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Screening and Treatment Rates for Latent Tuberculosis Among Newly-Arrived Refugees in an Urban Facility in Connecticut. 在康涅狄格州的一个城市设施中，新到达的难民中潜伏性结核病的筛查和治疗率。
Connecticut Medicine Pub Date : 2017-05-01
Dylan Duchen, Andrew T Boyd, Aniyizhai Annamalai
{"title":"Screening and Treatment Rates for Latent Tuberculosis Among Newly-Arrived Refugees in an Urban Facility in Connecticut.","authors":"Dylan Duchen,&nbsp;Andrew T Boyd,&nbsp;Aniyizhai Annamalai","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>There is a high prevalence of latent tuberculosis infection (LTBI) and risk of reactivation among refugees. This study describes LTBI prevalence, treatment initiation, and completion rates in refugee patients seen at one urban Connecticut hospital. This retrospective chart review includes 248 adult refugee patients screened between January 2009 and April 2012. Demographics, tuberculin skin test (TST) results, treatment initiation and completion rates, and treatment-related variables were collected. Ninety-eight percent of adult refugees received TST screening and 44.0% were diagnosed with LTBI. Of these, 95.5% initiated treatment, and of those, 48.2% completed treatment. Early treatment discontinuation was high, with 29.5% of patients diagnosed with LTBI defaulting after the first clinic visit. Despite near-universal screening within this refugee population, LTBI treatment initiation and completion rates remain low. Greater efforts should be made to ensure LTBI treatment initiation and completion among refugees through early case management and shorter treatment duration.</p>","PeriodicalId":35577,"journal":{"name":"Connecticut Medicine","volume":"81 5","pages":"291-298"},"PeriodicalIF":0.0,"publicationDate":"2017-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36078736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Ham Sandwiches and Medical Malpractice: Time for a Change. 火腿三明治和医疗事故:是时候改变了。
Connecticut Medicine Pub Date : 2017-05-01
Michael M Deren
{"title":"Ham Sandwiches and Medical Malpractice: Time for a Change.","authors":"Michael M Deren","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":35577,"journal":{"name":"Connecticut Medicine","volume":"81 5","pages":"309-311"},"PeriodicalIF":0.0,"publicationDate":"2017-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36078738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Unsustainable Cost of Medicaid: Insights from a Hospital-Based Academic Dermatology Practice. 医疗补助不可持续的成本:从医院为基础的学术皮肤科实践的见解。
Connecticut Medicine Pub Date : 2017-05-01
Michael J Payette
{"title":"The Unsustainable Cost of Medicaid: Insights from a Hospital-Based Academic Dermatology Practice.","authors":"Michael J Payette","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the lost revenue associated with Medicaid patients in a university-based dermatology practice over a one-year period compared to non-Medicaid patients. Specifically, the goal was to investigate the change in revenue if Medicaid visits were associated with a range of copayments.</p><p><strong>Results: </strong>The total billed across all encounters for the 2014 -2015 fiscal year was $31017159, of which $3715393 (13.61%) was for Medicaid. 'he total revenue for all encounters was $12267832, of which $420230 (3.55%) was for Medicaid. After adding potential copayments, the reduced financial impact that such fees would have had on our practice for the past fiscal year ranged from $745.85 at $0.05/visit to $149170 at $10/visit.</p><p><strong>Conclusion: </strong>Adding a small copaymentforMedicaid patients would decrease lost revenue. The degree of financial impact would vary based on the size of the copayment. Broad adoption of such a plan could significantly help hospitals reduce lost revenue.</p>","PeriodicalId":35577,"journal":{"name":"Connecticut Medicine","volume":"81 5","pages":"267-269"},"PeriodicalIF":0.0,"publicationDate":"2017-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36078336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Changes in Hospital Utilization Among Seriously Mentally Ill Patients Following Enrollment in an Integrated Primary and Behavioral Health Care Program. 纳入综合初级和行为卫生保健计划后，严重精神疾病患者医院使用率的变化
Connecticut Medicine Pub Date : 2017-05-01
Christopher Steele, Jane Ungemack, Marie Mormile-Mehler, William Rabitaille
{"title":"Changes in Hospital Utilization Among Seriously Mentally Ill Patients Following Enrollment in an Integrated Primary and Behavioral Health Care Program.","authors":"Christopher Steele,&nbsp;Jane Ungemack,&nbsp;Marie Mormile-Mehler,&nbsp;William Rabitaille","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objectives: </strong>Integrated primary and behavioral health care models are emerging to improve access to care; however, the effect they have on utilization and expenditure has yet to be studied.</p><p><strong>Methods: </strong>A retrospective, longitudinal review of all patients (N = 343; 97% Medicaid) enrolled in our primary and behavioral health care program looked at hospital utilization up to a year before and after enrollment and estimated spending from Medicaid reimbursement data.