Surgical complications and subsequent revision surgeries among noma cases treated in Ethiopia.

Introduction: Noma, an overlooked infectious disease, inflicts severe facial tissue damage, posing substantial challenges in patient care. This study delves into surgical complications and subsequent revision surgeries among noma cases treated in Ethiopia. Materials and Methods: The research employed a cross-sectional retrospective review of medical records treated between 2007 and 2019 retrieved from the Facing Africa database. Results: The review encompasses 235 noma cases. Twenty-four cases (19 females and 5 males) experienced various complications, predominately major complications leading to subsequent revision surgeries. The identified complications included flap necrosis, abscess formation, tenderness, graft site infection, flap bulking, dental misalignment, corner of the mouth dehiscence, infected bone and plate, flap malpositioning, restricted mouth opening with ankylosis, neuropathic pain, recurrent flap infection, and offensive odor. Revision surgeries included wound cleansing, abscess drainage, skin graft removal, exploratory surgery, wound care, debulking, scar removal, debridement, trismus release, commisuroplasty, and flap repositioning. Conclusion: These findings illuminate the intricacies of noma surgery in Ethiopia, emphasizing the importance of understanding the nature and frequency of complications for optimizing treatment outcomes. Insights from this study can guide healthcare providers, especially novice surgeons, and policymakers, in refining surgical interventions and enhancing outcomes for noma patients. Improved knowledge in this realm is crucial for advancing patient care and developing targeted interventions. Level of Evidence: 5.

Avaliação da comunicação para melhoria da qualidade da assistência à saúde em pediatria: estudo descritivo / Assessment of communication to improve health care quality in pediatrics: a descriptive study / Evaluación de la comunicación para mejorar la calidad de la atención en salud en pediatría: estudio descriptivo

OBJETIVO: avaliar a qualidade da comunicação escrita da equipe multiprofissional em uma Unidade de Dependentes de Ventilação Mecânica de um hospital público pediátrico. MÉTODOS: pesquisa descritiva quantitativa, num Hospital Público Pediátrico, em quatro etapas: identificação e priorização de um problema de qualidade; análise das causas do problema; desenvolvimento de critérios para avaliar o nível de qualidade; avaliação do nível de qualidade. RESULTADOS: 75,0% dos não cumprimentos de critérios são sobre registro da data e hora e a utilização do prontuário eletrônico pelos enfermeiros, médicos e técnicos de enfermagem. Os fisioterapeutas apresentaram 32,3% de descumprimento na identificação dos profissionais, os médicos tiveram 8,3%, os enfermeiros 68,3% e os técnicos de enfermagem 86,7%. CONCLUSÕES: foi observado ausência da data e hora nos registros dos médicos e da enfermagem, baixa adesão dos médicos na evolução noturna no prontuário eletrônico, e limitação no acesso e utilização desse sistema pela equipe de enfermagem.

OBJECTIVE: to assess the quality of the written communication of the multiprofessional team in a Unit for Mechanical Ventilation Dependents at a public pediatric hospital. METHODS: a quantitative and descriptive research study conducted at a Public Pediatric Hospital, in four stages, namely: identification and prioritization of a quality problem; analysis of the causes of the problem; development of criteria to evaluate the quality level; and assessment of the quality level. RESULTS: 75.0% of the cases of criterion non-compliance are related to date and time recording and to use of electronic medical charts by nurses, physicians and nursing technicians. Physiotherapists presented 32.3% non-compliance in identification of the professionals; among the physicians, the percentage was 8.3%; in the nurses, 68.3%; and in the nursing technicians, 86.7%. CONCLUSIONS: absence of date and time in the physicians' and Nursing records was observed, as well as low adherence by the physicians to night evolution in electronic medical charts, and limited access and use of this system by the Nursing team.

