Chart Recorder Research Articles

Anesthesia for muscle biopsy to test susceptibility to malignant hyperthermia

IntroductionMalignant hyperthermia is an autosomal dominant pharmacogenetic disorder, characterized by hypermetabolic crisis triggered by halogenated anesthetics and/or succinylcholine. The standard method for diagnosing malignant hyperthermia susceptibility is the in vitro muscle contracture test in response to halothane-caffeine, which requires muscle biopsy under anesthesia. We describe a series of anesthetic procedures without triggering agents in malignant hyperthermia, comparing peripheral nerve block and subarachnoid anesthesia. MethodWe assessed the anesthetic record charts of 69 patients suspected of malignant hyperthermia susceptibility who underwent muscle biopsy for in vitro muscle contracture in the period of 7 years. Demographic data, indication for malignant hyperthermia investigation, in vitro muscle contracture test results, and surgery/anesthesia/recovery data were analyzed. ResultsSample with 34±13.7 years, 60.9% women, 65.2% of in vitro muscle contracture test positive. Techniques used: peripheral nerve blocks — lateral femoral and femoral cutaneous, latency 65±41min — (47.8%); subarachnoid anesthesia (49.3%), and total venous anesthesia (1.4%). There was 39.4% failure of peripheral nerve block and 11.8% of subarachnoid anesthesia. Adverse events (8.7%) occurred only with subarachnoid blockade (bradycardia, nausea, and transient neurological syndrome). All patients remained in the post-anesthesia care unit until discharge. Age and weight were significantly higher in patients with blockade failure (ROC cut-off point of 23.5 years and 59.5kg) and blockade failure was more frequent in the presence of increased idiopathic creatine kinase. ConclusionAnesthesia with non-triggering agents has been shown to be safe in patients with malignant hyperthermia susceptibility. Variables such as age, weight, and history of increased idiopathic creatine kinase may be useful in selecting the anesthetic technique for this group of patients.

The effect of factors related to periodontal status toward peri-implantitis.

To investigate the association between periodontal status and peri-implant diseases in patients with osseointegrated dental implants of different implant systems. This cross-sectional study evaluated 200 consecutive implant patients using clinical and radiographic examinations during periodontal maintenance visits. The demographic data and treatment history were obtained from history taking and chart record review. The association between periodontal status and peri-implant diseases was analyzed using chi-square and logistic regression analysis. Patients with a history of chronic periodontitis had a significantly higher prevalence of peri-implantitis compared with those without a history of periodontal disease (25% vs. 10.9%). The highest prevalence of peri-implantitis was observed in patients with a history of severe chronic periodontitis. Data analysis revealed that peri-implant health status was significantly associated with past periodontal status, maintenance status, and present periodontal status. However, multivariate analysis indicated that only a history of chronic periodontitis was significantly associated with peri-implantitis (adjusted OR=2.55, 95% CI 1.14-5.70, p=0.02). Patients with a history of chronic periodontitis, especially those with severe periodontal disease had a 2.5-fold increased risk of peri-implantitis.

Increasing Prevalence of Chronic Hepatitis C Virus Infection in a Southern Academic Obstetrical Clinic.

