Average Number Of Interventions Research Articles

Characteristics of the most severely ill and injured patients in a Norwegian helicopter emergency medical service: a retrospective cohort study

BackgroundPhysician-staffed helicopter emergency medical services (HEMS) are dispatched to a variety of incidents, ranging from less serious to life-threatening. The skillset of a physician may be important to provide appropriate care for the most critically ill and severely injured patients. A better understanding of these patients may therefore be important to optimize dispatch criteria, training, and equipment setups for HEMS units.The aim of this study was to describe the characteristics of patients with the national advisory committee on aeronautics (NACA) score 5 and 6, primarily by diagnostic group and interventions performed.MethodsRetrospective cohort study on aggregated data from the HEMS-base in Trondheim, Norway. All patients with NACA score 5 and 6 in the 10-year period from 2013 to 2022 were included. Patients with return of spontaneous circulation (ROSC) after successful cardiopulmonary resuscitation were described separately from non-cardiac arrest patients.ResultsOut of 9546 patient encounters, 2598 patients were included, with 1640 in the NACA 5 and 958 in NACA 6 group. Patient age was median 63 (interquartile range 45–74) and 64% of the patients were male. Post-ROSC patients accounted for 24% of patients. Of the non-cardiac arrest patients, the most frequent aetiology was trauma (16%), cardiac (15%), neurologic (14%) and respiratory (11%). The most common physician-requiring advanced interventions were general anaesthesia (22%), intubation (21%), invasive blood pressure monitoring (21%) and ventilator treatment (18%). The mean number of advanced interventions per mission were consistent during the study period (1,78, SD 0,25).ConclusionTwenty-seven percent of all HEMS dispatches were to NACA 5 and 6 patients. Twenty-four percent of these were post-ROSC patients. Sixty-three percent of all patients received at least one advanced physician-requiring intervention and the average number of interventions were consistent during the last 10 years. Hence, the competence a physician-staffed HEMS resource provide is utilized in a high number of critically ill and injured patients.

OTHR-09. The prevalence and complex management of MEK inhibitor induced cutaneous side effects

BACKGROUND: Cutaneous side effects commonly occur with MEK inhibitor (MEKi) therapy and can be challenging to manage. METHODS: A retrospective chart review was performed on sixteen pediatric patients treated with MEKi therapy for at least three months. These patients were diagnosed with either a brain tumor, plexiform neurofibroma, Langerhans Cell Histiocytosis, or Parkes Weber Syndrome (PWS). OBJECTIVES: To describe cutaneous side effects from MEKi therapy, compare the side effect profiles of patients treated for different diagnoses, and compare the side effect profiles between different MEKi agents. RESULTS: The most prevalent cutaneous toxicities for all eligible patients were acneiform rash (81%, most common), paronychia (50%, second most common), hair changes and xerosis. Mean number of cutaneous skin toxicities were 3.2 (trametinib group: 3.4, selumetinib group: 2.8). Only one patient, treated with trametinib for PWS, did not experience a cutaneous side effect. The average number of interventions (new medication or over-the-counter product) recommended to prevent or treat cutaneous-related toxicities was 6.8 per person, the majority of those were for acne and paronychia. Over 75% of the interventions were topical. Of those who experienced an acneiform rash, the average number of recommended interventions were 3.1. Sixty two percent of these patients developed acne within the first cycle; average time to development was 2.6 months into therapy. Most exhibited improvement overtime following intervention. Those patients who experienced paronychia were treated with a mean of 3.1 interventions – 37.5% developed paronychia within the first cycle of therapy; average time to development was 3.9 months into therapy. CONCLUSIONS: Cutaneous side effects are common, occur early in therapy, and require multiple interventions. The number and complexity of these interventions may further complicate the overall management of cutaneous side effects given that the responsibility of the administration falls on the patient. This differs from traditional chemotherapy regimens.

Perspectives from the frontline: A pharmacy department's response to the COVID-19 pandemic.