</p><p><strong>Results: </strong>There was a significant decrease in emergency department (ED) visits per person before enrollment vs after enrollment (2.39 vs 1.88, P = .009) with a decrease in those classified as high ED utilizers (four or more times in a year) from 22% to 16%, respectively (P = < .001). 'here was no change in inpatient admissions or length of stay. Medicaid saved $701.89 per client while costing the hospital $981.93 per client.</p><p><strong>Conclusion: </strong>Integrated health care may decrease ED utilization for clients with a serious mental ill- ness (SMI) while increasing savings for Medicaid and reducing hospital revenue.</p>","PeriodicalId":35577,"journal":{"name":"Connecticut Medicine","volume":"81 5","pages":"271-279"},"PeriodicalIF":0.0,"publicationDate":"2017-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36078338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Bisphosphonates and the Role of Calcium Plus Vitamin D in Osteoporosis. 双膦酸盐和钙加维生素D在骨质疏松症中的作用。
Connecticut Medicine Pub Date : 2017-05-01
Rachel R Comito, Kelly Richard
{"title":"Bisphosphonates and the Role of Calcium Plus Vitamin D in Osteoporosis.","authors":"Rachel R Comito,&nbsp;Kelly Richard","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":35577,"journal":{"name":"Connecticut Medicine","volume":"81 5","pages":"299-305"},"PeriodicalIF":0.0,"publicationDate":"2017-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36078737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Refractory Psoriatic Arthritis and Polyarteritis Nodosa: Co-occurrence in a Patient with Undiagnosed HIV. 难治性银屑病关节炎和结节性多动脉炎:在未确诊的HIV患者中共同发生。
Connecticut Medicine Pub Date : 2017-05-01
Sam Awan, Ranadeep Mandhadi, Aryeh M Abeles
{"title":"Refractory Psoriatic Arthritis and Polyarteritis Nodosa: Co-occurrence in a Patient with Undiagnosed HIV.","authors":"Sam Awan,&nbsp;Ranadeep Mandhadi,&nbsp;Aryeh M Abeles","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Human immunodeficiency virus (HIV) infection can result in several autoimmune illnesses, including psoriasis, psoriatic arthritis (PsA), and polyarteritis nodosa (PAN). We describe a patient who presented with PsA refractory to both synthetic and biologic disease-modifying antirheumatic drugs (DMARDs), who then developed PAN while on antitumor necrosis factor (TNF) therapy. The onset ofvasculitic disease led to the discovery of the HIV infection, and manifestations of both PsA and PAN remitted with the introduction of highly active antiretroviral therapy. To our knowledge, this is the first casewhere both PsA and PAN developed in an HIV-positive patient. Our review focuses on the pathogenesis, presentation, and treatment of HIV related psoriasis, PsA, and PAN. This unusual case underscores the need to remain vigilant for underlying HIV infection in immunosuppressed patients, and serves as a reminder ofthe unusual autoimmune manifestations the virus can provoke.</p>","PeriodicalId":35577,"journal":{"name":"Connecticut Medicine","volume":"81 5","pages":"285-289"},"PeriodicalIF":0.0,"publicationDate":"2017-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36078342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Durable Complete Response of Primary CNS Lymphoma in an 80-Year-Old Patient with Retroviral Infection. 80岁患者原发性中枢神经系统淋巴瘤逆转录病毒感染的持久完全缓解。
Connecticut Medicine Pub Date : 2017-04-01
Michael Del Rosario, Henry Tsai, Constantin A Dasanu
{"title":"Durable Complete Response of Primary CNS Lymphoma in an 80-Year-Old Patient with Retroviral Infection.","authors":"Michael Del Rosario,&nbsp;Henry Tsai,&nbsp;Constantin A Dasanu","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>People aging with human immunodeficiencyvirus (HIV) present a unique set of challenges for their providers. Cardiovascular, metabolic, neurodegenerative, and renal disorders, and certain cancers are more common in this cohort, which is attributed to elevated rates of inflammation. Although survival remains compromised, integration of efficacious antiretrovirals and high-dose methotrexate (HD-MTX) was shown to improve clinical results in HIV-infected patients with primary central nervous system lymphoma (PCNSL). However, optimal management of PCNSL in the elderly is not known. We present the case of an 80-year-old patientwith HIV-associated PCNSL who achieved a durable complete response with HD-MTX andrituximab. He remains in complete remission 18 months after the diagnosis. Our case supports using the HD-MTX/rituximab combination in the very old subjects with HIV-related PCNSL.</p>","PeriodicalId":35577,"journal":{"name":"Connecticut Medicine","volume":"81 4","pages":"223-226"},"PeriodicalIF":0.0,"publicationDate":"2017-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36058345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Effect of an Educational Intervention on the Accuracy of Data Submitted to a National Quality Registry. 教育干预对提交给国家质量登记处的数据准确性的影响。
Connecticut Medicine Pub Date : 2017-04-01
Vinay Gulati, Ossama Elsaid, Matthew W Parker, Michael Thorns, Thea Ling, Steven Zweibel
