PRACTICAL EPIGRAM OF APGAR SCORE

PEDIATRICS ◽  
1989 ◽  
Vol 84 (5) ◽  
pp. 778-778
Author(s):  
Joseph Butterfield
Keyword(s):  
Apgar Score ◽  
Scoring System ◽  
Medical Center ◽  
Medical Personnel ◽  
Effective Adjunct

Despite the value of the [Apgar] scoring system, experience has shown that it may be difficult to memorize the categories that make up the score and that [some] medical personnel are not familiar with it. The purpose of this communication is to describe an epigram (Figure) which embodies the basic components of the scoring system and implements its application. [SEE TABLE 1 IN SOURCE PDF.] The epigram has not altered the essence of the Apgar scoring system. . . . It does afford a means of remembering it easily. This has been an effective adjunct in expanding the use of the Apgar Score in this medical center, and it may be of value to those physicians who are interested in furthering the employment of this scoring system in their hospitals.

scholarly journals External validation of the R.I.R.S. scoring system to predict stone-free rate after retrograde intrarenal surgery

BMC Urology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Cong Wang ◽  
ShouTong Wang ◽  
Xuemei Wang ◽  
Jun Lu
Keyword(s):  
Scoring System ◽  
Kidney Stone ◽  
Medical Center ◽  
External Validation ◽  
Retrograde Intrarenal Surgery ◽  
Stone Burden ◽  
Stone Free Rate ◽  
Stone Density ◽  
Free Rate ◽  
Free Status

Abstract Background The R.I.R.S. scoring system is defined as a novel and straightforward scoring system that uses the main parameters (kidney stone density, inferior pole stones, stone burden, and renal infundibular length) to identify most appropriate patients for retrograde intrarenal surgery (RIRS). We strived to evaluate the accuracy of the R.I.R.S. scoring system in predicting the stone-free rate (SFR) after RIRS. Methods In our medical center, we retrospectively analyzed charts of patients who had, between September 2018 and December 2019, been treated by RIRS for kidney stones. A total of 147 patients were enrolled in the study. Parameters were measured for each of the four specified variables. Results Stone-free status was achieved in 105 patients (71.43%), and 42 patients had one or more residual fragments (28.57%). Differences in stone characteristics, including renal infundibulopelvic angle, renal infundibular length, lower pole stone, kidney stone density, and stone burden were statistically significant in patients whether RIRS achieved stone-free status or not (P < 0.001, P: 0.005, P < 0.001, P < 0.001, P: 0.003, respectively). R.I.R.S. scores were significantly lower in patients treated successfully with RIRS than patients in which RIRS failed (P < 0.001). Binary logistic regression analyses revealed that R.I.R.S. scores were independent factors affecting RIRS success (P = 0.033). The area under the curve of the R.I.R.S. scoring system was 0.737. Conclusions Our study retrospectively validates that the R.I.R.S. scoring system is associated with SFR after RIRS in the treatment of renal stones, and can predict accurately.

scholarly journals Clippers (Chronic Lymphocytic Inflammation with Pontine Perivascular Enhancement Responsive to Steroids) Management Experience at a single Third-level Medical Center in México.

2021 ◽  
Vol 8 (2) ◽  
pp. 01-07
Author(s):  
Brenda Bertado Cortes ◽  
Brian Madariaga Cortes ◽  
Massiel Zenteno Zenteno ◽  
Bayron Alexander Sandoval Bonilla
Keyword(s):  
Stereotactic Biopsy ◽  
Medical Center ◽  
Medical Personnel ◽  
The Central Nervous System ◽  
Management Experience ◽  
Magnetic Resonance Imaging Mri ◽  
Salt And Pepper ◽  
First Contact ◽  
First Time ◽  
Very High

