Ventriculostomy supply cart decreases time-to-external ventricular drain placement in the emergency department

Background: Minimizing time-to-external ventricular drain (EVD) placement in the emergency department (ED) is critical. We sought to understand factors affecting time-to-EVD placement through a quality improvement initiative. Methods: The use of process mapping, root cause analyses, and interviews with staff revealed decentralized supply storage as a major contributor to delays in EVD placement. We developed an EVD “crash cart” as a potential solution to this problem. Time-to-EVD placement was tracked prospectively using time stamps in the electronic medical record (EMR); precart control patients were reviewed retrospectively. Results: The final cohorts consisted of 33 precart and 18 postcart cases. The mean time-to-EVD in the precart group was 99.09 min compared to 71.88 min in the postcart group (two-tailed t-test, P = 0.023). Median time-to-EVD was 92 min in the precart group compared to 64 min in the postcart group (rank sum test, P = 0.0165). Postcart patients trended toward improved outcomes with lower modified Rankin score scores at 1 year, but this did not reach statistical significance (two-tailed t-test, P = 0.177). Conclusion: An EVD “crash cart” is a simple intervention that can significantly reduce time-to-EVD placement and may improve outcomes in patients requiring an EVD.

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Effect of time and temperature before chilling on the hygiene of carcasses in wild boar hunted in central Italy

Italian Journal of Food Safety ◽

10.4081/ijfs.2021.9959 ◽

2022 ◽

Vol 10 (4) ◽

Author(s):

Roberto Barbani ◽

Giulia Lalinga ◽

Lia Bardasi ◽

Raffaella Branciari ◽

Dino Miraglia ◽

...

Keyword(s):

Wild Boar ◽

Environmental Temperature ◽

Central Italy ◽

Colony Count ◽

Elapse Time ◽

Moderate Correlation ◽

Factors Affecting ◽

Wild Boars ◽

The Mean ◽

Mean Time

The interest in certified game meat chains highlights the need for the evaluation and the management of factors affecting carcass hygiene along the peculiar steps of the production. The effects of time and temperature before chilling were specifically evaluated on aerobic colony count and Enterobacteriaceae count in hunted wild boar carcasses. Thirty wild boars were considered in two process steps where the hunted animal are still not chilled: after evisceration and just before chilling. Environmental temperature, carcass temperature and the elapse time between the two-step considered were registered. Furthermore, surface microbial loads were analyzed on the inner part of the carcasses. The mean time between the two sampling steps was 6 hours with an average environmental temperature of 20.49°C. A carcass temperature 9.6°C drop was observed during this period. In this lap of time aerobic colony count and Enterobacteriaceae count increased of 0.68 Log CFU/cm2 and 1.01 Log CFU/cm2 respectively, with a moderate correlation with the time but not with the temperature delta. The results reveal that the temperature conditions in central Italy hunting areas were not able to quickly reduce the carcass temperature and therefore the time between carcass evisceration and chilling should not exceed 6 hours.

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Abstract to Publication in Microsurgery: What Are the Discrepancies?

Journal of Reconstructive Microsurgery ◽

10.1055/s-0040-1713150 ◽

2020 ◽

Vol 36 (08) ◽

pp. 577-582

Author(s):

Rose S. Maisner ◽

Haripriya S. Ayyala ◽

Richard L. Agag

Keyword(s):

