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Computed tomography scan imaging in diagnosing acute uncomplicated pancreatitis: Usefulness vs cost

World Journal of Gastroenterology 2019年第9期25卷 1080-1087页

作者： Shana Kothari Michael Kalinowski Matthew Kobeszko Tarek Almouradi Department of Internal Medicine University of Illinois at Chicago - Advocate Christ Medical Center Department of Gastroenterology Advocate Christ Medical Center

BACKGROUND Literature has suggested that imaging is over-utilized in the diagnosis of pancreatitis. If the diagnosis of acute pancreatitis(AP) is established with abdominal pain and increased serum amylase or lipase activity without systemic signs of severe disease, computed tomography(CT) imaging may not be necessary. We hypothesize that among patients with uncomplicated acute pancreatitis(AUP), there is a significant number of unwarranted CT imaging studies. This imposes increased expenditure and cost in our healthcare system and does not improve hospital stay or management of *** To assess the overutilization and associated cost of CT imaging among patients meeting diagnostic criteria for *** In this Institutional Review Board-approved retrospective, single-center study,we identified all adult patients admitted with AP from January 1, 2012 through October 1, 2017. Patients were identified via International Classification of Diseases(ICD-9) code for AP(577.0) and ICD-10 codes for different etiological AP(K85.9 unspecified, K85.0 idiopathic, K85.1 biliary, K85.2 alcohol-induced, K85.3 drug-induced, and K85.8 other). Diagnosis was confirmed by chart review using established non-imaging diagnostic criteria(presence of typical abdominal pain and elevated lipase or amylase greater than 3 times upper limit of normal).Ranson criteria and BISAP scores on presentation were calculated and patients that met scores less than or equal to 2 for both were included to suggest *** utilization and cost of imaging in these patients were *** Between January 2012 and October 2017, 1305 patients presented to the emergency department with AP, and 405 patients(31%) met our inclusion criteria for AUP(201 males, 204 females; mean age 49 years, range 18-98). Of those, 210 patients(51.85%) underwent CT imaging. One patient(0.47%) had evidence of pancreatic necrosis, one patient had cyst formation(0.47%), and the remaining208 patients(99.05%) had either normal CT

关键词： Acute pancreatitis Diagnostic criteria Computed tomography imaging utilization Quality improvement Healthcare expenditure Emergency department

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Computed tomography angiography-negative aortic dissection in a patient using Phencyclidine

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World Journal of Emergency Medicine 2018年第2期9卷 144-148页

作者： Daniel DeWeert Elise Lovell Samir Patel advocate christ medical center 4440 95th St Oak Lawn IL 60453 USA

Although the average age of diagnosis for aorticdissection is 63,[1] this case demonstrates the need toconsider AD in younger patients, particularly in thepresence of risk factors or in the absence of anotherreasonable diagnosis. This case suggests PCP use as aprecipitant for hypertension and sympathomimetic stresson the aorta. Despite high sensitivity, false negativeCTA imaging for AD can occur. If pretest probabilityremains high, further imaging must be obtained. Duringresuscitation in the ED, focused point-of-care ultrasoundcan also assist with medical decision making.

关键词： Computed tomography angiography-negative aortic dissection a patient using Phencyclidine

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Paraneoplastic Leukocytosis and Thrombocytosis as Prognostic Biomarkers in Non-small Cell Lung Cancer

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中国肺癌杂志 2016年第11期19卷 725-730页

作者： Prajwal BODDU Dana VILLLINES Mebea AKLILU Department of Internal Medicine Advocate Illinois Masonic Medical Center Department of Clinical Research Advocate Illinois Masonic Hospital Hematology/Oncology Advocate Creticos Cancer Center

