Ecthyma Gangrenosum in a Pediatric Patient and Review of the Literature

Erythema Gangrenosum (EG), is an infective lesion of skin, and mucous membranes typically occurring in patients with chronic disease or immunocompromised patients. İt is a very rarely seen vasculitis with a potentially progressive and fatal course. An 8-year-old pediatric patient was referred to an external medical center with complaints of fever, abdominal pain, and skin rashes starting 2 days previously, and upon deterioration of his general health state, he was admitted into a surgical intensive care unit with manifestations of septic shock. In the treatment, all necrotic tissues including skin, and subcutaneous tissue were excised down to a healthy tissue after excision of all necrotic tissue. Vacuum Assisted Closure (VAC) was applied on this area for drainage. Herein, we aimed to indicate that definitive treatment of a neuropathic child with EG is surgery excision, and also emphasize critical importance of re-excision of newly developed necrotic tissue at an early stage, and close monetarization of the patient

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Application of RSClin to guide treatment recommendations for premenopausal patients with early-stage hormone-positive breast cancer and intermediate risk oncotype recurrence scores.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e12511 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e12511-e12511

Author(s):

Brittney Shulman Zimmerman ◽

Shana Berwick ◽

Alaina J Kessler ◽

Danielle Seidman ◽

Sara Malin Hovstadius ◽

...

Keyword(s):

Breast Cancer ◽

Early Stage ◽

Medical Center ◽

Academic Medical Center ◽

Recurrence Score ◽

Treatment Recommendations ◽

Definitive Treatment ◽

Treatment Recommendation ◽

Intermediate Risk ◽

Premenopausal Patients

e12511 Background: The RSClin model, which incorporates the Oncotype Recurrence Score (RS) and clinicopathologic features, was recently developed to further tailor prognosis and prediction of chemotherapy benefit for patients with early-stage hormone positive (HR+) breast cancer (BC) (Sparano et al, 2020). The RSClin calculator is available online to assist treatment planning for situations where chemotherapy benefit is uncertain. Covariates include Oncotype RS, tumor grade, tumor size and patient age. The risk calculator generates a 10-year distant recurrence risk and absolute chemotherapy benefit. This tool may be especially helpful to determine treatment management for premenopausal patients with early-stage HR+ BC with intermediate risk (IR) Oncotype RS (16-25). We retrospectively applied RSClin to this patient population to determine if it would have changed treatment recommendations. Methods: We identified premenopausal women with node-negative early-stage BC with IR RS (16-25) within our large Oncotype database. Using the RSClin model, we selected >5% absolute chemotherapy benefit as a reasonable cutoff to recommend chemotherapy. We compared the treatment recommendation based on RSClin with the treatment previously recommended by breast oncologists at our large academic medical center in New York City. Results: There were 86 patients who met criteria with a median age of 46 years. Of these, 26 patients (30%) were recommended chemotherapy plus endocrine therapy (ET) and 60 (70%) were recommended ET alone. After applying the RSClin model (data available for 83/86 patients), 19 (23%) would have resulted in a change in treatment recommendation and 64 (77%) would have remained unchanged. Overall, 8 (10%) would have withheld chemotherapy when it was previously offered and 11 (13%) would have recommended chemotherapy when it was previously excluded. There were 8 (9%) secondary invasive breast events in this population, with 2 (2%) being ipsilateral, 3 (3%) being contralateral and 3 (3%) metastatic at a median follow up of 46.9 months. Conclusions: The RSClin model would have changed management of premenopausal patients with IR RS in 23% of patients. This model, although not yet prospectively validated, may help individualize therapy for patients with less definitive treatment plans. Using RSClin, we can aim to minimize recurrence rates and avoid unnecessary chemotherapy in selected patients. This model is easy to apply and will have important clinical utility moving forward.

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Outcome and Subsequent Pregnancy after Fertility-Sparing Surgery of Early-Stage Cervical Cancers

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17197103 ◽

2020 ◽

Vol 17 (19) ◽

pp. 7103

Author(s):

Chia-Yi Lee ◽

Yu-Li Chen ◽

Ying-Cheng Chiang ◽

Ching-Yu Cheng ◽

Yen-Ling Lai ◽

...

