scholarly journals Flexible Nasal Endoscopic Procedures in Family Medicine: Indications and Effectiveness

2021 ◽  
Vol 53 (10) ◽  
pp. 886-889
Author(s):  
John Malaty ◽  
Dongyuan Wu ◽  
Susmita Datta
Keyword(s):  
Family Medicine ◽  
Laryngopharyngeal Reflux ◽  
Upper Airway ◽  
Retrospective Chart Review ◽  
True Vocal Cord ◽  
Endoscopic Procedures ◽  
Specialist Referral ◽  
Postnasal Drip ◽  
The University

Background and Objectives: Most literature about flexible nasolaryngoscopy comes from specialty clinics, making it unclear if these indications can be effectively managed without referral. This study evaluated effectiveness of diagnosis and management of upper airway complaints, utilizing flexible nasal endoscopic procedures, in a family medicine center. Methods: We performed retrospective chart review for all patients who had nasal endoscopy, nasopharyngoscopy, and nasolaryngoscopy performed at the University of Florida Family Medicine Center over 3 years (n=89) with 5 additional years of follow up. We used descriptive statistics to evaluate indications, diagnoses, effectiveness of management by family medicine, and referral rate. Results: The most common primary indications were hoarseness (n=33, 37%), chronic cough (n=20, 22%), nasal obstruction (n=9, 10%), and unilateral ear dysfunction (n=6, 7%). The most common primary diagnoses found were allergic rhinitis/postnasal drip (n=41, 46%), laryngopharyngeal reflux (LPR)/gastroesophageal reflux disease (GERD; n=24, 27%), masses concerning for malignancy (n=4, 4.5%), true vocal cord (TVC) polyp (n=3, 3%), TVC nodules (n=3, 3%), and epistaxis (n=3, 3%). Of the four concerning masses, two were confirmed cancers (2%). In addition, there was one case (1%) of erythroleukoplakia with dysplasia of the TVC. Most patients had documented improvement with family medicine management (n=57, 64%) and another six (7%) had follow up without documentation of status and no need for referral. Thus, a total of 71% (n=64) did not require referral and 20% (n=18) needed specialist referral. Conclusions: Flexible nasal endoscopic procedures are effective in the care of patients in a family medicine residency center and can be safely performed and taught to residents.

Outcomes of advanced HL with ABVD: The University of Pennsylvania experience.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e18529-e18529
Author(s):  
Meghna S. Trivedi ◽  
David Bajor ◽  
Tahamtan Ahmadi ◽  
Jakub Svoboda ◽  
Alison W. Loren ◽  
...  
Keyword(s):  
Salvage Therapy ◽  
Standard Therapy ◽  
Prognostic Score ◽  
Stage Iv ◽  
Retrospective Chart Review ◽  
Complete Response ◽  
Salvage Chemotherapy ◽  
University Of Pennsylvania ◽  
The University

e18529 Background: Hodgkin Lymphoma (HL) is considered a curable malignancy with standard therapy using the doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) regimen. Even with standard therapy, the relapse rate for patients with advanced HL (stage IIB and higher) remains significant. The International Prognostic Score (IPS) uses 7 adverse prognostic factors (serum albumin, hemoglobin, male sex, age, stage IV disease, leukocytosis, and lymphopenia) to predict outcomes in advanced HL. Methods: We performed a retrospective chart review of all patients evaluated at the University of Pennsylvania for primary HL from July 2006 to June 2011. Of 257 patients, 26 were identified as those with advanced HL who initiated ABVD treatment at the University of Pennsylvania. The study outcomes were defined by RECIST criteria. The 26 patients were stratified by IPS and outcomes were evaluated. Results: 22 of 26 patients (85%) achieved lasting complete response (CR) after receiving treatment with ABVD with a median length of follow-up of 2.93 years. Three patients had primary refractory disease. Of these patients, two (IPS 1-2) achieved CR with salvage therapy. The third patient (IPS 5) had initial partial response (PR) to ABVD then continued to have relapsed disease after 4.50 years of follow-up. One patient (IPS 5) relapsed 2.74 years after receiving ABVD and at best had PR with salvage chemotherapy. Conclusions: ABVD was effective in achieving CR; however, 4 patients were unable to achieve lasting CR from ABVD alone. Two patients with IPS of 1 and 2 eventually achieved CR from salvage therapy. Two patients with IPS of 5 were unable to achieve lasting CR. Based on this data, IPS of 5 was associated with worse outcome. Use of IPS may be helpful to identify patients needing more intensive initial therapies. [Table: see text]