PurposeThe global coronavirus 2019 (COVID-19) pandemic has created unprecedented strains on healthcare systems around the world. Challenges surrounding an overwhelming influx of patients with COVID-19 and changes in care dynamics prompt the need for care models and processes that optimize care in this medically complex patient population. The purpose of this report is to describe our institution’s strategy to deploy pharmacy resources and standardize pharmacy processes to optimize the management of patients with COVID-19.MethodsThis retrospective, descriptive report characterizes documented pharmacy interventions in the acute care of patients admitted for COVID-19 during the period April 1 to April 15, 2020. Patient monitoring, interprofessional communication, and intervention documentation by pharmacy staff was facilitated through the development of a COVID-19–specific care bundle integrated into the electronic medical record.ResultsA total of 1,572 pharmacist interventions were documented in 197 patients who received a total of 15,818 medication days of therapy during the study period. The average number of interventions per patient was 8. The most common interventions were regimen simplification (15.9%), timing and dosing adjustments (15.4%), and antimicrobial therapy and COVID-19 treatment adjustments (15.2%). Patients who were admitted to an intensive care unit care at any point during their hospital stay accounted for 66.7% of all interventions documented.ConclusionA pharmacy department’s response to the COVID-19 pandemic was optimized through standardized processes. Pharmacists intervened to address a wide scope of medication-related issues, likely contributing to improved management of COVID-19 patients. Results of our analysis demonstrate the vital role pharmacists play as members of multidisciplinary teams during times of crisis.

OP0200 PATIENTS WITH HYPERMOBILITY RELATED DISORDERS HAVE A SIGNIFICANT NUMBER OF ORTHOPAEDIC INTERVENTIONS ON MULTIPLE SITES AND AT A YOUNG AGE: DATA FROM A TERTIARY REFERRAL CENTRE

Background:Mechanisms of pain associated with joint hypermobility are poorly understood and include nociceptive pain from structural joint changes along with soft tissue injuries linked to impaired proprioception; central sensitisation associated with chronic pain and muscle weakness alongside deconditioning. Anxiety and depression are also thought to play a role in patients presenting with pain and hypermobility. We have observed an increase in the rate of orthopaedic surgical procedures undertaken in patients attending the hypermobility clinics compared to those attending the general rheumatology and chronic pain clinics. There is limited published data regarding orthopaedic interventions in patients with hypermobility related disorders especially those with confirmed genetic mutations.Objectives:We aimed to evaluate the characteristics of patients in our hypermobility cohort focusing on those who had received prior surgical intervention in order to understand the underlying mechanism behind their presentations.Methods:A retrospective review of medical records was conducted of patients attending a hypermobility clinic at our tertiary referral centre, University College London Hospital, between January 2018 and December 2018.Results:There were 350 patients (300 females, 50 males) with a mean age of 36 years (range 18-71 years). 63% had a diagnosis of Hypermobility Spectrum Disorder or Hypermobility Syndrome and 37% had a type of Ehlers-Danlos Syndromes (EDS) (hypermobile, classical, vascular or other rare type). 46 patients (13%) had documented genetic mutations. 83 patients (24%) had undergone orthopaedic interventions including 9 who had EDS with confirmed genetic mutations. 54% of patients who had surgical intervention were under the age of 40. The total number of surgical procedures in the cohort was 227 (equating to 0.6485 interventions per patient). Of those requiring operative intervention, the average number of interventions per patient was 2.73. One third of patients had surgery on two or more joint groups, including 8 patients (2%) who had surgery in four or more joint groups. Knees (24%) and hips (23%) were the most common sites for operative intervention with 9% having surgery on their shoulders. 29% of pts had significant hypermobility with a Beighton score of 7 and above but there was no correlation between Beighton score and number of surgical procedures. Only 2% of cases were referred from an orthopaedic team thereby excluding a referral bias.Conclusion:Patients with hypermobility related disorders have a significant number of orthopaedic surgical procedures on multiple sites and at a young age, with indication of mechanical pathology playing an important role in their symptoms. The Beighton score does not appear to be a reliable predictor of surgical intervention. This is not surprising given that the score only covers 5 joint areas and excludes common surgical sites such as the hips and shoulders. Early diagnosis and a holistic non-operative approach combining physiotherapy and chronic pain management is essential to reduce the need for multiple surgical procedures.

