Accurate Medical History Research Articles

Evaluation of the clinical pharmacist services at a gynaecological oncology preadmission clinic

BackgroundPharmacists working in the multidisciplinary gynaecological oncology pre-admission clinic (PAC) are involved in the perioperative assessment of patients for a comprehensive medication history and information provision regarding withholding of medications before surgery. ObjectiveTo evaluate the current services provided by pharmacists to multidisciplinary staff and patients attending the PAC. MethodsA staff and a patient feedback survey on the value and impact of PAC pharmacy services were distributed within the PAC. The impact of the PAC pharmacist was also assessed by analysing pharmacist interventions and key performance indicators documented. ResultsFifteen staff responses were recorded, 5 nursing staff, 2 midwives and 8 anaesthetists. Eighty-seven percent (n = 13) strongly agreed or agreed that pharmacists at PAC help reduce medication errors on admission. Staff strongly agreed 73% (n = 11) pharmacists obtain a more accurate medication history. Staff reported benefits in having a pharmacist at the clinic to discuss medication related questions with 87% (n = 13) strongly agreeing or agreeing with the statement. A staff overall satisfaction rating of 4.87 out of 5 was recorded. In the patient survey, respondents (n = 6) gave a 4.83 out of 5 rating in confidence in making changes to their medication and their overall satisfaction with the service provided. In reviewing data from January to June 2022, the number of patients seen by the pharmacist were 178 of 681 patients (26.1%) who attended the clinic. The most common medications involved in the pharmacist intervention include those that were advised to be withheld and those that required other changes to therapy prior to their procedure. ConclusionThe role of a PAC pharmacist can be greatly appreciated by the multidisciplinary team and patients. Pharmacist interventions and key performance indicators have demonstrated the important activities of clinical pharmacy services in the PAC in optimising patient care in medication management.

Clear Cell Carcinoma Gall Bladder: Mimicker of Xanthogranulomatous Cholecystitis

The incidence of clear cell carcinoma of gall bladder is very low. The mean age of diagnosis is 60 years. The potential cause of clear cell carcinoma of gall bladder has been shown to be associated with gallstones. It is difficult to determine that clear cell morphology is due to metastasis, notably from clear cell renal cell carcinoma or whether these are primary tumor of the gall bladder. We report a case of clear cell carcinoma of the gall bladder in a 56-year-old female, who presented with abdominal discomfort along with pain and bloating that was aggravated mainly after the meal, with an aim to emphasize the importance of taking an accurate medical history in patients with clear cell carcinoma, a rare malignant tumor of the gall bladder.

Impact of pharmacist interventions provided in the emergency department on quality use of medicines: a systematic review and meta-analysis

BackgroundPharmacists have an increasing role as part of the emergency department (ED) team. However, the impact of ED-based pharmacy interventions on the quality use of medicines has not been well...

Drug-Induced Liver Injury in Paediatrics: A Short Review

Drug-induced liver injury (DILI) is an under-recognized cause of paediatric liver disease. Although DILI in children accounts for about 1% of all reported adverse drug reactions throughout all age groups and less than 10% of all clinical DILI cases, it is responsible for about 20% of acute liver failure (ALF) cases. A wide range of drugs, herbal products and nutritional supplements have been associated with the development of DILI through dose-dependent, idiosyncratic or indirect mechanism. Limited literature is available in pediatric population, making DILI a still challenging diagnosis. An accurate medical history is of pivotal importance and should investigate about drug consumption, clinical and laboratory findings, individual and family risk factors for drug-related side effects or comorbidities, the timing of the injury onset after the implicated agent has been started (latency). Clinical presentation of DILI varies from asymptomatic or very mild to serious and sometimes fatal conditions; laboratory tests may be helpful in ruling out other causes of liver injury but, with few exceptions, they are aspecific. Early suspicion and prompt withdrawal of the offending drug play a key role for a successful management of most cases.
 Rarely a specific therapy is available, as for acetaminophen toxicity, treated with N-acetylcysteine, and sodium valproate toxicity, where carnitine may be beneficial. Although controlled trials are not available yet, corticosteroids and ursodeoxycholic acid can be considered if no improvement is proven after discontinuation of drug.
 The present short review is not intended to deal with all aspects concerning DILI but to focus on epidemiology, pathogenesis, clinical features, practical management and current challenges in paediatric age.

