scholarly journals Telemedicine Consultation to Assess Neonatal Encephalopathy in Rural Community Hospitals and Tertiary Care Centers

2022 ◽  
Vol 4 (1) ◽  
Author(s):  
Rachel Coffey ◽  
Misty Melendi ◽  
Anya K Cutler ◽  
Alexa K. Craig
Keyword(s):  
Rural Community ◽  
Tertiary Care ◽  
Neonatal Encephalopathy ◽  
Community Hospitals ◽  
Telemedicine Consultation ◽  
Tertiary Care Centers

Hospital-Wide Reduction in Central Line–Associated Bloodstream Infections: A Tale of Two Small Community Hospitals

2011 ◽  
Vol 32 (6) ◽  
pp. 619-622 ◽  
Author(s):  
Aysegul Gozu ◽  
Colleen Clay ◽  
Faheem Younus
Keyword(s):  
Tertiary Care ◽  
Bloodstream Infections ◽  
Central Line ◽  
Small Community ◽  
Community Hospitals ◽  
Central Line Insertion ◽  
Line Insertion ◽  
Large Tertiary Care ◽  
Tertiary Care Centers ◽  
General Wards

Despite increasing awareness of central line-associated bloodstream infections (CLABSIs) in general wards, published strategies come from intensive care units (ICUs) of large tertiary care centers. After implementing a central line insertion checklist, two community hospitals experienced an 86% reduction in CLABSI rates in ICUs and a 57% reduction in non-ICU settings over 36 months.

scholarly journals Epidemiology of Positive Blood Cultures due to Multidrug-Resistant Organisms From an Academic Center and Community Hospitals

2020 ◽  
Vol 41 (S1) ◽  
pp. s473-s473
Author(s):  
Frances Boly ◽  
Margaret Olsen ◽  
Dustin Stwalley ◽  
Jason Burnham ◽  
Jennie Kwon
Keyword(s):  
Risk Factors ◽  
Rural Community ◽  
Urine Culture ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Multidrug Resistant ◽  
Blood Cultures ◽  
Community Hospitals ◽  
Academic Center ◽  
Multidrug Resistant Organisms

Background: Multidrug-resistant organisms (MDROs) are a threat to public health. The objective of this study was to define risk factors and outcomes of patients with positive blood cultures due to MDROs in 2 rural community hospitals as compared to a tertiary-care academic center. Methods: Retrospective cohort study with IRB approval from 1 tertiary-care academic center and 2 rural community hospitals (Barnes-Jewish [BJH], Parkland Health Center, and Missouri Baptist Sullivan Hospital) from July 1, 2013, to August 1, 2018. Demographics, comorbidities, procedures, outcomes, and blood and urine culture data were collected from the BJH informatics database for hospitalized patients with positive blood cultures due to MDROs. MDROs were defined according to European and US CDC standards. Results: Of the patients with positive blood cultures growing organisms with the potential to be MDR, 1,065 (55%) blood cultures grew MDROs from the academic center and 157 (33%) grew MDROs from the 2 community hospitals (P < .0001). Among these, methicillin-resistant Staphylococcus aureus (35% at BJH and 37% at community hospitals) and MDR Enterobacteriaceae (29% at BJH and 36% at community hospitals) were the most common organisms grown from blood cultures at all hospitals. Among patients with positive MDRO blood cultures, 60% were males and 69% were white, with a mean age of 58 years at BJH. At the community hospitals, 47% were male and 99% were white, with a mean age of 66 years. The most common comorbidity in patients with MDRO bacteremia at BJH was cancer, compared to diabetes at the community hospitals. At all hospitals, >33% of patients with MDRO bacteremia required an ICU stay. Also, 17% of patients with MDRO bacteremia at BJH died during hospitalization compared to 4% at the community hospitals. Among individuals with positive MDRO blood cultures, 9% had a matching isolate from a urine culture at BJH and 46% had a matching urine isolate at the community hospitals. Conclusions: At an academic medical center, the most common organisms identified in MRDO-positive blood cultures included MRSA, MDR Enterobacteriaceae, and VRE. However, at the community hospitals, MRSA, MDR Enterobacteriaceae, and ESBL Enterobacteriaceae were most common. Patients with a positive MDRO blood culture were more likely to have a matching isolate from urine culture at a community hospital compared to the academic center. Further research is needed regarding risk factors and interventions to prevent, detect, and treat MDRO infections.Funding: NoneDisclosures: Margaret A. Olsen reports consulting fees for contract research from Pfizer, Merck, and Sanofi Pasteur.

