Overgaardbrowne3138
Despite palliative chemotherapy and trastuzumab, the patient died 2 months after the diagnosis of metastasis to the parotid gland. CONCLUSIONS We report a rare case of metastasis from breast cancer to the parotid gland, with imaging findings including neck ultrasonography and contrast-enhanced neck computed tomography. Breast cancer rarely metastasizes to the parotid gland, but radiologists should be aware of this possibility, especially in patients with a prior history of breast cancer.
Incorporation of Lean into health care requires consideration of the patient and other customer experience of care as well as final health outcomes. We incorporate experience-based design (EBD) into our Lean management method to assess the experience of care, guide redesign of care processes, and assess the effectiveness of quality improvement on the care experience. Foundational to EBD is identification of "touch points," moments in the health care delivery process where a patient has a strong positive or negative emotional response that has the potential to alter the way patients feel about their overall care experience.
EBD proceeds sequentially from qualitative assessment of customer experience and touch points (through observations and interviews); semiquantitatively assessing the experience across many patients (through EBD questionnaires); engaging in codesign with patients (through improvement teams and events); and reassessing the care experience after improvement (through follow-up EBD questionning change.
The American Society for Gastrointestinal Endoscopy and Society of American Gastrointestinal and Endoscopic Surgeons provide guidelines for managing suspected common bile duct (CBD) stones. We sought to evaluate adherence to the guidelines among patients with choledocholithiasis and/or acute biliary pancreatitis (ABP) and to evaluate the ability of these guidelines to predict choledocholithiasis.
We prospectively identified patients undergoing same-admission cholecystectomy for choledocholithiasis and/or ABP from 2016 to 2019 at 12 United States medical centers. Predictors of suspected CBD stones were very strong (CBD stone on ultrasound; bilirubin >4 mg/dL), strong (CBD > 6 mm; bilirubin ≥1.8 to ≤4 mg/dL), or moderate (abnormal liver function tests other than bilirubin; age >55 years; ABP). Patients were grouped by probability of CBD stones high (any very strong or both strong predictors), low (no predictors), or intermediate (any other predictor combination). The management of each probability < 0.001).
Almost 45% of patients with suspected CBD stones were managed discordantly from the American Society for Gastrointestinal Endoscopy and Society of American Gastrointestinal and Endoscopic Surgeons guidelines. We believe these guidelines warrant revision to better reflect the ability of the clinical variables at predicting choledocholithiasis.
Therapeutic/Care Management; Level IV.
Therapeutic/Care Management; Level IV.
At Kaiser Permanente Mid-Atlantic States (KPMAS), we designed a three anatomic site panel (urine, oropharynx and rectum) with a self-collect feature for rectal sites. We compared the proportion tested at each anatomic site, demographic factors, and HIV status between those who received the three-site panel vs usual care.
Patients entered our laboratories without a prior appointment and underwent urine (usual care - patient collected), oropharynx (lab technician collected) and rectal site (patient collected) testing. Providers recommended the panel to their patients. Patients then had the choice to accept or to reject the panel. Multivariate and logistic regressions were conducted to explore the relationship of age, gender, race and HIV status with GC and CT test results as well as the type of testing (three-site panel vs usual care testing) received.
145,854 patients received usual care testing as compared to 9,227 that received the panel. For those that underwent usual care testing 4.0% tested positiveress the racial and gender differences observed in the panel enrollment and increase utilization. Self-collection for rectal sites should lead to higher detection of CT and GC.
Accurate same-day STI diagnostic testing is generally unavailable, leading to syndromic management with high rates of over- and under-treatment. We analyzed the ease of integration of the Visby STI Panel into clinical practice, studied acceptance by patients and clinic personnel, and assessed the potential to inform accurate treatment decisions.
In a cross-sectional single visit study of 55 women, aged 18-56 years, women self-collected vaginal swab samples which were analyzed using the Visby STI panel for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Trichomonas vaginalis (TV). Results were compared to standard-of-care clinic results from send-out laboratory PCR tests. Surveys assessed patient and device operator experiences with the Visby STI panel and clinicians' perceived need for and acceptance of the device. Time parameters were measured to evaluate impact on clinical workflow, and syndromic treatment decisions were compared to anticipated treatment based on the Visby STI panel results.
Patients strongly agreed that sample self-collection was easy, and operators reported the device easy to use. Clinicians valued the rapid return of results, and patients were comfortable waiting up to 30-minutes to receive them. In 13 of 15 cases, the Visby STI Panel correctly identified undertreated patients as infected, and correctly identified all 33 incidences of overtreatment.
Clinical adoption of the Visby STI Panel into primary care clinics and doctors' offices could reduce over- and under-treatment of STIs. If integrated efficiently into the clinical workflow, the test would have minimal impact on staff time and visit duration for patients.
Clinical adoption of the Visby STI Panel into primary care clinics and doctors' offices could reduce over- and under-treatment of STIs. If integrated efficiently into the clinical workflow, the test would have minimal impact on staff time and visit duration for patients.
Approximately 20% of chlamydia (CT) and gonorrhea (GC) cases in Louisiana are diagnosed at Parish Health Units (PHU). Patient notification of CT and GC test results involves nurses' phone calls and letters to positive patients, which is time consuming and inefficient.
