scholarly journals Outcomes of eosinophilic esophagitis in patients managed in a multidisciplinary clinic

2022 ◽  
Vol 43 (1) ◽  
pp. 78-84 ◽  
Author(s):  
Jeremy C. McMurray ◽  
Benjamin St Clair ◽  
Sarah W. Spriet ◽  
Steve B. Min ◽  
Daniel I. Brooks ◽  
...  
Keyword(s):  
Eosinophilic Esophagitis ◽  
Chart Review ◽  
Multidisciplinary Approach ◽  
Complex Disease ◽  
Clinical Symptoms ◽  
Medical Center ◽  
Retrospective Chart Review ◽  
Multidisciplinary Teams ◽  
Poor Growth ◽  
Multidisciplinary Clinic

Background: Eosinophilic esophagitis is a complex disease with an increasing prevalence. Multidisciplinary teams are often needed to manage this difficult-to-treat condition. Objective: To observe the clinical and histologic outcomes of patients with eosinophilic esophagitis after management in a multidisciplinary clinic. Methods: An observational, retrospective chart review was conducted to include all patients referred to the Walter Reed National Military Medical Center multidisciplinary eosinophilic esophagitis clinic between August 2012 and February 2021. Only patients who had at least one esophagogastroduodenoscopy before referral, one or more visits and endoscopy after multidisciplinary management, and documented clinical symptoms were included. Statistical analysis was performed by using McNemar and Wilcoxon tests. Results: A total of 103 patients were included in the study, with a mean age at diagnosis of 17.9 years. Management in the multidisciplinary clinic was associated with a reduction in solid-food dysphagia by 70.9%, poor growth by 70.8%, and emesis or regurgitation by 87.5%. We observed that 48.5% and 62.1% had histologic remission (<15 eosinophils/hpf) on the initial and any post-multidisciplinary endoscopy, respectively. Only seven patients (5.8%) with two or more visits and endoscopies did not achieve histologic remission. More than two-thirds of the patients (68.9%) required combination therapy to achieve remission. Conclusion: Although an observational study, these findings may suggest that the management of patients with eosinophilic esophagitis in a multidisciplinary clinic may improve the likelihood of clinical and histologic remission. Targeted management with a multidisciplinary approach may reduce overall morbidity and slow disease progression; however, more research is needed.

Evaluation of Cost-effectiveness and Clinical Value of Routine Histopathologic Examination of Septoplasty Specimens

2021 ◽  
pp. 019459982110129
Author(s):  
Randall S. Ruffner ◽  
Jessica W. Scordino
Keyword(s):  
Chart Review ◽  
Medical Center ◽  
Academic Medical Center ◽  
Cost Savings ◽  
Retrospective Chart Review ◽  
Clinical Value ◽  
Level Of Evidence ◽  
Significant Pathology ◽  
National Model ◽  
Routine Histopathologic Examination

Objectives During septoplasty, normal cartilage and bone are often sent for pathologic examination despite benign appearance. We explored pathology results following septoplasty from April 2016 to April 2018, examining clinical value and relevance, implications, and cost analysis. Study Design Retrospective chart review. Setting Single-institution academic medical center. Methods A retrospective chart review was compiled by using Current Procedural Terminology code 30520 for septoplasty for indication of nasal obstruction, deviated septum, and nasal deformity. Results A total of 236 consecutive cases were identified spanning a 2-year period. Septoplasty specimens were sent for pathology evaluation in 76 (31%). The decision to send a specimen for histopathology was largely physician dependent. No cases yielded unexpected or significant pathology that changed management. The average total charges for septoplasty were $10,200 at our institution, with 2.2% of procedural charges accounting for pathology preparation and review, averaging $225. Nationally, this results in an estimated charged cost of $58.5 million. The Centers for Medicare and Medicaid Services (CMS) reimbursement for septoplasty pathology charges was $46 in 2018, accounting for 1.3% of hospital-based reimbursements and 2.2% of ambulatory center reimbursements. With CMS as a national model for reimbursement, $11.8 million is spent yearly for septoplasty histopathology. Given that CMS reimbursement is significantly lower than private insurers, national total reimbursement is likely considerably higher. Conclusion Routine pathology review of routine septoplasty specimens is unnecessary, unremarkable, and wasteful. Correlation of the patient’s presentation and intraoperative findings should justify the need for pathology evaluation. This value-based approach can offer significant direct and indirect cost savings. Level of evidence 4.

