scholarly journals Therapy Utilization among Children with Vitiligo at an Urban Tertiary Care Center

2021 ◽  
Vol 7 (1) ◽  
pp. 1-4
Author(s):  
Leslie Castelo-Soccio ◽  
Keyword(s):  
Household Income ◽  
Care Center ◽  
Private Insurance ◽  
Insurance Coverage ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Cost Effective ◽  
Light Therapy ◽  
Topical Steroids ◽  
Median Household Income

Vitiligo is a skin disorder characterized by depigmentation, and 25% of children develop symptoms by age 10. Children with vitiligo have suffered from social isolation and bullying, and thus many seek treatment for re-pigmentation. However, there is limited data on the use of therapies in pediatric vitiligo patients. To address this knowledge gap, we performed a retrospective chart review of 360 patients who were diagnosed with vitiligo under the age of 18 at The Children’s Hospital of Philadelphia. The average age was 10.8 years; average age at diagnosis was 6.21 years. The median household income by zip code was $78,660. Majority were insured by private insurance (53.9%); 44.2% had Medicaid and 1.9% had no information on insurance coverage. Most subjects used topical steroids (55.6%) and/or topical pimecrolimus (58.9%); only a small proportion (17.2%) received light therapy in clinic or at home. Although vitiligo has been shown to affect patients of color more negatively, of those using Home-Based Phototherapy (HBPT) (13), 8 were self-described Caucasian. Twelve out of the 13 had private insurance and the median household income was $105,080 for those using HBPT. Our results indicate that certain groups of patients, such as children of color, those without private insurance, and those from lower-income areas, may not have equal access to the most cost-effective vitiligo therapies. These findings support the need for creation of educational resources and strategies to ensure access to cost-effective vitiligo treatments for patients from all backgrounds.

Prevalence, Correlates and Management of Hyperglycemia in Diabetic Non-critically Ill Patients at a Tertiary Care Center in Lebanon

2019 ◽  
Vol 15 (2) ◽  
pp. 133-140 ◽  
Author(s):  
Ghada El Khoury ◽  
Hanine Mansour ◽  
Wissam K. Kabbara ◽  
Nibal Chamoun ◽  
Nadim Atallah ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Care Center ◽  
Descriptive Analysis ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
Diabetic Patients

Background: Diabetes Mellitus is a chronic metabolic disease that affects 387 million people around the world. Episodes of hyperglycemia in hospitalized diabetic patients are associated with poor clinical outcomes and increased morbidity and mortality. Therefore, prevention of hyperglycemia is critical to decrease the length of hospital stay and to reduce complications and readmissions. Objective: The study aims to examine the prevalence of hyperglycemia and assess the correlates and management of hyperglycemia in diabetic non-critically ill patients. Methods: The study was conducted on the medical wards of a tertiary care teaching hospital in Lebanon. A retrospective chart review was conducted from January 2014 until September 2015. Diabetic patients admitted to Internal Medicine floors were identified. Descriptive analysis was first carried out, followed by a multivariable analysis to study the correlates of hyperglycemia occurrence. Results: A total of 235 medical charts were reviewed. Seventy percent of participants suffered from hyperglycemia during their hospital stay. The identified significant positive correlates for inpatient hyperglycemia, were the use of insulin sliding scale alone (OR=16.438 ± 6.765-39.941, p=0.001) and the low frequency of glucose monitoring. Measuring glucose every 8 hours (OR= 3.583 ± 1.506-8.524, p=0.004) and/or every 12 hours (OR=7.647 ± 0.704-79.231, p=0.0095) was associated with hyperglycemia. The major factor perceived by nurses as a barrier to successful hyperglycemia management was the lack of knowledge about appropriate insulin use (87.5%). Conclusion: Considerable mismanagement of hyperglycemia in diabetic non-critically ill patients exists; indicating a compelling need for the development and implementation of protocol-driven insulin order forms a comprehensive education plan on the appropriate use of insulin.