OBJETIVO: evaluar la calidad de la comunicación escrita del equipo multidisciplinario en una Unidad de Ventilación Mecánica de un hospital pediátrico público. MÉTODO: investigación descriptiva cuantitativa realizada en un Hospital Pediátrico Público en cuatro etapas: identificación y priorización de un problema de calidad; análisis de las causas del problema; desarrollo de criterios para evaluar el nivel de calidad; evaluación del nivel de calidad. RESULTADOS: el 75,0% de los incumplimientos de los criterios están relacionados con el registro de fecha y hora y el uso de la historia clínica electrónica que hacen los enfermeros, médicos y técnicos en enfermería. Los fisioterapeutas presentaron un 32,3% de incumplimiento en la identificación de los profesionales, los médicos un 8,3%, los enfermeros un 68,3% y los técnicos en enfermería un 86,7%. CONCLUSIÓN: se observó que faltaba la fecha y hora en los registros que realizaron los médicos y enfermeros, baja adherencia de los médicos en la evolución nocturna de la historia clínica electrónica y limitado acceso y uso de este sistema por parte del equipo de enfermería.

Reasons for Initiating Canakinumab among Patients with Systemic Juvenile Idiopathic Arthritis and Adult-Onset Still's Disease in the U.S. Real-World Settings.

INTRODUCTION: The aim of this study was to understand the reasons for canakinumab initiation among patients with Still's disease, including systemic juvenile idiopathic arthritis (SJIA) and adult-onset Still's disease (AOSD), in US clinical practice. METHODS: Physicians retrospectively reviewed the medical charts of patients with Still's disease (regardless of age at symptom onset) who were prescribed canakinumab from 2016 to 2018. Patients aged < 16 years at symptom onset were classified as having SJIA and those aged ≥ 16 years at symptom onset (calculated from case-record forms) were classified as having AOSD. Patient treatment history and physician reasons for canakinumab initiation were analyzed. Overall results were presented as SJIA/AOSD. Sensitivity analyses were performed for the robustness of the results. RESULTS: Forty-three physicians in the USA (rheumatologists/dermatologists/immunologists/allergists: 51.2/27.9/11.6/9.3%; subspecialty in adults/pediatrics: 67.4/32.6%) abstracted information for 72 patients with SJIA/AOSD (SJIA/AOSD/age unknown at symptom onset: 75.0/18.1/6.9%; mean age 19.4 years; children 61.1%; females 56.9%). Most patients (90.3%) received treatment directly preceding canakinumab initiation (etanercept 27.7%; anakinra 18.5%; adalimumab 16.9%); the respective treatment was discontinued due to lack of efficacy/effectiveness (43.1%) and availability of a new treatment (27.8%). Most common reasons for canakinumab initiation were physician perceived/experienced efficacy/effectiveness of canakinumab (77.8%; children/adults: 81.8/71.4%), lack-of-response to previous treatment (45.8%; children/adults: 36.4/60.7%), convenient administration/dosing (26.4%; children/adults: 29.5/21.4%) and ability to discontinue/spare steroids (25.0%; children/adults: 20.5/32.1%). The sensitivity analysis provided similar results. CONCLUSIONS: In US clinical practice, physician perceived/experienced efficacy/effectiveness of canakinumab and lack-of-response to previous treatment were the primary reasons for canakinumab initiation among patients with SJIA/AOSD. Physician perceived/experienced efficacy/effectiveness and convenient administration/dosing of canakinumab were the most common reasons for canakinumab initiation among children, whereas lack-of-response to previous treatment and ability to discontinue/spare steroids being the most frequent reasons among adults.

Consideraciones legales sobre las notas de evolución en odontología / Legal considerations on medical charts in dentistry

El expediente clínico es considerado un documento de importancia médica y legal en donde se integran los datos necesarios para registrar el diagnóstico y los tratamientos realizados en cada paciente. Uno de los elementos más importantes dentro del expediente clínico son las notas de evolución, documentos con los que el odontólogo informa sobre el estado general del paciente y los tratamientos realizados cita tras cita. Existen legislaciones específicas en México que orientan al estomatólogo sobre los componentes mínimos necesarios que una nota de evolución debe tener; sin embargo, una de las omisiones más comunes de los odontólogos es que, por desconocimiento, no se dé la debida importancia a la elaboración de una adecuada nota de evolución, aumentando el riesgo de problemas legales. El objetivo del presente artículo es analizar la importancia de las notas de evolución dentro del expediente clínico, destacando su importancia clínica y legal (AU)

The clinical file is considered a document of medical and legal importance where the data necessary to record the diagnosis and the treatments performed on each patient are integrated. One of the most important elements within the clinical records are the medical charts, documents through which de dentist reports on the general condition of the patient and the treatments performed appointment after appointment. There are specific laws in Mexico that guide the stomatologist on the minimum necessary components that a medical chart must have, however, one of the most common omissions of dentist is that, due to ignorance, due importance is not given to the preparation of an adequate medical chart, increasing the risk of legal problems. The aim of this article is to analyze the importance of the evolution charts within the clinical records, highlighting their clinical and legal importance (AU)

Isolation of Multidrug Resistant Bacteria from Patients Medical Charts.

