scholarly journals Analysis of critical report notification from musculoskeletal radiology in a tertiary academic medical institution with a regional trauma center

PLoS ONE ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. e0262511
Author(s):  
Tae Ran Ahn ◽  
Yu Mi Jeong ◽  
So Hyun Park ◽  
Ji Young Jeon ◽  
Sheen-Woo Lee ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Musculoskeletal System ◽  
Body Part ◽  
Radiology Department ◽  
Musculoskeletal Radiology ◽  
Loss To Follow Up ◽  
Institutional Review ◽  
Academic Medical ◽  
Enhance Patient Care

Purpose We aimed to analyze the prevalence, causes, and clinical settings of 4-year critical radiologic reports (CRRs) notified from the musculoskeletal section of the radiology department. Then, we investigated the communication outcomes. Methods This study was approved by our institutional review board. We retrospectively included 175 musculoskeletal CRRs from our database between January 2017 and December 2020. The CRRs were analyzed by two musculoskeletal radiologists, who categorized the CRRs by clinical setting (emergency department(ED) patient, outpatient, and inpatient), body part, type of image modality, reason for CRR, incidental lesion, and clinical outcome. The clinical outcome was retrieved from the electronic medical records. Results The 175 musculoskeletal CRRs accounted for 5.4% of the CRRs (n = 3217) available in the study period. Most CRRs (94.9%, 166/175) corresponded to the musculoskeletal system, while the remaining ones (5.1%, 9/175) corresponded to the non-musculoskeletal system. In addition, the spine, extremities, and thoracic cage accounted for 52.6%, 40.6%, and 1.7% of the musculoskeletal CRRs, respectively. Moreover, most patients presented to the ED (50.3%, 88/175), followed by inpatients (30.9%, 54/175), and outpatients (18.9%, 33/175). The CRR reasons included missed fracture (54.3%), suspected malignancy (16%), clinical emergency (10.3%), unexpected infection/inflammation (11.4%), and others (8%). Furthermore, 11 (6.3%) incidental lesions were not related to the primary imaging purpose. Referring clinicians actively acknowledged 80% of the CRRs. The loss to follow-up action was the highest in the ED patients (35.2%, 31/88; p < 0.001), being significantly higher than that in outpatients (6.1%, 2/33) and inpatients (3.7%, 2/54). Conclusion Missed fractures were the most common cause of musculoskeletal CRRs. ED showed prevalence in musculoskeletal CRRs and reflected the highest loss to follow-up action. ED physicians should pay more attention to CRRs to enhance patient care.

194 A multicenter characterization of chronic toxicities following adjuvant anti-PD-1 therapy for high risk resected melanoma

2020 ◽  
Vol 8 (Suppl 3) ◽  
pp. A209-A209
Author(s):  
James Patrinely ◽  
Rebecca Johnson ◽  
Aleigha Lawless ◽  
Prachi Bhave ◽  
Amelia Sawyers ◽  
...  
Keyword(s):  
Time Course ◽  
Treatment Decision ◽  
Low Grade ◽  
Term Survival ◽  
Treatment Decision Making ◽  
Institutional Review ◽  
Academic Medical ◽  
Grade 3 ◽  
Resected Stage

BackgroundAnti-programmed death-1 (anti-PD-1) therapies have improved long-term survival across many advanced cancers. However, chronic immune-related adverse events (irAEs) are not well-defined. We sought to determine the incidence, time-course, spectrum, and predictors of chronic irAEs arising from adjuvant anti-PD-1.MethodsIn this retrospective cohort, we analyzed patients from 8 academic medical centers with stage III-IV melanoma treated with anti-PD-1 in the adjuvant setting. Acute and chronic (persisting at least 3 months after therapy cessation) irAEs were characterized by type, time-course, management, and incidence.ResultsAmong 387 patients, most were male (60.7%) with a median age of 63 years, had cutaneous primaries (85.8%), BRAF/NRAS WT (51.2%), and resected stage IIIb (33.1%) or IIIc (39.5%) melanomas. Median overall survival and relapse-free survival (RFS) were not reached. 359 patients (93.0%) were alive at median follow-up of 529 days. Patients with acute (p<0.009) or chronic (p<0.001) irAEs had superior RFS compared with patients lacking irAEs. Treatment was discontinued for therapy completion (50.0%), irAEs (25.3%), and disease progression (20.9%). 267 patients (69.0%) had any acute irAE, including 19.5% (n=52) with grade 3–5 events. Acute irAEs were most commonly dermatitis/pruritis (25.8%), thyroiditis/hypothyroid (16.3%), arthralgias (10.6%), colitis/diarrhea (9.8%) and required glucocorticoids in 109 patients (28.2%). Of these, 167 patients (43.2%) developed chronic irAEs; 82 (49.1%) were symptomatic, 55 (32.9%) required glucocorticoids, and most were grade 1–2 (96.4%). Endocrinopathies (73/88, 83.0%) arthritis (22/45, 48.9%), xerostomia (9/17, 52.9%), neurotoxicities (8/8, 100.0%), and ocular events (5/8, 63.0%) were likely to become chronic events. In contrast, colitis (6/44, 13.6%), hepatitis (4/25, 16.0%), pneumonitis (6/18, 33.3%) were less likely to become chronic. Overall, the most common chronic irAEs were hypothyroidism (14.0%), dermatitis/pruritis (6.6%) arthralgias (5.7%), adrenal insufficiency (3.1%), and xerostomia (2.3%). Age (p=0.67), gender (p=0.31), time of onset of acute irAEs (p=0.95), and initial need for glucocorticoids (p=0.15) were not associated with chronicity. Only 24 (14.4%) of chronic irAEs ultimately resolved during the median 529-day follow-up. In particular, endocrinopathies (100%) arthralgias (100%) ocular events (100%), xerostomia (88.9%), and cutaneous events (89.5%) had high rates of persistence at last follow-up.ConclusionsChronic irAEs to anti-PD-1 were more common than previously recognized and frequently persisted even with prolonged follow-up, although most were low-grade. The risks of chronic toxic effects should be integrated into treatment decision making.Ethics ApprovalThis study was approved by the Vanderbilt Institutional Review Board