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 Incidental Petrous Apex Findings on Magnetic Resonance Imaging

2001 ◽  
Vol 80 (4) ◽  
pp. 200-206 ◽  
Author(s):  
John P. Leonetti ◽  
Harish Shownkeen ◽  
Sam J. Marzo
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Care Center ◽  
Tertiary Care ◽  
Clinical Manifestations ◽  
Retrospective Chart Review ◽  
Petrous Apex ◽  
Resonance Imaging ◽  
Mri Findings ◽  
Clinical Surveillance

We performed a retrospective chart review to categorize a group of petrous apex findings that were noted incidentally on magnetic resonance imaging (MRI) in 88 patients. These patients were among those who had been seen at a tertiary care center between July 1988 and July 1998. These incidental findings, which were unrelated to the presenting clinical manifestations, included asymmetric fatty bone marrow (n = 41), inflammation (19), cholesterol granulomas (14), cholesteatomas (9), and neoplasms (5). Followup imaging and clinical surveillance of these patients has not demonstrated any significant change in the incidentally detected lesions. In all cases, the incidental MRI findings represented benign pathology.

Extensive Acquired Cholesteatoma in Children: When the Penny Drops

2005 ◽  
Vol 114 (7) ◽  
pp. 539-542 ◽  
Author(s):  
Craig W. Semple ◽  
Murali Mahadevan ◽  
Robert G. Berkowitz
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Acute Otitis Media ◽  
Retrospective Chart Review ◽  
Computed Tomographic ◽  
Recurrent Acute Otitis Media ◽  
Tympanostomy Tubes ◽  
Acquired Cholesteatoma ◽  
High Index Of Suspicion ◽  
Conductive Hearing

Objectives: To determine the factors associated with the diagnosis of acquired cholesteatoma (AC) in children, we performed a retrospective chart review at a tertiary care center. Methods: We reviewed children with a diagnosis of AC that extended beyond the mesotympanum in the presence of a nonintact tympanic membrane who underwent surgical treatment over a 14-year period. Results: There were 116 children (78 male, 38 female) between 3 and 18 years of age (mean, 9.5 years). Their average period of management in a specialist otolaryngology clinic before the diagnosis of cholesteatoma was made was 3.2 years, and 68% of the children had previously undergone insertion of tympanostomy tubes. Symptoms and signs included chronic otorrhea (59%), recurrent acute otitis media (58%), and conductive hearing loss (51%). The diagnosis of AC was eventually made after office otoscopy (26%), temporal bone computed tomography (24%), or examination under anesthesia (17%). In 33% of children, the diagnosis was made only after surgical exploration of the middle ear and mastoid. Conclusions: Our data underscore the importance of maintaining a high index of suspicion for AC in managing children with long-standing otologic symptoms, and considering otomicroscopy, computed tomographic scanning, or tympanomastoid exploration if medical treatment fails.

scholarly journals Trichotillomania in Children and the Different Approaches between Dermatological and Behavioral Health Professionals at an Urban Tertiary Care Center

2020 ◽  
pp. 1-7
Author(s):  
Sneha Rangu ◽  
Leslie Castelo-Soccio
Keyword(s):  
Behavioral Health ◽  
Chart Review ◽  
Complex Disease ◽  
Behavioral Therapy ◽  
Care Center ◽  
Treatment Options ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Psychosocial Impairment ◽  
Epidemiologic Features

<b><i>Background:</i></b> Trichotillomania (TTM) is a complex disease with varying clinical characteristics, and psychosocial impairment is noted in many TTM patients. Despite its prevalence in childhood, there is limited research on pediatric TTM. <b><i>Objective:</i></b> To analyze the clinical and epidemiologic features of TTM in children evaluated by dermatologists and behavioral health specialists. <b><i>Method:</i></b> We performed a retrospective chart review of 137 pediatric patients seen at the Children’s Hospital of Philadelphia with initial presentation of TTM at age 17 or younger. Patients were treated by dermatology or behavioral health. <b><i>Results:</i></b> The majority of the patients were females, with an average diagnosis age around 8 years. Over half had a psychiatric comorbidity, and over a quarter had a skin disorder. Skin disorders were more commonly present in those evaluated by dermatology, and psychiatric comorbidities were more commonly present in those evaluated by behavioral health. The most common form of treatment was behavioral therapy, with medications prescribed more often by dermatologists. <b><i>Conclusions:</i></b> TTM patients choose to present to behavioral health or dermatology; however, there are distinctive differences between the two cohorts. With behavioral and pharmacologic treatment options, a relationship between dermatologists and behavioral health specialists is necessary for multifactorial management of TTM.

scholarly journals The Experience of Hospital Death: Assessing the Quality of Care at an Academic Medical Center

2017 ◽  
Vol 35 (2) ◽  
pp. 189-197 ◽  
Author(s):  
Elise C. Carey ◽  
Ann M. Dose ◽  
Katherine M. Humeniuk ◽  
Yichen C. Kuan ◽  
Ashley D. Hicks ◽  
...  
Keyword(s):  
Medical Center ◽  
Care Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Cost Effective ◽  
Hospital Death ◽  
Personal Care ◽  
Predominately White ◽  
Dying Patients

