scholarly journals Analyzing 2,589 child neurology telehealth encounters necessitated by the COVID-19 pandemic

Neurology ◽  
2020 ◽  
Vol 95 (9) ◽  
pp. e1257-e1266 ◽  
Author(s):  
Salvatore C. Rametta ◽  
Sara E. Fridinger ◽  
Alexander K. Gonzalez ◽  
Julie Xian ◽  
Peter D. Galer ◽  
...  
Keyword(s):  
Outpatient Care ◽  
Minority Groups ◽  
Child Neurology ◽  
Patient Demographics ◽  
Retrospective Comparison ◽  
Before And After ◽  
Future Care ◽  
Icd 10 ◽  
Audio Video

ObjectiveTo assess the rapid implementation of child neurology telehealth outpatient care with the onset of the coronavirus disease 2019 (COVID-19) pandemic in March 2020.MethodsThis was a cohort study with retrospective comparison of 14,780 in-person encounters and 2,589 telehealth encounters, including 2,093 audio-video telemedicine and 496 scheduled telephone encounters, between October 1, 2019 and April 24, 2020. We compared in-person and telehealth encounters for patient demographics and diagnoses. For audio-video telemedicine encounters, we analyzed questionnaire responses addressing provider experience, follow-up plans, technical quality, need for in-person assessment, and parent/caregiver satisfaction. We performed manual reviews of encounters flagged as concerning by providers.ResultsThere were no differences in patient age and major ICD-10 codes before and after transition. Clinicians considered telemedicine satisfactory in 93% (1,200 of 1,286) of encounters and suggested telemedicine as a component for follow-up care in 89% (1,144 of 1,286) of encounters. Technical challenges were reported in 40% (519 of 1,314) of encounters. In-person assessment was considered warranted after 5% (65 of 1,285) of encounters. Patients/caregivers indicated interest in telemedicine for future care in 86% (187 of 217) of encounters. Participation in telemedicine encounters compared to telephone encounters was less frequent among patients in racial or ethnic minority groups.ConclusionsWe effectively converted most of our outpatient care to telehealth encounters, including mostly audio-video telemedicine encounters. Providers rated the vast majority of telemedicine encounters to be satisfactory, and only a small proportion of encounters required short-term in-person follow-up. These findings suggest that telemedicine is feasible and effective for a large proportion of child neurology care. Additional strategies are needed to ensure equitable telemedicine use.

24. Successful treatment of anal intraepithelial neoplasia by CO2 laser in a sexual health service

Sexual Health ◽  
2013 ◽  
Vol 10 (6) ◽  
pp. 581
Author(s):  
Jenny McCloskey ◽  
Janelle Hall ◽  
Michael Phillips ◽  
Cecily Metcalf
Keyword(s):  
High Resolution ◽  
Co2 Laser ◽  
Preliminary Analysis ◽  
Intraepithelial Neoplasia ◽  
Anal Intraepithelial Neoplasia ◽  
Patient Demographics ◽  
Sexual Health Service ◽  
Before And After ◽  
Anal Disease

Background Treatments for anal intraepithelial neoplasia (AIN) are still being established. Methods: An audit of patients referred for treatment of anal disease by CO2 laser at a Perth SHS was performed. Patient demographics including sex, sexual preference, age, and HIV status were documented. Anal cytology, histopathology, and HPV testing before and after treatment were reviewed in this preliminary analysis. Initial diagnosis of anal disease including AIN was made by high-resolution anoscopy (HRA) and by histological examination. Patients were then referred for treatment. Six-monthly HRA review occurred after treatment and the original site of HGAIN was biopsied. Results: Preliminary analysis of 28 patients included 16 patients with AIN 2 and 12 with AIN 3. After laser treatment, 7 patients had no AIN, 3 had AIN 1, 10 had AIN 2 and 4 had AIN 3, indicating successful reduction in AIN status (Pearson χ2 = 15.2, P = 0.002). The incidence of AIN decreased over the 18 months of follow-up. Conclusions: Studies of CO2 laser ablation of the anal canal are ongoing and need further study. Table 1. High-resolution anoscopy follow up Rx, treatment