Effect of Manipulation under Anesthesia of the First Knee in Staged Bilateral Total Knee Arthroplasty on Clinical Outcome and Satisfaction

2020 ◽  
Author(s):  
Jung-Won Lim ◽  
Yong-Beom Park ◽  
Dong-Hoon Lee ◽  
Han-Jun Lee
Keyword(s):  
Total Knee Arthroplasty ◽  
Patient Satisfaction ◽  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Knee Arthroplasty ◽  
Knee Flexion ◽  
Functional Score ◽  
Manipulation Under Anesthesia ◽  
Total Knee

AbstractThis study aimed to evaluate whether manipulation under anesthesia (MUA) affect clinical outcome including range of motion (ROM) and patient satisfaction after total knee arthroplasty (TKA). It is hypothesized that MUA improves clinical outcomes and patient satisfaction after primary TKA. This retrospective study analyzed 97 patients who underwent staged bilateral primary TKA. MUA of knee flexion more than 120 degrees was performed a week after index surgery just before operation of the opposite site. The first knees with MUA were classified as the MUA group and the second knees without MUA as the control group. ROM, Knee Society Knee Score, Knee Society Functional Score, Western Ontario and McMaster Universities (WOMAC) score, and patient satisfaction were assessed. Postoperative flexion was significantly greater in the MUA group during 6 months follow-up (6 weeks: 111.6 vs. 99.8 degrees, p < 0.001; 3 months: 115.9 vs. 110.2 degrees, p = 0.001; 6 months: 120.2 vs. 117.0 degrees, p = 0.019). Clinical outcomes also showed similar results with knee flexion during 2 years follow-up. Patient satisfaction was significantly high in the MUA group during 12 months (3 months: 80.2 vs. 71.5, p < 0.001; 6 months: 85.8 vs. 79.8, p < 0.001; 12 months: 86.1 vs. 83.9, p < 0.001; 24 months: 86.6 vs. 85.5, p = 0.013). MUA yielded improvement of clinical outcomes including ROM, and patient satisfaction, especially in the early period after TKA. MUA in the first knee could be taken into account to obtain early recovery and to improve patient satisfaction in staged bilateral TKA.

Pediatrics’ Total Parenteral Nutrition: Initiative and implementation of standardized formulation in Saudi Arabia

2018 ◽  
Vol 4 (3) ◽  
pp. 492-496
Author(s):  
Yousef Ahmed Alomi ◽  
Hussam Saad Almalki ◽  
Aisha Omar Fallatah ◽  
Awatif Faraj Alshammari ◽  
Nesreen Al-Shubbar
Keyword(s):  
Saudi Arabia ◽  
Clinical Outcome ◽  
Parenteral Nutrition ◽  
Drug Related Problems ◽  
Kingdom Of Saudi Arabia ◽  
Parental Nutrition ◽  
Management Project ◽  
Improve Patient ◽  
New System

The national total parental nutrition program with an emphasis on pediatrics started before several ago at Ministry of health hospitals In Kingdom of Saudi Arabia. The program covered several regions and consisted from the foundation of Intravenous Admixture and preparation of pediatric parenteral nutrition to administration and follow up of patients outcomes. In addition to the prior system, the new initiative project with the standardized formulation of pediatric’s parenteral nutrition is the complementary project of the parental nutrition for pediatrics. The project initiated to prevent drug-related problems of parental nutrition, improve patient clinical outcome and reduce the unnecessary economic burden on the healthcare system. It is the new system in the Middle East and Gulf counties in additional to Saudi Arabia. The initiatives are the systemic implementation of standardized pediatrics formulation using management project tools of starting new idea until finding in the ground.