Conversion Rate ◽

Statistical Significance ◽

Reconstructive Microsurgery ◽

The Mean ◽

American Society ◽

New Research ◽

Mean Time ◽

Comprehensive Literature Search ◽

Abstract Presentation ◽

Manuscript Publication

Abstract Background The American Society for Reconstructive Microsurgery (ASRM) annual meeting is a forum to present new research abstracts prior to peer-reviewed publication. The aim of this study is to determine the conversion rate, discrepancies, and time between presentation and publication. Methods A comprehensive literature search was conducted cross-referencing ASRM abstracts presented between 2014 and 2018 with peer-reviewed manuscripts. The title and authors of the abstract and manuscript, the journal of manuscript publication, and time in months between presentation and publication were recorded. The conversion rate was calculated as the proportion of publications to abstracts. Major discrepancies were defined as changes in the purpose, study design, methods, sample size, statistical analysis, results, or conclusions. Minor discrepancies were defined as changes in the title or authorship. Results Out of 667 oral abstract presentations, 361 (54%) resulted in publication. Of these abstracts, 53 were presented after their corresponding manuscripts were published. The mean conversion rate was 55.52 ± 10.17%. The mean time from presentation to publication was 13.83 months. Minor discrepancies were more frequent than major discrepancies (91 vs. 76%). The most common major and minor discrepancies involved changes in the results (63%) and authorship (79%), respectively. There was a significant association between the year of abstract presentation and whether the conclusion was changed (p = 0.001), but interyear relationships with all other discrepancies failed to reach statistical significance. Conclusion Only around half of abstracts presented at the annual ASRM conference have reached full publication in peer-reviewed journals, and most are undergoing significant changes between presentation and publication. This may be due to panel discussions at meetings suggesting study modifications, as well as revisions after careful peer review. Altering surgical practices may not be recommended based on abstracts' content.

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Quality of febrile neutropenia management in a regional cancer center emergency department.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.30_suppl.104 ◽

2014 ◽

Vol 32 (30_suppl) ◽

pp. 104-104

Author(s):

Priyanka Kapil ◽

Katherine Enright

Keyword(s):

Emergency Department ◽

Febrile Neutropenia ◽

Antibiotic Therapy ◽

Cancer Site ◽

Cancer Center ◽

Time To Initiation ◽

The Mean ◽

The Impact ◽

Mean Time

104 Background: ASCO's current guidelines for febrile neutropenia (FN) management support antibiotic administration within one hour of presentation to the emergency department (ED). Prompt initiation of antibiotic therapy is vital to decrease the likelihood of adverse outcomes. Many studies, however, have reported significant delays in antibiotic initiation with mean wait times far exceeding ASCO's guidelines. We aimed to assess the quality of FN management at a regional cancer centre ED. Methods: Patients undergoing chemotherapy who visited the ED at the Peel Regional Cancer Center in Ontario, Canada between 04/12 - 03/13 were identified using electronic medical records. Patients were excluded if there was no record of chemotherapy delivery within 30 days prior to ED visit. ICD-10 codes and chart data were used to identify patients who had presented for either fever or infection. The primary outcome measures were three major quality of health indicators; time to assessment by a physician, Canadian Triage and Acuity Scale (CTAS) score, and time to initiation of intravenous antibiotics. Results: In total 239 records were included in the analysis. CTAS score was concordant with recommendation for FN (level 1-2) in 85% of patients and did not vary based on primary cancer site (p = 0.17). The mean time to physician assessment was 97.2 min and the mean time to initiation of IV antibiotics was 194.7 min. Overall, 14.6% of patients received their first dose of antibiotic therapy within the recommended 1 hour window. Conclusions: Our audit identified a large margin for improvement in the time to initiation of antibiotic therapy for chemotherapy patients with suspected FN. Prompt recognition and initiation of standardized treatment pathways for FN in the ED may improve the time to initiation of antibiotic therapy. In an attempt to address this gap in quality we have developed and distributed a standardized wallet-sized fever card to all patients receiving cytotoxic chemotherapy within our regional cancer program. This card contains information pertaining to the current chemotherapy treatment and recommended ED treatment protocols for FN. An evaluation of the impact of these cards is ongoing.

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Agreement between Impression of Stroke in the Emergency Department and Diagnosis at the Neurology Department

Advances in Bioscience and Clinical Medicine ◽

10.7575/aiac.abcmed.v.7n.3p.7 ◽

2019 ◽

Vol 7 (3) ◽

pp. 7

Author(s):

Samad Shams-Vahdati ◽

Alireza Ala ◽

Eliar Sadeghi-Hokmabad ◽

Neda Parnianfard ◽

Maedeh Gheybi ◽

...

