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Number of Consults and Response Times to ED: Effects on Patient Flow and Outcomes. 会诊人数和ED反应时间:对患者流量和结果的影响。
Connecticut Medicine Pub Date : 2017-02-01
Mario F Perez, Jurgen L Holleck, Michael Sfondrini, Edward Nemergut, Craig G Gunderson, Daniel G Federman
{"title":"Number of Consults and Response Times to ED: Effects on Patient Flow and Outcomes.","authors":"Mario F Perez,&nbsp;Jurgen L Holleck,&nbsp;Michael Sfondrini,&nbsp;Edward Nemergut,&nbsp;Craig G Gunderson,&nbsp;Daniel G Federman","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objectives: </strong>'he number of consults and response times to our Emergency Department (ED) were tracked to understand the effects on patient flow and outcomes.</p><p><strong>Study design: </strong>We conducted a prospective observational study using convenience samples.</p><p><strong>Methods: </strong>There were 992 requests for physician consultations or logistical services (bed manager, transport, or room cleaning) logged during ED shifts from January through July, 2014 at the VA CT Healthcare System West Haven Campus (VACHS). Services were paged every 15 minutes until a response was received; the total response time was then recorded. One-hundred-eighty-six requests were triggered by one author's cohort of 392 patients, for which age, disposition, and outcomes were also tracked.</p><p><strong>Results: </strong>The median response times were one to six minutes depending on the service requested; outli- ers exceeded an hour. A patient's ED stay duration increased with the number of services paged. The number of services paged was associated with mortality despite adjusting for age, ED waiting time, ED total time, and disposition (odds ratio = 3.14, P = .02) although comorbidity scores were not tracked.</p><p><strong>Conclusions: </strong>Response time to ED pages varies widely. The number of services paged correlated with ED length of stay and possibly inpatient mortality.</p>","PeriodicalId":35577,"journal":{"name":"Connecticut Medicine","volume":"81 2","pages":"69-73"},"PeriodicalIF":0.0,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36078753","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
Immediate Tube Feeding after Percutaneous Endoscopic Gastrostomy: Early Return to Goal Tube Feeds without Added Complications. 经皮内镜胃造口术后立即管饲:早期返回目标管饲无增加并发症。
Connecticut Medicine Pub Date : 2017-02-01
Laura C Lamb, Vijay Jayaraman, Stephanie C Montgomery, Affan Umer, David S Shapiro, James M Feeney
{"title":"Immediate Tube Feeding after Percutaneous Endoscopic Gastrostomy: Early Return to Goal Tube Feeds without Added Complications.","authors":"Laura C Lamb,&nbsp;Vijay Jayaraman,&nbsp;Stephanie C Montgomery,&nbsp;Affan Umer,&nbsp;David S Shapiro,&nbsp;James M Feeney","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Percutaneous endoscopic gastrostomy (PEG) is frequently performed for delivery of nonoral enteral nutrition (EN) in critically ill patients. Tube-based supplement initiation is often delayed for a variety of reasons despite evidence that EN interruption results in worse outcomes.</p><p><strong>Objective: </strong>To determine if early initiation of EN after PEG placement is safe and well-tolerated in critically ill patients and if early initiation of EN results in more goal-accomplished days of EN.</p><p><strong>Design: </strong>A retrospective chart review of patients who underwent PEG and at least 24 hours of EN. Patients were stratified according to time to tube- feed initiation: immediate (< one hour), early (one to four hours), and late (four to 24 hours).</p><p><strong>Results: </strong>'Ihe three groups were similar with respect to demographics, comorbidities, and 30-day mortality. Sixty-one percent of patients in the immediate group were advanced to the previously-met goal EN rates compared to 24% and 18% in the early and delayed groups, respectively (P < .0001).</p><p><strong>Conclusion: </strong>Immediate reinitiation of nonoral EN after PEG procedure is safe and is associated with reaching goal nutrition faster.</p>","PeriodicalId":35577,"journal":{"name":"Connecticut Medicine","volume":"81 2","pages":"75-79"},"PeriodicalIF":0.0,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36078754","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
Brucellar Vertebral Osteomyelitis: A Case Report and Brief Review of the Literature. 布鲁氏菌性椎体骨髓炎1例报告及文献综述。
Connecticut Medicine Pub Date : 2017-02-01
Jessica Abrantes-Figueiredo, Ulysses Wu
