Cost analysis according to diagnosis in tertiary care patients in a university hospital

Abstract Introduction Cryoprecipitate (CRYO), a blood product prepared from FFP, is rich in fibrinogen, von Willebrand’s factor, and factors VIII and XIII. The major indication for CRYO transfusion is fibrinogen deficiency with increased risk of bleeding when fibrinogen is <100 mg/dL, a transfusion trigger rarely followed by the house staff or other clinicians. To limit wastage, Transfusion Services issue them as pools of five individual CRYO units. The use of CRYO at Robert Wood Johnson University Hospital (RWJUH) has significantly risen since 2010, so we conducted a study to identify the factors leading to increased CRYO transfusions. Methods Data on CRYO transfusions from 2010 to 2017 were obtained and analyzed for trends in overall usage and by nursing unit/departments. Cost-analysis was performed to determine the cost of CRYO usage. Conclusion Overall, CRYO usage has risen since 2010, with a sharp increase between 2015 and 2017 attributed to increased transfusions in the operating room (OR), surgical intensive care unit, and hematology-oncology units. There was a sixfold rise in transfusions in the hematology-oncology units. During this time, the lower limit of the fibrinogen reference range decreased from 234 to 190 mg/dL along with a drop in the number of trauma alerts. Values less than the lower reference range were used as the transfusion trigger by some overzealous hematology fellows. Cost-analysis showed that RWJUH lost 75% revenue per patient based on Medicare reimbursement despite efforts to limit wastage and lowering purchasing cost per unit by changing to a new blood supplier. The major determinants of intensified CRYO transfusions at RWJUH are (1) changes in the fibrinogen reference range concomitant with enhanced awareness, monitoring, and early treatment of hypofibrinogenemia, particularly in hematology-oncology units and (2) the complexity of surgical procedures (ie, VAD procedures) requiring more CRYO transfusions rather than the number of trauma alerts.

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Molecular epidemiologic study of ciprofloxacin-nonsusceptible Escherichia coli sequence types isolated from clinical specimens in a tertiary care university hospital in Korea

10.26226/morressier.56d5ba2cd462b80296c96934 ◽

2016 ◽

Author(s):

Hee Joo Lee

Keyword(s):

Escherichia Coli ◽

Tertiary Care ◽

Epidemiologic Study ◽

University Hospital ◽

Clinical Specimens ◽

Sequence Types ◽

Molecular Epidemiologic Study

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Post-Stroke Depression and Its Effect on Functional Outcomes during Inpatient Rehabilitation

Journal of Neurosciences in Rural Practice ◽

10.1055/s-0041-1731958 ◽

2021 ◽

Author(s):

Gurumayum Sonachand Sharma ◽

Anupam Gupta ◽

Meeka Khanna ◽

Naveen Bangarpet Prakash

Keyword(s):

Outcome Measures ◽

Functional Outcomes ◽

Rating Scale ◽

Tertiary Care ◽

Depression Scale ◽

Inpatient Rehabilitation ◽

University Hospital ◽

Post Stroke ◽

Significant Difference ◽

Post Stroke Depression

Abstract Objective The aim of the study is to observe the effect of post-stroke depression on functional outcomes during inpatient rehabilitation. Patients and Methods The design involved is prospective observational study. The location involved is Neurological Rehabilitation unit in a tertiary care university hospital. The study period ranges from October 2019 to April 2020. The participants involved are the patients with first ever stroke, male and female with age ≥18 years and duration less than 1 year. All participants were assessed at admission and after 14 sessions of inpatient rehabilitation by depression subscale of Hospital Anxiety and Depression Scale (HADS-D) and Hamilton Depression Rating Scale (HDRS). The stroke outcomes measures used were: Barthel Index (BI), Scandinavian Stroke Scale (SSS), and Modified Rankin Scale (MRS). Results There are a total of 30 participants (18 males) with median stroke duration of 90 days. The median age of the patients was 58 years. Sixteen patients had ischemic and 14 had hemorrhagic stroke. Out of these, 57% (n = 17) had symptoms of depression (HADS-D >7). Participants in both groups (with and without depression) showed improvement in all the functional outcome measures (BI, SSS, MRS) at the time of discharge as compared with admission scores. The changes in the outcome measures were statistically significant within groups (p < 0.05) but not significant between the groups (p > 0.05). Conclusion The post-stroke depression is common among stroke survivors of less than 1 year duration. There was no significant difference in the functional outcomes between stroke patients with depression and those without depression with inpatient rehabilitation program.