The opioid epidemic has resulted in rising rates of hepatitis C virus (HCV) infection in women of childbearing age. With this changing epidemiology in mind, the Infectious Diseases Society of America/American Association for the Study of Liver Diseases guidelines were updated in 2018 to recommend screening all pregnant women for HCV infection, irrespective of risk factors. Because HCV infection can affect maternal-fetal health and result in vertical transmission, presentation for pregnancy-related medical care represents an opportunity to diagnose and manage HCV infection, as well as prepare for treatment postpartum. We performed a retrospective chart review spanning 2007-2016 to examine the epidemiology of HCV infection and opioid use disorder in a southern academic obstetrical clinic and to explore the impact of new screening guidelines if implemented. Composite data from the electronic health record and individual chart review were used to determine rates of HCV infection and opioid use disorder in obstetrics, explore patient demographics, and examine perinatal outcomes. Rates of both opioid use disorder and chronic HCV infection increased significantly during the 10-year period of analysis. Patients diagnosed as having chronic HCV infection were primarily white (95%) and there was no observed impact of HCV on perinatal outcomes. HCV testing in pregnancy, even when patients had documented opioid use disorder, was infrequent (0.7% of all pregnancies). Documented follow-up for HCV postpartum for both mothers and infants was incomplete, with only one-third of identified HCV-exposed infants referred and only 9% receiving HCV testing at our institution. HCV prevalence increased between 2007 and 2016, but screening and treatment of HCV in this southern obstetrical cohort was infrequent. The implementation of universal screening in pregnancy will likely identify additional cases, and an improved cascade of care will be necessary to address the HCV epidemic.

THE EFFICIENCY OF MONITORING OF QUALITY OF TREATMENT OF PATIENTS IN OPTHALMOLOGIC SURGERY CLINIC

The purpose of study. To investigate efficiency of systematic monitoring of quality of treatment of patients in the ophthalmologic surgery clinic, its impact on minimization of number of cases of deviance from treatment standards. Materials and methods. The continuous statistic observation technique was applied to analyze outcomes of surgical operations and courses of treatment on one or both eyes simultaneously in 126,258 patients implemented in the Khabarovsk branch of the inter-branch scientific and technical complex «S.N. Fedorov Microsurgery of eye» during 2012-2016. The evaluation was applied to maintenance of treatment technology and functional result. The assessment of quality of maintenance of medical documentation was implemented during analysis of 108,143 medical patient records and record charts of patients completed treatment in the Branch during 2012-2016. The results were evaluated by 5 point scale. The assessment of satisfaction of patients by quality of medical care was implemented using anonymous questionnaire survey by evaluation scale. during analyzed period 2000 questionnaires were filled out. Results. During treatment, in the most of patients (99.1%) a maximal clinical result was achieved (10 or 12 points). The deviance from standard of clinical result of treatment was established in 0.9%. The monitoring of assessment of quality of treatment of patients with subsequent clinical analysis permitted to decrease rate of deviance from standard of clinical result of treatment during analyzed period up to 21.1%; rate of intra-operational complications - up to 63.6%. The results of systemic analysis of defects of maintenance of primary medical documentation permitted to decrease their number up to 1.5 times. The degree of satisfaction with quality of treatment according the sampled sociological questionnaire surveys of treated patients turned out high - 99.7%. Conclusion. The single system of assessment of quality of treatment of patients developed in the inter-branch scientific and technical complex «S.N. Fedorov Microsurgery of eye» permits to support a high level of treatment care provision and to detect on-the-fly defects of diagnostic examination and failures in technologies of treatment.

The application of register of patients with diabetes mellitus for verifying causes of death

The register of patients with diabetes mellitus is appropriate to implement for specification of diagnoses of death of persons registered in this registry. The new version of "The record chart of registration and monitoring of patient with diabetes mellitus" increased information value of register for verifying causes of death at the expense of adding indices of organization of observation of diabetes mellitus and concretization of complications of diabetes mellitus. The information concerning development of complications of diabetes mellitus including the forms the most dangerous for life is very important for rectifying chain ofpathological conditions resulted in death and as a consequence proper determination of initial cause. However, a number of informational and organizational problems are to be resolved to implement information about patients with diabetes mellitus (and other chronic diseases) with purpose of verifying causes of death. First, it is reasonable to make information of specialized registers available to medical specialists providing medical care related to other diseases. The easiest way of searching patient in various registers and data bases is on the basis of one’s personal number of insurance certificate and individual taxation number. The application of two authenticators increases validity of the system of medical information interchange. Second, corrections are to be made in register ofpatients with diabetes mellitus. To correct the record chart of striking individuals with diabetes mellitus off the register can be implemented by two ways. One, to leave empty fields in column "immediate cause of death" and to add subsection "initial cause of death" transferring points of subsection 3.5 to the new subsection. Two, to substitute name of subsection 3.5 with "initial cause of death". Hence, the column "diseases that favored coming of death" is unnecessary in the register of patients with diabetes mellitus.