Effects of a pharmacy-driven medication history program on patient outcomes.

Obtaining an accurate medication history is a vital component of medication reconciliation upon admission to the hospital. Despite the importance of this task, medication histories are often inaccurate and/or incomplete. We evaluated the association of a pharmacy-driven medication history initiative on clinical outcomes of patients admitted to the general medicine service of an academic medical center. Comparing patients who received a pharmacy-driven medication history to those who did not, a retrospective stabilized inverse probability treatment weighting propensity score analysis was used to estimate the average treatment effect of the intervention on general medical patients. Fifty-two patient baseline characteristics including demographic, operational, and clinical variables were controlled in the propensity score model. Hospital length of stay, 7-day and 30-day unplanned readmissions, and in-hospital mortality were evaluated. Among 11,576 eligible general medical patients, 2,234 (19.30%) received a pharmacy-driven medication history and 9,342 (80.70%) patients did not. The estimated average treatment effect of receiving a pharmacy-driven medication history was a shorter length of stay (mean, 5.88 days vs 6.53 days; P = 0.0002) and a lower in-hospital mortality rate (2.34% vs 3.72%, P = 0.001), after adjustment for differences in patient baseline characteristics. No significant difference was found for 7-day or 30-day all-cause readmission rates. Pharmacy-driven medication histories reduced length of stay and in-hospital mortality in patients admitted to the general medical service at an academic medical center but did not change 7-day and 30-day all-cause readmission rates. Further research via a large, multisite randomized controlled trial is needed to confirm our findings.

Role of a hospital pharmacist in cardiac day procedure ward: a prospective observational study

Abstract Background The cardiac day procedure ward provides peri-procedural care to elective patients attending hospital for a broad range of diagnostic and interventional cardiac catheterisation procedures. In this acute setting, changes to patients' medication regimen can often occur, however patient-completed questionnaires are often inaccurate.1,2 Australian standards recommend that an accurate medication history be obtained, and medication reconciliation performed for all patients.3 A plan for cessation and restarting of relevant medications should also be documented.1 However, the role of a pharmacist in this setting has not been widely studied. Purpose The aim of this study is to evaluate the role of a pharmacist in a cardiac day procedure ward and identify patient groups who may benefit from a pharmacist medication review. Methods A prospective, observational study was conducted over 5 weeks (24/2/20–27/3/20) in a cardiac day procedure ward at a major tertiary referral centre, in a multi-site Australian metropolitan hospital network. An 8-hour per day clinical pharmacy service was provided to the ward, which is open approximately 12 hours per day. Results In the study period, 297 patients presented to the ward, and 79% (234/297) received a pharmacist medication review (a systematic assessment of a patient's medication management to optimise treatment outcomes). Elective day procedures were planned for 247 patients, and in 74% (182/247) a pharmacist documented a best possible medication history (comprehensive list of a patient's prescription and non-prescription medicines using two or more information sources). Medication-related problems were identified in 51 patients, with the majority (79%, 70/89) in patients presenting for coronary angiography. 93% (83/89) of interventions were accepted after discussion with the hospital resident medical officer or interventionalist. The remainder (7%, 6/89) were not enacted as further monitoring of vital signs or cardiologist follow-up was needed. Following their procedure, 155 patients returned to the ward for recovery. A specific plan for continuation, cessation or restarting of medications post-procedure was initially documented for 16% (25/155) of patients by catheterisation laboratory staff, and increased to 90% (140/155) with pharmacist medication review. Prescriptions for medications changes were required in 25% (38/155) of patients, and prescription medication counselling was provided by the pharmacist for all patients. Conclusion Pharmacists can optimise medication management of patients in cardiac day procedure wards by obtaining an accurate medication history, identifying medication related problems, and documenting a post-procedure medication plan; particularly for patients presenting for coronary angiography. While this study supports the embedding of a clinical pharmacy service in cardiac day procedure wards, more research is needed to fully elucidate the impact on patient outcomes. Funding Acknowledgement Type of funding sources: None.

Plantar Injuries in Runners: Is There an Association With Weekly Running Volume?