Keyword(s):

Cervical Cancer ◽

Live Birth ◽

Early Stage ◽

Medical Center ◽

Subsequent Pregnancy ◽

Definitive Treatment ◽

Clinicopathologic Characteristics ◽

Fertility Sparing Surgery ◽

Fertility Sparing ◽

Early Stage Cervical Cancer

We aimed to investigate the outcomes and subsequent pregnancies of early-stage cervical cancer patients who received conservative fertility-sparing surgery. Women with early-stage cervical cancer who underwent conservative or fertility-sparing surgery in a tertiary medical center were reviewed from 2004 to 2017. Each patient’s clinicopathologic characteristics, adjuvant therapy, subsequent pregnancy, and outcome were recorded. There were 32 women recruited, including 12 stage IA1 patients and 20 stage IB1 patients. Twenty-two patients received conization/LEEP and the other 10 patients received radical trachelectomy. Two patients did not complete the definite treatment after fertility-sparing surgery. There were 11 women who had subsequent pregnancies and nine had at least one live birth. The live birth rate was 73.3% (11/15). We conclude that patients with early-stage cervical cancer who undergo fertility-sparing surgery can have a successful pregnancy and delivery. However, patients must receive a detailed consultation before surgery and undergo definitive treatment, if indicated, and regular postoperative surveillance.

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The Role of Understaffing in Central Venous Catheter-Associated Bloodstream Infection

Infection Control and Hospital Epidemiology ◽

10.1017/s0195941700006445 ◽

1996 ◽

Vol 17 (3) ◽

pp. 150-158

Author(s):

Scott K. Fridkin ◽

Suzanne M. Pear ◽

Theresa H. Williamson ◽

John N. Galgiani ◽

William R. Jarvis

Keyword(s):

Central Venous Catheter ◽

Medical Center ◽

Bloodstream Infections ◽

Venous Catheter ◽

Case Control ◽

Assisted Ventilation ◽

Surgical Intensive Care Unit ◽

Central Venous ◽

Surgical Intensive Care ◽

Outbreak Period

AbstractObjective:To determine risk factors for central venous catheter-associated bloodstream infections (CVC-BSI) during a protracted outbreak.Design:Case-control and cohort studies of surgical intensive care unit (SICU) patients.Setting:A university-affiliated Veterans Affairs medical center.Patients:Case-control study: all patients who developed a CVC-BSI during the outbreak period (January 1992 through September 1993) and randomly selected controls. Cohort study: all SICU patients during the study period (January 1991 through September 1993).Measurements:CVC-BSI or site infection rates, SICU patient clinical data, and average monthly SICU patient-to-nurse ratio.Results:When analyzed by hospital location and site, only CVC-BSI in the SICU had increased significantly in the outbreak period compared to the previous year (January 1991 through December 1991: pre-outbreak period). In SICU patients, CVC-BSI were associated with receipt of total parenteral nutrition [TPN]; odds ratio, 16; 95% confidence inter val, 4 to 73). When we controlled for TPN use, CVC-BSI were associated with increasing severity of illness and days on assisted ventilation. SICU patients in the out-break period had shorter SICU and hospital stays, were younger, and had similar mortality rates, but received more TPN compared with patients in the pre-outbreak period. Furthermore, the patient-to-nurse ratio significantly increased in the outbreak compared with the pre-outbreak period. When we controlled for TPN use, assisted ventilation, and the period of hospitalization, the patient-to-nurse ratio was an independent risk factor for CVC-BSI in SICU patients.Conclusions:Nursing staff reductions below a critical level, during a period of increased TPN use, may have contributed to the increase in CVC-BSI in the SICU by making adequate catheter care difficult. During healthcare reforms and hospital downsizing, the effect of staffing reductions on patient outcome (ie, nosocomial infection) needs to be critically assessed.

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Inappropriate Continuation of Stress Ulcer Prophylactic Therapy After Discharge

Annals of Pharmacotherapy ◽

10.1345/aph.1k227 ◽

2007 ◽

Vol 41 (10) ◽

pp. 1611-1616 ◽

Cited By ~ 42

Author(s):

Paul D Wohlt ◽

Lizbeth A Hansen ◽

Jeffrey T Fish

Keyword(s):