Chronyc lymphosytic inflammation with pontine perivascular enhacement responsive to steroids (CLIPPERS), described for the first time in 2010 by Pittock and collaborators, is a rare inflammatory disease of the central nervous system (SNC) characterized by the presence of punctuate or curvilinear lesions described like “salt and pepper” appearance on the magnetic resonance imaging (MRI), that enhance with Gadoliniumn administration; this lesions show an exquisite response to corticosteroid therapy. The etiology of this disease remains unknown. However, the existing articles suggest an autoimmune component, which may or may not be related to other autoinmmune, infectious or malignant pathologies. Due to the above, it is generally considered that in order to reach the diagnosis of CLIPPERS, the possibility of other more common or aggressive pathologies must first be ruled out through extensive investigation. However, if the clinical and imaging presentation are typical and there is a very high suspicion of CLIPPERS, early initiation of glucosteroid therapy may be recommended. There is no unanimous therapy plan due to the few cases reported worldwide thus far. In cases of severe relapses or atypical behavior, both clinical and radiological, it is recommended to consider a stereotactic biopsy of the lesion to integrate the definitive diagnosis. Because it is a rare disease, it is relatively unknown to first- contact medical personnel; in our particular case, this leads to referral to the neurosurgery department who, thanks to their experience, have considered a demilinizing disease as a diagnostic possibility and requested an assessment by the neurology department. Here, we report the evolution and management of three diagnosed cases of CLIPPERS at a single Third-level Medical Center in México; based on clinical, radiological and neuropathological findings; as well as highlighting the importance of lesion biopsy in selected cases.

scholarly journals 151. Comparing the Clinical Utility of Rapid Diagnostic Tests for Gram-Negative Bloodstream Infection Using a Desirability of Outcomes Ranking

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S102-S102
Author(s):  
Kimberly C Claeys ◽  
Kathryn Schlaffer ◽  
Zegbeh Kpadeh-Rogers ◽  
Yunyun Jiang ◽  
Scott R Evans ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Scoring System ◽  
Clinical Utility ◽  
Medical Center ◽  
Credit Scoring ◽  
Small Sample ◽  
Clinical Microbiology Laboratory ◽  
Partial Credit ◽  
Gram Negative ◽  
Organism Identification

Abstract Background Rapid diagnostic testing (RDT) technology in bloodstream infections (BSI) has outpaced provider understanding of how to effectively use it. To optimize the use of RDT platforms and antibiotic therapy, decision makers must determine which RDTs to implement at their institutions. A thorough understanding of which platform to choose extends beyond simple analytic measures of sensitivities and specificities and should include a robust analysis of how these RDTs could impact clinical decisions. Methods Retrospective study of adult patients with Gram-negative (GN) BSI from at University of Maryland Medical Center. The clinical microbiology laboratory used Verigene® BC-GN in clinical practice. Discarded blood samples were run on BioFire® FilmArray BCID. Final organism identification/susceptibility, antibiotic exposures, and clinical outcomes were reviewed. DOOR was applied to theoretical therapy decisions based on both actual prescribing adherence to institutional algorithm recommendations; 1 being most and 6 being least desirable (Table 1). A partial credit scoring system was applied to DOOR from most (100) to least desirable (0) outcome. Comparisons were made in a paired manner. Results 77 patients met inclusion. The median age was 58 (IQR 47, 68), 44.2% were in the ICU, and 75.3% had ID consult within 24 hours of BSI. Organism identification included: E. coli (35.1%), K. pneumoniae (23.4%), P. mirabilis (10.4%), S. marcescens (10.4%), Enterobacter spp. (9.4%), P. aeruginosa (3.9%). The only resistance determinant was CTX-M (11.6%). An antibiotic change occurred in 26.2% of cases, divided between antibiotic escalation and de-escalation. Based on the actual utilization of RDT results, median DOOR was not different between BC-GN and BCID (3 [IQR 3.4] vs. 4 [IQR 3.4], P = 0.44). Using a partial credit scoring system, the mean score was not different between platforms (49.8 [SD 26.8] vs. 47.7 [SD 20.3], P = 0.44). Through pairwise comparisons, BC-GN would have resulted in an optimal outcome of 15.3% (95% CI 4.7% to 19.3%) more often than BCID. Conclusion Based on the actual use of RDTs for GN BSI there was no difference in potential clinical outcomes between platforms in this relatively small sample. DOOR is a novel mechanism to quantitate clinical utility and compare RDTs. Disclosures All authors: No reported disclosures.

