Clinical Utility of the Transthoracic Echocardiogram for Isolated Lacunar Infarcts: A Single-Center Experience.

Background: Stroke is a prominent and financially burdensome disease. Lacunar strokes are traditionally attributed to small vessel disease rather than cardioemboli, which typically occlude larger arteries. Thus, the benefit of screening for potential sources of cardioemboli in lacunar stroke patients is unclear.

Factors associated with antiretroviral therapy adherence among people living with HIV in Haiti: a cross-sectional study.

Background: Socioeconomic, demographic and clinical factors can affect adherence to treatment among people living with HIV (PLH) and potentially have an impact on their prognosis and survival. The main objective of this study was to assess these factors as potential barriers to adherence among patients receiving care in central Haiti.

Methods: A cross-sectional study was conducted among PLH receiving antiretroviral therapy (ART) at the TB/HIV clinic at St.

Utility of Head Computed Tomography Scans Before Outpatient Follow-up for Low-Risk Mild Traumatic Brain Injury.

Background: Neurosurgeons are frequently consulted for traumatic brain injuries (TBIs) resulting in intracranial hemorrhage (ICH). After inpatient confirmation of hemorrhage stability, outpatient head computed tomography (CT) is often performed to assess for hemorrhage resolution. Our objective was to assess the practice patterns and clinical utility of routine outpatient head CT scans for patients with mild TBI (mTBI).

Beyond Initial Screening: One-Year Follow-up of Adolescents with Internalizing Problems on the Pediatric Symptom Checklist.

Objective: Screening for adolescent depression is a quality indicator for pediatric care, and the parent-completed, 17-item Pediatric Symptom Checklist's internalizing (PSC-17P-INT) subscale has been validated for this purpose. The current study assessed the feasibility of PSC-17P-INT screening, the prevalence of risk on 2 consecutive PSC-17P-INTs, and rates of behavioral health (BH) service use before and after screening.

Methods: The parent-report PSC-17 was completed on tablet devices before well-child visits (WCVs) with results instantaneously available to clinicians in the electronic health record.

Implementation of an Electronic Approach to Psychosocial Screening in a Network of Pediatric Practices.

Objective: A network of 18 pediatric practice locations serving predominantly commercially insured patients implemented the electronic administration of the Pediatric Symptom Checklist-17 parent-report (PSC-17P) for all 5.50- to 17.99-year-old children seen for well child visits (WCVs) and wrote up the results as a quality improvement project.

Factors Associated With Increased Collection of Patient-Reported Outcomes Within a Large Health Care System.

Importance: The collection of patient-reported outcomes (PROs) has garnered intense interest, but dissemination of PRO programs has been limited, as have analyses of the factors associated with successful programs.

Objective: To identify factors associated with improving PRO collection rates within a large health care system using a centralized PRO infrastructure.

Design, Setting, And Participants: This cohort study included 205 medical and surgical clinics in the Partners Healthcare system in Massachusetts that implemented a PRO program between March 15, 2014, and December 31, 2018, using a standardized centralized infrastructure.

How an Electronic Medical Record System Facilitates and Demonstrates Effective Psychosocial Screening in Pediatric Primary Care.

Using questionnaires, administrative claims, and chart review data, the current study explored the impact of using an electronic medical record system to administer, score, and store the Pediatric Symptom Checklist (PSC-17) during annual pediatric well-child visits. Within a sample of 1773 Medicaid-insured outpatients, the electronic system demonstrated that 90.5% of cases completed a PSC-17 screen electronically, billing codes indicating a screen was administered agreed with the existence of a questionnaire in the chart in 98.

Cervical cancer treatment in Haiti: A vertically-integrated model for low-resource settings.

•Raising awareness is critical to any cancer program and through our outreach events we were able to educate 33,258 women.•We have treated over 4500 women with VIA and cryotherapy or thermocoagulation.•At least 30 of our patients are currently receiving individualized chemotherapy, whether neoadjuvant, adjuvant or palliative.

Epidemiological, Clinical, and Histopathological Features of Breast Cancer in Haiti.

Purpose: Little is known about the epidemiology of breast cancer in developing countries, and Haiti has perhaps the least data of any country in the Western Hemisphere.

Methods: We conducted a retrospective review of all patients enrolled in an ongoing breast cancer treatment program in Port-au-Prince, Haiti, from July 1, 2013, through June 30, 2017. Data were drawn from each patient's electronic medical record, paper chart, and biopsy results.

Evaluation of antibiotic self-medication among outpatients of the state university hospital of Port-Au-Prince, Haiti: a cross-sectional study.