Gastric Acid ◽

Critically Ill ◽

Critically Ill Patients ◽

Stress Ulcer ◽

Medical Center ◽

Stress Ulcer Prophylaxis ◽

Surgical Intensive Care Unit ◽

Prophylactic Therapy ◽

Surgical Intensive Care ◽

Ulcer Prophylaxis

Background: Medications for stress ulcer prophylaxis are appropriately started in critically ill patients with risks for developing stress ulcers. It is unknown whether these drugs are discontinued once the risk factors are removed. Objective: TO assess the duration of stress ulcer prophylactic therapy in critically ill patients. Methods: A retrospective chart review was conducted at a multidisciplinary, 24 bed medical/surgical intensive care unit (ICU) of a university-affiliated tertiary referral medical center. Three hundred ninety-four patients fulfilled eligibility criteria during the study period of July 1, 2005, through September 30, 2005. Patients were considered to be appropriately discharged from the hospital on gastric acid suppressants it they met any of the following criteria: continued mechanical ventilation, gastroesophageal reflux disease, peplic ulcer disease, history of gastrointestinal ulceration or bleeding within the past year, prescribed medications used for stress ulcer prophylaxis prior to admission, gastrointestinal bleed during hospitalization, or prescriber indication of reason to continue therapy. Results: Three hundred fifty-seven patients received stress ulcer prophylaxis during their ICU stay. Of these, 80% continued on gastric acid suppressants on transfer from the ICU, with 60% of the therapy being inappropriate. The percentage of critically ill patients discharged from the hospital with inappropriate prescription of gastric acid suppressants was 24.4%. Based on the average wholesale cost, the total cost for unnecessary gastric acid suppressant therapy within the follow-up period was $13,973. Conclusions: Gastric acid suppressant medications initially prescribed for stress ulcer prophylaxis are frequently prescribed inappropriately on discharge for patients who were initially admitted to the medical/surgical ICU.

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Evaluation of the Intensive Care Unit Resources and Utilization in Two Governmental Hospitals in Tripoli, Libya

AL-MUKHTAR JOURNAL OF SCIENCES ◽

10.54172/mjsc.v34i3.241 ◽

2019 ◽

Vol 34 (3) ◽

pp. 130-136

Author(s):

Ahmed Atia ◽

Abdulsalam Ashur ◽

Hosam Elmahmoudi ◽

Ahmed Abired ◽

Nafisa Bkhait

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Medical Center ◽

Critically Ill Patient ◽

Surgical Intensive Care Unit ◽

Mechanical Ventilators ◽

Surgical Intensive Care ◽

Data Collection Sheet ◽

Number Of Patients ◽

Service Areas

The growing population in Tripoli is projected to have a sustained increase in the demand for health services, especially in-service areas with limited resources such as intensive care units (ICUs). Currently, ICUs in the city of Tripoli routinely operate at or near full capacity and have a limited ability to accommodate the next critically ill patient. This disparity in demand and supply makes a substantial strain on our health care system. In response to this rising problem, the current study aimed to investigate the ICU capacity in the two largest hospitals in Tripoli, Libya. This is a retrospective observational study that conducted to compare ICU capacities and admission in the Medical intensive care unit (MICU) and surgical intensive care unit (SICU) of Tripoli Medical center (TMC) and Alkhadra hospital (AH) in Tripoli city of Libya. ICUs capacity and admissions were assessed and recorded in data collection sheet that includes; type of ICU, number of available ICU beds, number of available functional monitors, number of available functional mechanical ventilators, number of patients admitted to the ICU, and number of ICU nurse. In TMC, MICU occupied with 4 beds, 4 monitors, 3 mechanical ventilators (MV), 5 patients admitted, and 13 nurses. Whereas SICU engaged with 4 beds, 5 monitors, 5 MV, 13 patients admitted and 15 nurses. While MICU at AHT was occupied with 4 beds, 4 monitors, 1 MV, and 4 admitted patients with 1 nurse care, SICU at CHT was comprised of 3 beds, 3 monitors, 0 MV, and 3 patients with 1 nurse stuff. We concluded that facilities at both MICU and SICU at Alkhadra hospital of Tripoli were less efficient than MICU and SICU at Tripoli Medical centre. Both ICUs at AHT had not enough beds, observation equipment, and nursing staff to take care of patients. However, facilities of both ICUs at TMC were also not sufficient.