scholarly journals Health Characteristics of the Madeira Riverine Population

2020 ◽  
Vol 185 (7-8) ◽  
pp. e1222-e1228
Author(s):  
Lízia Felix Cotias de Mattos Oliveira ◽  
Robert P Lennon ◽  
John W Roman ◽  
John F Sullivan ◽  
Edmund A Milder
Keyword(s):  
Intestinal Parasites ◽  
Medical Center ◽  
Dental Health ◽  
Large Population ◽  
Medical Personnel ◽  
Urban Centers ◽  
Chi Square ◽  
Brazilian Government ◽  
Institutional Review ◽  
Hospital Ships

Abstract Introduction The Amazon River Basin is the largest and the most complex fluvial system in the world. The Brazilian government provides dental and medical care to the riverine populations in this region in part through medical assistance missions, conducted by four hospital ships. The Brazilian Navy invited U.S. Navy medical personnel to join the February 2019 mission aboard Navio de Assistência Hospitalar (NAsH) Carlos Chagas to provide care along the Madeira River. Materials and Methods In the course of providing primary care services, demographic, health, and dental data of the Madeira Riverine population were collected. Descriptive statistics were used to generate average health and dental data. Chi-square tests were used to compare population prevalence data. Linear regression was used to evaluate dental caries per patient with proximity to nearest large population center and village population. This project was approved by Naval Medical Center Portsmouth Institutional Review Board. Results The Madeira Riverine population has similar dental health to Brazilians living in urban centers. Their prevalence of hypertension and diabetes compared favorably with the U.S. averages (17.7% vs. 34.3% [P &lt; 0.001] and 3% vs. 9.4% [P &lt; 0.001], respectively). Based on the most prevalent ICD-10 code diagnoses, future missions can expect high volumes of patients with intestinal parasites, hypertension, common skin infections, women’s health concerns, and musculoskeletal complaints. Conclusions This study adds to the limited health data currently available on Brazilian Riverine populations. It demonstrates the effectiveness of the Hospital Assistance missions in providing dental care and documents some unique aspects of Riverine health that warrant further study.

scholarly journals 2168. Comparison of Rapid Diagnostic Tests for Bloodstream Infections Using Desirability of Outcome Ranking Management of Antimicrobial Therapy (DOOR-MAT)

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S735-S736
Author(s):  
Kimberly C Claeys ◽  
Teri Hopkins ◽  
Zegbeh Kpadeh-Rogers ◽  
Yunyun Jiang ◽  
Scott R Evans ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Antimicrobial Therapy ◽  
Diagnostic Tests ◽  
Scoring System ◽  
Medical Center ◽  
Credit Scoring ◽  
Bloodstream Infections ◽  
Rapid Diagnostic Tests ◽  
Average Score ◽  
Partial Credit