Keyword(s):

Emergency Department ◽

Ischemic Stroke ◽

Statistical Significance ◽

Retrospective Chart Review ◽

Chi Square ◽

Prevention Therapy ◽

Significant Difference ◽

Chi Square Test ◽

Academic Teaching Hospital ◽

The Mean

Background: Missing to detect an ischemic stroke in the emergency department leads to miss acute interventions and treatment with secondary prevention therapy. Our study examined the diagnosis of stroke in the emergency department (ED) and neurology department of an academic teaching hospital. Methods and Materials: A retrospective chart review was performed from March 2017 to March 2018. ED medical document (chart) were reviewed by a stroke neurologist to collect the clinical diagnosis and characteristics of ischemic stroke patients. For determining the cases of misdiagnosed and over diagnosed data, the administrative data codes were compared with the chart adjudicated diagnosis. The adjusted estimate of effect was estimated through testing the significant variables in a multivariable model. The comparisons were done with chi square test. Statistical significance was considered at P < 0.05. Results: Of 861 patients of the study, 54% were males and 43% were females; and the mean age of them was 66.51 ± 15.70. We find no statically significant difference between patient’s Glasgow Coma Scale (GCS) in the emergency department (12.87±3.25) and patients GCS in the neurology department (11.77±5.15). There were 18 (2.2%) overdiagnosed of ischemic stroke, 8 (0.9%) misdiagnosed of ischemic stroke and 36 (4.1%) misdiagnosed of hemorrhagic strokes in the emergency department. Conclusion: There was no significant difference between impression of stroke in the emergency department and diagnosis at the neurology department.

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Is publication bias present in gastroenterological research? An analysis of abstracts presented at an annual congress

PeerJ ◽

10.7717/peerj.4995 ◽

2018 ◽

Vol 6 ◽

pp. e4995 ◽

Cited By ~ 2

Author(s):

Chase Meyer ◽

Kaleb Fuller ◽

Jared Scott ◽

Matt Vassar

Keyword(s):

Publication Bias ◽

Median Time ◽

Medical Literature ◽

Statistical Significance ◽

Citation Count ◽

Design Time ◽

Published Report ◽

Annual Congress ◽

The Mean ◽

Mean Time

Background Publication bias is the tendency of investigators, reviewers, and editors to submit or accept manuscripts for publication based on their direction or strength of findings. In this study, we investigated if publication bias was present in gastroenterological research by evaluating abstracts at Americas Hepato-Pancreato-Biliary Congresses from 2011 to 2013. Methods We searched Google, Google Scholar, and PubMed to locate the published reports of research described in these abstracts. If a publication was not found, a second investigator searched to verify nonpublication. If abstract publication status remained undetermined, authors were contacted regarding reasons for nonpublication. For articles reaching publication, the P value, study design, time to publication, citation count, and journals in which the published report appeared were recorded. Results Our study found that of 569 abstracts presented, 297 (52.2%) reported a P value. Of these, 254 (85.5%) contained P values supporting statistical significance. The abstracts reporting a statistically significant outcome were twice as likely to reach publication than abstracts with no significant findings (OR 2.10, 95% CI [1.06–4.14]). Overall, 243 (42.7%) abstracts reached publication. The mean time to publication was 14 months and a median time of nine months. Conclusion In conclusion, we found evidence for publication bias in gastroenterological research. Abstracts with significant P values had a higher probability of reaching publication. More than half of abstracts presented from 2011 to 2013 failed to reach publication. Readers should take these findings into consideration when reviewing medical literature.

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Retrospective investigation of anticoagulant complications in long term after mechanical heart valve replacement surgery in Turkey

10.32592/ircmj.2021.23.1.13 ◽

2020 ◽

Keyword(s):

Emergency Department ◽

Valve Replacement ◽

Heart Valve ◽

Mechanical Heart Valve ◽

Heart Valve Replacement ◽

Factors Affecting ◽

Replacement Surgery ◽

The Mean ◽

Valve Replacement Surgery

Background: Patients with mechanical heart valve replacement surgery (MHVRS) should be followed up in terms of prosthetic valve-related and open heart surgery complications. This study aimed to determine the anticoagulant complications in long term in patients with MHVRS. Methods: This retrospective and descriptive study was conducted in a university hospital, İzmir, Turkey. The data were collected from July to December 2019. In total, 73 patients referring for regular check-ups to the hospital with intervals not exceeded more than 90 days, and those who had international normalized ratio (INR) measurements for January-April-July-October 2018 were included in this study. Results: The mean age of the patients was obtained at 58.98±12.89 years, and 53.4% (n=39) of the cases were male. Moreover, the mean follow-up period was estimated at 65.98±28.47 months. According to the results, complications developed in 60 patients (82.2%). The first hospitalized unit was the emergency department. The factors affecting the development of complications after MHVRS were evaluated, and a difference was found regarding gender (X2=6.18, P=0.013), comorbidities (X2=25.58, P=0.018), and monthly referral for regular check-ups to the hospital (X2=5.20, P=0.023). There was no relationship between the INR levels and the development of complications. Furthermore, the results of evaluating the factors affecting the number of hospitalizations after MHVRS revealed that monthly referral to hospital for check-ups (t=3.18, P=0.002) and history of previous valve surgery (Z=201.00, P=0.03) affected the number of hospitalizations. Conclusions: It was observed that patients frequently refer to the emergency department and struggled with various complications. Moreover, it was found that the patients had frequent bleeding and refer to the emergency service repeatedly. Accordingly, there is a need for interventional studies to reduce postoperative complications and provide the therapeutic INR level.