Background and Objectives: Search for inexpensive laboratory markers have identified associations between blood counts and lung cancer outcomes. In this study, we evaluated the prognostic value of paraneoplastic leukocytosis(p-Leukocytosis) and paraneoplastic thrombocytosis(p-Thrombocytosis) in patients with non-small cell lung cancer(NSCLC). We also studied their relation to the expression of commonly detected molecular markers. Methods: We conducted a retrospective chart review on 571 consecutive NSCLC patients over a 10 year period. Blood counts were recorded at the time of cancer diagnosis. Kaplan-Meier survival curves were used to compare overall survival(OS) between patients with and without p-Leukocytosis(or) p-Thrombocytosis(p-Leuko/Thrombocytosis). Cox regression was used to determine if leukocytosis/thrombocytosis was a predictor of OS in ***: Patients with p-Leukocytosis and p-Thrombocytosis had a significantly poorer survival compared patients with normal blood counts(P<0.001). In a multivariate survival analysis, both continued to correlate even when adjusted for histology, gender, stage and chemotherapy(P<0.01, 0.03 respectively). Stage I and II NSCLC with p-Leuko/Thrombocytosis did not perform poorly compared to stage I/II NSCLC patients without paraneoplasia. Patients with the combined leukothrombocytosis syndrome did not have worse outcomes compared to those with either paraneoplastic syndrome alone. Conclusions: p-Leuko/Thrombocytosis is an accessible laboratory parameter of prognostic value in NSCLC. Evidence of p-Leuko/Thrombocytosis portends poor survival. The role of various cytokines in tumor pathobiology provides a rationale for identifying cytokine factors responsible for the paraneoplasia and administering anti-cytokine therapies alongside traditional chemotherapy in an attempt to improve survival outcomes in these subset of patients.

关键词： Paraneoplastic Leukothrombocytosis Paraneoplastic leukocytosis Paraneoplastic thrombocytosis Lung neoplasms Prognosis Cytokine Epidermal growth factor receptor

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Efficacy and safety of stellate ganglion block in chronic ulcerative colitis

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World Journal of Gastroenterology 2017年第17期23卷 3193-3194页

作者： Eugene Lipov Ken Candido department of anesthesiology advocate illinois masonic medical center

Sympathetic system modulation by stellate ganglion blockade may modulate immune dysfunction and significantly improve symptoms of chronic ulcerative colitis.

关键词： Stellate ganglion block Ulcerative colitis Immune function Chronic ulcerative colitis

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The prevalence of methicillin-resistant Staphylococcus aureus colonization in emergency department fast track patients

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World Journal of Emergency Medicine 2013年第4期4卷 278-280页

作者： Kelly Williamson April Bisaga Katherine Paquette Elise Lovell Department of Emergency Medicine Advocate Christ Medical CenterChicagoUSA

BACKGROUND:Over the past two decades,methicillin-resistant Staphylococcus aureus(MRSA) has evolved from a hospital-associated infection to a significant public health threat in the community,causing outbreaks of soft tissue infections in otherwise healthy *** goal of this study was to determine the prevalence of nasal MRSA colonization in low acuity Emergency Department(ED) Fast Track patients in order to better characterize the epidemiology of this ***:We conducted a cross-sectional study of a convenience sample of adult patients from our ED Fast *** swabs were analyzed for MRSA using a polymerase chain reaction *** participants completed a survey assessing traditional risk factors for CA-MRSA ***:A total of 106 ED Fast Track patients were ***(3.8%,95%CI 1.5%-9.3%)were MRSA *** traditional CA-MRSA risk factors(personal history of abscess,family history of abscess,and participation in contact sports) were *** patients with a positive MRSA nasal swab,only a personal prior history of abscess retained significance(OR 33,95%C11.7-676,P=0.02).CONCLUSION:This study found a higher prevalence of nasal MRSA colonization in low acuity ED Fast Track patients compared with historical community surveillance studies.A personal history of prior abscess was a significant risk for CA-MRSA carriage.

关键词： Methicillin-resistant Staphylococcus aureus Emergency department

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Emergency bedside ultrasound for the diagnosis of pediatric intussusception: a retrospective review

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World Journal of Emergency Medicine 2014年第4期5卷 255-258页

作者： Samuel H. F. Lam Adam Wise christopher Yenter Department of Emergency Medicine Advocate Christ Medical Center Department of Emergency Medicine University of Illinois at Chicago