Abstract Background Rapid diagnostic tests (RDTs) for bloodstream infection (BSIs) are increasingly common. Decisions regarding which RDT to implement remains a clinical challenge given the diversity of organisms and resistance mechanisms detected by different platforms. The desirability of Outcome Ranking Management of Antimicrobial Therapy (DOOR-MAT) has been proposed as a framework to compare RDT platforms but reports of clinical application are lacking. This study compared potential antibiotic decisions based on results of two different RDTs for BSI using DOOR-MAT. Methods Retrospective study at University of Maryland Medical Center from August 2018 to April 2019 comparing Verigene® BC (VBC) to GenMark Dx ePlex® BCID for clinical blood cultures. VBC was part of standard of care, ePlex was run on discarded fresh or frozen blood samples. In this theoretical analysis, RDT result and local susceptibility data were applied by two Infectious Diseases pharmacists to make decisions regarding antibiotic selection in a blinded manner. Cohen’s Kappa statistic summarized overall agreement. DOOR-MAT, a partial credit scoring system, was applied to decisions based on final organism/susceptibility results (Figure 1). Scores were averaged between reviewers and mean scores compared between RDT systems using the t-test. Additionally, a sensitivity analysis with varied point assignment among Gram-negatives (AmpC-producers) was conducted. Results 110 clinical isolates were included; 41 Gram-negative, 69 Gram-positive organisms. Overall agreement was 82% for VBC and 83% for ePlex. The average score for VBC was 86.1 (SD 31.3) compared with ePlex 92.9 (SD 22.9), P = 0.004. Among Gram-negatives, the average score for VBC was 79.9 (SD 32.1) compared with ePlex 88.1 (SD 28.8), P = 0.032. Among GPs the average score for VBC was 89.9 (SD 30.4) compared with ePlex 95.8 (SD 18.3), P = 0.048. Sensitivity analysis demonstrated an average score for of 89.9 (SD 30.4) for VBC compared with 95.8 (SD 18.3) for ePlex, P = 0.27. Conclusion The use of a partial credit scoring system such as the DOOR-MAT allows for comparisons between RDT systems beyond sensitivity and specificity allowing for enhanced clinical interpretation. In this theoretical comparison, the Genmark ePlex BCID scored higher among both GP and GN organisms. Disclosures All authors: No reported disclosures.

scholarly journals A Qualitative Exploration to Understand Hospitalists’ Attitude Toward the Patient Experience Scoring System

2020 ◽  
Vol 7 (6) ◽  
pp. 1036-1043 ◽  
Author(s):  
Ankur Segon ◽  
Yogita Segon ◽  
Vivek Kumar ◽  
Hirotaka Kato
Keyword(s):  
Scoring System ◽  
Medical Center ◽  
Academic Medical Center ◽  
Healthcare Providers ◽  
Semistructured Interview ◽  
Academic Medical ◽  
Knowledge And Attitude ◽  
Patient’S Perception ◽  
The Impact ◽  
Hcahps Survey

Patient’s perception of their inpatient experience is measured by the Center for Medical Services’ (CMS) administered Hospital Consumer Assessment of Healthcare Providers & Systems (HCAHPS) survey. There is scant existing literature on physicians’ perceptions toward the HCAHPS scoring system. Understanding hospitalist knowledge and attitude toward the HCAHPS survey can help guide efforts to impact HCAHPS survey scores by improving the patient’s perception of their hospital experience. The goal of this study is to explore hospitalists’ knowledge and perspective of the physician communication domain of the HCAHPS survey at an academic medical center. Seven hospitalists at an academic medical center were interviewed for this report using a semistructured interview. Thematic analysis approach was used to analyze data. Open, line-by-line coding was performed on all 7 transcripts. Categories were derived in an inductive fashion. Categories were refined using the techniques of constant comparison and axial coding. We generated themes reflecting hospitalists’ knowledge of the HCAHPS scoring system, their perception of the HCAHPS scoring system and the impact of the HCAHPS scoring system on their practice. While hospitalists acknowledged physician–patient communication is a challenging area to study, they are unlikely to embrace the feedback provided by HCAHPS surveys. There is a need to deploy tactics that provide timely and actionable feedback to providers on their bedside communication skills.

scholarly journals Expansion of the Surgical Apgar Score across All Surgical Subspecialties as a Means to Predict Postoperative Mortality