scholarly journals 627. Tele-OPAT Outcomes at Two Community Hospitals

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S373-S374
Author(s):  
Kathleen R Sheridan ◽  
Rima Abdel-Massih ◽  
Nupur Gupta ◽  
John Mellors
Keyword(s):  
Rural Areas ◽  
Medical Officer ◽  
Community Hospitals ◽  
Research Support ◽  
Readmission Rates ◽  
Initial Infection ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Patient Demographics ◽  
Audio Video

Abstract Background Outpatient parenteral antimicrobial therapy (OPAT) is well-established for the care of patients requiring IV antibiotics after hospital discharge but little is known about the effectiveness of OPAT delivered through telemedicine.1-3 We therefore investigated outcomes from telemedicine OPAT services (Tele-OPAT) at two community hospitals. Methods Data was collected from two community hospitals in the UPMC system for which both inpatient and outpatient telemedicine ID services (Tele-ID), including Tele-OPAT services, are provided. Tele-ID services at Site 1 (171 beds) began in January 2014 and at Site 2 (133 beds) in January 2018. All patients had inpatient Tele-ID consults via live audio-video (AV) visits or EHR review. After discharge, patients were managed by a Tele-OPAT team consisting of an ID pharmacist, RN and ID physician. Live AV Tele-OPAT outpatient follow-up visits were conducted with the assistance of a tele-presenter at 2 clinic sites. Results A total of 489 unique patients with 536 encounters were evaluated. Site 1 accounted for 284 patients, Site 2 had 252. Demographics are listed in Table 1. 47% of the patients were male with an average age of 65. 51% of the patients were diabetic. Half of the patients were discharged to home. Bacteremia (24.4%) and osteomyelitis (23.3%) were the most frequent diagnoses. Vancomycin was the most commonly used antibiotic (25.6%). Tele-ID Clinic follow up rates varied by year and site between 19 to 26.6% (Figure 1). The choice of follow-up was determined by the primary inpatient physician. 30 Day Readmission Rates were lower for patients that were seen by the Tele-OPAT service (combined rate of 7.4%) vs. no follow up (62%) vs. PCP follow up (22%) vs. follow up with another MD (12.8%) (Figure 2a). Most patients seen by Tele-OPAT were readmitted for reasons not related to their initial infection or their antibiotic course (Figure 2b). Table 1. Patient Demographics Figure 1. Clinic Follow Up Rates Figure 2. Readmission Rates & Reasons for Readmission Conclusion Patients discharged on IV antibiotics who were managed via a Tele-OPAT service in an outpatient clinic had lower readmission rates than those who were seen by non-ID physicians or who had no outpatient follow-up. Tele-OPAT is an important option for patients residing in rural areas who are discharged on parenteral antibiotics. Disclosures Rima Abdel-Massih, MD, Infectious Disease Connect (Shareholder, Other Financial or Material Support, Chief Medical Officer) John Mellors, MD, Abound Bio (Shareholder)Accelevir Diagnostics (Consultant)Co-Crystal Pharmaceuticals (Shareholder)Gilead (Consultant, Grant/Research Support)Merck (Consultant)

107 First come, first served: a comparison of first-ever seizure patients and those presenting after recurrent-untreated seizures

2018 ◽  
Vol 89 (6) ◽  
pp. A42.2-A43
Author(s):  
Sarah Holper ◽  
Emma Foster ◽  
Patrick Kwan
Keyword(s):  
Correct Diagnosis ◽  
Medical Attention ◽  
Inclusion Criteria ◽  
Social Barriers ◽  
Patient Demographics ◽  
Icd 10 ◽  
Impaired Awareness ◽  
To Receive ◽  
New Onset