Anestesia durante biópsia muscular para teste de suscetibilidade à hipertermia maligna

IntroductionMalignant hyperthermia is an autosomal dominant pharmacogenetic disorder, characterized by hypermetabolic crisis triggered by halogenated anesthetics and/or succinylcholine. The standard method for diagnosing malignant hyperthermia susceptibility is the in vitro muscle contracture test in response to halothane‐caffeine, which requires muscle biopsy under anesthesia. We describe a series of anesthetic procedures without triggering agents in malignant hyperthermia, comparing peripheral nerve block and subarachnoid anesthesia. MethodWe assessed the anesthetic record charts of 69 patients suspected of malignant hyperthermia susceptibility who underwent muscle biopsy for in vitro muscle contracture in the period of 7 years. Demographic data, indication for malignant hyperthermia investigation, in vitro muscle contracture test results, and surgery/anesthesia/recovery data were analyzed. ResultsSample with 34±13.7 years, 60.9% women, 65.2% of in vitro muscle contracture test positive. Techniques used: peripheral nerve blocks — lateral femoral and femoral cutaneous, latency 65±41minutes — (47.8%); subarachnoid anesthesia (49.3%), and total venous anesthesia (1.4%). There was 39.4% failure of peripheral nerve block and 11.8% of subarachnoid anesthesia. Adverse events (8.7%) occurred only with subarachnoid blockade (bradycardia, nausea, and transient neurological syndrome). All patients remained in the post‐anesthesia care unit until discharge. Age and weight were significantly higher in patients with blockade failure (ROC cut‐off point of 23.5 years and 59.5kg) and blockade failure was more frequent in the presence of increased idiopathic creatine kinase. ConclusionAnesthesia with non‐triggering agents has been shown to be safe in patients with malignant hyperthermia susceptibility. Variables such as age, weight, and history of increased idiopathic creatine kinase may be useful in selecting the anesthetic technique for this group of patients.

Medtronic Carelink 2090 Programmer

Waters was project manager responsible for the design, development and manufacture of the Medtronic CareLink™ programmer. The programmer is a specialised medical computer able to communicate with implanted cardiac devices e.g.: pacemaker, defibrillator, or cardiac resynchronization. It was the worlds first FDA approved programmer to do this. The programmer had to be fully portable, water-resistant and lightweight. It had to enable Consultants to interact with technical experts who could be based anywhere, worldwide. The programmer had to allow real-time viewing of its screen at a location that had a personal computer with Remote View software. Human factors requirements were crucial to the success of this product. The programmer has a large, bright, movable screen providing a wider viewing angle and allowing the screen to be read from greater distances. The screen is three times brighter than previous programmers and can be read by several people simultaneously. The programmer has a built-in keyboard, a three-speed chart recorder, provides single-handed paper loading and is twice the speed of previous programmers. Waters applied his research and product development expertise in medical product development to this project. This was essential to the success of this project. He developed his expertise in cross-cultural collaboration to assist the development of techniques to enable teams from companies across Europe, Asia and the USA to work in close cooperation on real-time federated databases, despite the teams working across several time zones. This research has significantly benefited CfDR’s InSTeP and CMI ERDF projects. Waters research into human factors, specifically in relation to hand held medical product development has augmented the CfDR’s expertise in human centred design. The Medtronic Carelink programmer has been presented in papers at conferences around the world, including the, UK Design Conference Tokyo, 2003, British Council Exhibition Singapore 2005, British Council Design Lecture series, Bangkok 2007

Propensity-Matched Survival Analysis of Upper Urinary Tract Urothelial Carcinomas between End-Stage Renal Disease with and without Kidney Transplantation.