Differences in Nutrition Interventions Among Malnourished Hospitalized Patients

Abstract Objectives This study examined how nutrition intervention approach and utilization rate varied by the method of malnutrition risk documentation. Methods 16,669 hospital patient records collected from 4 US hospital systems from January–June 2019 as part of the Malnutrition Quality Improvement Initiative (MQii) Learning Collaborative were analyzed. Nutrition interventions included: enteral nutrition, parenteral nutrition, ONS, feeding assistance, food and nutrition related medical management, nutrition education, counseling, and care coordination. Results Similar numbers of patients were documented as malnourished by nutrition assessment (n = 1087) and medical diagnosis (n = 1186). Only 46% (n = 692) of patients documented as malnourished by assessment or diagnosis received a nutrition intervention. The most frequently used interventions were ONS (n = 854), nutrition education (n = 318), and care coordination (n = 290). 53.1% of patients who received a nutrition intervention received multiple nutrition interventions; the average number of interventions was 2.03. Patients with a physician diagnosis of malnutrition more frequently received parenteral and enteral nutrition (7.75% vs 1.78%, P = 0.0191, and 26.36% vs 7.69%, P < 0.0001, respectively), while patients with malnutrition documented by a registered dietitian more frequently received ONS (82.84% vs 58.14%, P < 0.0001) and counseling (52.66% vs 1.55%, P < 0.0001). Conclusions Utilization of nutrition interventions for patients documented by nutrition assessment and medical diagnosis are quite similar, suggesting a positive level of care coordination exist. Differences in intervention utilization rate and approach are consistent with previous literature showing that physicians diagnose and treat more severely malnourished patients, often through enteral and parenteral nutrition. Future work is needed to investigate the impact of each intervention type separately and combined on patient health and economic outcomes. Funding Sources The MQii is a project of the Academy of Nutrition and Dietetics, Avalere Health, and hospital stakeholders who participated in the collaborative partnership. Abbott provided financial support for MQii development and application.

Management of Subdural Hematohygromas in Abusive Head Trauma.

The optimal management of nonacute subdural fluid collections in infantile abusive head trauma (AHT) remains controversial. To review the outcomes and costs of the various treatments for symptomatic subdural fluid collections in children with AHT at a single center. Our AHT database was queried to identify children requiring any intervention for hematohygromas. Demographic, hospital course, radiologic, cost, readmission, and follow-up information were collected. From January 2009 to March 2018, the authors identified 318 children with AHT, of whom 210 (66%) had a subdural collection of any type (blood or cerebrospinal fluid). A total of 50 required some form of intervention specifically for chronic hematohygromas. The initial management consisted of transfontanelle percutaneous aspiration (n=31), burr holes with (n=12) or without (n=3) external subdural drainage, and mini-craniotomy (n=4). Of those who were initially managed with 1 or more needle aspiration, 23 (74%) required further intervention-12 subduroperitoneal shunts and 11 nonshunt procedures. No patient who underwent burr holes/external drainage required further intervention (n=16). Overall, the average number of interventions needed in these 50 children for definitive treatment was 1.8 (range, 1-4). A total of 15 children ultimately required a subduroperitoneal shunt. Complications (infectious, hemorrhagic, and thrombotic) were significant and occurred in all treatment groups except burr holes without drainage (n=3). The average hospital charge for the entire cohort was $166 300.25 (range, $19 126-$739 248). Based on our experience to date, burr hole with controlled external subdural drainage is an effective and preferred treatment for traumatic hematohygromas; complications and need for additional intervention is low.

A nurse-led paediatric oncology fast-track clinic proves a successful ambulatory intervention for patients.

To assess the impact of a pilot nurse-led paediatric oncology fast-track clinic (OFTC) for complications and side effects following chemotherapy within a paediatric tertiary hospital. Prospective clinical data from the first 100 patients seen in the OFTC were compared with retrospective data of oncology patient presentations to the emergency department (ED) (over a 1-year period, n = 196) who would have been eligible for review in the OFTC. Parent and patient satisfaction of clinical care were also assessed via surveys pre- and post-OFTC implementation. Analysis which achieved statistical difference was a reduction in the number of blood tubes taken in OFTC (average 1.9 for those discharged from clinic, 2.9 for those admitted from clinic) in comparison to those seen in the ED (average 3.2) (p = 0.0027). The average number of interventions per patient seen in the ED were 2.1 (standard deviation 1.64) compared with 1.7 (standard deviation 1.55) interventions per patient seen in the OFTC, and who were not admitted following review. This result approached statistical significance with p = 0.0963. Other results which did not meet statistical significance included a reduction in treatment times, hospital admissions and medical oncology reviews. Our pilot study implementing an OFTC for the triage and assessment of chemotherapy-related complications has proven successful from an operational and consumer perspective. The clinic improved care by ensuring expedited review, more streamlined interventions, and less overall hospital admissions. The improvements in efficiency were also mirrored by increased parent and patient satisfaction.