In Haiti, where all drugs are available over the counter, self-medication with antibiotics appears as a common practice. Inappropriate use of beta-lactams and macrolides is likely to contribute to the development of antimicrobial resistance. This study aimed to (i) assess the extent of self-medication with antibiotics, (ii) explore the contributing factors (age, gender and educational background) and (iii) identify specific antibiotic drug classes used among patients attending the outpatient clinic of the State University Hospital of Port-au-Prince.

Factors Associated with Postoperative Complications in Hydrocephalic Infants Diagnosed at Bernard Mevs Hospital in Port-au-Prince, Haiti, from 2011 to 2013.

Objective: Complications worsen the prognosis of hydrocephalic children who undergo surgery. The main objective of this study was to determine factors associated with postoperative complications in Haitian infants with hydrocephaly.

Methods: This was a cross-sectional study conducted on hydrocephalic infants diagnosed in a Haitian hospital from 2011 to 2013.

Regional distribution of mercury in sediments of the main rivers of French Guiana (Amazonian basin).

Use of mercury (Hg) for gold-mining in French Guiana (up until 2006) as well as the presence of naturally high background levels in soils, has led to locally high concentrations in soils and sediments. The present study maps the levels of Hg concentrations in river sediments from five main rivers of French Guiana (Approuague River, Comté River, Mana River, Maroni River and Oyapock River) and their tributaries, covering more than 5 450 km of river with 1 211 sampling points. The maximum geological background Hg concentration, estimated from 241 non-gold-mined streams across French Guiana was 150 ng g(-1).

Antipsychotic prescribing patterns, and the factors and outcomes associated with their use, among patients requiring prolonged mechanical ventilation in the long-term acute care hospital setting.

Background: Administration of scheduled antipsychotic therapy to mechanically ventilated patients to prevent or treat delirium is common, despite the lack of evidence to support its use. Among long-term acute care hospital (LTACH) patients requiring prolonged mechanical ventilation (PMV), the frequency of scheduled antipsychotic therapy use, and the factors and outcomes associated with it, have not been described.

Objective: To identify scheduled antipsychotic therapy prescribing practices, and the factors and outcomes associated with the use of antipsychotics, among LTACH patients requiring PMV.

Accidental decannulation following placement of a tracheostomy tube.

Background: Accidental decannulation is a cause of substantial morbidity and mortality in patients in long-term acute care hospitals who require a tracheostomy tube.

Objective: To analyze features of accidental decannulation (AD) following placement of a tracheostomy tube, and to implement strategies to reduce the problem.

Methods: An analysis of data collected prospectively for quality management in a long-term acute care hospital was performed.

Unplanned transfers following admission to a long-term acute care hospital: a quality issue.

The unplanned transfer of patients from long-term acute care hospitals (LTACHs) back to acute facilities disrupts the continuity of care, delays recovery and increases the cost of care. This study was performed to better understand the unplanned transfer of patients with pulmonary disease. A retrospective analysis of data obtained for quality management in a cohort of patients admitted to an LTACH system over a 3-year period.

Epidemiology of decompensated heart failure in a single community in the northeastern United States.

Limited data are available describing the clinical characteristics, hospital treatment practices, and hospital and long-term death rates of patients hospitalized with decompensated heart failure (HF). To examine the descriptive epidemiology of acute HF in residents of a large New England metropolitan area during the 2 study years of 1995 and 2000, we reviewed the medical records of patients hospitalized with acute HF at 11 medical centers in the Worcester, Massachusetts, metropolitan area during 1995 and 2000 for purposes of collecting information about patients' sociodemographic and clinical characteristics, hospital management approaches, and hospital and postdischarge mortalities. The mean age of 4,537 residents of the Worcester metropolitan area hospitalized with decompensated HF was 76 years, 57% were women, and most study patients had been previously diagnosed with several co-morbidities.

Terminal withdrawal of mechanical ventilation at a long-term acute care hospital: comparison with a medical ICU.

Background: Failure to wean from prolonged mechanical ventilation (MV) is common in long-term acute care hospitals (LTACHs), but the process of terminal withdrawal of MV in LTACHs is not well described. We compared terminal withdrawal of MV at an LTACH with that in a medical ICU (MICU).

Methods: A retrospective medical chart review was done of all patients undergoing terminal withdrawal of MV in an LTACH (n = 30) and in a MICU (n = 74) over a 2-year period.

Renal trauma: evaluation, management, and return to play.

Renal injuries can occur in sports participation by both traumatic and atraumatic mechanisms. Atraumatic injury includes exercise-induced proteinuria, which is seen in intense exercise and usually resolves quickly without kidney damage. Exercise-induced hematuria typically resolves within 24-48 h without need for further investigation.