Urothelial carcinoma is the most common cancer following kidney transplantation (KT) in Taiwan. Unusual presentation of upper urinary tract urothelial carcinoma (UTUC) is noted in Taiwan and China. As the post-KT-UTUC oncological course is not fully understood, the aim of this study is to identify postulated significant differences for the clinical cancer course of UTUC among end-stage renal disease (ESRD) patients with and without KT. From 2005 January to 2016 March, 194 ESRD patients underwent radical nephroureterectomy due to UTUC in our hospital. The parameters were obtained from the chart record and pathology report. SPSS version 21 software was used for all statistical analyses. Unequal matching created study groups wherein a 0.2 caliper width was performed for adjusting these confounding pathological factors. Propensity score-matching cohort was performed for each population first, and then for all the study patients. We observed that the average age of UTUC in ESRD patients after KT was younger than in those without KT. The pathological factors such as stage, bladder cancer history, papillary structure, lymphovascular invasion, and variant histology were equal in these two groups. However, younger onset (p<0.001), more multifocal tumors, and carcinomas in situ were observed in post-KT UTUC (p<0.001 and 0.006, respectively). After adjustment of pathological factors by propensity score-matched analysis, the 5-year systemic UTUC recurrence was significantly more in ESRD after KT compared with ESRD without KT (p=0.03). No obvious difference in 5-year cancer related death could be observed between these two groups (p=0.314). Post-kidney transplantation upper urinary tract urothelial carcinoma in Taiwan is relatively common, has younger onset, and is associated with aggressive pathological features. The oncologic outcome of UTUC after KT is poor in our observation, even after propensity scored-matched analysis. It indicates the immunosuppression status is still associated with more malignant UTUC behavior.

Bordetella pertussis Infection in Infants and Young Children in Shanghai, China, 2016-2017: Clinical Features, Genotype Variations of Antigenic Genes and Macrolides Resistance.

The global resurgence of pertussis in countries with high vaccination coverage has been a concern of public health. Nasopharyngeal swabs were collected for Bordetella pertussis culture from children with suspected pertussis. Clinical and vaccination information were reviewed through electronic medical chart and immunization record. Antibiotics susceptibility was evaluated using E-test for erythromycin, azithromycin, clarithromycin and sulfamethoxazole/trimethoprim. The MLST genotypes and 7 antigenic genes (ptxP, ptxA, ptxC, Prn, fim3, fim2 and tcfA) of Bordetella pertussis were identified by polymerase chain reaction amplification and sequencing. During January 2016 to September 2017, a total of 141 children 1-48 months of age were culture-confirmed with pertussis, of whom 98 (69.5%) were younger than 6 months, 25 (17.7%) had completed at least 3 doses of DTaP and 75 (53.2%) had a clear exposure to household members with persistent cough. Fully vaccinated cases manifested milder disease than unvaccinated and not-fully vaccinated cases. All strains were MLST2. High-virulent strains characteristic of ptxP3/prn2/ptxC2 constituted 41.1% (58/141) and were all susceptible to macrolides while low-virulent strains characteristic of ptxP1/prn1/ptxC1 constituted 58.9% (83/141) and 97.6% (81/83), respectively, were highly resistant to macrolides. Pertussis is resurging among infants and young children in Shanghai, and household transmission is the main exposure pathway. The high-virulent strains harboring ptxP3/prn2/ptxC2 and the macrolide-resistant Bordetella pertussis strains are quite prevalent. These issues impose a public health concern in Shanghai. Our findings are important to modify the DTaP vaccination strategy and the management guideline of pertussis in China.