2011 ◽  
Vol 114 (6) ◽  
pp. 1305-1312 ◽  
Author(s):  
Paul Q. Reynolds ◽  
Neal W. Sanders ◽  
Jonathan S. Schildcrout ◽  
Nathaniel D. Mercaldo ◽  
Paul J. St. Jacques
Keyword(s):  
Apgar Score ◽  
Scoring System ◽  
Postoperative Mortality ◽  
Predictive Ability ◽  
Apgar Scores ◽  
Logistic Regression Models ◽  
Risk Of Death ◽  
Estimated Blood Loss ◽  
Increased Risk ◽  
Surgical Apgar Score

Background A surgical scoring system, akin to the obstetrician's Apgar score, has been developed to assess postoperative risk. To date, evaluation of this scoring system has been limited to general and vascular services. The authors attempt to externally validate and expand the Surgical Apgar Score across a wide breadth of surgical subspecialties. Methods Intraoperative data for 123,864 procedures including all surgical subspecialties were collected and associated with Surgical Apgar Scores (created by the summation of point values associated with the lowest mean arterial pressure, lowest heart rate, and estimated blood loss). Patients' death records were matched to the corresponding score, and logistic regression models were created in which mortality within 7, 30, and 90 days was regressed on the Apgar score. Results Lower Surgical Apgar Scores were associated with an increased risk of death. The magnitude of this association varied by subspecialty. Some subspecialties exhibited higher odds ratios, suggesting that the score is not as useful for them. For most of the subspecialties the association between the Apgar score and mortality decreased as the time since surgery increased, suggesting that predictive ability ceases to be helpful over time. After adjusting for the patient's American Society of Anesthesiologists classification, Apgar scores remained associated with death among most of the subspecialties. Conclusion A previously published methodology for calculating risk among general and vascular surgical patients can be applied across many surgical services to provide an objective means of predicting and communicating patient outcomes in surgery as well as planning potential interventions.

scholarly journals Practical Risk Scoring System for Predicting Severity of COVID-19 Disease

2022 ◽  
Vol 15 ◽  
pp. 2632010X2110684
Author(s):  
Jeffrey Petersen ◽  
Darshana Jhala
Keyword(s):  
Scoring System ◽  
Clinical Laboratory ◽  
Disease Risk ◽  
Medical Center ◽  
Statistical Significance ◽  
Scoring Systems ◽  
Urgent Care ◽  
Smoking History ◽  
Risk Scoring ◽  
Risk Scoring System

Objectives: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of COVID-19 disease, has become an international pandemic with numerous casualties. It had been noted that the severity of the COVID-19 disease course depends on several clinical, laboratory, and radiological factors. This has led to risk scoring systems in various populations such as in China, but similar risk scoring systems based on the American veteran population are sparse, particularly with the vulnerable Veteran population. As a simple risk scoring system would be very useful, we propose a simple Jhala Risk Scoring System (JRSS) to assess the severity of disease risk. Methods: A retrospective review of all SARS-CoV-2 reverse transcriptase-polymerase chain reaction (RT-PCR) tests collected and performed at the regional Veterans Administration Medical Center (VAMC) serving the Philadelphia and surrounding areas from March 17th, 2020 to May 20th, 2020. Data was collected and analyzed in the same year. These tests were reviewed within the computerized medical record system for demographic, medical history, laboratory test history, and clinical course. Information from the medical records were then scored based on the criteria of the Jhala Risk Scoring System (JRSS). Results: The JRSS, based on age, ethnicity, presence of any lung disease, presence of cardiovascular disease, smoking history, and diabetes history with laboratory parameters correlated and predicted (with statistical significance) which patients would be hospitalized. Conclusion: The JRSS may play a role in informing which COVID-19 positive patients in the emergency room/urgent care for risk stratification.

scholarly journals 807. A Risk-Stratified Approach to Healthcare-Associated Tuberculosis Exposures Following the “Stone in the Pond” Principle

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S289-S289
Author(s):  
Dana E Pepe ◽  
Michael Aniskiewicz ◽  
George Paci ◽  
Linda Sullivan ◽  
Louise-Marie Dembry ◽  
...  
Keyword(s):  
Scoring System ◽  
Large Scale ◽  
Medical Center ◽  
Academic Medical Center ◽  
Risk Groups ◽  
Low Risk ◽  
Contact Tracing ◽  
Healthcare Personnel ◽  
Foreign Born ◽  
Healthcare Associated

