Changes in the Antenatal Utilization of High-Risk Obstetric Services and Stillbirth Rate during the COVID-19 Pandemic

2021 ◽  
Author(s):  
Megan C. Oakes ◽  
Fan Zhang ◽  
Lori Stevenson ◽  
Bree Porcelli ◽  
Ebony B. Carter ◽  
...  
Keyword(s):  
High Risk ◽  
Study Design ◽  
Linear Models ◽  
Care Center ◽  
Tertiary Care ◽  
Perinatal Outcomes ◽  
Well Being ◽  
Primary Objective ◽  
Stillbirth Rate ◽  
Obstetric Services

Objective The primary objective of this study was to evaluate coronavirus 2019 (COVID-19) pandemic–related changes in the antenatal utilization of high-risk obstetric services. Our secondary objective was to characterize change in stillbirth rate during the pandemic. Study Design This is a retrospective, observational study performed at a single, tertiary care center. Maternal-Fetal Medicine (MFM) visits, ultrasounds, and antenatal tests of fetal well-being during the pandemic epoch (2020), which spans the first 12 weeks of the year to include pandemic onset and implementation of mitigation efforts, were compared with the same epoch of the three preceding years visually and using general linear models to account for week and year effect. An analysis of stillbirth rate comparing the pandemic time period to prepandemic was also performed. Results While there were decreased MFM visits and antenatal tests of fetal well-being during the pandemic epoch compared with prepandemic epochs, only the decrease in MFM visits by year was statistically significant (p < 0.001). The stillbirth rate during the pandemic epoch was not significantly different when compared with the prepandemic period and accounting for both week (p = 0.286) and year (p = 0.643) effect. Conclusion The COVID-19 pandemic resulted in a significant decrease in MFM visits, whereas obstetric ultrasounds and antenatal tests of fetal well-being remained unchanged. While we observed no change in the stillbirth rate compared with the prepandemic epoch, our study design and sample size preclude us from making assumptions of association. Our findings may support future work investigating how changes in prenatal care for high-risk obstetric patients influence perinatal outcomes. Key Points

scholarly journals Medical Trainee Continuity of Care Following Emergency Department Consultations in a Pediatric Hospital

2016 ◽  
Vol 8 (1) ◽  
pp. 33-38 ◽  
Author(s):  
Kim Bjorklund ◽  
Emily A. Eismann ◽  
Roger Cornwall
Keyword(s):  
Emergency Department ◽  
Continuity Of Care ◽  
Broad Spectrum ◽  
Medical Records ◽  
Care Center ◽  
Tertiary Care ◽  
Well Being ◽  
Tertiary Care Center ◽  
Pediatric Hospital ◽  
Medical Trainee

ABSTRACT Background The importance of continuity of care in training is widely recognized; however, a broad-spectrum assessment across all specialties has not been performed. Objective We assessed the continuity of care provided by trainees, following patient consultations in the emergency department (ED) across all specialties at a large pediatric tertiary care center. Methods Medical records were reviewed to identify patients seen in consultation by a resident or fellow trainee in the ED over a 1-year period, and to determine if the patient followed up with the same trainee for the same condition during the next 6 months. Results Resident and fellow trainees from 33 specialties participated in 3400 ED consultations. Approximately 50% (1718 of 3400) of the patients seen in consultation by a trainee in the ED followed up with the same specialty within 6 months, but only 4.1% (70 of 1718) followed up with the same trainee for the same condition. Trainee continuity of care ranged from 0% to 21% among specialties, where specialties with resident clinics (14.4%) have a greater continuity of care than specialties without resident clinics (2.7%, P &lt; .001). Continuity of care did not differ between fellows (4.2%) and residents (4.0%, P = .87), but did differ between postgraduate years for residents (P &lt; .001). Conclusions Trainee continuity of care for ED consultations was low across all specialties and levels of training. If continuity of care is important for patient well-being and trainee education, efforts to improve continuity for trainees must be undertaken.

scholarly journals S288 Missed High-Risk Adenomas and Colorectal Cancers Due to COVID-19 Pandemic at an Urban U.S. Tertiary Care Center in 2020