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Navigation with laparoscopic ultrasound during fundus-first laparoscopic cholecystectomy-a single-centre retrospective case control study

10.21203/rs.3.rs-60946/v1 ◽

2020 ◽

Author(s):

Maciej Sebastian ◽

Agata Sebastian ◽

Jerzy Rudnicki

Keyword(s):

Laparoscopic Cholecystectomy ◽

Statistical Significance ◽

Laparoscopic Ultrasound ◽

Retrospective Case ◽

Exact Test ◽

Critical View ◽

Critical View Of Safety ◽

The Mean ◽

Mean Time ◽

Bail Out

Abstract Background Laparoscopic cholecystectomy is considered as the gold standard treatment for cholecystolithiasis. The critical view of safety is a generally accepted technique of intraoperative visualization but during inflammation and fibrosis in the region of Calot’s triangle it may fail. Fundus-first laparoscopic cholecystectomy with laparoscopic ultrasound navigation may be an attractive bail-out option when the intraoperative conditions are difficult. Methods The study group consisted of 900 patients with symptomatic cholecystolithiasis which was divided into two subgroups. The first subgroup where the only method of intraoperative identification was the critical view of safety consisted of 402 patients, the second subgroup where the critical view of safety and laparoscopic ultrasound were used consisted of 498 patients. In the first subgroup fundus-first laparoscopic cholecystectomy was performed in 13 patients, in the second subgroup in 42 patients. Statistical analysis included the Mann-Whitney U test for continuous and Fisher’s exact test for binary variables. The level of statistical significance was set at 95% (p < 0.05). Results Fundus-first technique was significantly more often in the subgroup with laparoscopic ultrasound and the hospitalization time of fundus-first laparoscopic cholecystectomies was significantly shorter than in converted cases. The mean time of laparoscopic cholecystectomy and the mean time to obtain the transection level between the gallbladder and the hepatoduodenal ligament were significantly shorter and the conversion rate was significantly lower in the fundus-first and laparoscopic ultrasound group. Conclusions Fundus-first technique with laparoscopic ultrasound navigation may be a very efficient bail-out option during laparoscopic cholecystectomy due to a more precisely and significantly faster defined plane of dissection what enables safe performance of laparoscopic cholecystectomy with significantly lower rate of conversions.

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Effect of a Dialysis Access Coordinator on Preemptive Access Placement among Veterans: A Quality Improvement Initiative

American Journal of Nephrology ◽

10.1159/000452346 ◽

2016 ◽

Vol 45 (1) ◽

pp. 14-21 ◽

Cited By ~ 6

Author(s):

Randall C. Gale ◽

Doreen Kehoe ◽

Yiming Z. Lit ◽

Steven M. Asch ◽

Manjula Kurella Tamura

Keyword(s):