Use of Nursing Interventions as an Indicator to Assess the Workload of Nurses in a Tertiary Care Surgical Ward Setting in Sri Lanka.

This research looked into the possibility of using the number of Nursing Interventions as a measure of Nurses workload in a Surgical ward setting. The quantification of the number of interventions was done using the Nursing Interventions Classification (NIC). This strategy could generate the average number of interventions required per patient and per shift as well as could assess the variation of the number of interventions under different factors.

Optimal Scene Time to Achieve Favorable Outcomes in Out-of-hospital Cardiac Arrest: How Long Is Too Long?

BackgroundDespite advances in resuscitation science and public health, out-of-hospital cardiac arrest (OOHCA) cases have an average survival rate of only 12% nationwide, compared to 24.8% of cases occurring in hospital. Many factors, including resuscitation interventions, contribute to positive patient outcomes and have, therefore, been studied in attempts to optimize emergency medical services (EMS) protocols to achieve higher rates of return of spontaneous circulation (ROSC) in the field. However, no consensus has been met regarding the appropriate amount of time for EMS to spend on scene.AimA favorable outcome is defined as patients that achieved the combination of ROSC and a final disposition of “ongoing resuscitation in the emergency department (ED).” The primary purpose of this preliminary study was to determine the scene time interval (STI) in which American urban EMS systems achieved the highest rates of favorable outcomes in non-traumatic OOHCAs.MethodsAll EMS-related data, including demographics, presenting rhythm, airway management, chemical interventions, and ROSC were recorded using a standardized EMS charting system by the highest-ranking EMS provider on the ambulance. The reports were retrospectively collected and analyzed.ConclusionOur data suggest that the optimal 20-minute STI for OOHCA patients in an urban EMS system is between 41 and 60 minutes. Interestingly, the 10-minute interval within the 41-60 minute cohort that provided the highest rate of ROSC was between 41 and 50 minutes. Generally, the longer the STI, the greater the percentage of favorable outcomes up to the 50-minute mark. Once past 50 minutes, a phenomenon of diminishing return was observed and the rates of favorable outcomes sharply declined. This suggests a possible “sweet spot” that may exist regarding the optimal scene time in a cardiac arrest encounter. Significant differences between the average number of interventions per patient were found, however, many confounding factors and the limited data set make the results difficult to generalize.

Abstract No. 141 - Management of central venous stenosis in hemodialysis patients: comparison of outcomes with the Hemodialysis Reliable Outflow (HeRO) graft versus stenting

To evaluate outcomes of HeRO graft placement and compare its efficacy to central venous stenting in hemodialysis patients with recalcitrant central venous stenosis. We performed a retrospective review of hemodialysis patients who underwent HeRO graft placement or stenting for central venous stenosis between January 2010 and September 2016. The fraction of patients requiring no further intervention, the post-intervention primary lesion patency and number of interventions per patient year for both groups were analyzed. We identified 29 patients with a total of 30 HeRO graft placement procedures. Two patients with no follow-up information after graft placement were excluded from this study. One patient whose HeRO graft was removed due to infection had a repeat HeRO graft placement. We also identified 14 patients who underwent stenting for their central venous stenosis. At the time of this interim analysis, in the HeRO group, 16/28 (57%) were still patent with no further intervention after the graft placement, with a mean follow-up time of 582 days (± 532). In the stent group, 4/14 (28%) were still patent with no further intervention after stenting, with a mean follow up of 579 days (± 371). Among patients requiring an intervention, mean post-intervention primary lesion patency for the HeRO graft (N = 12) was 479 days versus 332 days for the stent group (N = 10). The average number of interventions per patient year for the HeRo and stent groups were 1.4 and 2.3, respectively. Student’s t-test for post-intervention primary lesion patency and number interventions per year for the two groups showed no statistically significant differences (p-values: 0.115 and 0.401, respectively). For the stent group, mean number of intervention per year for covered stent (N = 4) was 0.43 versus 2.12 for non-covered stent (N = 10). Our preliminary analysis of this ongoing study shows no statistically different outcome in patients treated with the HeRO graft versus stenting for central venous stenosis. HeRO is a viable option for hemodialysis patients with recalcitrant central stenosis who are non-surgical candidates for AV fistula.