IntroductionFirst seizure diagnosis may be delayed due to financial, geographical or social barriers to healthcare, or misdiagnosis with differentials including syncope or stroke. Seizures may recur until correct diagnosis and appropriate treatment is instituted; meanwhile, patients may experience increased seizure-related morbidity and mortality. We compare patient and seizure characteristics between a first-ever ‘new-onset’ seizure (NOS) cohort, and a recurrent-untreated seizure (RUS) cohort.MethodMedical charts were reviewed to extract information on patient demographics and clinical characteristics using a standardised proforma. Inclusion criteria were patients aged 18 or over who attended a tertiary-level Melbourne hospital between 1 January 2008 and 30 November 2016 with discharge codes ICD-10 G40-Epilepsy, G41-Status epilepticus, or R56.9-Unspecified convulsions.Results367 episodes were identified. 151 episodes met inclusion criteria: new-onset seizures (115) and recurrent-untreated seizures.36 216 excluded cases included pre-existing epilepsy (186), and non-seizure events.30 RUS-cohort experienced a median of two seizures prior to coming to medical attention, most commonly focal impaired awareness seizures (50.00%). Considering the index seizure, focal seizures were more common in RUS-cohort (36.11 vs 24.35%) while primary generalised seizures predominated in NOS-cohort (62.61% vs 50.00%). Compared to NOS-cohort, RUS-cohort was more likely to have unprovoked seizures (72.22% vs 55.65%), identifiable remote risk factors (41.67% vs 26.09%), younger age (69 vs 76), normal MRI and EEG, and be discharged on antiepileptic drugs (86.11% vs 73.91%). RUS-cohort was more likely to receive Neurology outpatient follow-up (72.22% vs 39.99%), and in a more timely manner compared to NOS-cohort (30.56% vs 11.31% saw a Neurologist within a month of discharge).ConclusionRecurrent-untreated seizures often have subtler semiology and are more likely to have normal MRI and EEG results than patients presenting immediately following new-onset seizures. RUS-cohort tend to receive more inpatient investigations and AED prescriptions, and are offered more timely neurology follow-up than NOS-cohort.

scholarly journals Effectiveness and Safety of Ultrasound-guided Percutaneous Microwave Ablation for Hepatic Alveolar Echinococcosis

2021 ◽  
Author(s):  
Xu Deng ◽  
Jing-jing Wang ◽  
Zhi-xin Wang ◽  
Hai-ning Fan ◽  
Hai-jiu Wang ◽  
...  
Keyword(s):  
Microwave Ablation ◽  
Alveolar Echinococcosis ◽  
Imaging Features ◽  
Paired Sample ◽  
Patient Demographics ◽  
Hepatic Alveolar Echinococcosis ◽  
Signed Rank ◽  
Before And After ◽  
Percutaneous Microwave Ablation

Abstract BackgroundMicrowave ablation (MWA) is a popular therapy for liver malignant tumor in recent years. Few studies have been conducted on its use in the treatment of hepatic alveolar echinococcosis (HAE). The study aims to evaluate the efficacy and safety of MWA in the treatment of HAE.MethodsThis study analyzed the data of 45 patients (mean age,38 ±2 years; 24 males) diagnosed with HAE and underwent MWA treatment between June 2014 to December 2019. The patients after MWA were examined by CT or MRI to determine whether the lesions were relapsed and to evaluate the therapeutic effect of MWA. The safety of MWA was evaluated by monitoring postoperative complications. Clinical data, such as patient demographics, imaging features of the lesions, relevant findings of laboratory tests before and after ablation, and information related to ablation, were collected and analyzed. Paired-sample t tests and paired-sample Wilcoxon signed-rank tests were used to compare relevant laboratory indicators before and after MWA. ResultsMWA was applied to 57 HAE lesions in 45 patients. The median size of lesions was 3.42 cm (IQR2.85-4.41). The rate of complete ablation was 100% (57/57). The median follow-up time was 32 months (IQR 23–48.5). The recurrence rate was 13% (6/45), and the median time of recurrence was 22 months. The rate of minor complications was 11.1% (5/45), and there were no major complications and deaths. Compared to preoperative, ALB, RBC, HBG, and PLT were decreased (p<0.001); ALT, TB, DB, and WBC were increased (p<0.001); and no statistically difference in PT, APTT, and INR (p＞0.05).ConclusionsMWA is a safe and effective way to cure HAE. Meanwhile, it provides a new option and a new way of thinking about the treatment modality for patients with lesions ≤ 5 cm in diameter.

