Retrospective Record Study Research Articles

The Use of Pesticides in Suicide Attempts in the Eastern Mediterranean Region of Turkey.

In parallel with common usage areas, pesticide poisonings are encountered in the community due to reasons such as no wearing of protective clothing and masks during use, unintentional consumption and suicide-intended intake. In this study was aimed to examine the cases who applied to the emergency department with pesticide poisoning and share of suicide cases. This study is a retrospective record study based on the files of 234 patients who reported to the emergency department for pesticide and rodenticide poisoning between 2014 and 2018. The patients were compared in terms of sociodemographic, substance type, prognosis, and accident/suicide status. Chi-square test, Binary logistic regression analysis were used in the analysis of the data. Organophosphates was the most common substance recorded as a cause of poisoning, while rat poison placed second. 38% of the acute poisoning cases were suicide attempts. Poisoning among men was found to be prominently due to accident whiles among women suicidal poisoning was more prominent. While the mortality rate is 4.7% in all acute intoxication cases, the mortality rate in poisonings with suicidal purposes is 5.6%. Patients with psychiatric diseases have a 28-fold higher risk of intoxication of attempting suicide. The most common comorbid psychiatric disorders in acute pesticide poisoning are anxiety and depression. A major proportion of pesticide poisoning cases is suicide attempts. Suicide attempt is at the forefront in women and death rates are higher in people with psychiatric illness. It may be advisable to avoid the easy accessibility of pesticides.

End-of-life care for homeless people in shelter-based nursing care settings: A retrospective record study

Background: Homeless people experience multiple health problems and early mortality. In the Netherlands, they can get shelter-based end-of-life care, but shelters are predominantly focused on temporary accommodation and recovery. Aim: To examine the characteristics of homeless people who reside at the end-of-life in shelter-based nursing care settings and the challenges in the end-of-life care provided to them. Design: A retrospective record study using both quantitative and qualitative analysis methods. Setting/participants: Two Dutch shelter-based nursing care settings. We included 61 homeless patients who died between 2009 and 2016. Results: Most patients had somatic (98%), psychiatric (84%) and addiction problems (90%). For 75% of the patients, the end of life was recognised and documented; this occurred 0–1253 days before death. For 26%, a palliative care team was consulted in the year before death. In the three months before death, 45% had at least three transitions, mainly to hospitals. Sixty-five percent of the patients died in the shelter, 27% in a hospital and 3% in a hospice. A quarter of all patients were known to have died alone. Documented care difficulties concerned continuity of care, social and environmental safety, patient–professional communication and medical-pharmacological alleviation of suffering. Conclusions: End-of-life care for homeless persons residing in shelter-based nursing care settings is characterised and challenged by comorbidities, uncertain prognoses, complicated social circumstances and many transitions to other settings. Multilevel end-of-life care improvements, including increased interdisciplinary collaboration, are needed to reduce transitions and suffering of this vulnerable population at the end of life.

Tuberculosis in North-East India: patient profile and treatment outcome of patient attending RNTCP

Background: Tuberculosis is a disease of global concern. India with its high burden of Tuberculosis, HIV and HIV-TB co-infection, this disease continue to have tremendous impact on its denizens especially the north-eastern states of the country because of its problem of HIV. It is imperative to understand every aspects of the disease for effective prevention and control.Methods: A retrospective record study of tuberculosis units was conducted.Results: The proportion of males was more as compared to females, with more cases seen with increasing age. Pulmonary TB was seen more among males, whereas extra-pulmonary TB was seen more among females. Favorable treatment outcome was seen in 84.7% of the population. HIV-TB Co-infection was seen 6.5% of the patients, with 46.3% having extra-pulmonary TB. Favorable treatment outcome was seen among them too.Conclusions: More common in males, showing increasing number of patients in older age group with favourable outcomes on treatment in all categories including HIV-TB co-infection patients.