The effect of emergency department crowding on lung-protective ventilation utilization for critically ill patients

ObjectiveTo measure effects of ED crowding on lung-protective ventilation (LPV) utilization in critically ill ED patients. MethodsThis is a retrospective cohort study of adult mechanically ventilated ED patients admitted to the medical intensive care unit (MICU), over a 3.5-year period at a single academic tertiary care hospital. Clinical data, including reason for intubation, severity of illness (MPM0-III), acute respiratory distress syndrome (ARDS) risk score (EDLIPS), and ventilator settings were extracted via electronic query of electronic health record and standardized chart abstraction. Crowding metrics were obtained at 5-min intervals and averaged over the ED stay, stratified by acuity and disposition. Multivariate logistic regression was used to predict likelihood of LPV prior to ED departure. ResultsMechanical ventilation was used in 446 patients for a median ED duration of 3.7 h (interquartile ratio, IQR, 2.3, 5.6). Mean MPM0-III score was 32.5 ± 22.7, with high risk for ARDS (EDLIPS ≥5) seen in 373 (82%) patients. Initial and final ED ventilator settings differed in 134 (30.0%) patients, of which only 47 (35.1%) involved tidal volume changes. Higher percentages of active ED patients (workup in-progress) and those requiring eventual admission were associated with lower odds of LPV utilization by ED departure (OR 0.97, 95%CI 0.94–1.00; OR 0.97, 95%CI 0.94–1.00, respectively). In periods of high volume, ventilator adjustments to settings other than the tidal volume were associated with higher odds of LPV utilization. Reason for intubation, MPM0-III, and EDLIPS were not associated with LPV utilization, with no interactions detected in times of crowding. ConclusionsED patients remain on suboptimal tidal volume settings with infrequent ventilator adjustments during the ED stay. Hospitals should focus on both systemic factors and bedside physician and/or respiratory therapist interventions to increase LPV utilization in times of ED boarding and crowding for all patients.

Proton pump inhibitor use is associated with elevated faecal calprotectin levels. A cross-sectional study on subjects referred for colonoscopy

Objectives: Faecal Calprotectin (FC) is a sensitive marker for gut inflammation. However, slightly elevated FC levels are also common in subjects without inflammation. We investigated the association between FC and clinical factors including concomitant use of medical therapy in patients with a normal colonoscopy.Material and methods: Out-patients (n = 1263) referred for colonoscopy, performed FC test (CALPRO) the day before the start of bowel preparation. All subjects answered questionnaires that included questions on the present and past health history, concomitant medical treatment and gastrointestinal symptoms (GSRS). A medical record chart review was performed to check for concomitant disease, cause of referral and the result of the colonoscopy including biopsies. Inclusion criteria were a normal colonoscopy. Exclusion criteria were inflammatory bowel disease, colon cancer and high-grade dysplasia.Results: Five hundred ninety subjects fulfilled the inclusion criteria and completed the study. Thirty-six per cent of the subjects had a FC >50 µg/g. In a logistic regression analysis, age (adjusted OR: 1.051; CI: 1.032–1.071), and the use of proton pump inhibitors (adjusted OR: 3.843; CI: 2.338–6.316), non-steroid anti-inflammatory drugs (adjusted OR: 2.411; CI: 1.162–5.002) and acetylsalicylic acid (adjusted OR: 2.934; CI: 1.085–3.448) were significantly associated with an elevated FC (>50 µg/g).Conclusions: More than one-third of the patients with a normal colonoscopy performed in clinical routine had a slightly elevated FC level. Our results emphasise the need for attention to age, the use of proton pump inhibitors, non-steroid anti-inflammatory drugs and acetylsalicylic acid in the interpretation of FC tests in clinical practice.