Abstract P475: Dementia and Heart Failure a Community Study

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Sheila M Manemann ◽  
David Knopman ◽  
Jennifer St. Sauver ◽  
Suzette J Bielinski ◽  
Alanna M Chamberlain ◽  
...  
Keyword(s):  
Heart Failure ◽  
Care Delivery ◽  
Care Utilization ◽  
Risk Of Death ◽  
Department Of Health ◽  
Increased Risk ◽  
Before And After ◽  
Diagnosis Of Dementia ◽  
Icd 10

Background: The effective self-management of heart failure (HF) is highly dependent on cognitive function. Dementia frequently coexists with HF, but its exact prevalence and impact on health care utilization and death is not well understood. Methods: Residents from 7 southeast Minnesota counties with a first-ever code for HF (ICD-9 428 and ICD-10 I50) between 1/1/2012 and 12/31/2017 were identified. Dementia before and after the HF diagnosis was ascertained with codes recommended by the US Department of Health and Human Services. Patients were followed through 12/31/2018 for death and hospitalizations. Cox and Andersen-Gill models were used to examine associations between dementia (prior and post HF) and death and hospitalizations, respectively. Dementia after HF was analyzed as a time-dependent variable. Results: Among 6,312 patients with HF (mean age 75 years, 49% female), 636 (10%) had a prior diagnosis of dementia. After a mean (SD) follow-up of 3.1 (1.8) years, 601 (9.5%) patients were diagnosed with dementia post HF. The median time from HF to dementia was 1.3 years, with 43% of dementia cases occurring within 1 year and 64% within 2 years post HF. During follow-up, 2,678 deaths and 15,095 hospitalizations occurred. After adjustment, patients with dementia before HF had nearly a 2-times increased risk of death and 10% increased risk of hospitalization compared to those that did not have dementia (Table). Dementia after HF was associated with a 78% increased risk of death and 63% increased risk of hospitalization compared to those that did not have dementia. Conclusions: Approximately 10% of patients had dementia prior to HF and 10% develop dementia shortly after HF diagnosis. Patients with HF and dementia have an increased risk of death and hospitalization compared to dementia-free counterparts. These data underscore the importance of recognizing the presence and impact of dementia on outcomes in HF to optimize care delivery.

scholarly journals Efficacy of Altered Two-Point Fixation in Zygomaticomaxillary Complex Fracture

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Jun Hyeok Kim ◽  
Ye Sol Kim ◽  
Deuk Young Oh ◽  
Young Joon Jun ◽  
Jong Won Rhie ◽  
...  
Keyword(s):  
Operation Time ◽  
Facial Asymmetry ◽  
Asymmetry Index ◽  
Patient Demographics ◽  
Before And After ◽  
Zygomaticomaxillary Complex Fracture ◽  
Eyebrow Incision ◽  
Group 2 ◽  
Zygomaticomaxillary Complex