Aiming Beyond: A Pharmacist Impact on 90-Day Readmissions and Clinical Outcomes Within a Family Medicine Service

2019 ◽  
Vol 33 (6) ◽  
pp. 738-744
Author(s):  
Lindsey E. Wiegmann ◽  
Matthew S. Belisle ◽  
Kristin S. Alvarez ◽  
Neelima J. Kale
Keyword(s):  
Family Medicine ◽  
Intervention Group ◽  
Retrospective Chart Review ◽  
Standard Of Care ◽  
Care Group ◽  
Readmission Rates ◽  
Medicine Service ◽  
The Impact ◽  
Disease Specific

Previous studies have shown pharmacists positively impact 30-day readmission rates. However, there is limited data regarding the effect of clinical pharmacist (CP) follow-up on 90-day readmission or evaluation of disease-specific goals after hospitalization. Investigators analyzed the impact of postdischarge extended CP follow-up within a family medicine service (FMS). The primary end point was all-cause 90-day readmission rates. Secondary end points included all-cause 30- and 60-day readmission rates and the achievement of disease-specific goals postdischarge. Retrospective chart review was performed for patients admitted from August 2016 to November 2017 who were seen by a physician within the FMS 14 days postdischarge. Fourteen percent of patients within the CP intervention group were readmitted within 90 days in comparison to 22% in the standard of care group ( P = .244). Readmission rates at 30 and 60 days were as follows: intervention group 2%, 10%, and standard of care group 16%, 22% ( P = .015, P = .089, respectively). In addition, multiple patients with uncontrolled diabetes who completed CP visits upon hospital discharge met glycemic goals at the end of the study time period. Despite inclusion of the CP in postdischarge care, 90-day readmission rate remained unchanged.

scholarly journals Successes, lessons and opportunities: 15-year follow-up of an integrated evidence-based medicine curriculum

2020 ◽  
pp. bmjebm-2020-111393
Author(s):  
Christina S Korownyk ◽  
G Michael Allan ◽  
James McCormack ◽  
Adrienne J Lindblad ◽  
Samantha Horvey ◽  
...  
Keyword(s):  
Family Medicine ◽  
Evidence Based Practice ◽  
Point Of Care ◽  
Evidence Based ◽  
Future Directions ◽  
University Of Alberta ◽  
Multiple Components ◽  
The University ◽  
Based Medicine

In 2005, the Department of Family Medicine at the University of Alberta introduced an evidence-based practice curriculum into the 2-year Family Medicine Residency Program. The curriculum was based on best available evidence, had multiple components and was comprehensive in its approach. It prioritised preappraised summary evidence over in-depth evidence appraisal. This paper describes the lessons learnt over the past 15 years including components that were eventually discontinued. We also discuss additions to the programme including the development of accessible, preappraised, summarised resources. We review the difficulties associated with evaluation and the incorporation of evidence-based practice into all aspects of residency training. Future directions are discussed including the incorporation of shared decision-making at the point of care.

scholarly journals Pediatric meningiomas: 65-year experience at a single institution

2017 ◽  
Vol 20 (1) ◽  
pp. 42-50 ◽  
Author(s):  
Andrew J. Grossbach ◽  
Kelly B. Mahaney ◽  
Arnold H. Menezes
Keyword(s):  
Pediatric Population ◽  
Retrospective Chart Review ◽  
Recurrence Rates ◽  
University Of Iowa ◽  
Who Grade ◽  
History Of ◽  
Grade Ii ◽  
The University ◽  
Pediatric Meningiomas

OBJECTIVEMeningiomas are relatively common, typically benign neoplasms in adults; however, they are relatively rare in the pediatric population. Pediatric meningiomas behave very differently from their adult counterparts, tending to have more malignant histological subtypes and recur more frequently. The authors of this paper investigate the risk factors, pathological subtypes, and recurrence rates of pediatric meningiomas.METHODSA retrospective chart review was conducted at the University of Iowa to identify patients 20 years old and younger with meningiomas in the period from 1948 to 2015.RESULTSSixty-seven meningiomas in 39 patients were identified. Eight patients had neurofibromatosis, 2 had a family history of meningioma, and 3 had prior radiation exposure. Twelve (31%) of the 39 patients had WHO Grade II or III lesions, and 15 (38%) had recurrent lesions after resection.CONCLUSIONSPediatric meningiomas should be considered for early treatment and diligent follow-up.

scholarly journals Age at Decannulation after Pediatric Tracheostomy.