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The use of Ventilator Parameters in the Prediction of Development and Outcome of Acute Respiratory Distress Syndrome in Postoperative Patients

10.21203/rs.3.rs-145686/v1 ◽

2021 ◽

Author(s):

Chew-Ten Kor ◽

Kai-Huang Lin ◽

Chen-Hsu Wang ◽

Jui-Feng Lin ◽

Cheng-Deng Kuo

Keyword(s):

Esophageal Cancer ◽

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Medical Center ◽

Volume Index ◽

Rate Pressure Product ◽

Surgical Intensive Care Unit ◽

Surgical Intensive Care

Abstract Background: To investigate the usefulness of ventilator parameters in the prediction of development and outcome of acute respiratory distress syndrome (ARDS) in postoperative patients with esophageal or lung cancer on admission to the surgical intensive care unit (SICU). Methods: A total of 32 post-operative patients with lung or esophageal cancer from SICU in a tertiary medical center were retrospectively analyzed. The study patients was divided into ARDS group (n = 21) and non-ARDS group (n = 11). ARDS group were the post-operative patients who developed ARDS after lung or esophageal cancer surgery. The ventilator variables were analyzed in this study. Principal component analysis (PCA) was performed to reduce the correlated ventilator variables to a small set of variables. By using the PCA selection method, top three ventilator variables with large coefficients can be considered as sensitive variables and were included in the analysis model based on the rule of 10 events per variable. Firth logistic regression with selective stepwise elimination procedure was performed to identify the most important predictors of morbidity and mortality in patients with ARDS. The ventilator parameters including rapid shallow breath index during mechanical ventilation (RSBIv), rate pressure product of ventilation (RPPv), rate pressure volume index (RPVI), mechanical work (MW), and inspiration to expiration time ratio (IER) were analyzed in this studyResults: The newly defined parameter MW/IER was the most important predictors for the development of ARDS, and both RPPv and RPVI were the significant predictors of mortality in patients with ARDS.Conclusion: Some ventilator parameters can be derived from ventilator readings and be used to predict the development and outcome of ARDS in mechanically ventilated patients on admission to the SICU, such as RPPv, RPVI and MW/IER defined in this study.

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Carbapenem-Resistant Klebsiella pneumoniae Cluster Associated With Gastroscope Exposure Among Surgical Intensive Care Unit Patients at University of Pittsburgh Medical Center

Open Forum Infectious Diseases ◽

10.1093/ofid/ofw172.115 ◽

2016 ◽

Vol 3 (suppl_1) ◽

Cited By ~ 6

Author(s):

Alyssa Parr ◽

Ashley Querry ◽

Anthony Pasculle ◽

Douglas Morgan ◽

Carlene Muto

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Klebsiella Pneumoniae ◽

Medical Center ◽

Surgical Intensive Care Unit ◽

Surgical Intensive Care ◽

University Of Pittsburgh ◽

Carbapenem Resistant ◽

Pittsburgh Medical

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Use of ventilator bundle to prevent ventilator-associated pneumonia in the Surgical Intensive Care Unit of a Medical Center

Journal of Microbiology Immunology and Infection ◽

10.1016/j.jmii.2015.02.314 ◽

2015 ◽

Vol 48 (2) ◽

pp. S89

Author(s):

Yi-Jan Hsieh ◽

Tsrang-Neng Jang ◽

Yu-Shan Shih ◽

Dorji Harnod ◽

Shu-Hua Lee

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Medical Center ◽

Surgical Intensive Care Unit ◽

Ventilator Associated Pneumonia ◽

Surgical Intensive Care

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A Computerized Intensive Care Unit Order-Writing Protocol

Annals of Pharmacotherapy ◽

10.1177/106002809202600222 ◽

1992 ◽

Vol 26 (2) ◽

pp. 251-254 ◽

Cited By ~ 7

Author(s):

Neil A. Halpern ◽

Robert E. Thompson ◽

Robert J. Greenstein

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Computer Network ◽

Medical Center ◽

Organ System ◽

Surgical Intensive Care Unit ◽

Surgical Intensive Care ◽

Unit Order ◽

Technical Requirements ◽

Safety Features

OBJECTIVE: To present a computerized intensive care unit order-writing protocol. DESIGN: Descriptive report. SETTING: Eight-bed surgical intensive care unit, Department of Surgery, Department of Veterans Affairs Medical Center, Bronx, NY. METHODS: IBM-based, computer network program that provides user-friendly, logical, and comprehensive organ-system order sequences for patient management. RESULTS: Since July 1988, an order program that stresses (1) improved and more efficient patient care, (2) the use of program-integrated automatic safety features, (3) the substitution of computer entry for handwriting, and (4) the assurance that physicians deliver obligatory care in a logical organ-system—based progression has been implemented. CONCLUSIONS: The order protocol system presented is simple to introduce and operate, has minimal training and technical requirements, and is demonstrably reliable.

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