Beliefs and practices associated with late presentation in patients with breast cancer; an observational study of patient presenting in a tertiary care facility in Southwest Nigeria

2015 ◽  
Vol 7 (4) ◽  
pp. 178-185 ◽  
Author(s):  
B. A. Ayoade ◽  
B. A. Salami ◽  
A. J. Agboola ◽  
A. O. Tade ◽  
A. O. Adekoya ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Observational Study ◽  
Tertiary Care ◽  
Care Facility ◽  
Late Presentation ◽  
Beliefs And Practices ◽  
Tertiary Care Facility ◽  
Southwest Nigeria

Temporary Central Venous Catheter Utilization Patterns in a Large Tertiary Care Center Tracking the “Idle Central Venous Catheter”

2012 ◽  
Vol 33 (1) ◽  
pp. 50-57 ◽  
Author(s):  
Sheri Chernetsky Tejedor ◽  
David Tong ◽  
Jason Stein ◽  
Christina Payne ◽  
Daniel Dressler ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Observational Study ◽  
Dwell Time ◽  
Antimicrobial Agents ◽  
Tertiary Care ◽  
Care Facility ◽  
Venous Catheter ◽  
Retrospective Observational Study ◽  
Central Venous ◽  
Tertiary Care Facility

Objectives.Although central venous catheter (CVC) dwell time is a major risk factor for catheter-related bloodstream infections (CR-BSIs), few studies reveal how often CVCs are retained when not needed (“idle”). We describe use patterns for temporary CVCs, including peripherally inserted central catheters (PICCs), on non-ICU wards.Design.A retrospective observational study.Setting.A 579-bed acute care, academic tertiary care facility.Methods.A retrospective observational study of a random sample of patients on hospital wards who have a temporary, nonimplanted CVC, with a focus on on daily ward CVC justification. A uniform definition of idle CVC-days was used.Results.We analyzed 89 patients with 146 CVCs (56% of which were PICCs); of 1,433 ward CVC-days, 361 (25.2%) were idle. At least 1 idle day was observed for 63% of patients. Patients had a mean of 4.1 idle days and a mean of 3.4 days with both a CVC and a peripheral intravenous catheter (PIV). After adjusting for ward length of stay, mean CVC dwell time was 14.4 days for patients with PICCs versus 9.0 days for patients with non-PICC temporary CVCs (other CVCs; P< .001). Patients with a PICC had 5.4 days in which they also had a PIV, compared with 10 days in other CVC patients (P< .001). Patients with PICCs had more days in which the only justification for the CVC was intravenous administration of antimicrobial agents (8.5 vs 1.6 days; P = .0013).Conclusions.Significant proportions of ward CVC-days were unjustified. Reducing “idle CVC-days” and facilitating the appropriate use of PIVs may reduce CVC-days and CR-BSI risk.Infect Control Hosp Epidemiol 2012;33(1):50-57

Optimizing Positioning for In-Office Otology Procedures

2016 ◽  
Vol 156 (1) ◽  
pp. 156-160 ◽  
Author(s):  
Nandini Govil ◽  
William M. DeMayo ◽  
Barry E. Hirsch ◽  
Andrew A. McCall
Keyword(s):  
Observational Study ◽  
Musculoskeletal Disorders ◽  
Study Design ◽  
Upper Limb ◽  
Supine Position ◽  
Tertiary Care ◽  
Care Facility ◽  
Musculoskeletal Discomfort ◽  
Patient Position ◽  
Tertiary Care Facility

Objective Surgeons often report musculoskeletal discomfort in relation to their practice, but few understand optimal ergonomic positioning. This study aims to determine which patient position—sitting versus supine—is ergonomically optimal for performing otologic procedures. Study Design Observational study. Setting Outpatient otolaryngology clinic setting in a tertiary care facility. Subjects and Methods We observed 3 neurotologists performing a standardized simulated cerumen debridement procedure on volunteers in 2 positions: sitting and supine. The Rapid Upper Limb Assessment (RULA)—a validated tool that calculates stress placed on the upper limb during a task—was used to evaluate ergonomic positioning. Scores on this instrument range from 1 to 7, with a score of 1 to 2 indicating negligible risk of developing posture-related injury. The risk of musculoskeletal disorders increases as the RULA score increases. Results In nearly every trial, RULA scores were lower when the simulated patient was placed in the supine position. When examined as a group, the median RULA scores were 5 with the patient sitting and 3 with the patient in the supine position ( P < .0001). When the RULA scores of the 3 neurotologists were examined individually, each had a statistically significant decrease in score with the patient in the supine position. Conclusion This study indicates that patient position may contribute to ergonomic stress placed on the otolaryngologist’s upper limb during in-office otologic procedures. Otolaryngologists should consider performing otologic procedures with the patient in the supine position to decrease their own risk of developing upper-limb musculoskeletal disorders.

scholarly journals Aetiologic Profile of Patients with Altered Mental Status in Medical Emergency in a Tertiary Care Medical Institute - A Cross Sectional Observational Study

