A case series of infectious complications in medical tourists requiring hospital admission or outpatient home parenteral therapy.

BACKGROUND: Travelling for medical care is increasing, and this medical tourism (MT) may have complications, notably infectious diseases (ID). We sought to identify MT-related infections (MTRIs) in a large Canadian health region and estimate resulting costs. METHODS: Retrospective and prospective capture of post-MT cases requiring hospital admission or outpatient parenteral antimicrobial therapy was completed by canvassing ID physicians practising in Calgary, Alberta, from January 2017 to July 2019. Cost estimates for management were made with the Canadian Institute for Health Information's (CIHI's) patient cost estimator database tool applied to estimated rates of Canadians engaging in MT from a 2017 Fraser Institute report. RESULTS: We identified 12 cases of MT-related infectious syndromes. Eight had microbial etiologies identified. MTs were young (mean 40.3 [SD 12.2] y) and female (n = 11) and pursued surgical treatment (n = 11). Destination countries and surgical procedures varied but were largely cosmetic (n = 5) and orthopaedic (n = 3). Duration to organism identification (mean 5.3 wk) and treatment courses (mean 19 wk) appeared lengthy. CIHI cost estimates for management of relevant infectious complications of our cases ranged from $6,288 to $20,741, with total cost for cases with matching codes (n = 8) totalling $94,290. CONCLUSIONS: In our series of MTRIs, etiologic organisms often found in Canadian-performed post-procedural infections were identified, and prolonged treatment durations were noted. Young women pursuing cosmetic surgery may be a population to target with public health measures to reduce the incidence of MTRIs and burden of disease.

HISTORIQUE: Le nombre de voyages pour obtenir des soins médicaux augmente, et ce tourisme médical (TM) peut être la source de complications, notamment de maladies infectieuses (MI). Les chercheurs ont entrepris de colliger les infections liées au TM (ILTM) dans une grande région sociosanitaire canadienne et d'en estimer les coûts. MÉTHODOLOGIE: Pour procéder à la saisie rétrospective et prospective des cas exigeant une hospitalisation ou un traitement antimicrobien parentéral ambulatoire après le TM, les chercheurs ont sondé les infectiologues d'une grande région sociosanitaire canadienne entre janvier 2017 et juillet 2019. Ils ont évalué les coûts du traitement de ces cas à l'aide de l'outil de la base de données d'évaluation des coûts des patients de l'Institut canadien d'information sur la santé (ICIS), qu'ils ont appliqué aux taux estimatifs de Canadiens qui avaient fait du TM d'après le rapport de l'Institut Fraser de 2017. RÉSULTATS: Les chercheurs ont détecté 12 cas de syndromes infectieux liés au TM, dont huit étaient rattachés à une étiologie microbienne connue. Les touristes médicaux étaient de jeunes (moyenne de 40,3 [ÉT = 12,2] ans) femmes (n = 11) qui voulaient subir une intervention chirurgicale (n = 11). Les destinations et les interventions chirurgicales variaient, mais elles étaient surtout esthétiques (n = 5) et orthopédiques (n = 3). La période avant d'identifier l'organisme (moyenne de 5,3 semaines) et la durée du traitement (moyenne de 19 semaines) semblaient longues. L'ICIS a estimé que les coûts de prise en charge des complications infectieuses pertinentes des cas se situent entre 6 288 $ à 20 741 $, le coût de tous les cas correspondant à un code (n = 8) totalisant 94 290 $. CONCLUSIONS: Dans la série d'ILTM, les chercheurs ont détecté des organismes étiologiques souvent constatés après une intervention réalisée au Canada et ont remarqué que le traitement était plus long. Les jeunes femmes qui veulent subir des interventions de chirurgie esthétique pourraient être une population ciblée pour transmettre des mesures sanitaires, afin de réduire l'incidence d'ILTM et le fardeau de la maladie.

Idiopathic granulomatous mastitis: a mimicking disease in a pregnant woman: a case report.

BACKGROUND: Idiopathic granulomatous mastitis is a rare, benign, inflammatory chronic condition of unclear etiology.This case is reported because it illustrates how idiopathic granulomatous mastitis can mimic other diseases, making it difficult to associate the presenting symptoms and the correct diagnosis; This disease is a challenge for clinicians to diagnose, manage and avoid iatrogenic complications, and requires consultation with experts in several specialties. CASE PRESENTATION: The patient was 30 years old, South-American, eleven weeks pregnant, and with an apparent infectious mastitis. She presented with progressive worsening of her breast symptoms and multiple negative laboratory tests. She suffered different side effects from several prescribed treatments and endured a prolonged recovery. The article emphasizes the need for ruling out common pathologies to arrive at the correct diagnosis such as bacterial and fungal infections; granulomatous conditions like tuberculosis and sarcoidosis; and inflammatory breast carcinoma. It also describes frequently used pharmacological and supplementary forms of treatment for patients with this condition. CONCLUSION: Idiopathic granulomatous mastitis is a rare unusual condition of unknown etiology. Pathological confirmation is required for its diagnosis and optimal management is still unclear. The presentation and management of this case is intended to advance its awareness to physicians from different specialties.

Physician adoption of an information system in an integrated health region.

We describe the strategies used to engage organizational and physician leadership through design, preparation, and support to achieve an inpatient Computerized Physician Order Entry (CPOE) rate over 70% by 1,700 physicians.

Is anybody managing the store? National trends in hospital performance.

Nine standardized measures compiled from Medicare data show trends in the safety, quality, financial management, and efficiency for more than 2,500 community hospitals over five years ending in 2003. Although much public attention has been given to hospital performance, along with exhortations to improve, few measures show substantial positive trends, either in variance reduction or overall improvement. The authors conclude that environmental forces are not stimulating improvement and that the overall picture is one of randomness rather than management.