Running is an athletic activity that is increasingly gaining popularity. Despite its benefits, there are many suspected risk factors for running-related overuse injuries. The objective of this study is to describe injuries and clinical symptoms observed on the sole of the foot in runners, giving special attention to the weekly running volume. The literature presented in this narrative review is based on a non-systematic search of the Medline, Google Scholar, and ResearchGate databases and focuses on foot injuries (the full spectrum of the foot pathology from bones to tendons and plantar fascia, nerve, and joint disorders) in runners, which represents an important topic for both professional and recreational runners. The weekly running distance appeared to be one of the strongest predictors for future overuse injuries. Marathon training and average weekly running of over 20 km are possible predictive factors in the development of plantar foot injuries. The plantar medial aspect of the foot is the anatomic area of the foot that most frequently experiences pain, with numerous pathologic conditions. As a result, diagnosis is always a challenging task. The ability to obtain an accurate medical history and carefully perform a physical examination, together with good knowledge of the foot anatomy and kinesiology, are also proven to be key players in ensuring proper diagnosis.

Characteristics and Risk Factors of Recurrent Epistaxis in Geriatric Patients

Background and Objectives Recurrent epistaxis requiring emergency department (ED) visits results in increased morbidity in the elderly and associated with high health care costs. This study is to analyze the frequency and characteristics of epistaxis patients in the elderly and to find out the risk factors and effective treatment for recurrent epistaxis. Subjects and Method We studied retrospectively the clinical cases of 977 emergency patients and 155 patients, aged over 65, for the treatment of epistaxis during the last 10 years from January 2008 to January 2018. The group A, comprised of 95 patients (68.29%), was treated with an initial treatment. The group B, which comprised of 60 patients (38.71%), visited for re-bleeding following an initial treatment. Results Patients made 2 to 10 ED visits due to re-bleeding and 32 of the 60 patients (53.5%) visited twice. The electrocauterization was the most common (61.7%) for treatment method during rebleeding, followed by posterior packing (18.3%). The factors that increases the risk of recurrent epistaxis are anticoagulants, posterior epistaxis, anterior packing, inefficient ED packing. There was no correlation between comorbidities and rebleeding. Conclusion Accurate medical history taking of anticoagulants may enable personnel to provide more effective management of these patients. The most important factors in the failure of primary care were not being able to find the precise area of bleeding and ineffective packing during the initial treatment. Therefore, it is important that we must carefully check the areas using the endoscope to decrease the failure of initial treatment of epistaxis.