2021 ◽  
Vol 116 (1) ◽  
pp. S126-S127
Author(s):  
Heidi Ahmed ◽  
James Connolly ◽  
Enoch Chung ◽  
Howard Cabral ◽  
Arpan Mohanty
Keyword(s):  
High Risk ◽  
Care Center ◽  
Tertiary Care ◽  
Colorectal Cancers ◽  
Tertiary Care Center

scholarly journals Assessment of indications of caesarean section among high risk women by Robson criteria: a prospective study

2018 ◽  
Vol 7 (7) ◽  
pp. 2623
Author(s):  
Kaveri Shaw Patel ◽  
Roma S. Nag
Keyword(s):  
High Risk ◽  
Caesarean Section ◽  
Care Center ◽  
Tertiary Care ◽  
Multiple Pregnancy ◽  
Group Classification ◽  
Classification Systems ◽  
World Health ◽  
Qualitative Assessment ◽  
Safe Delivery

Background: Caesarean section (CS) is a surgical intervention for safe delivery other than natural vaginal route. World Health Organization (WHO) has recommended ten group classification systems of Robson criteria which we have used to analyse CS at our center. The objective of the study to analyse the lower section caesarian section (LSCS) data under Robson criteria for implementation in regular practice in tertiary care center and to understand the need of it for future practice.Methods: A prospective analysis done for deliveries in Obstetric Department of Shalby Multispecialty Hospital of central India by Robson ten group classification criteria. The study was carried out for the period of two year from April 2016 to April 2018 including antenatal women attending labour room with high risks or referred cases from other centers.Results: The study reflected overall 196 live birth of high risk cases which were having other co morbidities like pre-eclampsia, eclampsia, hypothyroidism, diabetes, acute viral hepatitis. The data compared with Robsons guidelines and reflected that the centre is dealing with high risk primigravida (47.51%, 35-42% Robson criteria) cases with high CS rate (16.8%, group 5). There was multiple pregnancy, group 8, (2.32 %, >1.5-2% Robson Criteria) and preterm births as in group 10, 18.02 % (5% in Robson Criteria), exclusively high.Conclusions: The Robson criteria help to classify the population handled by the canter to develop the strategies for betterment of services. It has limitation in view of qualitative assessment of the data for comorbidities and severity of the disease.

scholarly journals Efficacy of Dexmedetomidine as an Adjuvant to Local Anesthetic Agent in Scalp Block and Scalp Infiltration to Control Postcraniotomy Pain: A Double-Blind Randomized Trial

2018 ◽  
Vol 09 (01) ◽  
pp. 073-079 ◽  
Author(s):  
Shankar Vallapu ◽  
Nidhi Bidyut Panda ◽  
Navneh Samagh ◽  
Neerja Bharti
Keyword(s):  
Nerve Block ◽  
Care Center ◽  
Tertiary Care ◽  
Primary Objective ◽  
Analgesic Requirement ◽  
Double Blind ◽  
Respiratory Parameters ◽  
Scalp Block ◽  
American Society ◽  
American Society Of Anesthesiologists

ABSTRACT Context: Scalp infiltration and scalp block are being used to manage postcraniotomy pain. Dexmedetomidine has been successfully used as an adjuvant in regional anesthesia. The study was intended to compare whether addition of dexmedetomidine prolonged the duration of analgesia as well as to compare the two techniques. Aims: The primary objective was to assess whether addition of dexmedetomidine to bupivacaine prolonged the duration of analgesia. The secondary objective was to compare between scalp nerve block and scalp infiltration as techniques for pain relief. Settings and Design: The randomized control study was conducted in a tertiary care center from November 2013 to October 2014. Materials and Methods: A total of 150 American Society of Anesthesiologists Physical Status I–II patients, aged 18–70 years undergoing elective craniotomy were included. Patients were randomized into three groups of 50 patients, i.e., Group BI (bupivacaine infiltration), Group BDI (bupivacaine and dexmedetomidine infiltration), and Group BDNB (bupivacaine and dexmedetomidine scalp nerve block). Patient's pain score, pain-free interval, rescue analgesic requirement, and hemodynamic and respiratory parameters were noted for 48 h. Patients were followed up at 1 and 3 months to assess postcraniotomy pain. Results: Pain-free period was significantly longer in Group BDNB than Groups BDI and BI (P < 0.0001) and pain control was better in dexmedetomidine containing groups than in bupivacaine group (BI) (P < 0.0001). The rescue analgesic requirement was significantly lower in Group BDNB and Group BDI compared to Group BI. Conclusion: The addition of dexmedetomidine (1 µg/kg) to bupivacaine prolonged the pain-free period. Scalp nerve block is a superior technique than scalp infiltration.

