scholarly journals Challenges in LTBI care in the United States identified using a nationwide TB medical consultation database

2021 ◽  
Vol 11 (3) ◽  
pp. 162-166
Author(s):  
N. T. Agathis ◽  
R. Bhavaraju ◽  
V. Shah ◽  
L. Chen ◽  
C. A. Haley ◽  
...  
Keyword(s):  
Medical Condition ◽  
Patient Characteristics ◽  
The United States ◽  
Medical Consultation ◽  
Centers Of Excellence ◽  
Ltbi Treatment ◽  
Clinical Patient ◽  
Control And Prevention ◽  
History Of ◽  
Latent Tb Infection

BACKGROUND: Identifying and treating individuals with latent TB infection (LTBI) represents a critical and challenging component of national TB elimination. Medical consultations by the Centers for Disease Control and Prevention (CDC) funded TB Centers of Excellence (COEs) are an important resource for healthcare professionals (HCPs) caring for individuals with LTBI. This study aimed to identify the most common clinical concerns regarding LTBI care and to describe epidemiologic and clinical features of patients discussed in these consultations.METHODS: This mixed-methods study randomly sampled 125 consultation inquiries related to LTBI from the COEs’ medical consultation database in 2018. Text from consultation records were reviewed and coded to identify reasons for the inquiries and common epidemiologic and clinical patient characteristics.RESULTS: The most common topics of inquiry for consultation included accurate LTBI diagnosis (36%), management of LTBI treatment-related issues (22%), and choice of appropriate LTBI treatment regimen (17%). Patients for whom consultations were requested commonly had another medical condition (34%), were non-U.S. born (31%), were children (25%), and had a history of travel to TB-endemic areas (18%).CONCLUSION: Our findings emphasize the challenge of managing patients with either suspected or confirmed LTBI, highlighting the need for ongoing medical consultation support for nuanced clinical and epidemiologic scenarios.

scholarly journals Covid-19 pandemic: What is the truth?

2021 ◽  
Vol 12 ◽  
pp. 591
Author(s):  
Russell L. Blaylock
Keyword(s):  
United States ◽  
Young People ◽  
Severe Acute Respiratory Syndrome ◽  
Early Treatment ◽  
The United States ◽  
Treatment Protocols ◽  
Scientific Support ◽  
Control And Prevention ◽  
History Of ◽  
Irreparable Damage

The ongoing “pandemic” involving the severe acute respiratory syndrome coronavirus 2 virus (SARS-CoV-2) has several characteristics that make it unique in the history of pandemics. This entails not only the draconian measures that some countries and individual states within the United States and initiated and made policy, most of which are without precedent or scientific support, but also the completely unscientific way the infection has been handled. For the 1st time in medical history, major experts in virology, epidemiology, infectious diseases, and vaccinology have not only been ignored, but are also demonized, marginalized and in some instances, become the victim of legal measures that can only be characterized as totalitarian. Discussions involving various scientific opinions have been eliminated, top scientists have been frightened into silence by threats to their careers, physicians have lost their licenses, and the concept of early treatment has been virtually eliminated. Hundreds of thousands of people have died needlessly as a result of, in my opinion and the opinion of others, poorly designed treatment protocols, mostly stemming from the Center for Disease Control and Prevention, which have been rigidly enforced among all hospitals. The economic, psychological, and institutional damage caused by these unscientific policies is virtually unmeasurable. Whole generations of young people will suffer irreparable damage, both physical and psychological, possibly forever. The truth must be told.

Cardiology

2018 ◽  
pp. 258-261
Author(s):  
Janey Phelps
Keyword(s):  
Transesophageal Echocardiography ◽  
Previous History ◽  
Pediatric Anesthesia ◽  
Invasive Procedure ◽  
Patient Characteristics ◽  
The United States ◽  
Good Choice ◽  
Risk Patients ◽  
History Of ◽  
Intranasal Midazolam

Congenital heart disease is the most common type of birth defect and is estimated to affect nearly 1% of all births per year in the United States. Echocardiograms are necessary to fully evaluate these defects, and depending on the age of the child, sedation may be required to ensure optimal imaging. This chapter discusses the sedation/anesthesia options for transthoracic echocardiography, transesophageal echocardiography, and cardioversion. For all of these procedures high-risk patients should be triaged to a pediatric anesthesia provider and in some cases, a pediatric cardiac anesthesiologist. Transthoracic echocardiograms can be completed with distraction and/or minimal sedation with oral or intranasal midazolam. If moderate sedation is required due to patient characteristics or previous history of failure with minimal sedation, intranasal dexmedetomidine is a good option. Transesophageal echocardiography is an invasive procedure; patients <2 years of age should be intubated and those >2 years of age can maintain a native airway with deep sedation with propofol. The need for cardioversion is infrequent in pediatrics but when needed, propofol is a good choice.