Maternal HIV infection and preeclampsia increased risk of low birth weight among newborns delivered at University of Gondar specialized referral hospital, Northwest Ethiopia, 2017

IntroductionGlobally, more than 20 million infants are born with low birth weight. The risk of neonatal mortality among low birth weight infants is 25 to 30 times greater than neonates with birth weight ≥ 2500 g. Low birth weight infants are at increased risk of infection, difficulty of feeding, and neurologic problems following birth. So far, the prevalence and factors associated with low birth weight have not been studied in the study area after completion of the time set for millennium development goals. Therefore, the study was aimed at assessing the prevalence and associated factors of low birth weight among newborns delivered at University of Gondar specialized referral hospital, Northwest Ethiopia, 2017.MethodsInstitution-based retrospective cross-sectional study was conducted from April 1 to May 28, 2017. A total of 240 newborns were included in the study. Systematic random sampling technique was used for selecting study participant’s medical record charts from delivery registration log book. Data were collected using data extraction tool. Binary logistic regression followed by multivariable regression model was fitted and interpretation was made based on the adjusted odds ratio and p-value of less than 0.05 with corresponding 95% CI.ResultsThe prevalence of low birth weight was 12.9% (95%CI: 8.94, 17.83%). No history of preeclampsia (AOR = 0.193, 95%CI: 0.0516, 0.723), negative maternal HIV infection (AOR = 0.015, 95%CI: 0.001, 0.277), and being preterm (AOR = 17.6, 95%CI: 5.18, 60.17) were significantly associated with low birth weight.Conclusion and recommendationsThe result of this study highlighted that the burden of low birth weight is a public health concern among babies delivered in University of Gondar specialized referral Hospital. Maternal HIV infection, preeclampsia, and prematurity were associated with low birth weight. Prevention and treatment of Human immunodeficiency virus infection during pregnancy, tackling prematurity and prevention of preeclampsia through strengthening of antenatal care service and other comprehensive strategies are strongly recommended.

Spatial Frailty Survival Model for Multidrug-Resistant Tuberculosis Mortality in Amhara Region, Ethiopia.

Tuberculosis (TB), a disease caused by Mycobacterium tuberculosis (MTB), is the main cause of death. It disproportionally affects those living in the different regions of countries and within the region. The aim of this study was to examine spatial variation of mortality and the risk factor of death on multidrug-resistant tuberculosis patients treated in different MDR-TB hospitals of Amhara region. The data for this study was used from multidrug-resistant tuberculosis patients' record charts and analyzed using STATA software. The result of this study shows that 61 (29.47%) of the patients died, and the rest, 146 (70.53%), of the patients were censored at the time of the study. Out of 207 MDR-TB, 146 (70.53%) were males and 61 (29.5%) were females. This study revealed that there was no heterogeneity for death in patients treated in different hospitals. Older patients, therapeutic delay, alcohol use, any clinical complication previously not treated, HIV coinfection, and presence of any chronic disease were the risk factors that influenced the death of multidrug-resistant tuberculosis patients.

A Project to Improve Postpartum Depression Screening Practices Among Providers in a Community Women’s Health Care Clinic

ObjectiveThe purpose of this project was to improve health care providers’ postpartum depression (PPD) knowledge and screening practices with the implementation of a standardized screening tool. DesignThe plan–do–study–act model was used as a framework to measure and implement a practice change aimed at universal screening for PPD. Setting/Local ProblemHealth care providers’ screening practices for PPD were inconsistent and lacked use of a standardized screening tool at a southwestern U.S. community women’s health care clinic serving minority women of lower socioeconomic status. ParticipantsHealth care providers at a community women’s health care clinic. Intervention/MeasurementsA single educational in-service was presented to health care providers regarding preventive PPD screening practices and documentation recommendations. Measurements included pre- and post-education questionnaire results and electronic health record chart reviews. ResultsPPD screening documentation rates increased from 56% to 92.7% (p < .5). ConclusionPPD screening education for health care providers and the addition of EPDS criteria to the electronic health record were associated with increased screening rates for PPD at a community women’s health care clinic.