Virtual Breakthrough Series, Part 2: Improving Fall Prevention Practices in the Veterans Health Administration

The Veterans Health Administration (VHA) implemented a Virtual Breakthrough Series (VBTS) collaborative to help prevent falls and fall-related injuries. This project enabled teams to expand program infrastructure, redesign improvement strategies, and enhance program evaluation. A VBTS collaborative involves prework, action, and continuous improvement. Actions included educational calls, monthly reports, coaching, and feedback. Evaluation included assessment of interventions, team capacity and infrastructure changes, and rates of falls and fall-related major injuries. Fifty-nine teams completed the project. The majority submitted monthly reports. The average number of interventions per team was 6.66 (range, 1-12; mode = 6). The most frequently implemented changes were staff education; post-fall huddles; data tracking; and classifying falls, handoff communication, and intentional rounding. On a program questionnaire aggregated average summary scores improved from 136.54 (baseline) to 58.26 (follow-up; range, 0-189; p < 0.0001). The mean aggregated fall-related major injury rate for participants decreased from 6.8 to 4.8 per 100,000 bed-days of care (p = 0.02), or 5 major injuries avoided per month. No statistically significant changes occurred for nonparticipants. The mean aggregated fall rate did not change significantly from baseline to follow-up for participants (p = 0.42) or nonparticipants (p = 0.21). Teams submitted reports and implemented changes resulting in decreased major injuries related to falls for participating units. Teams also made changes in their fall prevention programs such as classifying how they analyze falls and implementing injury reduction strategies. The approaches used show promise for reducing fall-related harm for inpatients, as well as assisting teams in implementing changes.

Problems, interventions and outcomes of the Omaha system in nursing clinical practice

Hepatic pancreatic biliary diseases are very common in gastroenterology. The issue of implementing the standardized terminology of the Omaha system in the Czech Republic has not been studied so far.The goal of the study was to identify the problems, interventions and the results of clients with a chosen gastroenterology problem according to the Omaha system in clinical nursing practice. The study used the quantitative method of documentation forms of the Omaha system with the author's permission. The studied sample group was composed of 23 clients who had a hepatic pancreatic biliary disease.The number of documented difficulties according to the Problem Classification Scheme was from 3 to 10, where 10% covered the environmental domain, 20% covered the psychological domain, 40% covered the physiological domain and 30% covered the domain of health-related behaviour. In total, there were 274 interventions. The average number of interventions was 11.9 per client. While mapping the interconnections of problems and interventions, most interventions occurred in the category of treatments and procedures (35.4%) and surveillance (31.8%). A very low number of interventions occurred in the category of teaching, guidance, counselling (18.2%), and case management (14.6%). The intervention in treatments and procedures category dominated in pain problem (35.5%), digestion – hydration (45.3%), skin (93.8%) and circulation (62.9%). Case management was used in substance use (50%) and nutrition (31.7%). After comparing the initial results to the final results, there was significant improvement in the knowledge and status regarding individual problems.The results of the study present the pilot experience with the implementation of the Omaha system in a selected group of clients. The most common problems of clients with hepatic pancreatic biliary disease were in the physiological domain and the health-related behaviour domain according to the Problem Classification Scheme of the Omaha system. More frequently, the problems were associated with the interventions in the treatments and procedures and surveillance categories. The interventions were less frequent in teaching, guidance and counselling and case management. Using a Problem Rating Scale for Outcomes an improvement in knowledge and status in individual problems was found. For future studies, we recommend verifying the components of the Omaha system using a larger number of respondents.