Failure to Implement Respiratory Isolation: Why Does it Happen?

2002 ◽  
Vol 23 (10) ◽  
pp. 595-599 ◽  
Author(s):  
Kentaro Iwata ◽  
Barbara A. Smith ◽  
Eloisa Santos ◽  
Bruce Polsky ◽  
Emilia M. Sordillo
Keyword(s):  
Chest Radiograph ◽  
Performance Indicator ◽  
The United States ◽  
Acid Fast Bacillus ◽  
Abnormal Chest ◽  
Immunodeficiency Virus ◽  
Control And Prevention ◽  
History Of ◽  
Almost All ◽  
Hispanic White

Background:Respiratory isolation for 90% of individuals with acid-fast bacillus (AFB)-smear–positive tuberculosis (TB) is a recommended performance indicator in recent Infectious Diseases Society of America and Centers for Disease Control and Prevention guidelines. However, compliance with respiratory isolation reported from multiple centers in the United States and Europe falls short of that goal.Objective:To identify missed clues in TB patients who are not appropriately isolated.Design:Retrospective survey.Setting:A 900-bed voluntary hospital.Patients:All patients with AFB-smear–positive TB admitted between January 1995 and December 1999 who were not appropriately isolated.Results:There were 173 TB cases admitted, including 106 with pulmonary TB. AFB smears were positive in 82 cases; 24 (29%) of these were not appropriately isolated. During the study period, the number of TB cases declined, but the proportion of appropriately isolated patients did not change. Most isolation failure cases were men (median age, 45.5 years); 21 of these patients were black, 2 were Hispanic white, and 1 was Asian, but none was non-Hispanic white. All isolation failure cases had at least one characteristic predictive of TB that could have been elicited at admission (eg, abnormal chest radiograph findings consistent with TB, fever, weight loss, a history of TB, a positive result on tuberculin skin test, hemoptysis, and human immunodeficiency virus infection).Conclusion:Consistent with experiences at other hospitals, we found that the rate of isolation failure remained unchanged despite an overall decline in TB cases. In our experience, almost all isolation failures could be avoided by careful review of the history, physical examination, and chest radiograph for characteristics classically considered predictive of TB. (Infect Control Hosp Epidemiol 2002;23:595-599).

Predictors of no-show among international patients with cancer: A 4-year analysis.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18302-e18302
Author(s):  
Nizar Bhulani ◽  
Lianchun Xiao ◽  
Manal Hassan ◽  
Renato Lenzi
Keyword(s):  
Univariate Analysis ◽  
Patient Characteristics ◽  
The United States ◽  
Outpatient Setting ◽  
Disease Stage ◽  
Multivariate Logistic Regression Model ◽  
Missed Appointments ◽  
Clinical Patient ◽  
Use Of Resources ◽  
Operational Costs

e18302 Background: Patient no-show (NSh) for scheduled medical appointments negatively impacts quality of care, impedes optimal use of resources, has negative economic consequences secondary to missed appointments, and uncovered referral processing costs. International patients (IntlPts) present challenging financial/travel arrangements and cultural and linguistic needs. There are currently very limited data regarding numbers of IntlPts visiting the United States for medical care and no data regarding NSh rates. The purpose of this study was to quantify costs and identify IntlPts-related variables correlating with NSh to develop interventions aimed at minimizing the associated negative financial consequences. Methods: A retrospective study of IntlPts accepted and scheduled for an appointment at the International Assessment Center at MD Anderson in fiscal years 2010 – 2013 was conducted. Overall 52 variables were evaluated that included socio-demographic and clinical patient characteristics, financial responsibility, and appointment timeline. For univariate analysis, Chi-square test and Wilcoxon rank sum test were applied. For multivariate analysis, a multivariate logistic regression model was fit. The multivariate logistic model with independent covariates was used to construct a nomogram. The Time Driven Activity-Based Cost method was used to assess the cost of processing referral requests. Results: Of 1031 IntlPts scheduled, 311 (30%) were NSh. NSh was significantly associated (p < 0.05) with country of origin, payer, diagnosis, referral source, disease stage, patient-delayed appointment date, number of symptoms, pain, bleeding, fatigue, dysphagia, jaundice, neurological symptoms, comorbidities, and appointment lag time. Direct operational costs were calculated using process maps and TDABC. Conclusions: These results provide the groundwork to understand operational costs and predictors of no-show of oncology IntlPts. Having knowledge of predictive factors for NSh in a new patient outpatient setting represents a necessary step towards decreasing its frequency, addressing associated costs, optimizing continuity of care, and ultimately improving outcomes and value of the provided care.