2021 ◽  
Vol 8 (9) ◽  
pp. 456-461
Author(s):  
Saraswati Kushwah ◽  
Pritam Singh ◽  
Kamal Singh ◽  
Daljinderjit Kaur ◽  
Sarabmeet Singh Lehl
Keyword(s):  
Observational Study ◽  
Mental Status ◽  
Tertiary Care ◽  
Total Mortality ◽  
Care Facility ◽  
Altered Mental Status ◽  
Medical Emergency ◽  
Medical Institute ◽  
Cross Sectional ◽  
Tertiary Care Facility

BACKGROUND Altered mental status (AMS) is a symptom complex that may arise from a variety of primary neurologic disorders and systemic illnesses. The underlying diagnosis affects final outcome of patients that may be predicted by use of objective tools. This study was conducted to describe the aetiologic distribution of such patients presenting to emergency room and assess the utility of Richmond Agitation Sedation Scale (RASS) and Glasgow Coma Scale (GCS) as prognostic tools. METHODS In this cross-sectional observational study, we identified such 120 adult patients at a single centre tertiary care facility and documented their bio-demographic profile, RASS & GCS scores, routine metabolic profile, specific investigations (like neuro-imaging, lumbar puncture, toxicologic screen) as indicated, along with patient outcome at 2 weeks. RESULTS The mean age of patients was 49.76 ± 18.72 years with 79 (66 %) patients being male. The aetiologic distribution was as follows; cerebrovascular (N = 24; 20 %), infections (N = 40; 33 %), metabolic (N = 37; 30.8 %), toxicologic (11; 9.2 %) and seizure disorder (N = 8; 6.7 %). The total mortality rate was 38 % as assessed at the end of two weeks. While RASS did not fare well as a prognostic tool, GCS score less than 8 was associated with statistically significant increase in mortality rates (52 % vs. 31 %). CONCLUSIONS Altered mental status has varied presentation and the aetiologies for AMS are evenly distributed among primary central nervous system (CNS) causes and systemic causes leading to secondary AMS. It is helpful to use some standardised scoring systems that bring uniformity in the assessment as well as prognostic implications. KEYWORDS Alerted Mental Status, Aetiologic Distribution, Outcome, RASS, GCS

scholarly journals Awareness of Mammographic Screening Amongst Females Visiting Breast Clinic at a Tertiary Care Hospital of Karachi

2020 ◽  
Vol 10 (3) ◽  
pp. 197-199
Author(s):  
Summayyah Shawana ◽  
Sehrish Shafique ◽  
Sarah Rabbani ◽  
Sobia Hassan ◽  
Santosh Sidhwani ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Health Care Professionals ◽  
Tertiary Care ◽  
Care Facility ◽  
Mammographic Screening ◽  
Breast Lesions ◽  
Care Hospital ◽  
Breast Clinic ◽  
Tertiary Care Facility ◽  
Malignant Breast

Objective: To assess the awareness of mammographic screening among women visiting the breast clinic at a tertiary care facility in Karachi. Study Design and Setting: This cross-sectional study was conducted at Jinnah Post Graduate Medical Centre Karachi over one month period from 1-10-2019 to 31-10-2019. Methodology: After receiving ethical approval, relevant information from patients coming to the breast clinic over the study period, regarding age, level of education, family history, diagnosis and awareness regarding mammographic screening was recorded on specially designed proformas and was statistically analyzed on SPSS 23. P value </= to 0.05 was considered as statistically significant. Results: Out of the 100 participants included in the study 68 patients had malignant lesions, 18 had a benign diagnosis while 14 patients were undiagnosed. Only 42 had at least some knowledge of mammographic screening of breast cancers and only 15 patients actually had a screening mammogram performed. Of those aware of the screening majority were informed regarding the procedure by health care professionals or through media sources. Only 4 out of 17 participants with a positive history of breast cancer in the family had the screening done. 12 patients diagnosed with malignant breast lesions were under the age of 40 years. Conclusion: Awareness of mammographic screening for breast cancer among females in our setup is still unsatisfactory and calls for improvements in the awareness programs for breast cancer screening. An early age at diagnosis for malignant breast lesions should prompt the concerned to revise the recommended lower age limit for commencing mammographic screening

Assessing Acute St-Elevation Myocardial Infarction With Prognostic Significance Of The Hyponatramia

2020 ◽  
Vol 11 (3) ◽  
pp. 3251-3260
Author(s):  
Makrand B Mane
Keyword(s):  
Myocardial Infarction ◽  
Ejection Fraction ◽  
Tertiary Care ◽  
Prognostic Significance ◽  
Care Facility ◽  
Early Death ◽  
Public Health Issue ◽  
Care Hospital ◽  
Tertiary Care Facility ◽  
Significant Public Health