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Glottic Keratosis: Significance and Identification of Laryngoscopic Findings

OTO Open ◽

10.1177/2473974x21994743 ◽

2021 ◽

Vol 5 (1) ◽

pp. 2473974X2199474

Author(s):

Mursalin M. Anis ◽

Jennylee Diaz ◽

Mausam Patel ◽

Adam T. Lloyd ◽

David E. Rosow

Keyword(s):

Logistic Regression ◽

Interrater Reliability ◽

Tertiary Care ◽

High Grade Dysplasia ◽

University Hospital ◽

High Grade ◽

Retrospective Case ◽

Voice Outcome ◽

Diagnostic Biopsy ◽

Virtual Chromoendoscopy

Objective Glottic keratosis poses a challenge because a decision to biopsy must weigh the likelihood of dysplasia and cancer against the voice outcome after biopsy. We determined the significance of laryngoscopic findings and agreement among clinicians to identify those specific findings. Study Design Retrospective case-control study. Setting Tertiary care university hospital. Methods Adults with glottic keratosis with preoperative office laryngoscopies were included. Preoperative videostroboscopies were reviewed by a blinded reviewer. Multivariable logistic regression was used to examine the correlation between laryngoscopic appearance of glottic keratosis and presence or absence of high-grade dysplasia or carcinoma on biopsies. Consensus among head and neck cancer surgeons to detect specific laryngoscopic findings was evaluated by presenting representative laryngoscopies to a blinded cohort. Interrater reliability was calculated using Fleiss’s κ. Results Sixty glottic keratotic lesions met inclusion criteria. On logistic regression, both erythroplakia and aberrant microvasculature like vascular speckling were significantly associated with high-grade dysplasia and carcinoma, P = .002 and P = .03, respectively. Interrater reliability among clinicians to identify erythroplakia and aberrant microvasculature was minimal, κ = 0.35 and κ = 0.29, respectively. Interrater reliability was improved with the use of virtual chromoendoscopy. Conclusion The presence of erythroplakia and aberrant microvasculature in glottic keratosis is associated with the presence of high-grade dysplasia or carcinoma. Virtual chromoendoscopy can be used to improve reliability for detecting erythroplakia and vascular speckling, and this is a potential area for practice-based learning. Clinicians should identify and consider immediate diagnostic biopsy of suspicious glottic keratosis.

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Prevalence, Persistence, and Factors Associated with SARS-CoV-2 IgG Seropositivity in a Large Cohort of Healthcare Workers in a Tertiary Care University Hospital in Northern Italy

Viruses ◽

10.3390/v13061064 ◽

2021 ◽

Vol 13 (6) ◽

pp. 1064

Author(s):

Gitana Scozzari ◽

Cristina Costa ◽

Enrica Migliore ◽

Maurizio Coggiola ◽

Giovannino Ciccone ◽

...

Keyword(s):