Predictors of no-show among international patients with cancer: A 4-year analysis.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 23-23
Author(s):  
Nizar Bhulani ◽  
Lianchun Xiao ◽  
Manal Hassan ◽  
Renato Lenzi
Keyword(s):  
Univariate Analysis ◽  
Patient Characteristics ◽  
The United States ◽  
Outpatient Setting ◽  
Disease Stage ◽  
Multivariate Logistic Regression Model ◽  
Missed Appointments ◽  
Clinical Patient ◽  
Use Of Resources ◽  
Operational Costs

23 Background: Patient no-show (NSh) for scheduled medical appointments negatively impacts quality of care, impedes optimal use of resources, has significant negative economic consequences secondary to missed appointments, and uncovered referral processing costs. International patients (IntlPts) present challenging financial/travel arrangements and cultural and linguistic needs. There are currently very limited data regarding numbers of IntlPts visiting the United States for medical care and no data regarding NSh rates. The purpose of this study was to quantify costs and identify IntlPts-related variables correlating with NSh to develop interventions aimed at minimizing the associated negative financial consequences. Methods: A retrospective study of IntlPts accepted and scheduled for an appointment at the International Assessment Center at MD Anderson in fiscal years 2010 – 2013 was conducted. Overall 52 variables were evaluated that included socio-demographic and clinical patient characteristics, financial responsibility, and appointment timeline. For univariate analysis, Chi-square test and Wilcoxon rank sum test were applied. For multivariate analysis, a multivariate logistic regression model was fit. The multivariate logistic model with independent covariates was used to construct a nomogram. The Time Driven Activity-Based Cost method was used to assess the cost of processing referral requests. Results: Of 1031 IntlPts scheduled, 311 (30%) were NSh. NSh was significantly associated (p <0.05) with country of origin, payer, diagnosis, referral source, disease stage, patient-delayed appointment date, number of symptoms, pain, bleeding, fatigue, dysphagia, jaundice, neurological symptoms, comorbidities, and appointment lag time. Direct operational costs were calculated using process maps and TDABC. Conclusions: These results provide the groundwork to understand operational costs and predictors of no-show of oncology IntlPts. Having knowledge of predictive factors for NSh in a new patient outpatient setting represents a necessary step towards decreasing its frequency, addressing associated costs, optimizing continuity of care, and ultimately improving outcomes and value of the provided care.

EmPHasis-10 as a Measure of Health-Related Quality of Life in Pulmonary Arterial Hypertension: data from PHAR

2020 ◽  
pp. 2000414
Author(s):  
Marissa Borgese ◽  
David Badesch ◽  
Todd Bull ◽  
Murali Chakinala ◽  
Teresa DeMarco ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Clinical Decision Making ◽  
Smoking Status ◽  
Unmet Need ◽  
Patient Characteristics ◽  
The United States ◽  
Clinical Patient ◽  
The Impact ◽  
Over Time

IntroductionWhile the performance of the emPHasis-10 (e10) score has been evaluated against limited patient characteristics within the United Kingdom, there is an unmet need for exploring the performance of the e10 score among PAH patients in the United States.MethodsUsing the Pulmonary Hypertension Association Registry, we evaluated relationships between the e10 score and demographic, functional, hemodynamics, and additional clinical characteristics at baseline and over time. Furthermore, we derived a minimally important difference (MID) estimate for the e10 score.ResultsWe analysed data from 565 PAH (75% female) adults 55.6±16.0 years of age. At baseline, the e10 score had notable correlation with factors expected to impact quality of life in the general population, including age, education level, income, smoking status, and body mass index. Clinically important parameters including six-minute walk distance and B-type natriuretic peptide/N-terminal-pro BNP were also significantly associated with e10 score at baseline and over time. We generated a MID estimate for the e10 score of −6.0 points (range −5.0 to −7.6 points).ConclusionsThe e10 score was associated with demographic and clinical patient characteristics suggesting that HRQoL in PAH is influenced by both social factors and indicators of disease severity. Future studies are needed to demonstrate the impact of the e10 score on clinical decision-making and its potential utility for assessing clinically important interventions.

scholarly journals COVID-19 Case Surveillance: Trends in Person-Level Case Data Completeness, United States, April 5–September 30, 2020

2021 ◽  
pp. 003335492110069
Author(s):  
Jeremy A.W. Gold ◽  
Jennifer DeCuir ◽  
Jayme P. Coyle ◽  
Lindsey M. Duca ◽  
Jennifer Adjemian ◽  
...  
Keyword(s):  
United States ◽  
Situational Awareness ◽  
Medical Condition ◽  
Temporal Trends ◽  
The United States ◽  
Surveillance Data ◽  
Data Completeness ◽  
Level Data ◽  
Control And Prevention ◽  
Region Data