{"title":"Brucellar Vertebral Osteomyelitis: A Case Report and Brief Review of the Literature.","authors":"Jessica Abrantes-Figueiredo,&nbsp;Ulysses Wu","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Brucellosis is the most common worldwide zoonosis which continues to remain a significant worldwide health problem and burden. Transmission usually occurs secondary to direct or indirect exposure to certain animals, but a major mode of transmission is the ingestion ofunpasteurized milk or milk products from infected animals. 'Ihe disease has a geographic distribution including the Mediterranean basin and Arabian Peninsula, India, Mexico, and parts of Central and South America. However, cases are seen in the United States in international travelers or due to ingestion ofusuallyimported, unpasteurized dairyproducts. Systemic infection with Brucella species can affect anyorgan, although focal forms ofbrucellosis do exist. We present a case of brucellar vertebral osteomyelitis.</p>","PeriodicalId":35577,"journal":{"name":"Connecticut Medicine","volume":"81 2","pages":"91-94"},"PeriodicalIF":0.0,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36078191","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
Value of Upright X-Rays in Diagnosis ofACJoint Injuries in Polytrauma Patients. 直立x线对多发创伤患者关节损伤的诊断价值。
Connecticut Medicine Pub Date : 2017-02-01
Raj J Gala, Arya G Varthi, Michael J Medvecky
{"title":"Value of Upright X-Rays in Diagnosis ofACJoint Injuries in Polytrauma Patients.","authors":"Raj J Gala,&nbsp;Arya G Varthi,&nbsp;Michael J Medvecky","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Acromioclavicular (AC)jointinjury is a common orthopaedic problem that can occur following trauma, but may be underdiagnosed in patients with multiple injuries. In the polytrauma patient, X-rays are commonly done in the supine position, which leads to an underestimation of the amount of displacement of the AC joint. When suspecting an AC joint separation, upright or standing images are needed, without support of the injured arm, in order to classify the injury and guide further management. If initial films are nongravity weight- ed images, they are not adequate and further follow-up is necessary. This manuscript outlines a standard protocol for obtaining upright radiographs to evaluate the AC joint, and describes the clinical course of three polytrauma patients who initially had under-diagnosed AC joint injuries. Only after their injuries were stabilized and the patients underwent upright radiographs were their high-degree injuries demonstrated and treatment recommendations changed from nonoperative to operative intervention.</p>","PeriodicalId":35577,"journal":{"name":"Connecticut Medicine","volume":"81 2","pages":"111-115"},"PeriodicalIF":0.0,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36078196","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
Unusual Breast Calcifications: Complete Replacement of Fibroglandular Tissue with Dystrophic Calcifications in End-Stage Renal Disease. 不寻常的乳房钙化:终末期肾脏疾病纤维腺组织被营养不良钙化完全取代。
Connecticut Medicine Pub Date : 2017-02-01
Shuo Li, Kusum Hooda, Sreelatha Diviti, Waqaar Ahmad, Dana Schwartz
{"title":"Unusual Breast Calcifications: Complete Replacement of Fibroglandular Tissue with Dystrophic Calcifications in End-Stage Renal Disease.","authors":"Shuo Li,&nbsp;Kusum Hooda,&nbsp;Sreelatha Diviti,&nbsp;Waqaar Ahmad,&nbsp;Dana Schwartz","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>We present a rare case of breast calcifications in a patient with end-stage renal disease (ESRD) who was noncompliant with peritoneal dialysis. She presented with rapid onset of a palpable breast mass. Breast ultrasound (US) demonstrated ill-defined areas of dense tissue in the breasts bilaterally. Mammography demonstrated coarse, branching calcifications, completely replacing normal fibroglandular tissue. A review of the literature yields one similar case. The current hypothesis for patients with increased breast calcifications includes elevated serum calcium, phosphate, and parathyroid hormone (PTH) levels; calcium phosphate products may be critical to calcification in ESRD. However, our patient presented with low-normal serum calcium and phosphate, suggesting that this rare entity of breast calcifications is probably related to other unknown factors.</p>","PeriodicalId":35577,"journal":{"name":"Connecticut Medicine","volume":"81 2","pages":"107-110"},"PeriodicalIF":0.0,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36078195","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
Unicompartmental Knee Arthroplasty: Indications, Outcomes, and Complications. 单室膝关节置换术:适应症、结果和并发症。
Connecticut Medicine Pub Date : 2017-02-01
Vineet Tyagi, Mohammad Farooq
{"title":"Unicompartmental Knee Arthroplasty: Indications, Outcomes, and Complications.","authors":"Vineet Tyagi,&nbsp;Mohammad Farooq","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Unicompartmental knee arthroplasty (UKA) is a surgical option which is indicated in a special subset of osteoarthritis patients. Although it is often technically challenging, out-comes are positive when indications are followed as operative criteria. Benefits compared to total knee arthroplasty (TKA) include lower morbidity and a shorter recovery time. Potential complications include dislocation of the mobile-bearing surface, prosthesis loosening, and periprosthetic fracture. Revision surgery often involves a conversion to TKA, with outcomes comparable to revisions after TKA. 'he purpose of this review is to summarize the indications, outcomes, and complications of UKA, as well as the clinical outcomes after revision procedures.</p>","PeriodicalId":35577,"journal":{"name":"Connecticut Medicine","volume":"81 2","pages":"87-90"},"PeriodicalIF":0.0,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36078756","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 History and Genealogy of Obamacare. 奥巴马医改的历史和谱系。