Strength-based assessment for future violence risk: a retrospective validation study of the Structured Assessment of PROtective Factors for violence risk (SAPROF) Japanese version in forensic psychiatric inpatients

BackgroundThe Structured Assessment of PROtective Factors for violence risk (SAPROF) was recently developed as a strength-based addition to the risk assessment of future violent behavior. We examined the interrater reliability and predictive accuracy of the SAPROF for violence in forensic mental health inpatient units in Japan.MethodsThis retrospective record study provides an initial validation of the SAPROF in a Japanese sample of 95 forensic psychiatric inpatients from a complete 2008–2013 cohort. Violent outcomes were assessed 6 and 12 months after hospitalization.ResultsWe observed moderate-to-good interrater reliability for the SAPROF total score and the internal factors, motivational factors, external factors, and the Final Protection Judgment scores. According to a receiver operating characteristic analysis, the SAPROF total score and all subscale scores predicted violence at both 6 and 12 months after hospitalization with high accuracy. Furthermore, the predictive validity of a combination of the SAPROF with the Historical Clinical Risk Management-20 (HCR-20) outperformed that of the HCR-20 alone.ConclusionsThe results provide evidence of the value of considering protective factors in the assessment of future violence risk among Japanese forensic psychiatric inpatients. The SAPROF might allow for a more balanced assessment of future violence risk in places where the population rates of violent crime are low, such as Japan, but a validation study in a different setting should confirm this. Moreover, future studies should examine the effectiveness of treatment and promoting community re-integration on motivating patients and treatment staff.

Predictive accuracy of the Historical-Clinical-Risk Management-20 for violence in forensic psychiatric wards in Japan.

Most structured assessment tools for assessing risk of violence were developed in Western countries, and evidence for their effectiveness is not well established in Asian countries. Our aim was to examine the predictive accuracy of the Historical-Clinical-Risk Management-20 (HCR-20) for violence in forensic mental health inpatient units in Japan. A retrospective record study was conducted with a complete 2008-2013 cohort of forensic psychiatric inpatients at the National Center Hospital of Neurology and Psychiatry, Tokyo. Forensic psychiatrists were trained in use of the HCR-20 and asked to complete it as part of their admission assessment. The completed forms were then retained by the researchers and not used in clinical practice; for this, clinicians relied solely on national legally required guidelines. Violent outcomes were determined at 3 and 6 months after the assessment. Receiver operating characteristic analysis was used to calculate the predictive accuracy of the HCR-20 for violence. Area under the curve analyses suggested that the HCR-20 total score is a good predictor of violence in this cohort, with the clinical and risk sub-scales showing good predictive accuracy, but the historical sub-scale not doing so. Area under the curve figures were similar at 3 months and at 6 months. Our results are consistent with studies previously conducted in Western countries. This suggests that the HCR-20 is an effective tool for supporting risk of violence assessment in Japanese forensic psychiatric wards. Its widespread use in clinical practice could enhance safety and would certainly promote transparency in risk-related decision-making. Copyright © 2016 John Wiley & Sons, Ltd.

Exploring the preventable causes of unplanned readmissions using root cause analysis: Coordination of care is the weakest link

ImportanceUnplanned readmissions within 30days are a common phenomenon in everyday practice and lead to increasing costs. Although many studies aiming to analyze the probable causes leading to unplanned readmissions have been performed, an in depth-study analyzing the human (healthcare worker)-, organizational-, technical-, disease- and patient-related causes leading to readmission is still missing. ObjectiveThe primary objective of this study was to identify human-, organizational-, technical-, disease- and patient-related causes which contribute to acute readmission within 30days after discharge using a Root-Cause Analysis Tool called PRISMA-medical.The secondary objective was to evaluate how many of these readmissions were deemed potentially preventable, and to assess which factors contributed to these preventable readmissions in comparison to non-preventable readmissions. DesignCross-sectional retrospective record study. SettingAn academic medical center in Amsterdam, The Netherlands. ParticipantsFifty patients aged 18years and older discharged from an internal medicine department and acutely readmitted within 30days after discharge. Main outcome measuresRoot causes of preventable and unpreventable readmissions. ResultsMost root causes for readmission were disease-related (46%), followed by human (healthcare worker)- (33%) and patient- (15%) related root causes. Half of the readmissions studied were considered to be potentially preventable. Preventable readmissions predominantly had human-related (coordination) failures. Conclusion and relevanceOur study suggests that improving human-related (coordinating) factors contributing to a readmission can potentially decrease the number of preventable readmissions.