Tertiary Care ◽

Multivariable Analysis ◽

Northern Italy ◽

University Hospital ◽

Care Workers ◽

Increased Risk ◽

Never Smokers ◽

The University ◽

Job Profile ◽

Pandemic Wave

This observational study evaluated SARS-CoV-2 IgG seroprevalence and related clinical, demographic, and occupational factors among workers at the largest tertiary care University-Hospital of Northwestern Italy and the University of Turin after the first pandemic wave of March–April 2020. Overall, about 10,000 individuals were tested; seropositive subjects were retested after 5 months to evaluate antibodies waning. Among 8769 hospital workers, seroprevalence was 7.6%, without significant differences related to job profile; among 1185 University workers, 3.3%. Self-reporting of COVID-19 suspected symptoms was significantly associated with positivity (Odds Ratio (OR) 2.07, 95%CI: 1.76–2.44), although 27% of seropositive subjects reported no previous symptom. At multivariable analysis, contacts at work resulted in an increased risk of 69%, or 24% for working in a COVID ward; contacts in the household evidenced the highest risk, up to more than five-fold (OR 5.31, 95%CI: 4.12–6.85). Compared to never smokers, being active smokers was inversely associated with seroprevalence (OR 0.60, 95%CI: 0.48–0.76). After 5 months, 85% of previously positive subjects still tested positive. The frequency of SARS-COV-2 infection among Health Care Workers was comparable with that observed in surveys performed in Northern Italy and Europe after the first pandemic wave. This study confirms that infection frequently occurred as asymptomatic and underlines the importance of household exposure, seroprevalence (OR 0.60, 95%CI: 0.48–0.76).

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Implementation of a Targeted Screening Program to Detect Airflow Obstruction Suggestive of Chronic Obstructive Pulmonary Disease within a Presurgical Screening Clinic

Canadian Respiratory Journal ◽

10.1155/2015/306720 ◽

2015 ◽

Vol 22 (4) ◽

pp. 209-214 ◽

Cited By ~ 5

Author(s):

Chantal Robitaille ◽

Esther Dajczman ◽

Andrew M Hirsch ◽

David Small ◽

Pierre Ernst ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Screening Program ◽

Tertiary Care ◽

Airflow Obstruction ◽

University Hospital ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Targeted Screening ◽

History Of

BACKGROUND: Targeted spirometry screening for chronic obstructive pulmonary disease (COPD) has been studied in primary care and community settings. Limitations regarding availability and quality of testing remain. A targeted spirometry screening program was implemented within a presurgical screening (PSS) clinic to detect undiagnosed airways disease and identify patients with COPD/asthma in need of treatment optimization.OBJECTIVE: The present quality assurance study evaluated airflow obstruction detection rates and examined characteristics of patients identified through the targeted screening program.METHODS: The targeted spirometry screening program was implemented within the PSS clinic of a tertiary care university hospital. Current or ex-smokers with respiratory symptoms and patients with a history of COPD or asthma underwent prebronchodilator spirometry. History of airways disease and smoking status were obtained during the PSS assessment and confirmed through chart reviews.RESULTS: After exclusions, the study sample included 449 current or ex-smokers. Abnormal spirometry results were found in 184 (41%) patients: 73 (16%) had mild, 93 (21%) had moderate and 18 (4%) had severe or very severe airflow obstruction. One hundred eighteen (26%) new cases of airflow obstruction suggestive of COPD were detected. One-half of these new cases had moderate or severe airflow obstruction. Only 34% of patients with abnormal spirometry results had reported a previous diagnosis of COPD. More than one-half of patients with abnormal spirometry results were current smokers.CONCLUSIONS: Undiagnosed airflow obstruction was detected in a significant number of smokers and ex-smokers through a targeted screening program within a PSS clinic. These patients can be referred for early intervention and secondary preventive strategies.

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Recovery of Both Vancomycin-Resistant Enterococci and Methicillin-ResistantStaphylococcus aureusFrom Culture of a Single Clinical Specimen From Colonized or Infected Patients

Infection Control and Hospital Epidemiology ◽

10.1086/593957 ◽

2009 ◽

Vol 30 (2) ◽

pp. 130-138 ◽

Cited By ~ 10

Author(s):

Sang Hoon Han ◽

Bum Sik Chin ◽

Han Sung Lee ◽

Su Jin Jeong ◽

Hee Kyung Choi ◽

...