P101 Dietary therapy for pediatric eosinophilic esophagitis: a retrospective chart review

2018 ◽  
Vol 50 (4) ◽  
pp. e394
Author(s):  
M. Malamisura ◽  
R. Tambucci ◽  
F. Rea ◽  
C. Riccardi ◽  
E.F. Romeo ◽  
...  
Keyword(s):  
Eosinophilic Esophagitis ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Dietary Therapy

scholarly journals Clinical Characteristics of Non-Suicidal Self-Injury and Suicide Attempts among Psychiatric Patients in Korea: A Retrospective Chart Review

2020 ◽  
Vol 17 (4) ◽  
pp. 320-330
Author(s):  
Yubeen Bae ◽  
Yoanna Seong ◽  
Seok Hyeon Kim ◽  
Sojung Kim
Keyword(s):  
Clinical Characteristics ◽  
Chart Review ◽  
Suicide Attempts ◽  
Medical Center ◽  
Psychiatric Patients ◽  
Retrospective Chart Review ◽  
The Other ◽  
Novelty Seeking ◽  
Medical Chart Review ◽  
Self Injury

Objective Limited data exist on non-suicidal self-injury (NSSI) and suicide attempts among psychiatric patients in Korea. In this study, we investigated the clinical characteristics of patients who engaged in NSSI and/or suicide attempts.Methods We performed a retrospective medical chart review of patients with NSSI and/or suicide attempts at the psychiatric department of a university medical center in Seoul between 2017 and 2019. According to their history, patients were allocated to one of three groups: NSSI only, suicide attempts only and NSSI and suicide attempts group. Groups were compared based on sociodemographic characteristics and psychological assessments.Results Overall, 80 patients with NSSI and/or suicide attempts were evaluated. Patients with NSSI and suicide attempts were more likely to be female than the other two groups. Patients with NSSI and suicide attempts were more likely to suffer from Cluster B personality disorder than the other groups. And patients with NSSI and suicide attempts scored significantly higher on novelty-seeking in TCI and RC8, RC9 in MMPI-2.Conclusion Patients with NSSI and/or suicide attempts were more likely to be female, younger, and showed higher levels of psychological disturbances. These findings highlight the importance of early detection and intervention for patients with NSSI.

scholarly journals A Retrospective Analysis of Patients with Short Stature in the South of China between 2007 and 2015

2018 ◽  
Vol 2018 ◽  
pp. 1-8
Author(s):  
Su Wu ◽  
Qian-qi Liu ◽  
Wei Gu ◽  
Shi-ning Ni ◽  
Xing Shi ◽  
...  
Keyword(s):  
Short Stature ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
The South ◽  
Treatment Needs ◽  
Normal Height ◽  
Poor Growth ◽  
Number Of Patients ◽  
Medical University ◽  
Age Range

Objective. To describe the demographic features of children with short stature and poor growth in the south of China and provide better guidance on clinical strategy and decisions. Study Design. This retrospective, chart review study analyzed children with short stature and poor growth admitted to the Department of Endocrinology of Children’s Hospital of Nanjing Medical University from Jan 2007 to Dec 2015. Results. The chart review yielded 4142 patients, including 2546 boys and 1596 girls (P < 0.001); the number of patients gradually increased per year from 2007 to 2015. There was an upward trend in the average levels of height standard deviations (SDs) during the study period (P < 0.001), both in males (P < 0.001) and females (P < 0.001). Mean height SDs were smaller in females (-2.42±1.09) than males (-2.33±1.03; P = 0.01). The percentage of females admitted at normal height (33.83%) was lower than that of males (37.20%; P = 0.028). The peak age range of hospitalization in males was 10–12 years of age, while females were generally admitted earlier—8–10 years. Conclusions. There was an increasing tendency to focus on children’s height. Parents and pediatricians were recommended to pay more attention to the treatment needs of girls while avoiding excessive treatment of those who merely appear not to be tall enough without a clear medical issue related to growth, especially for boys.

Efficacy of and potential morbidities associated with the use of antacid medications in preterm neonates

2017 ◽  
Vol 45 (8) ◽  
Author(s):  
Uday P. Patil ◽  
Sean M. Bailey ◽  
Elena V. Wachtel ◽  
Evan Orosz ◽  
Rebecca Zarchin ◽  
...  
Keyword(s):  
New York ◽  
Preterm Infants ◽  
Chart Review ◽  
Medical Center ◽  
Bacterial Flora ◽  
Retrospective Chart Review ◽  
Gastric Ph ◽  
Preterm Neonates ◽  
Gastrointestinal Function ◽  
New York University