Comparative Nursing Study of Patients Undergoing Coronary Intervention Therapy in Different Ways

Purpose: To compare the surgical indicators, perioperative complications and postoperative psychological status of patients with coronary interventional therapy (CIT) by radical artery and femoral artery puncture approaches. Methods: 120 patients with CIT were divided into femoral artery group (FAG) and radial artery group (RAG) according to the operation ways. The interventional operation was performed by the same surgeon team and methods. Data of surgical indicators and perioperative complications were recorded and collected. The psychological questionare survey was made within 48 hours the after surgery by the hospital anxiety and depression scale (HAD), and the results were scored by the psychiatrist. Results: The age, sex, ethnicity, education level, disease type, and combined diseases of the two groups had homogeneity without statistical difference. There was no obvious difference in X-ray exposure time, contrast agent usage and operation time in two ways (P > 0.05). The success rate of one-time catheterization was higher in FAG than in RAG (P < 0.05). However, the incidence of vascular complications such as subcutaneous hematoma, puncture site bleeding in RAG were significantly lower than those in FAG (P < 0.05). Complications of vascular and puncture site bleeding, the operative limb braking time and hospitalization time were longer in FAG than those in the RAG (P < 0.05).The postoperative anxiety and depression question are data analysis showed patients in both groups had obvious higher anxiety and depression scores compare to Chinese norm. Even though there was no difference on anxiety scores of the patients in two groups, but the depression scores showed that patients in the FAG were more prone to psychological depression than patients in the RAG. Combined with the clinical nursing requirements, the postoperative nursing record charts of patients with CIT were established according to general patient data and physical discomfort with high incidence in the above survey results. Conclusion: CIT via radial artery can reduce the incidence of postoperative complications, postoperative physical discomfort and psychological problems such as anxiety and depression of patients.

“Hidden fluid” in the critically ill patient: A wake-up call

Background and Aim: Fluid overload and unfavorable outcomes in critically ill patients have been demonstrated in many clinical settings, such as acute lung injury/acute respiratory distress syndrome, septic patients, and those with acute kidney injury. Fluid overload has been reported in up to 70% of patients admitted to the intensive care unit (ICU). Fluid optimization strategies are often used to prevent fluid overload. Less obvious sources of fluid intake are often overlooked. The aim of this study was to determine the contribution of intravenous medications to daily fluid intake and balance in our ICU. Methodology: We conducted a retrospective study on adult patients admitted to the ICU of the University College Hospital, Ibadan, from January to December 2015. Daily ICU record charts were reviewed to determine the sources and volumes of various fluids for the study patients. Fluid other than intravenous fluid, enteral feeds, and blood/blood products were categorized as hidden fluid. These were mainly intravenous medications. Data were analyzed using the Statistical Package for the Scientific Solutions Version 20. Results: A total of 286 patients were admitted during the study year. There were 26 nonadults (≤16 years) excluded, and the records of 74 patients were not available. The mean daily volume of drug solutions (473.4 ml) was about 16% of the mean daily intake (2846.1 ml). The percentage of hidden fluid was highest in the neurology group (26.7%). No group had

THE NEED FOR IMPLANT DENTISTS TO KNOW ABOUT THE METHOD OF FORENSIC HUMAN IDENTIFICATION USING DENTAL IMPLANTS

The aim of this study is to present two cases in which dental implants greatly enhanced the forensic human identification and to show the important role of the implant dentist in this process. The skeletonized remains of two victims with dental implants were sent for exams. The morphological features (qualitative) and linear measurements (quantitative) of the implants were analyzed in the ante-mortem and postmortem radiographs. The points of coincidence observed in both the implants and teeth showed compatibility of findings that led the experts to determine the positive identification. The implants found in the bodies were decisive in the process of identification. This identification was only possible because the implant dentists presented complete documentation with good technical quality, enabling an efficient expert approach to comparison of the data. Therefore, it is important to make implant dentists aware of this significant role because they may be asked by the authorities or family members of the deceased to present a complete record chart.

Outcomes among pregnant recently incarcerated women attending a reentry transitions clinic.