Background: The quality of perimortem care received by patients who died at our hospitals was unknown. Objective: To describe the quality of hospital care experienced in the last week of life, as perceived by decedents’ families. Design: Telephone survey that included established measures and investigator-developed content. Setting: Large, tertiary care center known for high-quality, cost-effective care. Participants: Family members of 104 patients who died in-hospital (10% of annual deaths) over the course of 1 year. Intervention: None. Measurements: Participant perceptions of the decedent’s care, including symptom management, personal care, communication, and care coordination. Results: Decedents were mostly male (64%), white (96%), married (73%), and Christian (91%). Most survey participants were spouses of the decedent (68%); they were predominately white (98%), female (70%), and Christian (90%) and had a median age of 70 years (range, 35-91 years). Overall satisfaction was high. Pain, dyspnea, and anxiety or sadness were highly prevalent among decedents (73%, 73%, and 55%, respectively) but largely well managed. Most participants believed that decedents were treated respectfully and kindly by staff (87%) and that sufficient help was available to assist with medications and dressing changes (97%). Opportunities for improvement included management of decedents’ anxiety or sadness (29%) and personal care (25%), emotional support of the family (57%), communication regarding decedents’ illness (29%), and receiving contradictory or confusing information (33%). Conclusion: Despite high satisfaction with care overall, we identified important unmet needs. Addressing these gaps will improve the care of dying patients.

A 10-Year Review of Necrotizing Fasciitis in the Pediatric Population: Delays to Diagnosis and Management

2016 ◽  
Vol 56 (7) ◽  
pp. 627-633 ◽  
Author(s):  
Heather VanderMeulen ◽  
Jeffrey M. Pernica ◽  
Madan Roy ◽  
April J. Kam
Keyword(s):  
Necrotizing Fasciitis ◽  
Chart Review ◽  
Pediatric Population ◽  
Care Center ◽  
Tertiary Care ◽  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
Causative Organism ◽  
Antibiotic Administration ◽  
Large Variability

Objective. To assess the promptness and appropriateness of management in pediatric cases of necrotizing fasciitis (NF). Methods. A retrospective chart review examined cases of pediatric NF treated at a pediatric tertiary care center over a 10-year period. Results. Twelve patients were identified over the 10-year period. The median (25th to 75th centile) times to appropriate antibiotic administration, infectious disease consults, surgical consults and debridement surgeries were 2.6 (2.1-3.2), 7.7 (3.4-24.4), 4.6 (1.7-21.0), and 22.1 (10.3-28.4) hours following assessment at triage. The initial antibiotic(s) administered covered the causative organism in 9 of 12 cases. The median (25th to 75th centile) length of hospital stay was 21 (14.0-35.5) days. Conclusions. The large variability in the care of these patients speaks to the range of their presenting symptomatology. The lack of a standardized approach to the pediatric patient with suspected NF results in delays in management and suboptimal antibiotic choice.

scholarly journals Cerebrospinal Fluid Pleocytosis in Critical Care Patients With Seizures

2017 ◽  
Vol 44 (4) ◽  
pp. 343-349
Author(s):  
Carly Scramstad ◽  
Alan C. Jackson
Keyword(s):  
Cerebrospinal Fluid ◽  
Critical Care ◽  
Care Center ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Critical Care Units ◽  
Generalized Seizures ◽  
Csf Pleocytosis ◽  
Magnetic Resonance Imaging Mri ◽  
Critical Care Patients

AbstractObjectives: To assess the etiology of cerebrospinal fluid (CSF) pleocytosis in critical care patients with seizure(s) or status epilepticus (SE). Many previous studies, some performed decades ago, concluded that CSF pleocytosis may be entirely attributable to seizure activity. Methods: We undertook a retrospective chart review of adult patients with an admitting or acquired diagnosis of seizure(s) or SE in critical care units at the Winnipeg Health Sciences Centre between 2009 and 2012. Patients were identified through a critical care information database at a tertiary care center. We limited our study to patients who had lumbar punctures at our center within 5 days of seizure(s) or SE. Results: Of 426 patients with seizures in critical care units, 51 met the inclusion criteria. Seizure subtypes included focal seizures (5 or 10%), generalized seizures (14 or 27%), and SE (32 or 63%). Twelve (seven with SE) of the 51 (24%) were found to have CSF pleocytosis. A probable etiological cause for the CSF pleocytosis was identified in all 12 cases. Conclusions: We conclude that seizures do not directly induce a CSF pleocytosis. Instead, the CSF pleocytosis more likely reflects the underlying acute or chronic brain process responsible for the seizure(s). This was not readily apparent in early studies without magnetic resonance imaging (MRI) of the brain and currently available laboratory investigations. An etiological cause of CSF pleocytosis must always be sought when patients present with seizures and it should never be assumed that seizures are the cause.

