A simple ergonomic measure reduces fluoroscopy time during ERCP: A multivariate analysis

Abstract Background and study aims Endoscopic retrograde cholangiopancreatgraphy (ERCP) carries a radiation risk to patients undergoing the procedure and the team performing it. Fluoroscopy time (FT) has been shown to have a linear relationship with radiation exposure during ERCP. Recent modifications to our ERCP suite design were felt to impact fluoroscopy time and ergonomics. This multivariate analysis was therefore undertaken to investigate these effects, and to identify and validate various clinical, procedural and ergonomic factors influencing the total fluoroscopy time during ERCP. This would better assist clinicians with predicting prolonged fluoroscopic durations and to undertake relevant precautions accordingly. Patients and methods A retrospective analysis of 299 ERCPs performed by 4 endoscopists over an 18-month period, at a single tertiary care center was conducted. All inpatients/outpatients (121 males, 178 females) undergoing ERCP for any clinical indication from January 2012 to June 2013 in the chosen ERCP suite were included in the study. Various predetermined clinical, procedural and ergonomic factors were obtained via chart review. Univariate analyses identified factors to be included in the multivariate regression model with FT as the dependent variable. Results Bringing the endoscopy and fluoroscopy screens next to each other was associated with a significantly lesser FT than when the screens were separated further (–1.4 min, P = 0.026). Other significant factors associated with a prolonged FT included having a prior ERCP (+ 1.4 min, P = 0.031), and more difficult procedures (+ 4.2 min for each level of difficulty, P < 0.001). ERCPs performed by high-volume endoscopists used lesser FT vs. low-volume endoscopists (–1.82, P = 0.015). Conclusions Our study has identified and validated various factors that affect the total fluoroscopy time during ERCP. This is the first study to show that decreasing the distance between the endoscopy and fluoroscopy screens in the ERCP suite significantly reduces the total fluoroscopy time, and therefore radiation exposure to patients and staff involved in the procedure.

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Prevalence and risk factors of anemia among pregnant women attending a high-volume tertiary care center for delivery

Journal of the Turkish-German Gynecological Association ◽

10.5152/jtgga.2015.15071 ◽

2015 ◽

Vol 16 (4) ◽

pp. 231-236 ◽

Cited By ~ 6

Author(s):

Cuneyt Eftal Taner ◽

Atalay Ekin ◽

Ulas Solmaz ◽

Cenk Gezer ◽

Birgul Cetin ◽

...

Keyword(s):

Risk Factors ◽

Pregnant Women ◽

Care Center ◽

Tertiary Care ◽

High Volume ◽

Tertiary Care Center

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Effect of the SARS-CoV-2 Pandemic on the Experience and Outcomes of Patients Who Underwent Resection for Pancreatic Cancer at a High-volume Tertiary Care Center

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2021.08.316 ◽

2021 ◽

Vol 233 (5) ◽

pp. e117

Author(s):

Rachel C. Kim ◽

Alexandra M. Roch ◽

Eugene P. Ceppa ◽

Attila Nakeeb ◽

C. Max Schmidt ◽

...

Keyword(s):

Pancreatic Cancer ◽

Care Center ◽

Tertiary Care ◽

High Volume ◽

Tertiary Care Center

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375. Cryptococcal Antigenemia in Advanced HIV Infection

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.448 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S196-S196

Author(s):

Jatin Ahuja ◽

Manish Soneja ◽

Naveet Wig ◽

Immaculata Xess ◽

Ashutosh Biswas ◽

...

Keyword(s):