Impact of a pharmacist-led oral chemotherapy-monitoring program in patients with metastatic castrate-resistant prostate cancer.

With the introduction of oral chemotherapy, the paradigm for cancer treatment is shifting. Use of oral chemotherapy agents offers a non-invasive option for patients with metastatic castrate-resistant prostate cancer. However, these medications are not without challenges including strict adherence for optimal effects, novel toxicity profiles, frequent lab parameter monitoring, high cost, and proper handling and disposal methods. Pharmacists are positioned to play a key role in providing patients with the education required to assure an optimal treatment course is carried out. Two cohorts of patients receiving abiraterone, bicalutamide, or enzalutamide for metastatic castrate-resistant prostate cancer seen in our outpatient cancer center 21 months before and 24 months after the implementation of a pharmacist-led oral chemotherapy-monitoring program in December of 2012 were retrospectively compared. Patients were evaluated for number of interventions, adherence to lab parameter monitoring, and overall time on each therapy. Of the 64 patients identified, 31 patients fulfilled inclusion criteria. A significant increase in the average number of interventions per patient (6.9 vs. 2.6; P = 0.004) and adherence to lab parameter monitoring (10 vs. 3; P = 0.04) in the post-program implementation cohort was found. However, no significant difference in overall time on therapy (10.3 vs. 8.1; P = 0.341) between the two groups was observed. These results suggest a potential opportunity exists to maximize oral chemotherapy treatment outcomes with the addition of a formalized monitoring program directed by an oncology pharmacist.

Localisation and Types of Cosmetic Medical Treatments - Correlation with Demographic Characteristics of Serbian Clients

Abstract There is a growing number of cosmetic medical treatments in the Balkan region. Yet, this trend has not been closely observed in terms of the correlation between procedure characteristics and clients’ sociocultural and psychological characteristics. The aim of this cross-sectional/retrospective research is to establish the correlation of types of cosmetic procedures with basic sociodemographic characteristics of clients in Serbia. Each of 144 study subjects underwent a cosmetic treatment (320 in total) within the first three months of 2014, while the study was being conducted. The sample included 5 male and 139 female subjects, with the age range of 17-71 (38.87±10.722). Peaks of interventions have been detected in subjects aged 31-35 and 36-40; more frequently those were individuals with a higher level of education and their motive most commonly was of aesthetic nature. The majority of the subjects (44.44%) underwent only one intervention, while the average number of interventions per subject within the period of three months was 2.21±1.40. Face interventions were considerably higher in number than others, with a rising trend with age. The number of procedures in the area of the abdomen, breasts and thighs, rose with the increase of a body mass index. The most popular treatments included removal of stretch marks and fillers, mesotherapy and botulinum toxin. Due to ever-growing sociocultural pressure and a modern concept of life, women often decide on cosmetic therapy at the first sign of ageing and hormonal changes, with a downward age trend especially with respect to minimally invasive procedures, as well as the most visible body parts, the face in the first place.

Three-year review of pharmacy students’ interventions and activities in an outpatient teaching family medicine center

ObjectiveAdditional justification of the value of pharmacy students in outpatient settings is needed, as interventions have primarily been documented in the acute care setting. This study describes the clinical interventions and activities of fourth-year pharmacy students working under the supervision of one pharmacy practice faculty member in an outpatient teaching family medicine setting over a three-year period. MethodsStudents at this site see patients for individual appointments with the pharmacist, see patients with resident physicians, and perform medication reconciliation activities. All clinical interventions and activities documented by pharmacy students in a web-based system under the supervision of one pharmacy faculty member from 2011–2013 were analyzed. ResultsIn the three-year study period, 5439 interventions and 1645 activities were documented at this practice site by 39 pharmacy students. The average number of interventions per student was 139.5 and the average number of activities was 42.2. The most commonly documented interventions were patient medication histories, patient counseling, and drug therapy adjustments/discontinuations/initiations. The total estimated potential cost savings/avoidance was $602,022, which equates to $15,436 per pharmacy student. ConclusionPharmacy students performed a wide range of clinical interventions and activities in an outpatient family medicine center. Pharmacy students can have a significant impact on patient care in this setting and may contribute to significant cost avoidance. These data may be useful to schools of pharmacy, as they pursue the development of additional outpatient training sites.