Procedural Sedation in Paediatric Practice

Introduction: Providing sedation techniques during the performance of diagnostic and therapeutic procedures on children decreases anxiety and discomfort. A number of drugs are available for the purpose. A retrospective record study in Paediatrics department of Burdwan Medical College & Hospital showed oral triclofos and per rectal diazepam were the two commonly used drugs for the purpose. However, intranasal midazolam is claimed to be a near ideal agent for procedural sedation. So, the above study was to compare efficacy and safety of intranasal midazolam over oral triclofos and per rectal diazepam. Methods: Participants having ASA score I or II having age group 1 to 6 years requiring noninvasive or minimally invasive procedure were divided into three groupsone group received oral triclofos sodium, second group received per rectal diazepam and third group received intranasal midazolam spray prior to the procedure. Levels of sedation and recovery were scored using Ramsey sedation score and modified Aldrete scoring system respectively. Induction of sedation was defined as attainment of Ramsey sedation score of at least 3. Complete recovery was defined as a minimum score of 10 of modified Aldrete scoring system. Original Research Article Roy et al.; BJMMR, 9(9): 1-6, 2015; Article no.BJMMR.18944 2 Results: Both times of induction and recovery were significantly higher in triclofos group when compared to other two groups. Level of sedation attained was higher in per rectal diazepam group, although there was no case of over sedation. Adverse effects were comparable except for nasal irritation which was exclusively limited to midazolam group. Cost of therapy was higher with intranasal midazolam therapy than with per rectal diazepam therapy. Conclusion: Per rectal diazepam appear to be a more ideal drug for procedural sedation over intranasal midazolam and oral triclofos.

Survival among hospital in-patients with troponin T elevation below levels defining myocardial infarction

Cardiac troponin T (cTnT) has an accepted place in the management of patients presenting with suspected acute coronary syndrome (ACS). Uncertainty remains about the significance and interpretation of elevated cTnT below the cut-off levels defining myocardial infarction (0.1 microg/l). To compare the mortality risks for elevation of cTnT in the ranges 0.01-0.029 microg/l, 0.03-0.099 microg/l and <0.01 microg/l. Retrospective record study in three hospitals. All cTnT measurements with values in the range >0.01-0.099 microg/l analysed during January 2002 were extracted from clinical biochemistry laboratory databases. Following agreed exclusion criteria, 179 patients with cTnT in the range 0.01-0.099 microg/l and 60 patients <0.01 microg/l were selected at random from across the three sites. Six-month follow-up was completed by review of case notes and contact with the patients' GP. There was a graded increase in mortality with increasing cTnT, although only achieving statistical significance for patients in the 0.03-0.099 microg/l range. The graded increase in relative risk with cTnT was weaker after adjustment for potential confounding factors We found a trend for worse survival with increasing cTnT within the range 0.01-0.099 microg/l in unselected patient populations presenting with possible acute coronary syndrome. This suggests that the combined effects of assay imprecision and co-morbidity should be taken into account when interpreting borderline elevation of cTnT. The use of a cut-off based on current standards of assay precision should be used to define the sensitivity of cTnT as biochemical evidence of ischaemic cardiac damage and as an indicator of mortality risk. This level is likely to be between 0.03 and 0.1 microg/l.

PREOPERATIVE CA-125 LEVEL AS A PREDICTOR OF NON-OPTIMAL CYTOREDUCTION OF ADVANCED EPITHELIAL OVARIAN CANCER

Background. Suboptimal cytoreduction of advanced ovarian cancer is related to initial tumor bulk which correlates with CA125 level. Methods. Retrospective record study of 40 patients with stage III ovarian cancer. The ability of a CA125 threshold level of 500 U/mL to predict suboptimal cytoreduction was determined. Results. Twenty-four (60%) of the patients were optimally cytoreduced. At the CA125 cut off level of 500 U/mL the sensitivity for predicting suboptimal debulking was 62% and specificity was 83%. Above a CA 125 level of 1500 U/mL none of the patients were optimally cytoreduced. Conclusions. More data are needed to determine the CA125 cut off level at which the standard approach of initial laparotomy and cytoreduction may be modified.