scholarly journals Impact of COVID-19 Pandemic on Neurosurgical Practice in a Tertiary Care Center in India

2020 ◽  
Author(s):  
Rahul Singh ◽  
Anurag Sahu ◽  
Kulwant Singh ◽  
Ravi Shankar Prasad ◽  
Nityanand Pandey ◽  
...  
Keyword(s):  
Negative Impact ◽  
Health Care Systems ◽  
Care Center ◽  
Tertiary Care ◽  
Admission Rate ◽  
Virtual Learning ◽  
Well Being ◽  
Resident Training ◽  
Management Approach ◽  
Tertiary Care Center

Abstract Objectives The aim of the study is to determine the magnitude of repercussions of coronavirus disease 2019 (COVID-19) pandemic on neurosurgical specialty and formulate a management approach. Materials and Methods This combined retrospective and prospective study was done in neurosurgical specialty of IMS–BHU, Varanasi, India, a tertiary care center, between January 1, 2020 and May 31, 2020. Analysis of impact on neurosurgical emergency and electives was done over before pandemic, during lockdown 1 and 2 and during lockdown 3 and 4 timelines. Effects of COVID-19 pandemic on psychology of neurosurgical team (50 members) and on patient party (88) were also evaluated. Virtual learning and webinars as a substitute to residential neurosurgical training were analyzed by a questionnaire given to 13 neurosurgeons of our department. Statistical Analysis Ordinary one-way ANOVA (analysis of variance) and unpaired t-test were used according to data analyzed. p < 0.05 was considered statistically significant. GraphPad Prism software was used for this analysis. Results On an average 8.22 admissions per day were done in neurosurgical emergency before pandemic. After lockdown these figures reduced to 3.2 admissions per day during lockdown 1 and 2 and to 5.36 admissions per day during lockdown 3 and 4. There was significant reduction in neurotrauma admission rate during lockdown (p < 0.0001) at our center. There was 76% reduction in emergency neurosurgical operated cases during pandemic. There was significant reduction in outpatient department (OPD) attendance per day, OPD admissions per day (p < 0.0001), and total elective surgeries (p < 0.0001) during lockdown. Of 50 neurosurgical team members (neurosurgeons, nursing, and ground staff) interviewed, 90% of them had the fear of contacting the COVID-19 disease, fear of well-being of family and children, and difficulty in transport. Three out of 13 neurosurgeons (23.1%) agreed on change in practice based on what they learned from virtual teaching and webinars and only two of them (15.4%) accepted improvement of skills based on virtual learning. Conclusion The COVID-19 pandemic is causing a significant impact on health care systems worldwide. For conserving resources elective surgical procedures should be limited. This pandemic has a negative impact on neurosurgical resident training program and psychology of both neurosurgical unit and patients.

Pathology Review of Outside Material: When Does It Help and When Can It Hurt?

2011 ◽  
Vol 29 (19) ◽  
pp. 2724-2727 ◽  
Author(s):  
Lauren B. Smith
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Well Being ◽  
Clinical Situation ◽  
Definitive Treatment ◽  
Representative Case ◽  
Doctor Patient Communication ◽  
Clinical Benefits ◽  
Problematic Situations ◽  
Pathology Review

Purpose Pathology review is performed for patients when care is transferred to a tertiary care center after diagnostic tissue has been obtained. While it has many benefits, this practice can lead to unforeseen difficulties in doctor-patient communication and patient well-being, especially if a diagnosis is overturned or modified years after treatment. The aim of this analysis is to identify clinical situations in which pathology review can result in challenging discussions between patients and oncologists. Patients Representative case scenarios are presented in the subspecialty area of hematopathology. Analysis of the clinical benefits and possible harm to patients, pathologists, and treating oncologists that may ensue from pathology review is performed. Results Pathology review may result in a valuable second opinion and expert subclassification. However, problematic situations may arise with pathology review, especially if the patient has already undergone definitive treatment and is referred to an academic institution in remission. Difficulties can also arise when patients do not understand the limitations of diagnosing disease on small biopsies. The patient may receive a different diagnosis or it may become apparent that the diagnosis could have been made more expeditiously. These discrepancies must be communicated to the patient and may cause confusion and distress. Conclusion Pathology review can be beneficial or potentially harmful depending on the clinical situation. Preliminary recommendations are provided for selecting patients for review. Limiting pathology review to certain clinical situations and encouraging patients to get second opinions before initial treatment at local referral centers may be helpful in minimizing reassignment of diagnoses after definitive treatment.

