Impact of problem-based charting on the utilization and accuracy of the electronic problem list

We report the effect of PBC on problem list utilization and accuracy at an academic intensive care unit (ICU).Materials and MethodsAn interrupted time series design was used to assess the effect of PBC on problem list utilization, which is defined as the number of new problems added to the problem list by clinicians per patient encounter, and of problem list accuracy, which was determined by calculating the recall and precision of the problem list in capturing 5 common ICU diagnoses.ResultsIn total, 3650 and 4344 patient records were identified before and after PBC implementation at Stanford Hospital. An increase of 2.18 problems (>50% increase) in the mean number of new problems added to the problem list per patient encounter can be attributed to the initiation of PBC. There was a significant increase in recall attributed to the initiation of PBC for sepsis ( β = 0.45,P 
Source: Journal of the American Medical Informatics Association - Category: Information Technology Source Type: research

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Authors: Alzahrani SM, Ko CS, Yoo MW Abstract Purpose: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) risk calculator is useful in predicting postoperative adverse events. However, its accuracy in specific disorders is unclear. We validated the ACS NSQIP risk calculator in patients with gastric cancer undergoing curative laparoscopic surgery. Materials and Methods: We included 207 consecutive early gastric cancer patients who underwent laparoscopic gastrectomy between January 2018 and January 2019. The preoperative characteristics and risks of the patients were review...
Source: Journal of Gastric Cancer - Category: Gastroenterology Tags: J Gastric Cancer Source Type: research
We report two cases of SARS-CoV-2 infection complicated by paralytic ileus. The first patient was a 33-year-old man who was hospitalized with severe COVID-19 pneumonia requiring ventilator support and intensive care. He developed large bowel dilatation and perforation of the mid-transverse colon, and underwent laparotomy and colonic resection. Histopathology of the resected bowel specimen showed acute inflammation, necrosis, and hemorrhage, supporting a role for COVID-19-induced micro-thrombosis leading to perforation. The second patient was a 33-year-old man who had severe COVID-19 pneumonia, renal failure, and acute panc...
Source: The American Journal of Tropical Medicine and Hygiene - Category: Tropical Medicine Authors: Tags: Am J Trop Med Hyg Source Type: research
AbstractCoagulopathy represents one of the most important determinants of morbidity and mortality in coronavirus disease-19 (COVID-19). Whether standard thromboprophylaxis is sufficient or higher doses are needed, especially in severe patients, is unknown. To evaluate the safety of intermediate dose regimens of low-weight molecular heparin (LWMH) in COVID-19 patients with pneumonia, particularly in older patients. We retrospectively evaluated 105 hospitalized patients (61 M, 44 F; mean age 73.7  years) treated with subcutaneous enoxaparin: 80 mg/day in normal weight and mild-to-moderate impair or normal renal fun...
Source: Journal of Thrombosis and Thrombolysis - Category: Hematology Source Type: research
J Knee Surg DOI: 10.1055/s-0040-1713128Given a national push toward bundled payment models, the purpose of this study was to examine the prevalence as well as the effect of smoking on early inpatient complications and cost following elective total knee arthroplasty (TKA) in the United States across multiple years. Using the nationwide inpatient sample, all primary elective TKA admissions were identified from 2012 to 2014. Patients were stratified by smoking status through a secondary diagnosis of “tobacco use disorder.” Patient characteristics as well as prevalence, costs, and incidence of complications were co...
Source: Journal of Knee Surgery - Category: Orthopaedics Authors: Tags: Original Article Source Type: research
Conclusions: High-quality randomized evidence indicates that therapeutic hypothermia is associated with higher mortality and no difference in good neurologic outcome compared with normothermia in critically ill patients. Although there still might be a possibility that therapeutic hypothermia is beneficial in a specific setting, routine application of therapeutic hypothermia would better be avoided outside the settings indicated by international guidelines (adult cardiac arrest and hypoxic-ischemic encephalopathy of newborns).
Source: Critical Care Medicine - Category: Emergency Medicine Tags: Review Articles Source Type: research
We report a 66-year-old female patient with post-mortem diagnosis of COVID-19 who presented progressive livedo racemosa, acute renal failure and myocardial injury, as well as an absence of respiratory symptoms. Transthoracic echocardiography showed severe spontaneous echo contrast in the right cardiac chambers and right-sided cardiac overload presumed to result from pulmonary microvascular thrombosis or embolism.d-dimer levels were increased. The patient developed an acute ischemic stroke and died 2  days following presentation despite therapeutic anticoagulation. Her predominantly thromboembolic presentation supports...
Source: Journal of Thrombosis and Thrombolysis - Category: Hematology Source Type: research
The novel coronavirus 2 (SARS-CoV-2) was first described in Wuhan, China, in December 2019, and causes the infectious disease; COVID-19, which has been declared a pandemic by the World Health Organization. COVID-19 pneumonia may lead to acute respiratory distress syndrome and severe respiratory failure [1]. Other complications include myocarditis, renal failure and neurological involvement [2].
Source: Thrombosis Research - Category: Hematology Authors: Tags: Letter to the Editors-in-Chief Source Type: research
Authors: Aziz KT, Best MJ, Skolasky RL, Ponnusamy KE, Sterling RS, Khanuja HS Abstract Background: The number of patients with systemic lupus erythematosus (herein, lupus) undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA) is increasing. There is disagreement about the effect of lupus on perioperative complication rates. We hypothesized that lupus would be associated with higher complication rates in patients who undergo elective primary THA or TKA. Methods: Records of more than 6.2 million patients from the National Inpatient Sample who underwent elective primary THA or TKA from 2000 to 2...
Source: Clinics in Orthopedic Surgery - Category: Orthopaedics Tags: Clin Orthop Surg Source Type: research
This article investigated the prevalence of underestimation of risk by the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Surgical Risk Calculator (SRC) in patients with pathologic humerus fractures. Two hundred seven (207) patients were identified and analyzed using the ACS-NSQIP SRC. Predicted and actual outcomes were then compared. Average hospitalization was 6 ± 10 days. Ten patients (5%) had a mild adverse event (AE), and 15 (7%) had a serious AE. The ACS-NSQIP SRC underestimated hospitalizations (p
Source: Journal of surgical orthopaedic advances - Category: Orthopaedics Tags: J Surg Orthop Adv Source Type: research
Abstract Dabigatran etexilate is a direct oral anticoagulant (thrombin inhibitor) used for the prevention of stroke and systemic thromboembolic events in patients with permanent atrial fibrillation; prevention of venous thromboembolic events and deep veins thrombosis; treatment and prevention of pulmonary embolism. Dabigatran is a relatively new drug, and as a result, its interactions with other medications and their significance are not fully known. A 72 years old male, having a medical history of heart and renal failure, was hospitalized for pneumonia treatment. The patient was taking several drugs, including da...
Source: Medicina (Kaunas) - Category: Universities & Medical Training Authors: Tags: Medicina (Kaunas) Source Type: research
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