{"title":"Effect of an Educational Intervention on the Accuracy of Data Submitted to a National Quality Registry.","authors":"Vinay Gulati,&nbsp;Ossama Elsaid,&nbsp;Matthew W Parker,&nbsp;Michael Thorns,&nbsp;Thea Ling,&nbsp;Steven Zweibel","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>We hypothesize that data-entry errors within the National Cardiovascular Data Registry® (NCDR) ICD Registry™ may be an important reason behind labeling many cases as nonevidence-based.</p><p><strong>Objective: </strong>To describethe frequency of data-entry errors in implantable cardioverter-defibrillator (lCD) implant data from our institution and develop a plan for quality improvement using the Deming cycle.</p><p><strong>Methods and results: </strong>We assessed data of patient report forms from2007to 2010 and compared these data with forms submitted from 2011 to 2012 after implementation of a continuous multicomponent staff education and training program. Of 211 ICD implants between 2007 and 2010, 36 (17%) were labeled nonevidence-based. Twenty-four (11.4%) resulted from misclassification due to data entry errors and 12 (5.7%) were actual nonevidence-based. Postintervention, review of 97 submitted patients' data revealed one (1%) data-entry error and three (3.1%) actual nonevidence-based implants.</p><p><strong>Conclusions: </strong>Multicomponent educational intervention was effective in reducing errors in data sub- mitted to the NCDR ICD Registry.</p>","PeriodicalId":35577,"journal":{"name":"Connecticut Medicine","volume":"81 4","pages":"197-202"},"PeriodicalIF":0.0,"publicationDate":"2017-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36058341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Peripheral Tibial Nerve Stimulation for Overactive Bladder Syndrome: Treatment Success and Patient Satisfaction. 胫外周神经刺激治疗膀胱过度活动综合征:治疗成功及患者满意度。
Connecticut Medicine Pub Date : 2017-04-01
Katie Propst, Haylie Butler, David M O'Sullivan, Elena Tunitsky Bitton
{"title":"Peripheral Tibial Nerve Stimulation for Overactive Bladder Syndrome: Treatment Success and Patient Satisfaction.","authors":"Katie Propst,&nbsp;Haylie Butler,&nbsp;David M O'Sullivan,&nbsp;Elena Tunitsky Bitton","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the success rate and patient satisfaction ofperipheral tibial nerve stimulation (PTNS) therapy.</p><p><strong>Method: </strong>Retrospective cohort study assessing PTNS treatment success and patient satisfaction.</p><p><strong>Results: </strong>Data from 34 women were included. On average, patients were 70.2 (± 12) years of age, had a BMI of 29.9 (± 8.9) kg/M², and traveled 11.2 (± 12.3) miles to receive weekly PTNS treatments. Overall, 22 patients (64.7%) were satisfied, four (11.8%) unsatisfied, and eight (23.5%) undecided. Those who were satisfied completed an average of 10.9 treatments (± 2.4), those who were unsatisfied completed an average of 9.5 treatments (± 2.6), and those left undecided completed an average of 7.2 treatments (± 4.3). The fourth treatment visit was the most likely to predict whether a patient would be satisfied or unsatisfied by the 12th treatment.</p><p><strong>Conclusion: </strong>Overall the success of the PTNS therapy was 64.7%, consistent with previous studies. Most patients note improvement after the fourth treatment.</p>","PeriodicalId":35577,"journal":{"name":"Connecticut Medicine","volume":"81 4","pages":"209-213"},"PeriodicalIF":0.0,"publicationDate":"2017-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36058343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Injuries Associated with Subdural Hematoma: A Study of the National Trauma Data Bank. 与硬膜下血肿相关的损伤:国家创伤数据库的研究。
Connecticut Medicine Pub Date : 2017-04-01
Nidharshan S Anandasivam, Glenn S Russo, Andre M Samuel, Ryan Grant, Daniel D Bohl, Jonathan N Grauer
{"title":"Injuries Associated with Subdural Hematoma: A Study of the National Trauma Data Bank.","authors":"Nidharshan S Anandasivam,&nbsp;Glenn S Russo,&nbsp;Andre M Samuel,&nbsp;Ryan Grant,&nbsp;Daniel D Bohl,&nbsp;Jonathan N Grauer","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Of 92030 patients with subdural hematoma (SDH) in the National Trauma Data Bank (NTDB), 55729 had fall mechanisms of injury (61%), while 36301 had other traumatic mechanisms (nonfall, 39%). For nonfall mechanisms, the three associated injuries with the highest incidence were: skull fractures (43.3%), rib/sternum injuries (25.0%), and thoracic organ injuries (24.0%). For fall mechanisms, the three associated injuries with the highest incidence were: skull fractures (19.0%), spinal injuries (7.1%), and upper extremity fractures (6.8%). Mortality was associated with age and most studied associated injuries (odds ratios ofup to 2.04). 'This study conveys an important clinical point: even though traditional teaching highlights the risk of noncontiguous spine fractures in patients with a known spine fracture, the risk of a noncontiguous spine fracture is higher when dealing with a patient with SDH. This is underscored by the fact that mortality is higher for SDH patients with other associated injuries.</p>","PeriodicalId":35577,"journal":{"name":"Connecticut Medicine","volume":"81 4","pages":"215-222"},"PeriodicalIF":0.0,"publicationDate":"2017-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36058344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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