Objectives To obtain timely and detailed data on COVID-19 cases in the United States, the Centers for Disease Control and Prevention (CDC) uses 2 data sources: (1) aggregate counts for daily situational awareness and (2) person-level data for each case (case surveillance). The objective of this study was to describe the sensitivity of case ascertainment and the completeness of person-level data received by CDC through national COVID-19 case surveillance. Methods We compared case and death counts from case surveillance data with aggregate counts received by CDC during April 5–September 30, 2020. We analyzed case surveillance data to describe geographic and temporal trends in data completeness for selected variables, including demographic characteristics, underlying medical conditions, and outcomes. Results As of November 18, 2020, national COVID-19 case surveillance data received by CDC during April 5–September 30, 2020, included 4 990 629 cases and 141 935 deaths, representing 72.7% of the volume of cases (n = 6 863 251) and 71.8% of the volume of deaths (n = 197 756) in aggregate counts. Nationally, completeness in case surveillance records was highest for age (99.9%) and sex (98.8%). Data on race/ethnicity were complete for 56.9% of cases; completeness varied by region. Data completeness for each underlying medical condition assessed was <25% and generally declined during the study period. About half of case records had complete data on hospitalization and death status. Conclusions Incompleteness in national COVID-19 case surveillance data might limit their usefulness. Streamlining and automating surveillance processes would decrease reporting burdens on jurisdictions and likely improve completeness of national COVID-19 case surveillance data.

scholarly journals Traumatic Brain Injury: Patient Characteristics, Hospital Costs and Trends Over Time

10.36469/9893 ◽  
2014 ◽  
Vol 2 (2) ◽  
pp. 108-118
Author(s):  
Pankaj A. Patel ◽  
Peter J. Mallow ◽  
Mary Vassar ◽  
John A. Rizzo ◽  
Bhavik J. Pandya ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Medical Condition ◽  
Hospital Costs ◽  
Patient Characteristics ◽  
The United States ◽  
Inpatient Setting ◽  
Outpatient Basis ◽  
Hospital Perspective ◽  
Over Time

Background: Traumatic brain injury (TBI) is an increasingly diagnosed condition, but the trends in TBI visits and the cost of which have not been quantified from the hospital perspective. Objectives: To quantify the costs of TBI stratified by inpatient and outpatient visits and to examine trends in TBI incidence over time. Methods: This descriptive study utilized data for 2007-2012 from the Premier hospital database, which includes clinical and utilization information from hospitals across the United States. TBI was identified through International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes. Descriptive data were obtained to identify the TBI costs, visit costs, patient characteristics, and intertemporal trends in TBI rates. Results: TBI patients were treated on an outpatient basis 88% of the time. Nearly 45% (44.3%) of TBI patients requiring inpatient admissions were age 65 or over, and 20% of TBI patients treated as an outpatient were age 75 or over. Children aged 4 or younger accounted for nearly 14% of TBI cases treated on an outpatient basis. TBI patients treated in the inpatient setting incurred fairly long hospital visits (mean 4.8 days; median 3.0 days) and substantial hospital costs (mean $12,717; median $8,176). The rate of TBI visits have risen substantially over time, especially among children under age 18 years and patients in the Northeast US Census Region. Conclusion: TBI is a serious medical condition that appears to be on the rise. Large differences exist between the hospital costs associated with TBIs treated in the inpatient and outpatient settings. Further research to understand factors affecting the costs and clinical outcomes of TBI can help refine treatment strategies to enhance patient outcomes while providing cost effective care.

scholarly journals Demographic predictors of hospitalization and mortality in U.S. children with COVID-19

2020 ◽  
Author(s):  
Alvaro Moreira ◽  
Kevin Chorath ◽  
Karthik Rajasekaran ◽  
Fiona Burmeister ◽  
Mubbasheer Ahmed ◽  
...  
Keyword(s):  
African American ◽  
Medical Condition ◽  
Pediatric Population ◽  
Mixed Race ◽  
The United States ◽  
Population Based ◽  
Hospital Death ◽  
Increased Risk ◽  
Control And Prevention ◽  
Underlying Medical Condition

Abstract Understanding which children are at increased risk for poor outcome with COVID-19 is critical. In this study, we link pediatric population-based data from the United States’ Center for Disease Control and Prevention to COVID-19 hospitalization and in-hospital death. In 27,045 U.S. children with confirmed COVID-19, we demonstrate that African American [OR 2.28 (95% CI: 1.93, 2.70)] or mixed race [OR 2.95 (95% CI: 2.28, 3.82)] and an underlying medical condition [OR 3.55 (95% CI: 3.14, 4.01)] are strong predictors for hospitalization. Death occurred in 39 (0.19%) of 20,096 hospitalized children; children with a prior medical condition had an increased odd for death [OR 8.8 (95% CI: 3.7, 21.1)].Conclusion: Hospitalization and in-hospital death are rare in children diagnosed with COVID-19. However, children at higher risk for these outcomes include those with an un underlying medical condition, as well as those of African American descent.

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