Health systems turn to inventive methods to document OTCs in the EHR

What was once a relatively small selection of OTCs has expanded into more than 80 classes of OTC medications at any given pharmacy. However, this convenience is not without its drawbacks. Discrepancies in hospital OTC documentation can pose a substantial risk to patient safety, such as drug–drug interactions, accidental drug duplication, and unforeseen drug–disease complications. These risks are compounded when hospital providers are not aware of a patient's OTC usage, causing harm that often propagates throughout a patient's hospitalization, even after discharge. In recognition of this growing concern, the National Association of Chain Drug Stores Foundation convened a summit in October 2016 of several industry stakeholders to establish basic guidelines for the advancement of OTC integration into hospital electronic health records (EHRs) through the creation of an OTC medication tracking system—similar to the process utilized for prescription medication tracking through insurance metadata. However, the guidance that resulted from this summit is vague and unconstructive—a far cry from the Joint Commission's National Patient Safety Goals, for instance. It begs the question if progress has been made on any of these goals. In general, there is a common feeling among hospital pharmacists that limited progress has been made on the integration of OTC medications into EHRs, and even less on creating a universal OTC metadata registry. “Electronic health records oftentimes do not even include options for providers to add OTC medications,” said Edgar Peñaloza, PharmD, a clinical pharmacy specialist at Ascension Sacred Heart Bay Medical Center in Panama City, FL. “Since they are not commonly administered during inpatient stays, OTCs may not be entered into an EHR simply because the EHR program itself will not allow the medications to be entered in as a discrete identifier within the system.” Peñaloza went on to explain that if an OTC medication is added to a patient's medication administration record, the system does not recognize it. Oftentimes, it necessitates adding the medication through the EHRs “non-formulary” process. But profiling the medication this way bypasses the EHRs ability to run the medication through interaction programs that can help ensure patient safety. Peñaloza listed examples such as Kratom and cannabidiol-containing agents, which may consist of varying ingredients affecting a patient's response to drug therapy. The ability to have EHRs automatically integrate a patient's OTC history is a complex, multifaceted obstacle, with virtually no obvious solutions. While broadscale industry leadership may have failed to make meaningful progress on tracking OTC medication use within EHR systems, some national health systems, such as the Ascension hospital system, have been attempting to tackle the issue on their own. Ascension, one of the largest private health care systems in the United States has recently piloted a telehealth medication history program within its Texas hospital network to facilitate the accurate recording of all newly admitted patient's medications, whether prescriptions, OTCs, nutraceuticals, or herbal supplements. A review of this pilot program was published by McGinnis and colleagues in the Journal of the American Pharmacists Association in 2019. By using videoconferencing equipment installed on mobile computer carts stationed in the ED, Ascension employed highly trained, pharmacy technicians. These technicians interviewed patients about all of the medications they were taking in order to minimize as many discrepancies as possible when transferring them over to the EHR. According to McGinnis and colleagues, “The motivation for this program was the inconsistent and ineffective use of [hospital] resources to reliably conduct accurate medication histories, demonstrated by the sharp decline in medication history completion rates after removal of the site-based ED technicians and institution of a nurse-driven program.” After Ascension's pilot program was initiated, medication history completion rates continued to improve significantly. An exploratory analysis of this pilot program demonstrated pharmacy technicians were both more accurate and efficient when performing medication histories. Hopefully, as telehealth continues to permeate deeper into the clinical sphere, novel approaches to solving the safety issues of a dubious inpatient OTC medication history will continue to manifest themselves. It may have not been the exact solution hoped for, but it is certainly a step in the right direction.

Medical Record Aggregation Using Blockchain Technology

Healthcare domain and a reliable method to store every patient’s data record securely by keeping protection of privacy in mind are considered to be one of the major concerns in the field of study and implementation. An efficient decentralized system for control accessed interoperability of transactions or data between the owner (patient) and the healthcare practitioner is required. This would also ensure a complete and accurate medical history of the patient and allow the full use of it by the health organization as well. The rise in blockchain technology has enabled to build the needs to bridge the gap between the patient and practitioner to securely store and utilize personal data digitally. This paper is a study on proposed implementations and a scope of those medical health aggregation methods have been discussed along with an idea to improve the existing system. A two-level access-controlled mechanism of the patient’s private medical record and granting the requested access or transfer of ownership properties to the practitioner in any chain of a hospital is proposed. Hence, a decentralized, automatically verifiable, transparent and immutable smart e-healthcare card medical records aggregation system could be designed using the Hyperledger Sawtooth framework built on the blockchain technology platform. Three algorithms are being proposed to ensure an atomic transaction - Proof of Work (PoW), Byzantine Fault Tolerance (BFT) and Asymmetric Cryptography (like RSA) algorithm. The aim is to implement the proposed model and strive towards the scope of betterment in the field of healthcare. The health data is planned to be stored in a format like Electronic Health Records (EHR).

Laparoendoscopic Management of Colonic Trichobezoar Causing Acute Large Bowel Obstruction in an Adolescent Girl

Laparoendoscopic Management of Colonic Trichobezoar Causing Acute Large Bowel Obstruction in an Adolescent Girl

A prospective assessment of the Medicaid Web portal for admission medication reconciliation at a community hospital in Montana.

Medication reconciliation (MR) is a complicated and tedious process but is crucial to prevent errors when ordering patients' discharge medications during a hospital admission. Our institution currently uses a variety of methods to gather a patient's medication history, including review of the medical records and electronic pharmaceutical claims data (EPCD) from a commercial health information exchange organization, as well as a patient or caregiver interview. Occasionally, more information is needed to obtain the most accurate history. To augment current methods, EPCD can also be accessed for patients with Medicaid insurance using a state Medicaid Web portal. We aimed to evaluate the utility of the Medicaid Web portal for reducing medication errors during the MR process at hospital admission. A single-center, prospective, quality improvement initiative was conducted to evaluate 100 patient medication lists for all nonobstetric Medicaid patients admitted to our institution to identify discrepancies in medication lists when the state Medicaid Web portal was used in addition to standard MR methods. We found that, when EPCD from commercial organizations were available, they matched the patient's current medication list 64% of the time. One in 4 patients had at least 1 discrepancy on their verified medication list that was identified using the Medicaid Web portal. The discrepancies identified were addressed and corrected in real time to improve patient care. EPCD from the state Medicaid Web portal could supplement the use of current methods to obtain a more accurate medication history and reduce the number of erroneously ordered discharge medications during hospital admission.