KARAKTERISTIK KLINIS PASIEN YANG MENERIMA TERAPI ARV DI RSUD KABUPATEN BULELENG

2020 ◽  
Vol 6 (2) ◽  
pp. 212-216
Author(s):  
I Gusti Ngurah Putu Candra ◽  
Dewi Aprelia Meriyani ◽  
Luh Putu Desy Puspaningrat ◽  
Yopita Triguno ◽  
Ni Kadek Ayu Tamara Widya Sari
Keyword(s):  
Loss To Follow Up ◽  
Hiv Aids

  ABSTRAK Latar Belakang Penyakit menular yang selalu memberikan dampak tidak hanya kesehatan tetapi social dan ekomoni adalha HIV/AIDS.Tujuan untuk mendeskripsikan kondisi klinis dan dmeografi pasien yang menerima terapi ARV.MetodePenelitian deskriptif dengan pendekatan secara kohort retrospektifmenggunakan data sekunder dari register kohort ARV dari tahun 2005-2015 (11 tahun terapi ARV). Analisis yang digunakan adalah analisis univariat menggunakan SPSS versi 17.Hasil Karakteristik klinis dan demografi pada odha yang menerima terapi ARV yaitu 45,32% dalam kondisi ambulatory, 75.42% mendapatkan regimen NNRTI jenis zidovudine, 75.82 % mendapatkan terapi regimen NRTI nevirapine, 79.66% pada kondisi stadium 3 dan 4, dengan klasifikasi umur produktif (< 40 tahun sebanyak 82.05%, sebagian besar berjenis kelamin laki-laki 62.96%, dan memiliki pengawas minum obat (PMO) sebesar 68.25%. Proporsi kematian sebesar  9.3 % (112 orang), LTFU (loss to follow up) 18.52% (223 orang), subsitusi regimen lini satu 9.88% (119 orang),rujuk keluar 1.83% (22 orang) dan yang masih dalam pengobatan sebesar 69.93% (842).Kesimpulan Pasien yang mengalami LTFU terbagi dalam beberapa kondisi yaitu LTFU dalam kondisi meninggal 3.07% (37 orang), LTFU dalam kondisi hidup 0.5% (6 orang), dan LTFU yang tidak diketahui kondisinya sebesar 14.95% (180 orang).Saran Monitoring dan evaluasi pada program pengobatan dilakukan secara berkelanjutan untuk meningkatkan konsistensi terapi yang dilakukan.  Kata Kunci : Karakteristik, Terapi, HIV/AIDS 

Congenital hyperinsulinism due to SUR1 (ABCC8) mutation in newborn twins: improvement of clinical outcome after eight years follow-up

2015 ◽  
Author(s):  
Betul Ersoy ◽  
Nermin Tansug ◽  
Abdulkadir Genc ◽  
Deniz Kizilay ◽  
Semiha Kiremitci ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Congenital Hyperinsulinism

scholarly journals Predictors of loss to follow-up in art experienced patients in Nigeria: a 13 year review (2004–2017)

2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Ahmad Aliyu ◽  
Babatunde Adelekan ◽  
Nifarta Andrew ◽  
Eunice Ekong ◽  
Stephen Dapiap ◽  
...  
Keyword(s):  
Patient Adherence ◽  
Cross Sectional Study ◽  
Emergency Plan ◽  
Cross Sectional ◽  
Loss To Follow Up ◽  
Viral Loads ◽  
Review Period ◽  
Lost To Follow Up ◽  
Differentiated Care

Abstract Background Expanded access to antiretroviral therapy (ART) leads to improved HIV/AIDS treatment outcomes in Nigeria, however, increasing rates of loss to follow-up among those on ART is threatening optimal standard achievement. Therefore, this retrospective cross-sectional study is aimed at identifying correlates and predictors of loss to follow-up in patients commencing ART in a large HIV program in Nigeria. Methods Records of all patients from 432 US CDC Presidents Emergency Plan for AIDS Relief (PEPFAR) supported facilities across 10 States and FCT who started ART from 2004 to 2017 were used for this study. Bivariate and multivariate analysis of the demographic and clinical parameters of all patients was conducted using STATA version 14 to determine correlates and predictors of loss to follow-up. Results Within the review period, 245,257 patients were ever enrolled on anti-retroviral therapy. 150,191 (61.2%) remained on treatment, 10,960 (4.5%) were transferred out to other facilities, 6926 (2.8%) died, 2139 (0.9%) self-terminated treatment and 75,041 (30.6%) had a loss to follow-up event captured. Males (OR: 1.16), Non-pregnant female (OR: 4.55), Patients on ≥ 3-monthly ARV refills (OR: 1.32), Patients with un-suppressed viral loads on ART (OR: 4.52), patients on adult 2nd line regimen (OR: 1.23) or pediatric on 1st line regimen (OR: 1.70) were significantly more likely to be lost to follow-up. Conclusion Despite increasing access to anti-retroviral therapy, loss to follow-up is still a challenge in the HIV program in Nigeria. Differentiated care approaches that will focus on males, non-pregnant females and paediatrics is encouraged. Reducing months of Anti-retroviral drug refill to less than 3 months is advocated for increased patient adherence.

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