2020 ◽  
pp. 1-8
Keyword(s):  
Airway Obstruction ◽  
Medical Records ◽  
Chart Review ◽  
Pediatric Patients ◽  
Upper Airway ◽  
Retrospective Chart Review ◽  
Upper Airway Obstruction ◽  
Neurological Condition ◽  
Neurological Conditions

Background: Parents of tracheostomized infants often enquire when their children will undergo decannulation. However, there are few studies on the decannulation of children who are tracheotomized in infancy. Therefore, this study investigated when decannulation should be performed in children by retrospectively analysing medical records. Methods: We performed a retrospective chart review of tracheostomy, decannulation and tracheostoma closure in 48 children who underwent tracheostomy before the age of 3 years. The indications for tracheostomy included upper airway obstruction, neurological conditions, cardiopulmonary conditions, craniofacial conditions and trauma. Result: Nineteen (33.3%) patients were decannulated during the follow-up period: 12 had upper airway obstruction, four had cardiopulmonary conditions, one had a neurological condition and two had craniofacial conditions. The average age at tracheostomy was 13.6 months. The average age at the start of the decannulation therapy was 5.4 years. The average age at decannulation was 7.2 years. The average age at tracheostoma closure was 9.2 years. Conclusion: This description of ages at decannulation after pediatric tracheostomy may be useful when explaining the prognoses and timelines of decannulation to parents and caretakers of pediatric patients who need to undergo tracheostomy.

scholarly journals P069: Does specialist referral influence emergency department return rate for patients with renal colic? A retrospective cohort study

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S88
Author(s):  
A. Kanji ◽  
P. Atkinson ◽  
P. Massaro ◽  
R. Pawsey ◽  
T. Whelan
Keyword(s):  
Emergency Department ◽  
Renal Colic ◽  
Significant Proportion ◽  
Retrospective Chart Review ◽  
Renal Stones ◽  
Renal Calculi ◽  
Return Rate ◽  
Specialist Referral ◽  
Significant Burden

Introduction: Renal colic is a common presentation which exerts a significant burden on healthcare infrastructure. A significant proportion of patients managed with observation may return to the Emergency Department (ED) prior to spontaneous passage due to inadequate analgesia. It is unclear whether early urologist consultation would limit the burden of renal stones by reducing returns to the ED. We wished to determine whether urologist referral from the ED department is associated with fewer returns to the ED with renal colic. Methods: We conducted a retrospective chart review using RECORD methodology of consecutive patients diagnosed with CT-confirmed, ureteric or renal calculi in our ED over a two-year period. Disposition was categorized as either hospital admission, outpatient urologist referral, follow up with primary care, or no follow up. The primary outcome was the 30-day ED re-presentation for renal colic. Multivariate logistic regression was used to identify predictors for ED-return. Results: In total, 232 patients met our inclusion criteria. Urgent or outpatient urologist referral was not associated with a significantly lower ED return rate when compared to patients with no follow-up. Surprisingly, urologic intervention and stent placement were both independent predictors for ED return (OR: 2.03; 95% CI: (1.06-3.88); p:0.03) and (OR:2.08; 95% CI: (1.07-4.05). Conclusion: A significant proportion of patients who underwent urologist-led intervention returned to the ED with renal colic. Further study may help clarify the role of early urologist referral for renal calculi, as this may not reduce ED return rates when compared to conservative management.

scholarly journals Low incidence of COVID-19 in a prospective cohort of patients with liver cirrhosis and hepatocellular carcinoma treated at a tertiary medical center during the 2020 pandemic

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0258450
Author(s):  
Thorben Fründt ◽  
Lilith Kuballa ◽  
Marc Lütgehetman ◽  
Dominik Nörz ◽  
Hannes Arend ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Cirrhosis ◽  
Liver Function ◽  
Medical Center ◽  
Upper Airway ◽  
Protective Measures ◽  
Airway Infection ◽  
Increased Risk ◽  
The University