Succinct Approach to Delirium in the Emergency Department

Purpose of ReviewThis study aims to provide a concise delirium review for practicing emergency medicine providers using the Assess, Diagnose, Evaluate, Prevent, and Treat (ADEPT) framework.Recent FindingsDelirium is a form of acute brain dysfunction that results in significant mortality and morbidity for older emergency department (ED) patients. Delirium is frequently missed by healthcare providers, but monitoring for this syndrome using brief delirium assessments may improve recognition. Once delirium is diagnosed, emergency medicine providers’ primary goal is to perform a comprehensive history and physical examination to uncover the underlying etiology for delirium. This includes obtaining history from a collateral historian and obtaining an accurate medication history. If posssible, emergency physicians (EPs) should treat the medical etiology that precipitated the delirium. If agitated, non-pharmacologic interventions such that minimize the use of tethers are preferred. Pharmacologic agents such as antipsychotic medications should be used as a last resort.SummaryDelirium is a common geriatric emergency and requires the EP to assess, diagnose, evaluate, prevent, and treat. Delirium is a key geriatric syndrome that geriatric ED providers should routinely screen for. A strong emphasis is on the widespread use of delirium screening, followed by prevention and treatment efforts.

Towards OPtimising Care of Regionally-Based Cardiac Patients With a Telehealth Cardiology Pharmacist Clinic (TOPCare Cardiology)

Cardiovascular disease is a major burden on the health of Australians, and cardiac health disparities exist for those who live outside of metropolitan areas. Poor patient medication literacy was identified by cardiologists at a regional Victorian health service as a barrier to medication optimisation and a factor in inefficiency in their service. Studies in Australia and overseas have shown pharmacists involved in multi-disciplinary and pre-admission models result in more accurate medication histories, increased patient medication knowledge and lower medication related adverse events. This study introduced a telehealth cardiology pharmacist clinic, with the primary aim of reducing cardiologist time gathering medication information and secondary aims of investigating the patient and cardiologist experience. A cardiology pharmacist clinic was introduced where a pharmacist undertook a consultation with a patient in the days preceding their appointment with their cardiologist. The primary outcome of this study was to determine whether a cardiology pharmacist consultation undertakenprior to a cardiologist consultation reduces the time spent by the cardiologist gathering medication information. This was measured via direct observation of cardiologist consultations with and without a prior cardiology pharmacist clinic consultation. Descriptive and inferential statistics were performed to assess differences in time spent gathering the patient's medication information by the cardiologist. The secondary outcomes included differences between: the total length of cardiologist consultations, the number of cardiologist appointments with a medication uncertainty, and attendance rates for cardiologist consultations with and without a prior cardiology pharmacist clinic consultation. Other secondary outcomes included a quantitative survey assessing patient satisfaction with the pharmacist consultation, satisfaction with telehealth, confidence in medication management. Finally, clinician perceptions of the value of the pharmacist consultation were explored via semi-structured interviews. The time spent gathering medication information immediately before, and during, the cardiologist appointment reduced from 4.66 minutes without a prior cardiology pharmacist clinic consultation to 0.66 minutes with a prior cardiology pharmacist clinic consultation (difference 4 min, 95% CI: 3.27-4.77 p≤001). There was a 4.1-minute reduction in the mean consultation length of the cardiologist appointment if a cardiology pharmacist clinic consultation occurred prior (95% CI: 1.9-6.3, p<0.001). There were zero medication uncertainties (0/44) in the cardiologist appointment when the patient had a cardiology pharmacist clinic consultation compared to 51% (22/43) when no cardiology pharmacist clinic consultation had occurred. Patients with a cardiology pharmacist clinic consultation had a 5% (17/340) 'did not attend' (DNA) rate for their next cardiologist appointment. Patients who did not have a cardiology pharmacist clinic consultation had a 24% (202/855) DNA rate to their next cardiologist appointment. There was 100% patient satisfaction with the consultation provided by the cardiology pharmacist (100/100) and telehealth was considered an acceptable mode of delivery by 99% (95/96) of patients. Patients expressed an increase in their confidence to discuss their medications with their cardiologist (84% [81/96]). Benefits described by the clinicians whose patients received the service were greater confidence and ability to make treatment decisions within consultations, as well as improved patient health literacy. A cardiology pharmacist consultation undertaken prior to a cardiologist consultation reduced the time spent by the cardiologist gathering medication information. Importantly, it reduced medication uncertainty in cardiologist consultations which clinicians indicated provided them with greater confidence and ability to make treatment decisions within consultations. Patients who undertook a cardiology pharmacist clinic consultation were more likely to attend their cardiologist consultation, reducing wasted appointments. Patients were highly satisfied with the cardiology pharmacist consultation and considered telehealth an acceptable mode of delivery.