Maternal Race/Ethnicity and Predictors of Pregnancy and Infant Outcomes

2005 ◽  
Vol 7 (1) ◽  
pp. 55-66 ◽  
Author(s):  
Shyang-Yun Pamela K. Shiao ◽  
Claire M. Andrews ◽  
Rebecca Jo Helmreich
Keyword(s):  
High Risk ◽  
Health Behaviors ◽  
Pregnancy Complications ◽  
Tertiary Care ◽  
Fetal Distress ◽  
Congenital Defects ◽  
Community Hospitals ◽  
Infant Outcomes ◽  
Race Ethnicity ◽  
Tertiary Care Centers

Objective. To examine predictors of pregnancy and infant outcomes, including maternal race/ethnicity. Design. Prospective and observational follow-up of high-risk pregnancies and births. Participants. Three hundred fifty-four mothers and their preterm and/or high-risk live-born neonates were closely followed in three tertiary care centers from the prenatal to postnatal periods for potential high-risk and/or preterm births that required neonatal resuscitations. Major Outcome Measures. Pregnancy complications, birth complications, and infant outcomes were examined in conjunction with maternal factors, including preexisting health problems, health behaviors (smoking, alcohol consumption, prenatal visits), and the birth setting (tertiary care centers or community hospitals). Results. About 22% of these infants were transferred into the tertiary care centers from the community hospitals right after birth; the rest were born in the centers. According to regression analyses, predictors of the birth setting were race (White vs. non-White), maternal health behaviors, pregnancy complications, fetal distress, and the presence of congenital defects for infants (p < .001). Predictors for fetal distress included race (Whites) and pregnancy-induced hypertension (p < .003). Predictors for lower birth weight included race (non-Whites), maternal cigarette smoking, pregnancy complications, fetal distress, and congenital defects (p < .001). Infant mortality rate was 3.9% for these high-risk infants, with the highest rate in infants born to Black mothers (8%). Conclusions. There are obvious health disparities among White and non-White women experiencing high-risk pregnancies and births. Future studies are needed to develop interventions targeted to different racial/ethnic groups during pregnancy to reduce preterm and high-risk births.

1835 EQUIPMENT USE DURING URETEROSCOPY: IS THERE A DIFFERENCE BETWEEN TERTIARY CARE CENTERS AND COMMUNITY HOSPITALS?

2012 ◽  
Vol 187 (4S) ◽  
Author(s):  
Justin Friedlander ◽  
Bin Xu ◽  
Zhamshid Okhunov ◽  
Cristina Sison ◽  
Brian Duty ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Community Hospitals ◽  
Tertiary Care Centers

scholarly journals 124. Six-year Longitudinal Analysis of an Inpatient Infectious Diseases Telemedicine Service at a Community Hospital

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S191-S192
Author(s):  
Nupur Gupta ◽  
Adit B Sanghvi ◽  
John Mellors ◽  
Rima Abdel-Massih
Keyword(s):  
Infectious Disease ◽  
Tertiary Care ◽  
Medical Officer ◽  
Rural Hospital ◽  
Hospital Length Of Stay ◽  
Observation Study ◽  
Patient Acuity ◽  
Telemedicine Service ◽  
Tertiary Care Centers ◽  
Over Time