Comparison of Hemodialysis and Peritoneal Dialysis — a Cost–Utility Analysis

Our aim was to compare both health-related quality of life and costs for hemodialysis (HD) and peritoneal dialysis (PD) in a defined population. Decision-tree modeling to estimate total costs and effects for two treatment strategies, HD and PD, among patients with chronic kidney failure, for 5 years following the start of treatment. Courses of events and health-care consumption were mapped in a retrospective matched-record study. Data on health status were obtained from a matched population by a quality-of-life questionnaire (EuroQol). The study has a societal perspective. All dialysis departments in the southeastern health-care region of Sweden. 136 patients with kidney failure, comprising 68 matched pairs, were included in a retrospective record study; 81 patients with kidney failure, comprising 27 matched triplets, were included in a prospective questionnaire study. Cost per life year and cost per quality-adjusted life year. The cost per quality-adjusted life year for PD was lower in all analyzed age groups. There was a 12% difference in the age group 21-40 years, a 31% difference in the age group 41-60 years, and an 11% difference in the age group 61+ years. Peritoneal dialysis and HD resulted in similar frequencies of transplantation (50% and 41%, respectively) and expected survival (3.58 years and 3.56 years, respectively) during the first 5 years after the initiation of treatment. The cost-utility ratio is most favorable for PD as the primary method of treatment for patients eligible for both PD and HD.

Termination of third-trimester pregnancy before term with gemeprost vaginal pessaries

Objective. Determination of the efficacy and side-effects of the synthetic prostaglandin analog gemeprost for termination of pregnancy in the third trimester. Patients. Retrospective record study of 40 women who had undergone third trimester termination of pregnancy before term by serial administration of gemeprost because of intrauterine fetal death or hopeless fetal prognosis. Patients with multiple pregnancy, a Bishop score > 5, contractions or contraindications to prostaglandins were excluded. Methods. Gemeprost vaginal pessaries (1-mg) were given at 6-hourly intervals until labor intervened. The main parameter studied was the induction-delivery interval, the length of time between administration of the first dose and delivery. Statistical analysis was performed with the chi-square and the Mann–Whitney U-test. Results. The median induction-delivery interval was 14.4 h (range 3–48 h). Delivery occurred within 12 h in 17 women (42.5%), within 24 h in 27 women (67.5%) and within 36 h in 37 women (92.5%). An average of 2.6 doses were given per patient. Multigravidae had a significantly shorter induction-delivery interval than primigravidae (p < 0.01). A total of 87.5% women required analgesia. Side-effects were infrequent. Conclusions. The administration of gemeprost vaginal pessaries represents an efficient method with few side-effects for the induction of labor in the third trimester, provided patients are chosen carefully and monitored closely.

Preoperative CA‐125 level as a predictor of non optimal cytoreduction of advanced epithelial ovarian cancer

Suboptimal cytoreduction of advanced ovarian cancer is related to initial tumor bulk which correlates with CA125 level. Retrospective record study of 40 patients with stage III ovarian cancer. The ability of a CA125 threshold level of 500 U/mL to predict suboptimal cytoreduction was determined. Twenty-four (60%) of the patients were optimally cytoreduced. At the CA125 cut off level of 500 U/mL the sensitivity for predicting suboptimal debulking was 62% and specificity was 83%. Above a CA 125 level of 1500 U/mL none of the patients were optimally cytoreduced. More data are needed to determine the CA125 cut off level at which the standard approach of initial laparotomy and cytoreduction may be modified.

Is it time to have another look at lithium maintenance therapy in bipolar disorder?

1. 1. Bipolar disorder is typically a chronic disease entailing an episodes course, whereby psychiatric status alternates between periods of normal functioning and periods of illness. Lithium is well established and approved for the treatment of bipolar disorder. However, its efficacy in practice is not as great as expected. This retrospective record study was undertaken to determine the efficacy of lithium in bipolar disorders. 2. 2. 48 patients who met DSM-III-R diagnostic criteria for bipolar I disorder and had been admitted once before lithium therapy and twice or more after that, were included in this study. 3. 3. No significant difference in length between episode (frequency) was observed before and after lithium maintenance therapy. In addition, the percentages of manic episode after lithium therapy were much greater than before that. 4. 4. The results indicate that it is worth re-examining the efficacy of lithium in bipolar disorders.

Group A Streptococcal Meningitis

A retrospective record study of six cases of meningitis caused by group A beta-hemolytic Streptococcus is presented. Associated findings included otitis media, pharyngitis, and erysipelas. All patients survived their infections despite major complications including seizures, shock, coma, renal failure, and hepatitis. Two patients had neurologic sequelae. Group A Streptococcus causes a severe form of bacterial meningitis in apparently healthy children.