BACKGROUND: Patient's medical charts in hospitals are potentially contaminated by pathogenic bacteria and might act as vehicles for transmission of bacterial infections.This study was aimed to determine the rate of contamination of medical charts by multidrug resistant bacteria. METHODS: Sampling of total 250 patient's medical charts from different wards was done with the help of cotton swabs soaked in sterile normal saline. The swabs thus collected were cultured using standard microbiological procedures.The colonies grown were then identified with the help of colony morphology, Gram's stain and biochemical tests. Antimicrobial susceptibility testing was performed by using Kirby-Bauer disc diffusion technique. RESULTS: Of the total 250 charts sampled, 98.8% grew bacteria; Bacillus spp. in 40.7%, followed by Staphylococcus aureus (17%), coagulase-negative Staphylococcus spp.(CoNS) (17%), Citrobacter freundii (9.6%) and Acinetobacter spp. (4.5%). Rate of multidrug resistance was highest in Acinetobacter spp. (50%). Among 83 isolates of S. aureus, methicillin resistance was found in 29 isolates. Similarly, two out of total 9 isolates of Enterococcus spp. were vancomycin resistant. CONCLUSIONS: This study showed that patient's medical charts were contaminated with multidrug resistant bacteria including methicillin resistant S. aureus and vancomycin resistant Enterococcus spp. Strict hand washing before and after handling medical charts is recommended.

Determinants of high cost in multiple sclerosis patients: a claims and chart review study.

OBJECTIVE: To identify factors associated with high cost multiple sclerosis (MS) patients using integrated administrative claims and medical charts data. METHODS: This study identified newly diagnosed MS patients (≥18 years) in a large United States managed care claims database between 1 January 2007 and 30 April 2011 using the ICD-9-CM code (340.xx). Mean annualized MS-related costs higher than the third quartile were categorized as high cost, lower than the first quartile as low, and the rest as medium. Patients were compared across cohorts with descriptive and inferential statistics. Baseline high cost factors were identified with multivariable logistic regression models. RESULTS: Administrative claims (n = 4342) and medical chart records (n = 400) data was evaluated. Mean (SD) annualized MS-related costs were $6313 ($14,177) for patients overall and $18,398 ($24,483) for high cost patients. Inpatient costs accounted for the largest proportion (49.69%) of MS-related costs among high cost patients. MS relapses and MS-related comorbidities were more prevalent in the high cost patients. In the multivariable analyses, patients with baseline use of antidepressants or corticosteroids, baseline muscle weakness, and initial treatment from a non-neurologist were likelier to be high cost MS patients. LIMITATIONS: MS-related clinical information was not completely available from medical chart data. The specificity of true MS-related costs may have been limited and the definition of the cost-based cohort segmentations was arbitrary. CONCLUSIONS: Overall, baseline use of MS-related medications, the presence of baseline MS-related comorbidities, MS relapses, and MS-related hospitalizations were significantly associated with high cost patients. Future comparative effectiveness studies of currently approved disease modifying therapies for MS may help to identify best strategies for individual patients to minimize clinical events that are associated with high disease related costs.

Estratégias populares de identificação e tratamento da loucura na primeira metade do século XX: uma análise dos prontuários médicos do Sanatório Espírita de Uberaba / Popular strategies for identification and treatment of insanity in the first half of the twentieth century: an analysis of medical charts from the Uberaba Spiritist Asylum

Pela análise de prontuários médicos de instituição para tratamento de alienados, dirigida por uma associação de seguidores do espiritismo de orientação kardecista, identificam-se as diferentes percepções e estratégias de tratamento e administração social da loucura desenvolvidas por setores da população brasileira na primeira metade do século XX, numa região interiorana do país. Enfatiza-se o aspecto multidimensional da experiência da loucura, tomando-a como acontecimento sociocultural capaz de produzir diferentes análises e interpretações por grupos heterogêneos de atores sociais, que irão interpretá-la a partir de seus sistemas próprios de significação e entendimento.