Purpose. To reconstruct a zygomaticomaxillary complex (ZMC) fracture, zygomaticofrontal (ZF) suture is the most reliable site to assess anatomical alignment and to secure rigidity. It has been chosen primary site to be fixed, but approach through the lateral eyebrow incision may leave a visible scar. This study suggests altered two-point fixation of ZMC fracture without accessing the ZF suture. Methods. In the retrospective study, a total of 40 patients with ZMC fracture were divided into two groups (group 1, two-point fixation and group 2, three-point fixation). Patient demographics and follow-up were evaluated, and degree of reduction including cortical gaps of ZF and inferior orbital (IO) area, protruding difference of zygoma, and malar difference using asymmetry index were measured through preoperative and postoperative CT. Results. Preoperatively, the means of ZF displacement, IO displacement, protruding difference of zygoma, and facial asymmetry index between the groups were not statistically different. The result was the same after the operation. However, all variables were significantly different before and after surgery within each group. Moreover, mean operation time was significantly different between groups (P value = 0.026). Conclusion. Altered two-point fixation in ZMC fracture excluding incision approaching the ZF provides surgical efficacy and similar surgical outcomes to three-point fixation but offers reduced operation time and fewer complications.

Melatih Kepemimpinan Perangkat Desa Kebonharjo Kulonprogo: Membangun Sikap Anti Korupsi

2018 ◽  
Vol 1 ◽  
pp. 107
Author(s):  
Adi Heryadi ◽  
Evianawati Evianawati
Keyword(s):  
Transformational Leadership ◽  
Data Collection ◽  
Paired Samples ◽  
Significant Difference ◽  
Before And After ◽  
Post Test ◽  
Sample Test ◽  
Corruption Perception ◽  
Measuring Tool

This study aims to prove whether transformational leadership training is effective for building anti-corruption attitudes of villages in Kebonharjo village, subdistrict Samigaluh Kulonprogo. This research is an experimental research with one group pre and posttest design.Subject design is 17 people from village of 21 candidates registered. Measuring tool used in this research is the scale of anti-corruption perception made by the researcher referring to the 9 anti-corruption values with the value of reliability coefficient of 0.871. The module used as an intervention made by the researcher refers to the transformational leadership dimension (Bass, 1990). The data collected is analyzed by statistical analysis of different test Paired Sample Test. Initial data collection results obtained sign value of 0.770 which means> 0.05 or no significant difference between anti-corruption perception score between before and after training. After a period of less than 1 (one) month then conducted again the measurement of follow-up of the study subjects in the measurement again using the scale of anti-corruption perception. The results of the second data collection were analysed with Paired Samples Test and obtained the value of 0.623 sign meaning p> 0.05 or no significant difference between post test data with follow-up data so that the hypothesis of this study was rejected.

SUBLINGUAL VITAMIN D3 DRUG THERAPY IN VITAMIN D DEFICIENCY PATIENTS AT PRAVARA RURAL HOSPITAL

2019 ◽  
pp. 18-20
Author(s):  
Sanjeeva Kumar Goud T ◽  
Rahul Kunkulol
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Vitamin D3 ◽  
Serum Vitamin ◽  
Cross Sectional ◽  
Serum Vitamin D ◽  
Significant Difference ◽  
Before And After

The present study was aimed to study the effect of Sublingual Vitamin D3 on Serum Vitamin D level in Vitamin D deficiency patients. This was a cross-sectional and interventional study. All the Vitamin D deficiency patients of age 18-60years and either gender, willing to participate in the study were included. Patients who had greater than 20 ng/ml were excluded from the study. The total number of participants in our study was 200, out of these 111 males and 89 females, the mean age in our study was 51.07 ± 7.39Yrs. All volunteers were given sublingual vitamin D3 (60,000IU) in six doses every fifteen days of follow up for 3 months. The subject’s serum 25(OH)D levels were estimated before and after the treatment of sublingual vitamin D3. There was a statistically significant difference in serum vitamin D3 level before 16.61±6.71 ng/ml and after 35.80±7.80 ng/ml after treatment with Sublingual Vitamin D3. Six doses of 60,000IU of Vitamin D3 sublingual route having improved the role of serum 25(OH)D levels in the treatment of Vitamin D3 deficiency patients.Keywords: Vitamin D3; Sublingual route

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