Gentian violet for pyoderma gangrenosum: a retrospective chart review

Pyoderma gangrenosum is a rare autoinflammatory skin disease. Treatment is multifactorial, addressing inflammation, pain, underlying disease, if present, and the wound. Gentian violet has been used for hundreds of years in a variety of dermatologic conditions for its anti-inflammatory properties. This study aims to evaluate gentian violet in wound healing for pyoderma gangrenosum. We conducted a retrospective chart review of patients with pyoderma gangrenosum treated with gentian violet at the Wake Forest School of Medicine Department of Dermatology in the last 10 years. The primary outcome was clinical improvement. Of the 34 cases that met inclusion criteria, 70% improved with gentian violet, 24% had no documented change, 3% initially improved then worsened, and 3% had unclear results. Gentian violet is a safe and cheap treatment that may improve resolution of pyoderma gangrenosum lesions in addition to systemic therapy

The relation of body mass index, demographic and health-related variables to length of stay for patients at an acute rehabilitation hospital after total hip arthroplasty

Obesity is a growing public health concern world-wide. At the same time, knee and hip replacements are becoming an increasingly regular treatment for osteoarthritis. There are conflicting reports in the literature as to what extent body mass affects the length of stay (LOS) of patients undergoing total hip replacements. This chart review aims at examining the ­relationship between body mass index (BMI), demographic and health-related variables, and LOS. The retrospective chart review of one acute inpatient rehabilitation facility involved n = 119 patients. There was no significant association between LOS and body mass index (BMI), confirming earlier results. Insurance payer type (Medicare vs private) was statistically significant related to LOS. Moreover, there was a trend for the potential influence of race/ethnic patient background on LOS with Caucasians having shorter hospital stays. © 2010 Greenberg and Kroll, publisher and licensee Dove Medical Press Ltd. This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.</p

Echocardiography role in syncope Patients

Methods: We did a retrospective chart review of 138 patients admitted to observation floor with diagnosis of syncope.https://jdc.jefferson.edu/patientsafetyposters/1054/thumbnail.jp

Cyclic vomiting syndrome: a retrospective chart review

Purpose: We aim to characterize a large cohort of CVS patients seen at MGH in order to better understand this disorder. In addition, as CVS patients are known to have a higher cannabis use than those with other functional disorders, characteristics specific to CVS marijuana user patients have yet to be determined. Therefore, we aim to determine the variables that are patient specific predictors of cannabis use in CVS. Methods: All patients with a CVS diagnosis were seen at our facility as inpatient, outpatient or in the emergency department and medical record numbers were identified via Research Patient Data Registry (RPDR) query search tool. From the medical records, we verified a diagnosis of CVS based on Rome III criteria and collected information on demographics, co-morbidities, health care utilization and substance abuse history over a 16 year time period (1997-2013). We then proposed patient specific predictor variables of marijuana use based on our experience with CVS patients and incorporated these variables into a model for predicting marijuana use. We used this model to examine the effect of patient characteristics on marijuana use via logistic regression with estimation of odds ratio and 95% confidence ratio. Results: A total of 91 CVS patients were obtained, 67% of which were male with a mean age of 28 years old, average age of first attack of 20.2 years and employment or full time student status in 62% of patients. Psychiatric conditions were present in 73% of individuals with anxiety present in 50% and depression in 47%. The presence of a chronic pain syndrome was found in 40%. Marijuana use was present in 76% of our cohort, daily alcohol use 53%, and narcotic use 27%. Men with CVS were at significantly greater risk for marijuana use compared to women (OR .23, 95% CI .07-.77) as well as daily alcohol use (OR 5.26, 95% CI 1.469-18.828). Individuals with a chronic pain syndrome were at significantly lower risk for cannabis use (OR .15, 95% CI .039-.575) and psychiatric illness, age and narcotic use were found not to be associated with marijuana use. On average, individuals presented to the ED 1.6 times/year with one patient having a high of 208 ED visits/year. Of those that presented more than once during the time period in study there was a median interval between visits of 103.6 days. Conclusion: We found that CVS patients had significant psychiatric co-morbidities, chronic pain syndromes, and history of substance abuse. We found male gender and alcohol use to be two variables that were predictors of marijuana use in the CVS population while the presence of a chronic pain syndrome decreased the likelihood of marijuana use. The significant employment rate and full time student status of our cohort suggests a higher degree of functionality. Further prospective studies are needed to determine the role of marijuana use in the CVS population in terms of quality of life, health care utilization, and severity of disease