Accuracy and safety of medication histories obtained at the time of intensive care unit admission of delirious or mechanically ventilated patients.

PurposeObtaining an accurate medication history from patients on hospital admission is a priority in pharmacy practice. Timely and accurate histories are imperative as they may help determine the etiology of illness and prevent medication errors. We conducted a quality improvement project to assess the accuracy of alternate-source medication histories obtained for critically ill patients who were delirious or mechanically ventilated at the time of intensive care unit admission.MethodsIncluded patients were 18 years of age or older, admitted to the medical intensive care unit from August 2017 through January 2018, and had a medication history obtained from a family member or outpatient pharmacy due to active delirium or mechanical ventilation. Patients were directly interviewed after resolution of delirium or extubation. Discrepancies between the initial and follow-up histories were documented and categorized using the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) Index for Categorizing Medication Errors.ResultsForty patients were included. One hundred four discrepancies were documented, with a median of 2 discrepancies per patient. The most common types of discrepancies were addition (51.9%), followed by omission (24.0%). NCC MERP index category A (51%) was the most common error classification identified.ConclusionDiscrepancies between initial and follow-up medication histories occurred at a frequent rate in delirious or mechanically ventilated patients; however, these discrepancies tended to be of low risk severity.

Identifying Potential High-Risk Medication Errors Using Telepharmacy and a Web-Based Survey Tool.

Obtaining patient medication histories during emergency department (ED) admissions is an important step towards identifying potential errors that could otherwise remain in the patient's active medication list. This is a descriptive report of a standardized, electronic data collection tool created to document potential medication errors in patients receiving high-risk medications during ED admissions. Trained pharmacy technicians completed a survey following medication history collection using a secure web platform called REDCap®. Data collected included patient-specific information, the number and type of high-risk medications, and potential medication errors identified in the collection process. During a pilot period of April 2019 to October 2020, 191 patient records were completed using the survey tool. Out of a total of 1088 medications recorded, 41% were considered high-risk medications. 42% of potential medication errors were classified as high-risk medication errors. Results from this survey tool demonstrated that 58% of high-risk medication orders could potentially result in a medication error that can be carried through patient admission and discharge. Accurate medication history and transitions of care can significantly impact patient quality of life. The cost of addressing a medication related-adverse event is also substantial. Based on published reports, annual gross savings to a hospital is estimated to be $4532 per harmful error in 2020, after adjusting for inflation. This equated to approximately $1,182,852 in estimated savings for Ascension Texas in 18 months. Nationwide, preventing potential medication errors in an outpatient setting can save on average $3.5 billion per year. This web-based survey tool has improved the quality and efficiency of potential error identification during medication history collection by pharmacy technicians. This information can be easily retrieved and aid in discussions regarding medication reconciliation at the leadership level and impact patient treatment outcomes by developing virtual processes that may result in fewer medication related events.

Presbylarynx: Is It a Sign of the Health Status of the Elderly?