BACKGROUND: Ultrasound diagnosis of pediatric intussusception is feasible with limited operator training. The authors report the test characteristics of bedside ultrasound(BUS) for the diagnosis of pediatric intussusception at a single ***: Inclusion criteria were: 1) patients of 0–18 years old were seen in the pediatric emergency department(ED) with a clinical presentation suspicious for intussusception; 2) BUS was performed to identify intussusception and bedside impression documented in the medical record; 3) a "formal" diagnostic study(such as computed tomography, ultrasound, or barium enema) was performed by the radiology department after BUS was completed. Electronic medical record and ED BUS archive were screened for potentially eligible ED visits between January 1st 2009 to October 3rd 2012. These records were then reviewed to identify patients for inclusion in the study. All emergency physicians who performed the BUS had undergone a minimum of 1-hour didactic training on the use of BUS to diagnose pediatric ***: A total of 1 631 charts were reviewed, with 49 meeting inclusion criteria. Five of those were later excluded for incomplete documentation or lack of saved BUS images. The prevalence of intussusception was 23%. The mean age of the subjects was 31 months. BUS was 100% sensitive(95%CI 66%–100%) and 94% specifi c(95%CI 79%–99%) for detection of pediatric intussusception compared to radiology study results. Positive and negative likelihood ratios were 16.5(95%CI 4.30%–63.21%) and 0(95%CI 0–0) ***: BUS is an accurate means of diagnosing acute intussusception in pediatric patients. Further study might be indicated to confi rm such benefi ts.

关键词： Emergency medicine Intussusception Ultrasonography

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An attending physician float shift for the improvement of physician productivity in a crowded emergency department

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World Journal of Emergency Medicine 2013年第1期4卷 10-14页

作者： Muhammad Umer Nasim Chintan Mistry Robert Harwood Erik Kulstad Laura Tommaso Department of Emergency Medicine Advocate Christ Medical CenterOak LawnILUSA advocate Lutheran General Hospital Park RidgeIllinois 60068USA

BACKGROUND:Patients backlogged in the emergency department(ED) waiting for an inpatient bed(boarders) continue to require the attention of ED physicians,exacerbating crowding in the *** address this problem,we added a "float shift" to our winter schedule solely to care for *** sought to quantify the effect of this float shift,hypothesizing greater physician ***:We performed a retrospective observational study in our community hospital ED,measuring the number of new patients seen in each 10-hour shift in the presence or absence of a float shift *** calculated the number of new patients seen per shift for each of the 7 daily shifts,during February(float shift scheduled) and May(float shift unscheduled) of *** then compared the mean number of patients seen per shift in February with ***:Total monthly patient volume was 6 656 for February and 6 775 for May,with the mean daily census being 230 and 219 patients,*** number of new patients seen during each shift was greater in February than in May,with a mean increase of 1.1 patients per shift(with the float shift).Surveying participants about intervention effectiveness showed 92%of residents,but only 65%of attending physicians,in favor of maintaining the float ***:The presence of a "float shift" physician caring only for boarding patients allows other physicians to maintain and even increase their productivity in our ED,despite the presence of longer throughput times and increased time on diversion.

关键词： Crowding Physician staffing Boarding patients Float shift

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Emergency medicine residencies structure of trainees'administrative experience:A cross-sectional survey

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World Journal of Emergency Medicine 2018年第3期9卷 187-190页

作者： Kelly Williamson Jeremy Branzetti Navneet Cheema Amer Aldeen Department of Emergency Medicine Advocate Christ Medical CenterOak LawnIllinois 60453USA Department of Emergency Medicine NYU Langone HealthNew YorkNY 10016USA Department of Emergency Medicine University of ChicagoChicagoIllinois 60637USA US Acute Care Solutions CantonOhio 44718USA

BACKGROUND:While the Accreditation Council for Graduate medical Education(ACGME)mandates that emergency medicine residencies provide an educational curriculum that includes administrative seminars and morbidity and mortality conference,there is significant variation as to how administrative topics are implemented into training *** seek to determine the prevalence of dedicated administrative rotations and details about the components of the ***:In this descriptive study,a 12-question survey was distributed via the CORD listserv;each member program was asked questions concerning the presence of an administrative rotation and details about its *** responses were then analyzed with simple descriptive ***:A total of 114 of the 168 programs responded,leading to a 68%response *** responders,73%have a dedicated administrative rotation(95%CI 64.0 to 80.4).The content areas covered by the majority of programs with a dedicated program include performance improvement(n=68),patient safety(n=64),ED operations(n=58),patient satisfaction(n=54),billing and coding(n=47),and inter-professional collaboration(n=43).Experiential learning activities include review of patient safety reports(n=66)and addressing patient complaints(n=45).Most of the teaching on the rotation is either in-person(n=65)and/or self-directed reading assignments(n=48).The most commonly attended meetings during the rotation include performance improvement(n=60),ED operations(n=59),and ED faculty(n=44).CONCLUSION:This paper provides an overview of the most commonly covered resident administrative experiences that can be a guide as we work to develop an ideal administrative curriculum for EM residents.