Abstract Background Telemedicine (TM) has emerged as a viable solution to extend infectious disease (ID) expertise to communities without access to this specialty.1 TM allows clinicians in rural settings to connect with specialists at distant sites and provide the best care for their patients, often eliminating the need for hospital transfers. Here, we describe the experience from one of the longest standing inpatient Tele-ID consult services using live audio-video (AV) visits with the assistance of a telepresenter. Methods Longitudinal data were collected from a 126-bed rural hospital in Pennsylvania that had no access to ID consultation before 2014. Live AV consults during business hours began in 2014 and telephonic physician to physician consults were made available 24/7. All ID consult data were extracted from the hospital electronic health record between 2014 to 2019. Key outcomes assessed included the number of consult encounters, total hospital length of stay (LOS), discharges to home, transfer to tertiary care centers, and readmission rates at 30 days. Results Most consulted patients were Caucasians, and females with an average age of 64.7 years (Table 1). The number of unique consult encounters increased annually from 111 in 2014 to 469 in 2019 (Table 1). The Charlson Comorbidity Score and Elixhauser Comorbidity Index also increased each year beginning in 2016 (Table 1). By contrast, LOS decreased each year as did the 30-day readmission rate (Table 2). Most patients were not transferred (average 89.4% over 6 years) to tertiary care centers and more than half were discharged to home each year (Table 2). Conclusion This longitudinal 6-year observation study of an inpatient TM ID service at a rural hospital showed remarkable annual growth in consult encounters (total growth &gt;400%). Despite increasing patient acuity, overall hospital LOS decreased over time (10.2 to 8.2 days). Patient transfers to tertiary care centers remained low (average 10.5% over 6 years) as did 30-day readmissions (average 16.3% over 6 years). The majority of patients were discharged to home (average 61.3% over 6 years). These findings show that a rural inpatient TM ID consult service can expand over time and is an effective alternative for hospitals without access to ID expertise. Disclosures John Mellors, MD, Abound Bio (Shareholder)Accelevir Diagnostics (Consultant)Co-Crystal Pharmaceuticals (Shareholder)Gilead (Consultant, Grant/Research Support)Merck (Consultant) Rima Abdel-Massih, MD, Infectious Disease Connect (Shareholder, Other Financial or Material Support, Chief Medical Officer)

scholarly journals Surgical outcome of primary intradural spinal arachnoid cysts: a series of 10 cases

2021 ◽  
Vol 57 (1) ◽  
Author(s):  
Essam Abdelhameed ◽  
Ahmed Ali Morsy
Keyword(s):  
Tertiary Care ◽  
Outer Wall ◽  
Arachnoid Cysts ◽  
Neurophysiological Monitoring ◽  
Japanese Orthopedic Association ◽  
Common Location ◽  
Before And After ◽  
Microsurgical Resection ◽  
Tertiary Care Centers ◽  
Intradural Arachnoid Cysts

Abstract Background Primary intradural spinal arachnoid cysts are rare pathologies of uncertain etiology and variable presentation from no symptoms to myelopathy or radiculopathy according to cord or root compression. MRI with diffusion and contrast differentiates them from many pathologies. There is a lot of debate regarding when to treat and how to treat such rare pathologies. Objective We present a series of 10 primary intradural arachnoid cysts and evaluate outcome after surgery. Methods This retrospective study includes patients having primary intradural spinal arachnoid cysts operated in two tertiary care centers from October 2012 till October 2019. Symptomatic cysts were subjected to microsurgical resection or outer wall excision and inner wall marsupialization under neurophysiological monitoring. The Japanese Orthopedic Association Score was used for clinical evaluation while MRI with contrast and diffusion was used for radiological evaluation before and after surgery. Results This series included 10 patients, 4 males and 6 females, with mean age of 40 years. Pain was the most common presentation. The most common location was dorsal thoracic region. Total excision was achieved in 2 cases and marsupialization in 8 cases. All symptoms improved either completely or partially after surgery. No neurological deterioration or recurrence was reported during the follow-up period in this series. Conclusion Treatment of symptomatic primary intradural spinal arachnoid cysts should be microsurgical resection, when the cyst is adherent to the cord, microscopic fenestration can be safe and effective.