Connecticut Medicine Pub Date : 2017-02-01
Michael M Deren
{"title":"The History and Genealogy of Obamacare.","authors":"Michael M Deren","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":35577,"journal":{"name":"Connecticut Medicine","volume":"81 2","pages":"119-121"},"PeriodicalIF":0.0,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36078197","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 Role of Patient History and Body Site Surveillance Cultures as Predictors of Colonization in a Long-Term Acute Care Hospital Setting. 患者病史和身体部位监测培养在长期急性护理医院环境中作为殖民预测因素的作用。
Connecticut Medicine Pub Date : 2017-02-01
Brenda A Nurse, Randall W Barton, Daniel T Larose
{"title":"The Role of Patient History and Body Site Surveillance Cultures as Predictors of Colonization in a Long-Term Acute Care Hospital Setting.","authors":"Brenda A Nurse,&nbsp;Randall W Barton,&nbsp;Daniel T Larose","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Long-term acute care hospitals (LTACHs) have high rates of antibiotic and device use, hospital-acquired infections, and antibiotic resistance. Admission surveillance cultures are controversial.</p><p><strong>Objective: </strong>Evaluate the significance of patienthistory and multiple body site admission surveillance cultures for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE).</p><p><strong>Design: </strong>Retrospective review of preadmission history and surveillance cultures from multiple body sites of 594 new admissions and cultures obtained for subsequent clinical status changes.</p><p><strong>Results: </strong>Thirteen percent of patients were positive for MRSA and 16% for VRE on admission screening. Neither MRSA nor VRE history was predictive of colonization: 44% of patients with MRSA history screened MRSA positive; 48% with VRE history screened VRE positive. No single body site was predictive for MRSA or VRE colonization.</p><p><strong>Conclusion: </strong>Neither patient history nor a single body site was highly predictive of colonization; multisite surveillance may be optimal to evaluate MRSA and VRE burden.</p>","PeriodicalId":35577,"journal":{"name":"Connecticut Medicine","volume":"81 2","pages":"81-85"},"PeriodicalIF":0.0,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36078755","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
Development of the Yale Gender Center: An Early Progress Report. 耶鲁性别中心的发展:早期进展报告。
Connecticut Medicine Pub Date : 2017-01-01
Christy L Olezeski, Susan D Boulware
{"title":"Development of the Yale Gender Center: An Early Progress Report.","authors":"Christy L Olezeski,&nbsp;Susan D Boulware","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>As the need for comprehensive, affirmative health care for transgender and gender nonconforming youth has increased in recent years, clinical practice has struggled to catch up with evolving standards of care. The Yale Gender Center is an example of an interdisciplinary model of care that addresses not only clinical needs, but also ancillary needs for patients and training opportunities for students across several health disciplines. In this article, we discuss our clinical and training models, lessons learned, and our proposed directions to expand care. It is our hope to not only offer a model for interdisciplinary care among other health care centers, but to be able to learn from missteps and potentially collaborate with other centers in the future.</p>","PeriodicalId":35577,"journal":{"name":"Connecticut Medicine","volume":"81 1","pages":"41-44"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36116244","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
Longitudinal Stress Fracture of the Femur: A Rare Entity. 股骨纵向应力性骨折:罕见病例。
Connecticut Medicine Pub Date : 2017-01-01
Yogesh Kumar, Daichi Hayashi, Kusum Hooda, Lawrence Lo, Ian Karol
{"title":"Longitudinal Stress Fracture of the Femur: A Rare Entity.","authors":"Yogesh Kumar,&nbsp;Daichi Hayashi,&nbsp;Kusum Hooda,&nbsp;Lawrence Lo,&nbsp;Ian Karol","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Exercise-induced stress reactions and stress fractures are common causes of pain in athletes. Although most stress fractures are trans- verse in orientation, rarely longitudinal stress fractures may occur in the tibia and femur. Early detection is important to start prompt and appropriate treatment to prevent complications. Thus, familiarity with the clinical presentation, imaging findings, and treatment of this rare entity are important for proper and timely treatment.</p>","PeriodicalId":35577,"journal":{"name":"Connecticut Medicine","volume":"81 1","pages":"31-33"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36116242","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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