The role of routine coagulation studies in the management of patients suffering from epistaxis is unclear. In an attempt to address this issue the case notes of all emergency admissions for epistaxis to a large Scottish teaching hospital were retrospectively reviewed over a one-year period. One hundred and forty patients (63 male, 77 female) were admitted between January and December 1998. The patients who had coagulation studies were identified and their results analysed. A total of 121 patients (86.4 per cent) had coagulation studies performed. Of these, 10 (8.3 per cent) had abnormal results and all were taking warfarin or a combination of warfarin and aspirin. No other coagulation abnormalities were identified. This study supports the view that there does not appear to be a role for routine coagulation studies in patients admitted with epistaxis. The investigation for potential haemostatic disorders should be performed when clinically indicated and, if necessary, in consultation with the haematology service.
Epistaxis remains the most common ENT emergency. The use of coagulation studies in Scotland to manage these patients was investigated to determine current practice. The study took the form of a postal questionnaire sent to all practising ENT consultants and a telephone survey of ENT senior house officers working in Scotland. Of the 60 questionnaires circulated amongst consultants, 55 responses were received (92 per cent). Thirty-eight consultants (70 per cent) indicated that they did not routinely request a coagulation screen for their patients, however, 30 per cent (16) did. Forty-three of the 45 junior staff were available for interview, 22 (51 per cent) of whom routinely requested coagulation studies. While the majority of consultants did not request routine coagulation studies, there did not appear to be any consensus among the junior staff. Although there is a paucity of scientific information with regard to this aspect of epistaxis patient management, there is support in the literature for targeted rather than blanket testing. There is perhaps a need to address this issue within individual departments, to achieve uniformity of practice, and to improve communication between junior and senior staff.
Background With the continuation of the COVID-19 pandemic, shifting active COVID-19 care from short-term acute care hospitals (STACHs) to long-term acute care hospitals (LTACHs) could decrease STACH census during critical stages of the pandemic and maximize limited resources. Objective This study aimed to describe the characteristics, clinical management, and patient outcomes during and after the acute COVID-19 phase in an LTACH in the Northeastern United States. Methods This was a single-center group comparative retrospective analysis of the electronic medical records of patients treated for COVID-19–related impairments from March 19, 2020, through August 14, 2020, and a reference population of medically complex patients discharged between December 1, 2019, and February 29, 2020. This study was conducted to evaluate patient outcomes in response to the holistic treatment approach of the facility. Results Of the 127 total COVID-19 admissions, 118 patients were discharged by the data cutoff. At admission, 29.9% (38/127) of patients tested positive for SARS-CoV-2 infection. The mean age of the COVID-19 cohort was lower than that of the reference cohort (63.3, 95% CI 61.1-65.4 vs 65.5, 95% CI 63.2-67.8 years; P=.04). There were similar proportions of males and females between cohorts (P=.38); however, the proportion of non-White/non-Caucasian patients was higher in the COVID-19 cohort than in the reference cohort (odds ratio 2.79, 95% CI 1.5-5.2; P=.001). The mean length of stay in the COVID-19 cohort was similar to that in the reference cohort (25.5, 95% CI 23.2-27.9 vs 29.9, 95% CI 24.7-35.2 days; P=.84). Interestingly, a positive correlation between patient age and length of stay was observed in the COVID-19 cohort (r2=0.05; P=.02), but not in the reference cohort. Ambulation assistance scores improved in both the reference and COVID-19 cohorts from admission to discharge (P<.001). However, the mean assistance score was greater in the COVID-19 cohort than in the reference cohort at discharge (4.9, 95% CI 4.6-5.3 vs 4.1, 95% CI 3.7-4.7; P=.001). Similarly, the mean change in gait distance was greater in the COVID-19 cohort than in the reference cohort (221.1, 95% CI 163.2-279.2 vs 146.4, 95% CI 85.6-207.3 feet; P<.001). Of the 16 patients mechanically ventilated at admission, 94% (15/16) were weaned before discharge (mean 11.3 days). Of the 75 patients admitted with a restricted diet, 75% (56/75) were discharged on a regular diet. Conclusions The majority of patients treated at the LTACH for severe COVID-19 and related complications benefited from coordinated care and rehabilitation. In comparison to the reference cohort, patients treated for COVID-19 were discharged with greater improvements in ambulation distance and assistance needs during a similar length of stay. These findings indicate that other patients with COVID-19 would benefit from care in an LTACH.