scholarly journals Perception about Etiology of Epilepsy and Help-Seeking Behavior in Patients with Epilepsy

2021 ◽  
Author(s):  
Gautam Das ◽  
Samar Biswas ◽  
Souvik Dubey ◽  
Durjoy Lahiri ◽  
Biman Kanti Ray ◽  
...  
Keyword(s):  
Help Seeking ◽  
Tertiary Care ◽  
Epileptic Seizures ◽  
Treatment Seeking ◽  
Professional Help ◽  
Epileptic Patients ◽  
Seeking Behavior ◽  
Tertiary Care Centers ◽  
Patients With Epilepsy

Abstract Objectives Patients with epilepsy and their family have diverse beliefs about the cause of their illness that generally determine their treatment-seeking behavior. In this study, our aim was to find out different beliefs about epilepsy that lead to different help-seeking patterns, which act as barrier to the intended modern medical management of epilepsy. Materials and Methods One hundred and fifty consecutive consenting patients accompanied by a reliable informant/family member fulfilling the International Classification of Epileptic Seizures (ICES), simplified version, were included. Demographic and clinical data of all the eligible subjects was collected. Perceived cause of illness and help-seeking pattern were explored from patient/informant by administering proper instruments. Results Respondents identified varied causes of epilepsy and explored multiple help-seeking options before reaching tertiary care centers. We observed that, generally, epileptic patients/relatives who had belief in causes like supernatural causes sought help from nonprofessional personnel and those attributed their symptom to bodily pathology had professional help-seeking. Conclusions The belief in supernatural causes not being conformed to the biomedical models of the epileptic disorders increases the treatment gap.

scholarly journals A national study of choanal atresia in tertiary care centers in Canada – part I: clinical presentation

2021 ◽  
Vol 50 (1) ◽  
Author(s):  
Josee Paradis ◽  
Agnieszka Dzioba ◽  
Hamdy El-Hakim ◽  
Paul Hong ◽  
Frederick K. Kozak ◽  
...  
Keyword(s):  
Respiratory Distress ◽  
Clinical Presentation ◽  
Tertiary Care ◽  
Choanal Atresia ◽  
Case Series ◽  
Retrospective Chart Review ◽  
National Study ◽  
Feeding Difficulties ◽  
Presenting Symptoms ◽  
Tertiary Care Centers

Abstract Background To evaluate the clinical presentation of choanal atresia (CA) in tertiary centers across Canada. Methods Multi-centre case series involving six tertiary care pediatric hospitals across Canada. Retrospective chart review of patients born between 1980 and 2010 diagnosed with CA at a participating center. Results The health charts of 215 patients (59.6% female) with CA were reviewed and included in this study. The mean age of patients at time of CA presentation was 0.4 months (range 0.1 to 7.2 months) for bilateral CA and 37.8 months (range 0.1 to 164.1 months) for unilateral cases. The most common presenting symptoms for bilateral CA in decreasing order were respiratory distress (96.4%), feeding difficulties (68.2%), and rhinorrhea (65.5%), and for unilateral cases in decreasing order were rhinorrhea (92.0%), feeding difficulties (24.7%), and respiratory distress (18.0%). For the majority of patients (73.2%), the obstruction comprised mixed bony and membranous tissue, with only 10.5% presenting with a purely membranous obstruction. Familial history of CA was confirmed in only 3.3% of cases. One half of patients with CA presented with one or more associated anomalies and 30.6% had a syndrome. Conclusions The present investigation is the first national multi-institutional study evaluating the clinical presentation of CA over three decades. The present cohort of CA patients presented with a breadth of co-morbidities with highly variable presentations, with bilateral cases being more severely affected than unilateral cases. Further investigation into hereditary linkages to CA development is warranted. Graphical abstract

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