Abstract Background Large-scale tuberculosis (TB) exposure investigations cause anxiety to healthcare personnel (HCP) and patients, in addition to being resource and time intensive. TB contact tracing in England and Singapore follow the “stone in the pond” principle. We propose a similar risk-stratified approach to TB exposure investigations in an area of low incidence. Methods This retrospective study was conducted at a 1,541 bed academic medical center in New Haven, CT between January 14 and 11, 2017. Microbiology records, patient charts, and infection prevention databases were reviewed to find TB exposures. A scoring system adapted from CDC’s “Guidelines for the Investigation of Contacts of Persons with Infectious Tuberculosis” was developed to predict infectivity (two points for laryngeal TB, one point each for: cavitary TB, ≥1 positive respiratory acid fast bacilli smear or Xpert MTB/RIF, multi-drug-resistant (MDR) TB, foreign-born status, immunocompromised status, cough/hemoptysis, or procedure associated with positive TB culture). Using the “stone in the pond” principle, contacts were graded based on the type of exposure (Figure 1). Based on high, medium, and low risk, our new risk-stratified approach was applied to contact tracing. Results During the study period, 17 of 29 patients with pulmonary TB led to exposures. A subset of seven TB patients with complete exposure data was selected for further analysis. The original exposure investigations led to contact tracing of 586 HCP and 72 patients. No active or latent TB cases were identified among these exposed contacts. Using our scoring system, these seven patients were categorized into three high, two medium, and two low infectivity risk groups. On applying our new risk-stratified approach, contact tracing could be reduced by 42% and 84% for medium and low-risk exposures, respectively, by excluding these HCP groups from investigation (Figure 2). Conclusion We recommend a risk-stratified approach to healthcare-associated TB exposure investigations similar to the “stone in the pond” principle, based on index patient’s infectivity risk and type of exposure. This has potential to optimize resources and possibly reduce anxiety in medium and low-risk TB exposures in an area of low TB incidence. Disclosures All authors: No reported disclosures.

Evaluating Discrepancies in Percent Total Body Surface Area Burn Assessments Between Prehospital Providers and Burn Center Physicians

2021 ◽  
Author(s):  
Duy P Tran ◽  
Donald H Arnold ◽  
Callie M Thompson ◽  
Neal J Richmond ◽  
Stephen Gondek ◽  
...  
Keyword(s):  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Service Providers ◽  
Medical Center ◽  
Total Body Surface Area ◽  
Medical Personnel ◽  
Burn Center ◽  
Emergency Medical ◽  
Total Body

Abstract Burns are routinely assessed at the scene of the incident by prehospital or emergency medical services providers. The initial management of burns is based on the calculation of the extent of the injury, reported as percent total body surface area. This study evaluates discrepancies in estimation of total body surface area (TBSA) between prehospital providers and burn team physicians over a 3-year period at an academic, university medical center serving as the regional burn center. A total of 120 adult and 27 pediatric patients (less than age 16 years) were included, with 95 (65%) male, 67 (45.6%) Caucasian, 62, median age 35 years (Interquartile Range 27). The most common etiology of burns was hot liquid, 39 (26.5%). Median [IQR] and mean (SD) estimated TBSA (%) were 4[1, 10] and 8.6 (12.8) for prehospital providers, and 2 [1, 6] and 5.9 (9.9) for burn team physicians. Bland-Altman plots evaluating 2nd and 3rd degree burns separately and combined demonstrated that, as burns involved more surface area, agreement decreased between emergency medical service providers and burn physicians. Agreement between pre-hospital providers and burn physicians decreased as total body surface areas of burns increased. This finding reaffirms the need for more standardized education and training for all medical personnel.

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