Multivariate Analysis ◽

Care Center ◽

Tertiary Care ◽

Latex Agglutination ◽

Cd4 Count ◽

North India ◽

World Health ◽

P Value ◽

The Mean

Abstract Background Diagnostic importance of asymptomatic cryptococcal antigenemia is being increasingly recognized in the last few years. Recently, WHO (World Health Organization) has recommended routine screening of CrAg (cryptococcal antigen) among PLHA with CD4 ≤100/mm3, albeit this procedure is not yet adopted by many developing countries including India. Methods We conducted a prospective observational study in a large tertiary care center of North India, upon ethical clearance. Latex agglutination test was performed to assess serum CrAg levels, followed by the lumbar puncture for detection of CrAg levels in the CSF. We analyzed the prevalence and treatment outcomes of cryptococcal antigenemia among PLHA with CD4 ≤ 100 cells/mm3. Detailed clinical examination was conducted, with follow-up of upto 3 months. Multivariate analysis was performed for the estimation of risk factors. Results The mean age (years) and BMI (kg/m2) of all the participants were 41.4 ± 11.2 and 22.1 ± 2.6, respectively. Notably, the mean CD4 count (cu.mm) at the time of recruitment was 62.3 ± 20.5. Noteworthy, 62 (60.8%) of the patients were ART naïve. We found 9.8% (n = 10) of the patients were positive for serum CrAg, and only 2.9% (n = 3) had clinical features of meningitis and 6.8% (n = 7) were asymptomatic (subclinical) CrAg positive. Strikingly, 3.9% (n = 4) of the asymptomatic cryptococcal antigenemia patients were also positive for CrAg in CSF, with 1.9% (n = 2) were only serum CrAg positive, and 1 patient was lost to follow-up (Graph 1). Multivariate analysis revealed that patients with long duration of HIV (P = 0.04), headache symptoms (P = 0.004) and possessing features of meningismus (P value=0.08) are more likely to be CrAg positive. Conversely, patients on fluconazole were protective against cryptococcal antigenemia (P = 0.1) as shown in Table 1. Overall mortality observed was 11.3% among advanced HIV patients. Moreover, mortality in CrAg-positive patients was 33.3% in comparison to CrAg-negative patients who had 9% (P = 0.06) in 3-months follow-up. Conclusion Cryptococcal antigenemia is common (9.8%) among patients with CD4 count ≤100/mm3 in India. Screening for CrAg should be made routine for PLHA with CD4 count ≤100/mm3 and if required preemptive treatment to be given in this regard. Disclosures All authors: No reported disclosures.

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573. Enterococcal Bacteremia in a Tertiary Care Center in Mexico: A Retrospective Analysis Focus on Vancomycin-Resistant E. faecium and Ampicillin-Resistant E. faecalis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.642 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S270-S271

Author(s):

Bruno A Lopez Luis ◽

Darwin Lambraño-Castillo ◽

Edgar Ortiz-Brizuela ◽

Andrea Ramirez-Fontes ◽

Yanet Estrella Tovar-Calderon ◽

...

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Care Center ◽

Strong Association ◽

Tertiary Care ◽

Acquired Resistance ◽

Venous Catheter ◽

Vana Gene ◽

Vancomycin Resistant ◽

History Of Use

Abstract Background The primary pathogens in genera enterococcus are E. faecalis and E. faecium, increasing acquired resistance to glycopeptides and β lactamic has done the management more challenging. We aimed to describe the risk factors for acquisition of bacteremia for vancomycin-resistant E. faecium (VRE) and ampicillin-resistant E. faecalis (ARE) and the 30-day mortality in comparison to susceptible enterococcal bloodstream infection (BSI) Methods From 2007- 2017 medical records of all BSI for E. faecalis and E. faecium were evaluated. Risk factor for acquisition of VRE and ARE as well as the significant variables associated with 30-day mortality for enterococcal BSI were determined by univariate and multivariate analysis. The molecular mechanism of VRE was performed by PCR Results There were 192 patients with E. faecium BSI of which 107(56%) patients had VRE BSI with 94% VRE strains expressing vanA gene. The index bacteremic episodes were classified as nosocomial o healthcare associated in 99%, 102(95%) had hospitalization 1 year before and 101(94%) history of use of antibiotics 3 months earlier, the multivariate analysis showed duration of the previous hospitalization >10 days (OR, 80.18; 95% CI, 1.81–634), use of central venous catheter [OR, 11.15; 95% CI, 2.48–50.2), and endotracheal cannula [OR, 17.91; 95% CI, 1.22–262) as significant associated variables. The mortality for VRE was greater than susceptible E. faecium (60% vs. 24%, P < 0.001). The only factors for 30-day mortality for E. faecium BSI in the multivariate analysis was APACHE ll score [OR,1.45; 95% CI, 1.26–1.66) and patients with chemotherapy of cancer. (OR, 3.52; 95% CI, 1.09–11.39). 147 patients had E. faecalis BSI of which 18 (11%) patients had ARE, we did not find relevant clinical differences of ARE in comparison with ampicillin-susceptible E. faecalis, neither in risk factors for acquisition of ARE nor 30-day mortality [7(39%) vs. 38(29%), P = 0.58] in uni and multivariate analysis Conclusion Our evaluation showed in a period of 10 years that VRE expressing vanA gene had a strong association with patients with previous nosocomial exposure. Severely ill patients and cancer patients on chemotherapy during the bacteremic episode were the variables more associated with 30-day mortality. ARE is yet of low prevalence and less known, constant surveillance about it is warranted Disclosures All authors: No reported disclosures.

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ERCP quality indicators: The experience of a high-volume tertiary care center in Saudi Arabia

Arab Journal of Gastroenterology ◽

10.1016/j.ajg.2019.01.005 ◽

2019 ◽

Vol 20 (1) ◽

pp. 32-37

Author(s):

Shahem Abbarh ◽

Mostafa Seleem ◽

Areej Al Balkhi ◽

Abdullah Al Mtawa ◽

Abdullah Al Khathlan ◽

...