AbstractObjectives:Antacid medications are frequently administered to preterm infants. These medications can change gastric pH levels and can affect regular gastrointestinal function and gut micro-bacterial flora. We hypothesized that preterm infants exposed to antacid medications are at a greater risk of necrotizing enterocolitis (NEC) and sepsis, and set out to determine any association, as well as to assess the clinical efficacy of these medications.Materials and methods:Retrospective chart review of preterm infants ≤30 weeks’ gestational age or birth weight ≤1250 g over a 2-year period at New York University Langone Medical Center. Subjects were divided into two groups: those who had been treated with antacid medications and those who had not. We then examined for any difference in NEC (≥Bell stage 2) or culture proven sepsis.Results:The study comprised 65 eligible neonates, 28 in antacid treatment group and 37 in control. The incidence of NEC (21.4% vs. 2.7%, P=0.04) was significantly higher in the antacid group, but these infants tended to be born more prematurely than control subjects. There was a trend toward more culture proven sepsis cases in the antacid group. We found no difference in signs generally associated with neonatal reflux (apnea, bradycardia, and desaturation events) in subjects treated with antacid medications after treatment began.Conclusions:Treatment of preterm infants with antacid medications is potentially associated with a higher risk of NEC, and possibly sepsis, while appearing to provide little benefit.

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 Predominant Endotype of Nasal Polyps in a Sample of Filipinos Following Endoscopic Sinus Surgery for Chronic Rhinosinusitis with Nasal Polyposis

2021 ◽  
Vol 36 (1) ◽  
pp. 28
Author(s):  
Karla Victoria Nable-Llanes ◽  
Rodante Roldan
Keyword(s):  
South Korea ◽  
Chronic Rhinosinusitis ◽  
Endoscopic Sinus Surgery ◽  
Nasal Polyps ◽  
Chart Review ◽  
Nasal Polyposis ◽  
Medical Center ◽  
Retrospective Chart Review ◽  
Sinus Surgery ◽  
Consecutive Sample

ABSTRACT Objective: To determine the prevalence of eosinophilic and non-eosinophilic nasal polyps in Filipino patients with chronic rhinosinusitis with nasal polyposis (CRSwNP) who underwent endoscopic sinus surgery. Methods: Design: Retrospective Chart Review Setting: Tertiary Government Training Hospital Participants: A consecutive sample of adult patients who underwent endoscopic sinus surgery for chronic rhinosinusitis with nasal polyposis at the Rizal Medical Center from 2015-2019.   Results: Out of 66 patients who underwent endoscopic sinus surgery during the study period, 36 (54.55%) had an eosinophilic endotype while 30 (45.45%) had a non-eosinophilic endotype. Conclusion: he slight predominance of eosinophilic nasal polyps found in our sample may suggest a contrasting trend compared to our Asian neighbors, who have a predominantly non[1]eosinophilic endotype – Indonesia (90.47%), Thailand (81.9%), South Korea (66.7%) and China (53.6%). However, this predominance is still lower than the 78-88% eosinophilia reported among Caucasians. Larger series may confirm these preliminary findings

scholarly journals Antibiotic use among twelve Canadian First Nations communities: A retrospective chart review of skin and soft tissue infections

2020 ◽  
Author(s):  
Dahn Jeong ◽  
Ha Nhan Thi Nguyen ◽  
Mark Tyndall ◽  
Yoko S Schreiber
Keyword(s):  
Soft Tissue ◽  
First Nations ◽  
Chart Review ◽  
Clinical Symptoms ◽  
Community Setting ◽  
Retrospective Chart Review ◽  
Indigenous Communities ◽  
Antibiotic Use ◽  
Soft Tissue Infections ◽  
Treatment And Prevention

Abstract Background Previous publications indicated an emerging issue with community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA), particularly skin and soft tissue infections (SSTIs), in Indigenous communities in Canada. The objectives of this analysis were to explore the prevalence of SSTIs due to CA-MRSA and patterns of antimicrobial use in the community setting. Methods A retrospective chart review was conducted as part of an environmental scan to assess antibiotic prescriptions in 12 First Nations communities across five provinces in Canada including Alberta, Saskatchewan, Manitoba, Ontario, and Québec. Charts were randomly selected from nursing stations and patients who had accessed care in the previous 12 months and were ≥18 years were included in the review. Data was collected from September to December, 2013 on antibiotic prescriptions, including SSTIs, clinical symptoms, diagnostic information including presence of CA-MRSA infection, and treatment. Results A total of 372 charts were reviewed, 60 from Alberta, 70 from Saskatchewan, 120 from Manitoba, 100 from Ontario, and 22 from Québec. Among 372 patients, 224 (60.2%) patients had at least one antibiotic prescription in the previous 12 months and 569 prescriptions were written in total. The prevalence of SSTIs was estimated at 36.8% (137 cases of SSTIs in 372 charts reviewed). In 137 cases of SSTIs, 34 (24.8%) were purulent infections, and 55 (40.2%) were due to CA-MRSA. Conclusions This study has identified a high prevalence of antibiotic use and SSTIs due to CA-MRSA in remote and isolated Indigenous communities across Canada. This population is currently hard to reach and under-represented in standard surveillance system and randomized retrospective chart reviews can offer complimentary methodology for monitoring disease burden, treatment and prevention.

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