Only a full understanding of how different diseases affect the same or different anatomical/functional entities, may provide a clue on how comorbidity should be taken into consideration. The aim of this study was to evaluate the chronic medical illnesses of an elderly population, in order to analyze potential correlation of specific comorbidities with presbylarynx. This case-control, prospective, observational, and cross-sectional study was carried out on consecutive subjects observed by otorhinolaryngology, in a tertiary center, from January to September 2020. The inclusion criteria were ability to report an accurate medical history and ≥65 years of age. The exclusion criteria were neurologic diagnoses, autoimmune disease, history of thoracic or head and neck surgery, cancer, radiotherapy, thyroid pathology, vocal fold mass lesions, acute laryngitis, or vocal fold paralysis. Based on videostroboscopy of the larynx, the patients were subdivided into two main groups: presbylarynx versus no presbylarynx. Health status was assessed by evaluation of chronic medical illnesses (individual diagnoses of chronic conditions plus Charlson comorbidity index [CCI]), functional status (Katz index of independence in activities of daily living and functional Ambulation ambulation classification), and emotional status (Geriatric Depression Scale). A total of 174 subjects (60 males; 114 females) were included (mean age=73.99 years; range 65-95 years). Presbylarynx was identified in 71 patients (41%). A statistically significant difference was found concerning diabetes mellitus type 2 (T2DM); P< 0.001), asthma or chronic obstructive pulmonary disease (COPD; P< 0.001), and psychiatric disorder (P< 0.001). The mean score of CCI between "presbylarynx" and "no presbylarynx" groups was statistically different (P= 0.021). Results showed an association between some functional dependence (P< 0.001), and mild or severe depression (P< 0.001) and the presence of presbylarynx. Presbylarynx may be considered a sign of the health status of the elderly. Based on CCI, It was found that patients with higher probability of 10-year mortality exhibit more endoscopic signs of presbylarynx. It was also found that patients with better scores in functionality scales exhibited less endoscopic findings compatible with presbylarynx. Among chronic medical illnesses, T2DM, asthma, or COPD may be considered risk factors for noticeable endoscopic signs of presbylarynx.

Malignant hyperthermia: a case report with good outcome.

Malignant hyperthermia: a case report with good outcome.

The Use of Decision Trees for Analysis of the Epilepsy

Due to the rapid development of artificial intelligence (AI) technologies, the medical system knows a permanent improvement in the doctor-patient relationship that has undergone a long and unproductive transition throughout the ages. Nowadays, the smart systems focused on how to obtain an accurate and detailed medication history for each patient. The purpose of this paper was to develop a method that can produce a disease profile based on the decision trees algorithm, taking into account medical reports made along years for different patients from all over the world. It is well known that in the medical decision making there are many situations where decision must be made rapidly, rigorously and efficiently. In the paper we present the basic characteristics of decision trees and the successful alternatives to the traditional induction approach with the emphasis on existing and possible future applications in biomedicine domain.

Quality Improvement Incorporating a Feedback Loop for Accurate Medication Reconciliation.

Medication reconciliation errors on hospital admission can lead to significant patient harm. A pediatric intermediate care unit initiated a quality improvement project and aimed to reduce errors in admission medication reconciliation by 50% in 12 months. From August 2017 to December 2018, a multidisciplinary team conducted a quality improvement project with plan-do-study-act methodology. Continuous data collection was achieved by reviewing medications with home caregivers within 18 hours of admission to identify errors. Cycle 1 consisted of nursing training in accurate and thorough medication history documentation. Cycle 2 was aimed at improving data collection. Cycle 3 was aimed at improving pediatric housestaff processes for medication reconciliation. In cycle 4 intervention, the reconciliation process was redesigned to incorporate the bedside nurse reviewing final medication orders with the patient's home caregivers once the medication reconciliation process was complete. Intermittent maintenance data collection continued for 12 months thereafter. Cycle 1 and 2 interventions resulted in improvement in the medication reconciliation error rate from 9.8% to 4.7%. In cycle 2, the data collection rate improved from 61% to 80% of admissions sustained. Cycle 3 resulted in a further reduction in the medication error rate to 2.9%, which was sustained in cycle 4 and over the 12-month maintenance period. A patient's number of home medications did not correlate with the error rate. Reductions in admission medication reconciliation errors can be achieved with staff education on medication history and process for medication reconciliation and with process redesign that incorporates active medication order review as a closed-loop communication with home caregivers.