In December 2018, electronic results notification was implemented in Caddo PHU using Chexout software to notify enrolled patients via text or email when test results are ready to view in a patient portal. We compared the timeliness of GC/CT results notification and treatment pre- (December 2017-November 2018) and post- (December 2018-November 2019) Chexout implementation. A random sample of patients were interviewed to assess acceptability.
During December 2018 - November 2019, 5,432 patients were tested for CT/GC, 3,924 (72%) enrolled in Chexout, and notifications were sent to 3,884 (99%). Among CT positives, 472/568 (83%) viewed results in the portal compared to 2,451/3,356 (73%) CT negatives. Among GC positives, 300/353 (85%) viewed results compared to 2,657/3,571 (74%) GC negatives. Treatment success for CT improved from 493/670 (74%) to 506/568 (89%) and for GC from 332/409 (81%) to 325/353 (92%). Mean time to treatment decreased for CT (13.4 to 10.7 days) and GC (11.3 to 9.2 days). Enrolled patients found Chexout notification satisfactory 168/169 (99%) and easy to use 130/141 (92%). Reasons for declining electronic notification included lack of personal cell phone 55/86 (64%) and confidentiality concerns 42/86 (49%).
Electronic messaging decreased time to notification and increased treatment success. Nurses spent less time notifying patients leaving more time for patient care.
Electronic messaging decreased time to notification and increased treatment success. Panobinostat chemical structure Nurses spent less time notifying patients leaving more time for patient care.
In 2010, this Journal published my comprehensive review of the literature on hypertrophic scars and keloids. In that article, I presented evidence-based algorithms for the prevention and treatment of these refractory pathologic scars. In the ensuing decade, substantial progress has been made in the field, including many new randomized controlled trials. To reflect this, I have updated my review.
All studies were evaluated for methodologic quality. Baseline characteristics of patients were extracted along with the interventions and their outcomes. Systematic reviews, meta-analyses, and comprehensive reviews were included if available.
Risk factors that promote hypertrophic scar and keloid growth include local factors (tension on the wound/scar), systemic factors (e.g., hypertension), genetic factors (e.g., single-nucleotide polymorphisms), and lifestyle factors. Treatment of hypertrophic scars depends on scar contracture severity if severe, surgery is the first choice. If not, conservative therapies are ast decade. Although these studies suffer from various limitations, they have greatly improved hypertrophic scar and keloid management. Future high-quality trials are likely to improve the current hypertrophic scar and keloid treatment algorithms further.
Sodium-glucose cotransporter 2 (SGLT2) inhibitors have well-documented effects on reducing hospitalization for heart failure and cardiovascular mortality, while the effect on atrial fibrillation has not been comprehensively investigated. Therefore, we performed a meta-analysis to assess the association between SGLT2 inhibitors and atrial fibrillation risk by systematically searching PubMed, Embase and ClinicalTrials.gov. Two investigators independently identified randomized controlled trials which compared SGLT2 inhibitors with control in patients with type 2 diabetes, heart failure or chronic kidney disease. Primary outcomes were incident atrial fibrillation and stroke. We included 20 randomized trials involving 63604 patients. The SGLT2 inhibitors used were dapagliflozin (7 studies, 28834 patients), canagliflozin (7 studies, 17440 patients), empagliflozin (5 studies, 9082 patients) and ertugliflozin (1 study, 8246 patients). Follow-up ranged from 24 weeks to 202weeks. SGLT2 inhibitors treatment was associatients with type 2 diabetes, heart failure or chronic kidney disease. Primary outcomes were incident atrial fibrillation and stroke. We included 20 randomized trials involving 63604 patients. The SGLT2 inhibitors used were dapagliflozin (7 studies, 28834 patients), canagliflozin (7 studies, 17440 patients), empagliflozin (5 studies, 9082 patients) and ertugliflozin (1 study, 8246 patients). Follow-up ranged from 24 weeks to 202weeks. SGLT2 inhibitors treatment was associated with a significant attenuation in the risk of incident atrial fibrillation (OR=0.82, 95%CI0.72-0.93, P=0.002) compared with control. No significant difference in stroke between SGLT2 inhibitors and control groups was found (OR=0.99, 95%CI0.85-1.15, P=0.908). This present meta-analysis indicates that SGLT2 inhibitors are associated with a lower risk of incident atrial fibrillation and don't significantly affect stroke risk for patients with and without type 2 diabetes.
The optimal duration of dual antiplatelet therapy (DAPT) for patients implanted with new-generation drug-eluting stents (DES) in East Asians is currently still controversial. The purpose of this meta-analysis was to investigate the efficacy and safety of short-term DAPT in patients with those. In this study, randomized controlled trials from PubMed, EMBASE, and Cochrane Library were searched to compare the efficacy and safety of short-term DAPT (6- month or less) with long-term DAPT (12- month or more) in patients implanted with new-generation DES in East Asian from inception to September 2020. The primary efficacy outcome was all-cause death, the primary safety outcome was major bleeding, and the secondary outcomes included cardiovascular death, myocardial infarction, definite or possible stent thrombosis, and stroke.A total of six randomized controlled trials with 15688 patients met inclusion criteria, there were no significant differences in the incidence of all-cause death (RR 1.03, 0.76-1.39, P=0.856), cardiovascular death (RR 0.