Background and aims Patients with liver cirrhosis (LC) are considered to be at increased risk for mortality when acquiring SARS-CoV-2 infection and subsequently developing Corona Virus Disease 2019 (COVID-19). During the COVID-19 pandemic, hospitals are regarded as sites with increased risk of infection. Therefore, patient contacts are often limited to urgent indications, which could negatively affect disease monitoring. However, data regarding actual infection rates in cirrhotic patients is limited. The aim of this prospective study was to assess the incidence of COVID-19 in patients with LC with/without hepatocellular carcinoma (HCC) with physical presentation at our University Medical Center. Methods Patients were enrolled between 1st April and 30th June 2020 at the University Medical Center Hamburg-Eppendorf, Germany. Symptoms of upper airway infection at baseline and presence of SARS-CoV-2 antibodies (IgG/IgM/IgA) were assessed at baseline and follow-up (FU) using an Electro-chemiluminescence immunoassay (Roche Elecsys). FU visits, including liver function test, clinical assessment and symptom questionnaire, were conducted after 6–8 weeks (FU-1) and 6 months (FU-2). Prior to inclusion of the first patient, obligatory face masks and personal distance were implemented as protective measures. Results A total of 150 patients were enrolled, 23% (n = 35) also had diagnosis of HCC (median age: 64 years, range: 19–86), 69% were male. Liver function according to Child-Pugh score (CPS) was: CPS A: 46% (n = 62); CPS B: 37% (n = 50); CPS C: 17% (n = 23). Clinical symptoms indicating upper airway infection were present in 53% (n = 77): shortness of breath (n = 40) and coughing (n = 28) were the most frequent. For the 150 patients enrolled, 284 outpatient visits were registered and 33 patients were admitted to the University Medical Center during the follow-up period. After a median of 52 days, n = 110 patients completed FU-1 and n = 72 completed FU-2 after a median of 6.1 months. Only in one patient, an 80-year-old man with stable liver function (CPS A) and advanced HCC, SARS-CoV-2 antibodies were detected at baseline and FU-1, while antibody testing was negative in the remaining patients at baseline, FU-1 and FU-2. Conclusion The incidence of COVID-19 at our tertiary medical center during the pandemic was low in LC and HCC patients, when simple protective measures were implemented. Therefore, a routine care for patients with chronic liver diseases does not increase the risk of SARS-CoV-2 infection and should be maintained with protective measures.

Prospective evaluation for gastrointestinal bleedings at the University Hospital St. Pölten – one year of follow-up

2019 ◽  
Author(s):  
M Stättermayer ◽  
F Riedl ◽  
S Bernhofer ◽  
A Stättermayer ◽  
A Mayer ◽  
...  
Keyword(s):  
University Hospital ◽  
Prospective Evaluation ◽  
One Year ◽  
The University

Respiratory Complications in Outpatient Endoscopy with Endoscopist-Directed Sedation

2014 ◽  
Vol 23 (3) ◽  
pp. 255-259 ◽  
Author(s):  
Kilian Friedrich ◽  
Sabine G. Scholl ◽  
Sebastian Beck ◽  
Daniel Gotthardt ◽  
Wolfgang Stremmel ◽  
...  
Keyword(s):  
Antibiotic Treatment ◽  
Respiratory Infection ◽  
Endoscopic Procedure ◽  
Shortness Of Breath ◽  
Respiratory Complications ◽  
Endoscopic Procedures ◽  
Increased Risk ◽  
High Incidence ◽  
Respiratory Complaints

Background & Aims: Respiratory complications represent an important adverse event of endoscopic procedures. We screened for respiratory complications after endoscopic procedures using a questionnaire and followed-up patients suggestive of respiratory infection.Method: In this prospective observational, multicenter study performed in Outpatient practices of gastroenterology we investigated 15,690 patients by questionnaires administered 24 hours after the endoscopic procedure.Results: 832 of the 15,690 patients stated at least one respiratory symptom after the endoscopic procedure: 829 patients reported coughing (5.28%), 23 fever (0.15%) and 116 shortness of breath (SOB, 0.74%); 130 of the 832 patients showed at least two concomitant respiratory symptoms (107 coughing + SOB, 17 coughing + fever, 6 coughing + coexisting fever + SOB) and 126 patients were followed-up to assess their respiratory complaints. Twenty-nine patients (follow-up: 22.31%, whole sample: 0.18%) reported signs of clinically evident respiratory infection and 15 patients (follow-up: 11.54%; whole sample: 0.1%) received therefore antibiotic treatment. Coughing or vomiting during the endoscopic procedure resulted in a 156.12-fold increased risk of respiratory complications (95% CI: 67.44 - 361.40) and 520.87-fold increased risk of requiring antibiotic treatment (95% CI: 178.01 - 1524.05). All patients of the follow-up sample who coughed or vomited during endoscopy developed clinically evident signs of respiratory infection and required antibiotic treatment while this occurred in a significantly lower proportion of patients without these symptoms (17.1% and 5.1%, respectively).Conclusions: We demonstrated that respiratory complications following endoscopic sedation are of comparably high incidence and we identified major predictors of aspiration pneumonia which could influence future surveillance strategies after endoscopic procedures.

Sign in / Sign up

Export Citation Format

Share Document