Retrospective chart review of oral somatic delusions

Objective: Oral cenesthopathy is characterized by foreign body sensations without medical and dental evidence for them. It is thought to be a rare disease in psychiatry, but many patients are visiting dental clinics seeking treatment to remove a foreign body. Even though the features of oral cenesthopathy might be different between a psychiatric clinic and a dental clinic, there has been no clinico-statistical study from dentists. In this study, we report a clinico-statistical study of patients with oral cenesthopathy in dentistry. Methods: This is a retrospective chart review of 606 outpatients with oral cenesthopathy in Tokyo Medical and Dental University from April 2010 through to March 2015. Results: A total of 159 male and 447 female patients were included in this study. The mean age was 62.08 years, and female patients were older than male patients. The trigger of the dental treatment and the acute phase of depression at the onset were significantly related (p=0.037). Only 128 patients (36%) had clinically significant improvement after 6 months of pharmacotherapy. No history of psychiatric disorders (odds ratio [OR] 0.479 [95% confidence interval {CI}: 0.262–0.875], p=0.017) and longer duration of illness (>18 months) (OR 2.626 [95% CI: 1.437–4.799], p=0.002) were significant factors for clinical outcomes. Conclusion: Patients with oral cenesthopathy in our clinic were predominantly elderly female patients. Dental treatment in the acute phase of depression might be a risk factor for oral cenesthopathy. Therefore, comprehending the situation of psychiatric disorder and obtaining adequate informed consent might be required to prevent the trouble concerning oral cenesthopathy

Supplemental Intraoperative Intravenous Fluid Administration among Patients Undergoing Surgical Procedures and General Anesthesia for the Prevention of Postoperative Nausea and Vomiting: A Retrospective Chart Review

Background and Review of Literature: Postoperative nausea and vomiting (PONV) is one of the most common patient complications following general anesthesia. Recent literature supports the practice of supplemental intravenous fluid administration to patients receiving general anesthesia with no risk of fluid volume overload. Purpose: The purpose of this DNP project was to assess the overall occurrence of PONV and to determine if patients who experienced PONV after receiving general anesthesia, were administered supplemental intravenous fluids during the intraoperative period. Methods: The project consisted of a retrospective chart review. A total of 342 electronic health records (EHRs) were reviewed and 57 patients were included in the DNP project. Implementation Plan: A project site was identified; a retrospective chart review was conducted, examining one month of patient EHRs who underwent general anesthesia. Data was collected and analyzed via Microsoft Excel, which included the amount of intravenous fluids received during the intraoperative period, weight, gender, surgical procedure, and ASA physical status. Implications/Conclusions: At the completion of the retrospective chart review, it was discovered that 57 (17%) out of 342 patients who underwent general anesthesia were treated for PONV. Of the 57 patients, 50 (88%) did not receive intraoperative supplemental intravenous fluids. Only 7 (12%) patients received greater than 15mL/kg of intravenous fluid during the intraoperative period

Pediatric Primary Care Concussion Evaluation and Management

Concussions are an important and timely subject, especially within the pediatric population, as they are the most involved in extracurricular contact sports and are susceptible to concussions and their sequelae. The researcher performed a quasi-experimental pilot study in a pediatric primary care office where the researcher educated 15 providers on the HEADS UP concussion screening tool and management approach. The researcher gave providers pre- and post-intervention surveys to determine if providers’ comfort and knowledge regarding assessing and managing concussions within the pediatric primary care setting changed. Four providers participated in the study. The researcher conducted a chart review two months after the educational intervention to assess changes in clinical care. Retrospective chart review of pre-education concussion care demonstrated varied evaluation and management approaches. Post-education chart review found one of the four providers using the full educational intervention. Therefore, targeted education and a chart review may be helpful to improve providers’ behaviors and actions related to clinical practice guidelines