Keyword(s):

Risk Factors ◽

Tertiary Care ◽

Clinical Specimen ◽

Multivariate Logistic Regression Analysis ◽

University Hospital ◽

Cell Contact ◽

Patient Risk ◽

Clinical Specimens ◽

Vancomycin Resistant Enterococci ◽

Vancomycin Resistant

Objective.To describe the incidence of recovery of both vancomycin-resistant enterococci (VRE) and methicillin-resistantStaphylococcus aureus(MRSA) from culture of a single clinical specimen, to describe the clinical characteristics of patients from whom these specimens were recovered, and to identify the risk factors of these patients.Design.A retrospective cohort and case-control study.Setting.A tertiary care university hospital and referral center in Seoul, Korea.Methods.We identified 61 case patients for whom a single clinical specimen yielded both VRE and MRSA on culture, and 122 control patients for whom any clinical specimen yielded only VRE on culture. The control patients were selected by matching 2 :1 with the case patients for age, sex, and first date of sampling that led to isolation of VRE or both VRE and MRSA among 1,536 VRE-colonized patients from January 1, 2003, through December 31, 2006. To identify patient risk factors for the recovery of both VRE and MRSA in a single clinical specimen, we performed univariate comparisons between the 2 groups and then multivariate logistic regression analysis.Results.The incidence of recovery of both VRE and MRSA from culture of a single clinical specimen was 3.97% (for 61 of 1,536 VRE-colonized patients) over 4 years. Among these 82 single clinical specimens, the most common type was wound specimens (26.8%), followed by lower respiratory tract specimens (18.3%), urine specimens (17.1%), and catheter tips (15.9%). Of the 61 case patients, 14 (23.0%) had 2 or more single clinical specimens that yielded both VRE and MRSA on culture, and the longest interval from the first sampling that yielded both organisms to the last sampling that yielded both was 174 days. Independent patient risk factors for the presence of both VRE and MRSA in a single clinical specimen were chronic renal disease (odds ratio [OR], 7.00;P= .012), urinary catheterization (OR, 3.36;P= .026), and longer total cumulative duration of hospital stay within the previous year (OR, 1.03;P< .001).Conclusion.We confirmed that the recovery of VRE and MRSA from a single clinical specimen occurs continually. Because prolonged cell-to-cell contact can facilitate transfer ofvanA,close observation and surveillance for vancomycin-resistantS. aureus, especially among patients with risk factors for the recovery of both VRE and MRSA from a single clinical specimen, should be continued.

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An Outbreak of Pyodermas Among Neonates Caused by Ultrasound Gel Contaminated With Methicillin-SusceptibleStaphylococcus Aureus

Infection Control and Hospital Epidemiology ◽

10.1086/501729 ◽

2000 ◽

Vol 21 (12) ◽

pp. 761-764 ◽

Cited By ~ 52

Author(s):

Klaus Weist ◽

Constanze Wendt ◽

Lyle R. Petersen ◽

Hans Versmold ◽

Henning Rüden

Keyword(s):

Hip Joint ◽

Case Control Study ◽

Tertiary Care ◽

Significant Risk ◽

Significant Risk Factor ◽

Case Control ◽

University Hospital ◽

Good Physical Condition ◽

Rapd Pcr ◽

Control Study

Objective:To investigate an outbreak of methicillin-susceptibleStaphylococcus aureus(MSSA); infections in a neonatal clinic.Design:Prospective chart review, environmental sampling, and genotyping by two independent methods: pulsed-field gel electrophoresis (PFGE) and randomly amplified polymorphic DNA polymerase chain reaction (RAPD-PCR). A case-control study was performed with 31 controls from the same clinic.Setting:A German 1,350-bed tertiary-care teaching university hospital.Results:There was a significant increase in the incidence of pyodermas with MSSA 10 neonates in good physical condition with no infection immediately after birth developed pyodermas. A shared spatula and ultrasound gel were the only identified infection sources. The gel contained MSSA and was used for hip-joint sonographies in all neonates. PFGE and RAPD-PCR patterns from 6 neonates and from the gel were indistinguishable and thus genetically related clones. The case-control study revealed no significant risk factor with the exception of cesarean section (P=.006). The attack rate by days of hip-joint sonography between April 15 and April 27, 1994, was 11.8% to 40%.Conclusions:Inappropriate hygienic measures in connection with lubricants during routine ultrasound scanning may lead to nosocomialS aureusinfections of the skin. To our knowledge this source ofS aureusinfections has not previously been described.

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