scholarly journals Study of germline mutations in high risk cancer patients from a tertiary care center in India

2019 ◽  
Vol 30 ◽  
pp. ix127-ix128
Author(s):  
P.S. Kulkarni ◽  
S.S. Gandhi ◽  
A.M. Dastane ◽  
C.D. Deshmukh ◽  
S. Hingmire ◽  
...  
Keyword(s):  
High Risk ◽  
Cancer Patients ◽  
Care Center ◽  
Tertiary Care ◽  
Germline Mutations ◽  
Tertiary Care Center ◽  
High Risk Cancer

scholarly journals Attitude of Non-Mental Health Professionals Towards Mental Illness in a Tertiary Care Center

2019 ◽  
Vol 2 (02) ◽  
pp. 23-28
Author(s):  
Nishad P. M. A. ◽  
Dilshana N. B. ◽  
Anil Kakunje ◽  
Ravichandra K. ◽  
Kamran Chisty
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Health Care Professionals ◽  
Psychiatric Illness ◽  
Positive Attitude ◽  
Care Center ◽  
Tertiary Care ◽  
Primary Objective

BACKGROUND Mental and behavioral disorders are major health problems. Stigma can prevent the care and treatment of the mentally ill. There is a gross underestimation of psychiatric comorbidities among patients by non-mental health professionals. A positive attitude of these health professionals has a crucial role in the treatment of patients suffering from psychiatric illness. The primary objective of the study is to study the attitude of various nonmental health professionals towards mental illness. METHODS It is a crosssectional descriptive study, conducted in a private medical college in Mangalore, Karnataka in India. The study had 76 participants consisting of doctors and nurses. Instruments used were a semi-structured demographic proforma and Mental illness: Clinicians Attitude Scale - Version 4 (MICA-4). MICA-4 is a 16- item scale used for assessing attitude towards mental illness. RESULTS The total number of subjects included was 76 among which doctors constituted 57 and nurses 19. As the experience and age of the participants increased, a shift to the positive attitude towards psychiatric illness was noted. Specialist doctors had a higher positive attitude compared to non-specialist medical graduates and nurses. CONCLUSIONS It is essential to have structured training in psychiatry for all health care professionals.

scholarly journals A study of HIV/AIDS awareness among the ICTC clients in a tertiary care center

2021 ◽  
Vol 8 (2) ◽  
pp. 146-151
Author(s):  
Yashaswini M K ◽  
Archana Rao K ◽  
Sangeetha S
Keyword(s):  
Hiv Transmission ◽  
Care Center ◽  
Tertiary Care ◽  
Well Being ◽  
Unprotected Sex ◽  
The Public ◽  
Aids Awareness ◽  
Proper Training ◽  
Living With Hiv ◽  
Hiv Aids

HIV/AIDS poses a significant and one of the most genuine general well-being challenges. For HIV anticipation in the Indian scenario, the main plausible and financially savvy approach that can be adapted is proper training about HIV/AIDS and its various aspects. The present study was embraced to survey the degree of information and awareness about HIV/AIDS among clients attending ICTC facility in our hospital.A total of 200 clients, of age &#62;18yrs, attending the ICTC for HIV testing were studied over a period of 3 months. A questionnaire was prepared in regards to the methods of transmission, preventive techniques, mentality towards patient living with HIV/ AIDS and the source of HIV/ AIDS. The response of clients to the questionnaire was recorded.Among 200 participants, 97% were aware that unprotected sex is a mode of HIV transmission and 64% were aware that infected blood transfusion, use of unsterile needles and syringes contribute to other modes of HIV transmission. It was also noted that uneducated clients had a false perception that HIV can be transmitted by drinking water from same glass and by mosquito bite and this was statistically significant compared to educated individuals. The main source of acquiring positive information among the clients regarding HIV was observed to be television (32.5%). Stigma among the general public was mostly due to fear of contracting the illness. There is a requirement for more noteworthy endeavours toward making data with respect to HIV/AIDS accessible to all. The level of awareness regarding HIV/AIDS needs to be elevated among the public.

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