Implementation and outcomes of a pharmacy managed clinic for veterans in a substance abuse residential rehabilitation treatment program

ABSTRACT Purpose: The purpose of this study is to evaluate the impact of a newly implemented pharmacy managed service in a Substance Abuse Residential Rehabilitation Treatment Program (SARRTP) within a Veterans Medical Center setting. Patients receiving residential treatment may have a lapse in primary care services if their primary care provider is based out of a different facility. This can result in undesirable outcomes, including unnecessary emergency department (ED) visits or unaddressed medical needs. Additionally, these patients have often made significant lifestyle modifications that can have a major impact on the treatment of their chronic medical conditions. A pharmacy-managed clinic was created for these patients to provide medication therapy management as appropriate within the scope of a pharmacist. Methods: A retrospective chart review was performed using the Computerized Patient Record System to assess outcomes of the newly implemented pharmacy managed clinic for SARRTP patients. Institutional Review Board approval was obtained prior to data collection. Outcomes assessed included number of ED visits before and after clinic initiation, as well as number and type of pharmacist interventions. Fisher's exact test was used to determine statistical significance, defined as p&amp;lt;0.05. Results: Thirty-seven patients were seen in a total of 46 clinic visits over a period of six months. ED visits had a statistically significant decrease of 27.9% following clinic initiation (p&amp;lt;0.05). There was an average of 4.3 problems assessed per patient. Average number of interventions per patient was 2.7 with an average of 3.5 educational topics documented. Conclusion: ED visits decreased significantly following clinic initiation, resulting in cost savings. Multiple interventions were made through this new clinical service to improve Veteran care. Lifestyle modifications made by this patient population often require therapy adjustments and education to optimize care. This type of innovative clinical service would likely be beneficial for other facilities to consider providing.

Recurrent Laryngeal Papillomatosis, Juvenile and Adult: 1990‐2010

Objective: Laryngeal papillomatosis is a rare disease, benign, recurrent, with potential for malignancy according to viral type and aggravating factors. Its high recurrence raises different therapeutic modalities. Here we review our experience in 20 years on behavior and type of performed treatment. Method: A descriptive study of a cohort of patients of the University Complex Hospital to Vigo (CHUVI) from January 1990 to December 2010 with papilloma and recurrent respiratory papillomatosis. Results: We found 37 cases, 4.35 incidence rate per million population per year, average age 49 years, 81.1% males, 71% history of smoking, 51.4% had symptoms years before the first consultation, 33.3% settled on right vocal cord, 64.9% treated with CO2 laser, 51.5% histology compatible with human papilloma virus, 6 cases became viral typing, 4 positive and 100% HPV type 11. A total of 47.2% relapsed, the average number of interventions was 5 times per patient, 18.9% malignant and none of them had HPV study, 13.8% laryngectomy was performed, until the time of study 43.3% cured and 10% in remission. Conclusion: In our area, laryngeal papillomatosis is a rare disease, more common in middle-aged men with malignant potential and frequent relapses. It is important to study HPV monitored closely and cessation of toxic habits after surgery. It is necessary to seek alternative therapies.

Long-Term Results of Angioplasty and Stent Placement for Treatment of Central Venous Obstruction in 126 Hemodialysis Patients: A 10-Year Single-Center Experience