Research Objectives: To evaluate and compare static and dynamic balance as well as a gait in individuals with and without diabetic neuropathy.Design: Case-control study design. Setting: University setting. Participants: The study included a convenience sample of 13 individuals with type 2 DM (7 males, 6 females) with a mean age of 62.77AE11.9 years. Participants were grouped as neuropathy group (NG) (nZ6) or non-neuropathy group (NNG) (nZ7) based on 10-gram Semmes monofilament test results. Interventions: No intervention. Main Outcome Measures: Center of Pressure (COP) sway using a force plate in normal stance and Romberg stance, with eyes open and closed conditions. Clinically balance was assessed using the Mini-BESTest (anticipatory, reactive, sensory orientation, and dynamic gait). Gait parameters (velocity, stride, and step length) were assessed using the GAITRite. Results: Significant condition effects were found for total displacement (F Z9.14, pZ.006), amplitude anterior/posterior (F Z9.01, pZ.007), amplitude medial/lateral (F Z10.49, pZ.004), area (F Z19.24, p < 001), velocity anterior/posterior (F Z11.12, pZ.003) and velocity medial/lateral ((F Z13.03, pZ.002) for Romberg stance eyes closed condition in Neuropathy group. No significant group effect, condition effect, and interaction were found in the normal width stance. The Mini-BESTest components and gait parameters did not have any significant difference between the groups. There were no significant differences between the self-reported activity levels of the NG and NNG participants (UZ14.5; pZ.30). NG participants had significantly higher weight (pZ .035) than the NNG participants.Conclusions: This study demonstrates the importance of visual compensation for participants with neuropathy in a narrow stance as reflected through COP sway in Romberg's stance with eyes closed. Though the neuropathy group can maintain a similar level of gait and balance, when the base of support decreased, they need to rely on visual compensatory strategies. The neuropathy group had higher weights than the non-neuropathy participants even with similar activity levels. In addition to rehabilitative measures, there is a need for teaching visual compensatory strategies and weight reduction program for patients with diabetic neuropathy.
BACKGROUND Patients hospitalized with severe coronavirus disease-2019 (COVID-19) may face long hospital lengths-of-stay, making it unreasonable to expect a discharge to home without long-term consequences.Post-acute care, such as that provided at long-term acute care hospitals (LTACHs) can provide rehabilitation and/or palliative care in the post-COVID phase, as well as provide an alternative to conventional short-term acute care hospitalization (STACH) for active treatment, thereby reducing the burden on the STACH system. OBJECTIVE To describe characteristics, clinical management, and patient outcomes during and after acute COVID-19 phase in a LTACH in the Northeastern United States. METHODS A single-center retrospective analysis of electronic medical records of patients treated for COVID-19-related impairments, from March 19, 2020 through August 14, 2020, was conducted to evaluate patient outcomes in response to the facility’s holistic treatment approach. RESULTS Of the 127 total COVID-19 related patient admissions during this time, 118 admissions were discharged by the data cut-off. Mean patient age was 63 years, 64.1% were male, and 29.9% of patients tested-positive for SARS-CoV-2 infection at admission. The mean (SD) length-of-stay at was 25.5 (13.0) days and there was a positive correlation between patient age and length-of-stay. Of the 51 patients non-ambulatory at admission, 83.3% were ambulatory at discharge. Gait increased 217.4 feet from admission to discharge, a greater increase than the reference cohort of 146.3 feet. 93.8% (15/16) of patients mechanically ventilated at admission were weaned before discharge (mean 11.3 days). 74.7% (56/75) of patients admitted with a restricted diet were discharged on a regular diet. CONCLUSIONS The majority of patients treated at a long-term acute care hospital for severe COVID-19 and related complications improved significantly through coordinated care and rehabilitation.
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