scholarly journals Evaluation of Exome Sequencing Criteria for Hospital Stewardship and Insurance Authorization at a Pediatric Hospital

2021 ◽  
Author(s):  
Claire L. Wittowski ◽  
Sarah Clowes Candadai ◽  
Marie E. Perrone ◽  
Daniel F. Gallego ◽  
Jessie H. Conta ◽  
...  
Keyword(s):  
Exome Sequencing ◽  
Care Center ◽  
Insurance Coverage ◽  
Genetic Diseases ◽  
Tertiary Care ◽  
Pediatric Care ◽  
Molecular Diagnostic ◽  
Molecular Testing ◽  
Coverage Criteria ◽  
Significant Difference

Context.— Genomic molecular testing practices in a pediatric tertiary care institution. Objective.— To evaluate exome sequencing (ES) ordering practices and the effects of applying criteria to support ES stewardship. Exome sequencing can provide molecular diagnostic information for patients with known or suspected genetic diseases, but it is relatively expensive, and the cost is often borne by patients, institutions, and payers. Design.— We examined ordering patterns of ES approved by board-certified geneticists at our tertiary pediatric care center, as well as preauthorization outcomes for ES requests. We compared positivity rates among patients by patient phenotype, composite insurance coverage criteria, and insurance preauthorization outcome. Results.— Patients who met composite coverage criteria were more likely to receive a positive result from ES compared to patients who did not meet composite coverage criteria, though this trend was not statistically significant. There was no significant difference in ES results between patients who were denied or not denied preauthorization by insurance payers. Conclusions.— Insurance payers should consider implementing and/or expanding coverage criteria for ES and institutions should implement stewardship programs to support appropriate ES practices.

scholarly journals Cholelithiasis in Cystic Fibrosis Patients in a Tertiary Care Center in Saudi Arabia

2020 ◽  
Vol 2 (2) ◽  
pp. 37-43
Author(s):  
Banjar H ◽  
Al-Ghuneim L ◽  
Al-Shammari A ◽  
Al-Mulhim FA ◽  
Al-Eid M ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Clinical Laboratory ◽  
Care Center ◽  
Pancreatic Insufficiency ◽  
Tertiary Care ◽  
Age Groups ◽  
Retrospective Chart Review ◽  
Abdominal Ultrasound ◽  
Abdominal Sonography

Introduction: Cholelithiasis has been reported in 12%-24% of Cystic Fibrosis (CF) patients, and is usually made up of cholesterol gallstones. These abnormalities are frequently asymptomatic and can include intra and extrahepatic ducts, gallbladder thickening and contraction, micro gallbladders, and cholelithiasis. Abdominal sonography is routinely used in order to detect these abnormalities. Objectives: To obtain the prevalence of gall stones (Cholelithasis) in CF patients and its relation to other clinical, laboratory, radiological, and genetic data. Methodology: A retrospective chart review as part of the CF registry data from the period 1st January 1984 – 1st June 2018. All confirmed CF the patients of all age groups that have US studies done were included in the study. Patients with positive gallstones or sludge were evaluated and discussed. Results: A total of 391 confirmed CF patients were involved. Out of them, 252 patients had an abdominal ultrasound, 7 patients (3%) had gallstones on the abdominal US, 8 patients (3%) were revealed to have sludge and 237 patients (94%) had normal gallbladders. Pancreatitis was found in 4 patients (2%). 191 patients (76%) had pancreatic insufficiency.77 patients had follow up abdominal ultrasounds and 5 patients (7%) were found to have persistent gallstones, 4 patients (5%) had persistent sludge and 68 patients (88%) remained negative for gallstones. 2 patients required cholecystectomy. Conclusion: Cholelithiasis is a common complication of CF disease; its incidence is more than the general population. Thus, we recommend that every CF patient get an ultrasonography study as part of liver disease screening to rule out any Gallbladder pathology.

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