Non-Insertive Acupuncture and Neonatal Abstinence Syndrome: A Case Series from an Inner City Safety Net Hospital

OBJECTIVE: We report on the safety of non-insertive acupuncture (NIA) in 54 newborns diagnosed with Neonatal Abstinence Syndrome (NAS) in a busy inner city hospital. METHODS: For this case series, a retrospective chart review was conducted. Data on participant demographics, number of NIA treatments, provider referrals, and outcomes of interest (sleeping, feeding, and adverse events) were collected. RESULTS: Of the 54 newborns receiving NIA, 86% were non-Hispanic White; 87% were on Medicaid, and gestational age ranged from 33.2 to 42.1 weeks. Out of 54 chart reviews, a total of 92 NIA sessions were documented ranging from 1 to 6 sessions per infant. Of the total number of treatments (n = 92), 73% were requested by a physician. Chart reviews reported restless infants calmed down during NIA, babies slept through or fell asleep immediately following NIA, and better feeding was noted following NIA. There were no adverse events noted in the medical records. CONCLUSIONS: This retrospective chart review shows potential for the use of NIA as an adjunctive treatment in newborns with NAS symptoms during hospitalization. More research is necessary to study whether the incorporation of NIA can result in positive outcomes in newborns withdrawing from narcotics

The Impact of Lung Cancer Screening Education on Knowledge and Screening Rates in a Kentucky Cancer Survivorship Clinic

Background: Lung cancer is a significant problem in Kentucky, which ranks fourth in the nation in adults who currently smoke. Early detection, through lung cancer screening, can prevent untimely deaths. Several barriers to screening exist including lack of knowledge and awareness among patients regarding lung cancer screening. By increasing knowledge, at risk patients can take the necessary steps to decrease incidence of late stage diagnoses. Purpose: The purpose of this project was to evaluate patients’ knowledge of lung cancer screening and referral and screening rates before and after one-on-one patient education. Methods: This was a quality improvement project that used a quasi-experimental one group pre-test, post-test design. A pre-chart review determined participant eligibility. Baseline data were obtained through a pre-survey. After appointment, cancer survivors participated in an individual lung cancer screening educational intervention. Post intervention, change in knowledge, willingness to be screened, referral rates, and screening rates were measured. A retrospective chart review examined screening rates and chest CT results. Results: A total of eight patients participated in this project. Overall, there was an increase in all mean values from pre-survey to post-survey. The increase was statistically significant for one item. The mean score for “I know something about lung cancer screening” significantly increased from 3.5 (SD=1.41) before intervention to 4.9 (SD=0.35) after intervention, p=.028. A retrospective chart review could not evaluate the effect of the educational intervention on lung cancer screening referrals and screening rates post intervention, as 100% of participants received a chest CT scan prior to the intervention per oncology surveillance guidelines. However, a retrospective chart review analyzed the results from these scans. The retrospective chart review found that four participants (50%) had no pulmonary nodules, two (25%) had stable pulmonary nodules, one (12.5%) had a new nodule, and one (12.5%) had nodules that had increased in size. Conclusion: An educational intervention with a concurrent decision aid can be an effective way to improve lung cancer screening knowledge. Although most participants had heard of lung cancer screening and knew they were eligible prior to intervention, they were lacking knowledge about lung cancer screening. Education not only improves knowledge but positively impacts interest and willingness to be referred for screening. Analyzing chest CT scan results indicated the importance of lung cancer screening for asymptomatic, high-risk individuals

Clinical Outcomes of Utilization of Stress Ulcer Prophylaxis in Hospitalized, Non-ICU Patients

Goal This study is a retrospective chart review that aims to measure the effect of stress ulcer prophylaxis in hospitalized non-ICU level patients to determine the clinical effect of the presence or absence of stress ulcer prophylaxis