The objective of our study was to report and compare long-term results of percutaneous transluminal angioplasty and stenting of central venous obstruction in hemodialysis patients. Hemodialysis patients who underwent successful endovascular treatment of central venous obstruction were retrospectively evaluated. Stenotic lesions greater than 50% or inducing extremity swelling were subject to treatment. The primary treatment was angioplasty, and stent placement was accomplished in angioplasty-resistant obstructions. Angioplasty was the primary treatment of recurrence after stent placement. Additional stenting was reserved for angioplasty-resistant recurrences. One hundred forty-seven veins in 126 patients (63 males, 63 females) between 15 and 82 years old primarily underwent 101 angioplasties and 46 stent placements. The mean follow-up was 22.1 +/- 16.3 (SD) months. The average number of interventions per vein in the stent group (2.7 +/- 2.4 interventions) was significantly higher than that in the angioplasty group (1.5 +/- 1.0 interventions). Primary patency was significantly higher in the angioplasty group (mean, 24.5 +/- 1.7 months) than that in the stent group (mean, 13.4 +/- 2.0 months). Assisted primary patency of the angioplasty group (mean, 31.4 +/- 2.0 months) and that of the stent group (mean, 31.0 +/- 4.7 months) were equivalent. The overall mean primary patency was 21.1 +/- 1.4 months, and the overall mean assisted primary patency was 31.7 +/- 2.5 months. There were no significant differences in patency rates with regard to patient sex, the type of stent used, the vein or veins treated, or the type of lesions. Endovascular treatment of central venous obstruction is a safe and effective procedure in hemodialysis patients. Stenting has a significantly lower primary patency rate than angioplasty but adds to the longevity of vein patency in angioplasty-resistant lesions; therefore, stent placement should be considered in angioplasty-resistant lesions.

Accelerated treatment for early and late postpneumonectomy empyema

Background. Postpneumonectomy empyema is a rare but serious complication of pneumonectomy. Despite use of various therapeutic approaches and techniques during the last five decades, successful therapy remains difficult and is often associated with high morbidity and prolonged hospitalization. Methods. We evaluated a concept for accelerated treatment, which consists of radical debridement of the pleural cavity and packing with wet dressings of povidone-iodine. This was repeated in the operating theater every second day, until the chest cavity was macroscopically clean. If present, bronchial stump insufficiency was closed and secured by omentopexy. Finally, the pleural space was obliterated with antibiotic solution. Results. Twenty patients, 13 with early postpneumonectomy empyema (10 to 89 days; mean, 37 days) and 7 with late postpneumonectomy empyema (124 to 7,200 days; mean, 1,126 days) were treated. Fifteen patients presented with bronchopleural fistula (11 right, 4 left), which developed after chemotherapy (n = 6) or after radiotherapy (n = 3) (unknown cause in 4 patients). Six patients were referred after previously unsuccessful surgical attempts. Pleural cultures were positive in 17 cases for one or several bacteria including fungoides (n = 2). The average number of interventions was 3.5 (3 to 5). The chest was definitively closed in all patients within 8 days. Mean hospitalization time was 17 days (7 to 35 days). During the same hospitalization, 2 patients needed reoperation because of an undetected bronchopleural fistula. Postpneumonectomy empyema was successfully treated in all patients. There was no in-hospital or 3-month postoperative mortality. Conclusions. Repeated surgical debridement combined with closure of bronchopleural fistula and antimicrobial therapy enables successful treatment of early and late postpneumonectomy empyema within a short period and is a well-tolerated concept.

The efficacy of intrapartum fetal surveillance when fetal pulse oximetry is added to cardiotocography

Objective: To determine if oxygen saturation measurement with pulse oximetry (Spo2) in combination with cardiotocograghy (CTG), improves the assessment of the intrapartum fetal condition. Study Design: Four expert obstetricians individually evaluated 119 cases that were monitored during labor: during the first session the CTG data were available, and in the second session CTG and Spo2 data were evaluated. They were instructed to indicate the need for intervention and to estimate the umbilical artery pH. Results: In the non-acidotic group (umbilical artery pH≥7.15, n=112) the average(±S.D.) number of interventions decreased from 27(±17) to 16(±9) when Spo2 was available. This reduction in number of interventions resulted in an significantly increased specificity for two referees. In the acidotic group (n=7) the average number of interventions also decreased, from 6(±2) to 4(±2), and as a consequence the sensitivity decreased. The pH estimate based on CTG+Spo2 was higher in both acidotic and non-acidotic fetuses than the estimated pH based on CTG alone. Conclusion: In this study all referees intervened less frequently when Spo2 was used as an adjunct to CTG. This resulted in fewer unnecessary operative interventions, but may also lead to unidentified fetal acidosis. The number of acidotic newborns (n=7) was too small, however, to draw definite conclusions. Larger studies should address the efficacy of Spo2 in detecting fetal compromise before clinical use can be advocated.© 1997 Elsevier Science Ireland Ltd.