关键词： Graduate medical Education Administration

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Unilateral Diaphragmatic Agenesis with Lung Cyst Herniating into the Abdomen Precluding Diaphragmatic Hernia in an Adult

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World Journal of Cardiovascular Surgery 2016年第11期6卷 171-175页

作者： Binay Krishna Sarkar Krishnendu Chakravorty Ashis Halder Paresh Banerjee Saroja Bharati Department of Cardiovascular & Thoracic Surgery Nil Ratan Sircar Medical College & Hospital Kolkata India Rush University medical center Chicago IL USA University of Illinois College of Medicine Chicago IL USA advocate Children’s Hospital and advocate christ medical center Oak Lawn IL USA

Background: Diaphragmatic agenesis or complete absence of a hemidiaphragm in adulthood is rare. The significance of presence of a lung cyst occupying the common thoracoabdominal space lies in the absence of associated diaphragmatic hernia which has not been documented previously. Case Presentation: We report a case of previously undiagnosed complete absence of a hemidiaphragm in a 62-year-old male who presented with recurrent respiratory infection, episodes of nausea and postprandial fullness. Computed Tomography scan showed a large cyst in relation to the lower lobe of left lung. During surgery, he was found to have complete absence of a left hemidiaphragm and a large cyst arising from the lower lobe of left lung occupied the common thoracoabdominal space. Abdominal viscera were found displaced downwards and fixed in a thick fibrous membrane. There was no herniation of abdominal organs into the thoracic cavity after excision of the cyst. The left lung could be fully expanded and chest was closed after putting a chest drain. Diaphragmatic agenesis did not require any additional procedure. The cyst was excised with closure of bronchocystic opening. The patient had an uneventful recovery. Conclusions: The association of lung cyst with diaphragmatic agenesis (presented in the adulthood) is rare. It has precluded a diaphragmatic hernia and survived the patient acting as a protective barrier. The significance of lung cyst in presence of diaphragmatic agenesis lies in the absence of associated diaphragmatic hernia which has not been documented previously.

关键词： Lung Cyst Absent Hemidiaphragm Recurrent Respiratory Infection

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Gestational Weight Gain in Obese Patients and Adverse Pregnancy Events

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Health 2014年第12期6卷 1420-1428页

作者： Shelly H. Tien Dana Villines Barbara V. Parilla Department of Obstetrics and Gynecology Advocate Illinois Masonic Medical Center Chicago USA Department of Obstetrics and Gynecology Division of Maternal-Fetal Medicine Advocate Illinois Masonic Medical Center Chicago USA Department of Research Advocate Illinois Masonic Medical Center Chicago USA

Objectives: To examine pre-pregnancy obesity and gestational weight gain as predictors for adverse pregnancy outcomes in a predominantly non-white obstetric resident clinic population. Methods: Prenatal charts for patients with pre-pregnancy obesity cared for at our resident clinic from January 1, 2008 through December 31, 2010 were reviewed. Adverse maternal outcomes were grouped into a “Composite Morbidity Index” (CMI-M) and included gestational diabetes, gestational hypertension, preeclampsia, superimposed preeclampsia, dystocia, operative delivery, Cesarean section for arrest disorders, wound infection and disruption, and thromboembolic events. Fetal events, similarly categorized into a composite adverse fetal index (CMI-F), included macrosomia, Apgar at 5 minutes (≤3), NICU admission, congenital anomalies and intrauterine fetal demise. Results: 627 women with a singleton pregnancy and a pre-pregnancy body mass index (BMI) of 30 and greater were included in the analysis. As measured by the composite morbidity index, women with Class III obesity at their first prenatal visit were more likely to have at least one or more maternal and fetal complications compared to women with Class II or Class I obesity. For adverse maternal outcomes (CMI-M), 40.2%, 33.8%, and 27.4% of women within each respective obesity class experienced an adverse event (p = 0.027). Applying the CMI-F, fetal complications were observed in 28.2%, 18%, and 13.9% of Class III, II, and I obesity (p = 0.003). Total gestational weight gain per week was significantly greater for patients with one or more maternal complications (p = 0.045). Conclusion: Among an obese, resident clinic population comprised primarily of women of ethnic minorities, pre-pregnancy body mass index was the strongest indicator for adverse maternal and fetal outcomes.

关键词： Gestational Weight Gain Obesity and Pregnancy Obesity and Adverse Pregnancy Outcomes

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