difference in on-scene time.Results110 cases were abstracted (Haloperidol = 55; Ketamine = 55). Of the patients receiving haloperidol, 11/55 (20%) were co-administered a benzodiazepine, 4/55 (7%) received diphenhydramine and 34/55 (62%) received the three drugs in combination. There were no demographic differences between the haloperidol and ketamine groups.  On-scene time was not statistically different for patients receiving a haloperidol based regimen compared to ketamine (18.2 minutes, [95% CI 15.7-20.8] vs. 17.6 minutes, [95% CI 15.1-20.0]; p = 0.71).ConclusionsThe use of prehospital ketamine for chemical restraint was not associated with a clinically significant (≥5 minute) increased on-scene time compared to a haloperidol based regimen.  

scholarly journals Low-Dose Aminophylline for the Treatment of Neonatal Non-Oliguric Renal Failure—Case Series and Review of the Literature

2008 ◽  
Vol 13 (2) ◽  
pp. 80-87
Author(s):  
Bethany A. Lynch ◽  
Peter Gal ◽  
J. Laurence Ransom ◽  
Rita Q. Carlos ◽  
Mary Ann V.T. Dimaguila ◽  
...  
Keyword(s):  
Renal Failure ◽  
Renal Function ◽  
Acute Renal Failure ◽  
Chart Review ◽  
Low Dose ◽  
Case Series ◽  
Retrospective Chart Review ◽  
Review Of The Literature ◽  
Oliguric Renal Failure ◽  
The Impact

OBJECTIVE Aminophylline is a methylxanthine with multiple physiologic actions. At low doses, aminophylline can antagonize adenosine and improve renal function via increased glomerular filtration rate. Despite its clinical use, little data exists in neonates for this indication. Therefore, the objective of this report is to describe the impact of aminophylline on renal function indices in a series of neonates with acute renal failure. MATERIALS AND METHODS This was a retrospective chart review of 13 neonates with acute renal failure who received aminophylline during a 15-month study period. Aminophylline was administered at 1 mg/kg intravenously or orally every twelve hours. Forty-six percent (n = 6) of the patients received a 5 mg/kg loading dose before initiation of maintenance therapy. Most patients had already received other treatments for renal failure, including diuretics and dopamine. RESULTS Resolution of acute renal failure (with normalization of serum creatinine and blood urea nitrogen) was documented in 10 patients (77%). Four of the thirteen patients died from complications due to their prematurity. Failure of low-dose aminophylline was observed in 3 of the 4 patients who died. CONCLUSIONS Low-dose aminophylline in neonates with acute renal failure is associated with an improvement in renal function indices.

Retrospective Chart Review of Cryopreserved Amniotic Membrane for Knee Pain

2020 ◽  
Author(s):  
Ruben Berrocal Timmons
Keyword(s):  
Quality Of Life ◽  
Adverse Events ◽  
Amniotic Membrane ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Final Analysis ◽  
Mean Values ◽  
Number Of Patients ◽  
The Impact

Objective: Treatment of joint pain with an injection of the amniotic membrane has not been adequately studied. This study retrospectively reviewed Visual Analog Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and analgesic usage data from patients treated with the injection of cryopreserved amniotic membrane (CAM) in their knees to determine the impact of treatment on patients’ pain, quality of life, and analgesic usage. Methods: Chart review was conducted on 40 patients. Institutional Review Board (IRB) approval was obtained prior to initiation of the project. The membrane was utilized as per the FDA guidance of 21CFR1271. Retrospective data, including demographics, medical history, pain score, quality of life score, analgesic usage and adverse events, were collected from their medical records for each consenting patient through 6 months after CAM injection. Results: A total of 40 patients were considered in the final analysis. Mean VAS for pain level improved from 7.0 to 2.6 (p<0.001). WOMAC daily activity function score improved from a mean score of 52 to 28 (p<0.001). Opioid and non-steroidal anti-inflammatory drug (NSAID) usage decreased from 97% to 25% (p<0.001). No adverse events were reported. Conclusion: Mean values for VAS and WOMAC scores significantly improved at all time points and the number of patients who used analgesics decreased as compared to baseline. CAM injection into painful knee joints decreases pain, improves physical function, and decreases the use of analgesics in the absence of adverse events.

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