Acute Myocardial Infarction (AMI) has become a significant public health issue in developed and developing nations, following extensive diagnostic and management research over recent decades. The study intended to research the prognostic values of inexplicable Hyponatremia in patients with severe STelevation of myocardial infarction, in 100 consecutive patients admitted to Tertiary care hospital. In the analysis, identified patients on admission were diagnosed with or produced Hyponatremia within 72 hours—a lower ejection fraction than those with usual amounts of sodium. The research aimed to evaluate the prognosis significance of Hyponatremia for the estimation of early death in acute ST-elevated myocardial infarction. One hundred straight patients admitted in the Coronary Centre Tertiary Care Facility with severe STelevated myocardial infarction were studied. The data of the study on various risk factors in association with the development of Hyponatremia like as age, sex, use of tobacco, diabetes, hypertension, ejection fraction etc. were analyzed. Thus, the researchers reported that in patients diagnosed with severe ST section escalation, Hyponatremia showed the initial emergence of hyponatremia myocardial infarctions. This condition correlates with the severity of LV dysfunction (in term of LVEF) and can be considered as an individual early death indicator as well as a prediction exacerbates with hyponatremia frequency.

scholarly journals Clinical features and outcomes of infective endocarditis in Egypt: an 11-year experience at a tertiary care facility

2019 ◽  
Vol 71 (1) ◽  
Author(s):  
Hussein Hassan Rizk ◽  
Ahmed Adel Elamragy ◽  
Ghada Sayed Youssef ◽  
Marwa Sayed Meshaal ◽  
Ahmad Samir ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Hospital Mortality ◽  
Tertiary Care ◽  
Care Facility ◽  
Period 2 ◽  
Peripheral Embolization ◽  
Tertiary Care Facility ◽  
Few Data ◽  
Healthcare Associated ◽  
Complications And Mortality

Abstract Background Few data are available on the characteristics of infective endocarditis (IE) cases in Egypt. The aim of this work is to describe the characteristics and outcomes of IE patients and evaluate the temporal changes in IE diagnostic and therapeutic aspects over 11 years. Results The IE registry included 398 patients referred to the Endocarditis Unit of a tertiary care facility with the diagnosis of possible or definite IE. Patients were recruited over two periods; period 1 (n = 237, 59.5%) from February 2005 to December 2011 and period 2 (n = 161, 40.5%) from January 2012 to September 2016. An electronic database was constructed to include information on patients’ clinical and microbiological characteristics as well as complications and mortality. The median age was 30 years and rheumatic valvular heart disease was the commonest underlying cardiac disease (34.7%). Healthcare-associated IE affected 185 patients (46.5%) and 275 patients (69.1%) had negative blood cultures. The most common complications were heart failure (n = 148, 37.2%), peripheral embolization (n = 133, 33.4%), and severe sepsis (n = 100, 25.1%). In-hospital mortality occurred in 108 patients (27.1%). Period 2 was characterized by a higher prevalence of injection drug use-associated IE (15.5% vs. 7.2%, p = 0.008), a higher staphylococcal IE (50.0% vs. 35.7%, p = 0.038), lower complications (31.1% vs. 45.1%, p = 0.005), and a lower in-hospital mortality (19.9% vs. 32.1%, p = 0.007). Conclusion This Egyptian registry showed high rates of culture-negative IE, complications, and in-hospital mortality in a largely young population of patients. Improvements were noted in the rates of complications and mortality in the second half of the reporting period.

scholarly journals Characteristics of Critically Ill Patients with COVID-19 Compared to Patients with Influenza—A Single Center Experience

2021 ◽  
Vol 10 (10) ◽  
pp. 2056
Author(s):  
Frank Herbstreit ◽  
Marvin Overbeck ◽  
Marc Moritz Berger ◽  
Annabell Skarabis ◽  
Thorsten Brenner ◽  
...  
Keyword(s):  
Influenza A ◽  
Health Care Systems ◽  
Severe Disease ◽  
Tertiary Care ◽  
Care Facility ◽  
High Volume ◽  
Single Center Experience ◽  
Severe Influenza ◽  
Tertiary Care Facility ◽  
Care Systems

Infections with SARS-CoV-2 spread worldwide early in 2020. In previous winters, we had been treating patients with seasonal influenza. While creating a larger impact on the health care systems, comparisons regarding the intensive care unit (ICU) courses of both diseases are lacking. We compared patients with influenza and SARS-CoV-2 infections treated at a tertiary care facility offering treatment for acute respiratory distress syndrome (ARDS) and being a high-volume facility for extracorporeal membrane oxygenation (ECMO). Patients with COVID-19 during the first wave of the pandemic (n = 64) were compared to 64 patients with severe influenza from 2016 to 2020 at our ICU. All patients were treated using a standardized protocol. ECMO was used in cases of severe ARDS. Both groups had similar comorbidities. Time in ICU and mortality were not significantly different, yet mortality with ECMO was high amongst COVID-19 patients with approximately two-thirds not surviving. This is in contrast to a mortality of less than 40% in influenza patients with ECMO. Mortality was higher than estimated by SAPSII score on admission in both groups. Patients with COVID-19 were more likely to be male and non-smokers than those with influenza. The outcomes for patients with severe disease were similar. The study helps to understand similarities and differences between patients treated for severe influenza infections and COVID-19.

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