This mixed methods retrospective case series and qualitative descriptive study describes pregnancy outcomes during the postincarceration period. A retrospective case series via electronic medical record chart review from a subset of women attending a postincarceration primary care clinic with a condition of interest (pregnancy) described demographics, substance use, diagnoses, and pregnancy outcomes. We compared 27 pregnant to 79 nonpregnant women and contextualized quantitative data with qualitative descriptive vignettes. Twenty-seven women completed 29 pregnancies (2 women with 2 deliveries each), all of which were unplanned; there were 11 live births, 8 pregnant at study closure, 7 miscarriages, and 3 terminations. Although substance use history was high, rates were higher among nonpregnant women (92%vs 74%). Among the 5 births, 4 tested positive for substance use during pregnancy. All 11 infants had pregnancy or delivery complications. Although 7 of the 10 pregnant women with live births had prior pregnancy complications, only 4 were placed in a special care obstetrics clinic. Although unplanned pregnancies were common, most births did not demonstrate maternal substance use. All live births had pregnancy or delivery complications, but few were accepted to specialist prenatal care, suggesting potential considerations for recently incarcerated women.

Golden Hour Protocol for Preterm Infants: A Quality Improvement Project.

Preterm infants are a vulnerable patient population, especially during the first hours of life. Hypothermia, hypoglycemia, and early-onset sepsis are common problems related to prematurity. Implementation of a Golden Hour protocol has been shown to improve outcomes for preterm infants. To evaluate the effectiveness of a Golden Hour protocol for infants born at less than 32 weeks' gestation on improving the admission process in a military care facility. Specific aims focused on temperature, time to initiation of intravenous (IV) fluids, time to administration of antibiotics, and time to close of the incubator top. A pre-/postdesign was used to compare outcomes from preimplementation to postimplementation. Predata were collected using electronic health record chart review and postdata were collected from the Neonatal Intensive Care Unit admission worksheet. Although we did not find statistical significance, we found that more infants had a temperature greater than 36.5°C within 1 hour of birth and decrease in time to initiation of IV fluids and antibiotics from preimplementation to postimplementation, which is clinically significant. Time to close of the incubator top remained greater than 1 hour. Implementation of a Golden Hour protocol provides a guide to caring for preterm infants during the first hour of life to improve patient outcomes. Involvement of key stakeholders and staff education are key to successful implementation. Researchers should examine long-term outcomes related to implementation of a Golden Hour protocol in future studies. Future quality improvement projects should include the effectiveness of similar protocols and address possible barriers.

The 2015 Amtrak Philadelphia Train Derailment: After-Action Review of the Emergency Radiology Response at Temple University Health System

PurposeThe aim of this article is to assess a large tertiary care medical center’s emergency radiology response after the 2015 Amtrak Philadelphia train derailment. Methods and MaterialsA total of 55 patients with 308 total CTs and radiographs ordered within 12 hours of arrival to Temple University Health System (combining Temple University Hospital and Episcopal Hospital) emergency departments on May 12 to 13, 2015, were included in this study. A retrospective PACS and electronic medical record chart review of emergency department imaging turnaround times (TAT) during this event was completed and compared with emergency department radiology operations for the same 12-hour period throughout the preceding year. Wilcoxon’s rank-sum test analysis was performed. ResultsA total of 308 CTs and radiographs were performed, and 91 radiologically evident injuries were observed in a total of 30 patients, with fractures (n = 51) as the most common type of injury. There were no significant differences in time from patient arrival to beginning of radiological examination (26 min; interquartile range [IQR], 11-58 min) compared with annual median (28 min; IQR, 10-131 min; P = .232). Examination completion TATs were significantly increased (35 min; IQR, 17-112 min) compared with annual median (10 min; IQR, 5-15 min; P < .001), and time required from viewing of the examination by the radiologist to the examination being marked as read was significantly decreased (17 min; IQR, 6-45 min) compared with annual median (248 min; IQR, 126-441 min; P < .001). ConclusionsThe analysis highlights areas of efficiency in our response but also indicates areas for process improvement in future potential mass casualty events.