High Risk ◽

Statistical Significance ◽

P Value ◽

Quality Improvement Initiative ◽

Dialysis Access ◽

Intervention Period ◽

Historical Cohort ◽

Significant Difference ◽

The Mean ◽

Access Surgery

Background and Objectives: Preemptive placement of permanent dialysis access is recommended in order to reduce the morbidity associated with central venous catheters. We assessed the effect of a dialysis access coordinator on preemptive access placement in veterans who are at high risk for end-stage renal disease (ESRD). Design, Setting, Participants, and Measurements: Pre-post evaluation of a dialysis access coordinator in the nephrology clinics of the Veterans Affairs Palo Alto. The access coordinator streamlined access referrals, prioritized surgical waiting lists and addressed patient barriers. We compared the frequency of preemptive access referral, surgery, and use for dialysis during the intervention period, July 1, 2013 to May 31, 2016, to a pre-intervention period, January 1, 2011 to December 31, 2013, among all patients with a predicted 1-year risk for ESRD ≥20%. Results: There were 156 patients in the historical cohort and 131 in the intervention cohort. The mean age was 69.9 ± 11.6 years and the mean estimated glomerular filtration rate was 14.5 ± 5.7 ml/min/1.73 m2. The intervention was associated with an 11.8% increase in access referral (p value = 0.03), and a 9.4% increase in completed access surgery (p value = 0.05). Increases in permanent access at the start of dialysis (15.2%), and functional permanent access at the start of dialysis (12.4%) did not reach statistical significance. Among patients who received access surgery, there was no significant difference in the prevalence of unused access. Conclusions: Implementation of an access coordinator was associated with a modest increase in preemptive access placement among patients who are at high risk for ESRD without increasing the prevalence of unused access.

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Factors Affecting Long-Term Compliance of CPAP Treatment—A Single Centre Experience

Journal of Clinical Medicine ◽

10.3390/jcm11010139 ◽

2021 ◽

Vol 11 (1) ◽

pp. 139

Author(s):

Agata Gabryelska ◽

Marcin Sochal ◽

Bartosz Wasik ◽

Przemysław Szczepanowski ◽

Piotr Białasiewicz

Keyword(s):

Sleep Apnoea ◽

Factors Affecting ◽

Cpap Treatment ◽

Obstructive Sleep ◽

Clinical Covariates ◽

Single Centre Experience ◽

The Mean ◽

Mean Time ◽

Cpap Failure

Continuous positive airway pressure (CPAP) has been the standard treatment of obstructive sleep apnoea/hypopnoea syndrome (OSA) for almost four decades. Though usually effective, this treatment suffers from poor long-term compliance. Therefore, the aim of our one centre retrospective study was to assess factors responsible for treatment failure and long-term compliance. Four hundred subsequent patients diagnosed with OSA and qualified for CPAP treatment were chosen from our database and compliance data were obtained from medical charts. Many differing factors kept patients from starting CPAP or led to termination of treatment. Overall, almost half of patients ended treatment during the mean time of observation of 3.5 years. Survival analysis revealed that 25% of patients failed at a median time of 38.2 months. From several demographic and clinical covariates in Cox’s hazard model, only the presence of a mild OSA, i.e., AHI (apnoea/hypopnoea index) below 15/h was a factor strongly associated with long term CPAP failure. The compliance results of our study are in line with numerous studies addressing this issue. Contrary to them, some demographic or clinical variables that we used in our survival model were not related to CPAP adherence.

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Relapsing Time to Severe Acute Malnutrition and Hazards Among Children Treated in the Health Posts.

10.21203/rs.3.rs-718840/v2 ◽

2021 ◽

Author(s):

Abera Lambebo ◽

Desselegn Temiru ◽

Tefera Belachew

Keyword(s):

Negative Binomial ◽

Severe Acute Malnutrition ◽

Statistical Significance ◽

Acute Malnutrition ◽

Negative Binomial Regression Model ◽

Under Five ◽

Under Five Children ◽

The Mean ◽

Time To Relapse ◽

Mean Time

Abstract Background: Malnutrition has many unpleasant results on child health during illness and after discharge. However, in Ethiopia there is luck of study that address either time to relapse or post discharge statusObjective: To identify time of relapse and associated factors among children discharged after undergoing treatment for SAM in South, Ethiopia Methods: An institution Retrospective cohort study was done among children admitted to health posts for treatment of SAM from 2014/2015-2019/2020 under-five children after discharge. After checking all the assumptions finally multivariable Cox regression has been used. All tests were two sided and P values <0.05 were used to declare statistical significance. Results: The mean time for relapse of severe acute malnutrition among under five children was determined us 22 at 95% CI, (20.69-24.82) week from discharge to relapse time.On multivariable negative binomial regression model, after adjusting for background variables time for relapse of severe acute undernutrition was significantly associated with edema during admission (AHR,2.02 ,95%, CI: 1.17-3.50), age group of 6-11 months (AHR 5.2,95%, CI:1.95-13.87), less discharge MUAC for first admission increase hazard of relapse (AHR 12,95%, CI: 7.90-19.52). Conclusion: The mean time was 22 week and edema, Age and MUAC was associated time to relapse.

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