Keyword(s):

Saudi Arabia ◽

Quality Indicators ◽

Care Center ◽

Tertiary Care ◽

High Volume ◽

Tertiary Care Center

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Pancreaticoduodenectomy: Volume is not Associated with Outcome within an Academic Health Care System

HPB Surgery ◽

10.1155/2008/825940 ◽

2008 ◽

Vol 2008 ◽

pp. 1-6 ◽

Cited By ~ 23

Author(s):

Micheal T. Schell ◽

Anthony Barcia ◽

Austin L. Spitzer ◽

Hobart W. Harris

Keyword(s):

Health Care ◽

San Francisco ◽

Medical Center ◽

Care Center ◽

Tertiary Care ◽

Survival Rates ◽

High Volume ◽

Care Pathways ◽

Complication Rates ◽

Significant Difference

Hypothesis. Smaller and lower-volume hospitals can attain surgical outcomes similar to high-volume centers if they incorporate the expertise and health care pathways of high-volume centers. Setting. The academic tertiary care center, Moffit-Long Hospital (ML); the community-based Mount Zion Hospital (ZION); the San Francisco County General Hospital (SFGH); and the Veterans Affairs Medical Center of San Francisco (VAMC). Patients. 369 patients who underwent pancreaticoduodenectomy between October 1989 and June 2003 at the University of California, San Francisco (UCSF) affiliated hospitals. Interventions. Pancreaticoduodenectomy. Design. Retrospective chart review. To correct for the potentially confounding effect of small case volumes and event rates, data for SFGH, VAMC, and ZION was combined (Small Volume Hospital Group; SVHG) and compared against data for ML. Main Outcome Measures. Complication rates; three-year and five-year survival rates. Results. The average patient age and health, as determined by ASA score, were similar between ML and the SVHG. The postoperative complication rate did not differ significantly between ML and the SVGH (58.8% versus 63.1%). Patients that experienced a complication averaged 2.5 complications in both groups. The perioperative mortality rate was 4% for patients undergoing pancreaticoduodenectomy at either ML or the SVGH. Although the 3-year survival rate for patients with adenocarcinoma of the pancreas was nearly twice as high at ML (31.2% versus 18.3% at SVHG), there was no significant difference in the 5-year survival rates (19% at ML versus 18.3% at SVHG). Conclusions. Low-volume hospitals can achieve similar outcomes to high-volume tertiary care centers provided they import the expertise and care pathways necessary for improved results.

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Outbreak of Postoperative Endophthalmitis in a Thai Tertiary Care Center

Infection Control and Hospital Epidemiology ◽

10.1086/587809 ◽

2008 ◽

Vol 29 (6) ◽

pp. 564-566

Author(s):

Anucha Apisarnthanarak ◽

Supanee Jirajariyavej ◽

Kanokporn Thongphubeth ◽

Chananart Yuekyen ◽

David K. Warren ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Multivariate Analysis ◽

Infection Control ◽

Care Center ◽

Tertiary Care ◽

Postoperative Endophthalmitis ◽

Tertiary Care Center ◽

Associated Risk Factors

We performed a study with a 1:3 ratio of case patients (n = 11) to control patients (n = 33) to evaluate risk factors for postoperative endophthalmitis in a Thai tertiary care center. Multivariate analysis revealed that diabetes mellitus and surgeon A were associated risk factors. Preoperative diabetes mellitus control and the improvement of infection control practices led to the termination of the outbreak.

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Mo1185 Low In-Hospital Mortality and Adverse Events After Percutaneous Endoscopic Gastrostomy (PEG) in a High-Volume Tertiary Care Center

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2017.03.1056 ◽

2017 ◽

Vol 85 (5) ◽

pp. AB454

Author(s):

Bijun S. Kannadath ◽

Bharat S. Bhandari ◽

Shruti Khurana ◽

Akhil Munjal ◽

Emilia Khalil ◽

...

Keyword(s):

Adverse Events ◽

Hospital Mortality ◽

Percutaneous Endoscopic Gastrostomy ◽

Care Center ◽

Tertiary Care ◽

High Volume ◽

Tertiary Care Center ◽

Endoscopic Gastrostomy

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Clinical and laboratory characteristics of patients presenting to a tertiary care center emergency department with invasive group A streptococcal infections

CJEM ◽

10.1017/cem.2019.457 ◽

2020 ◽

Vol 22 (3) ◽

pp. 368-374

Author(s):

Karly Dudar ◽

Shalyn Littlefield ◽

Meghan Garnett

Keyword(s):

Emergency Department ◽

Care Center ◽

Tertiary Care ◽

Vital Signs ◽

High Volume ◽

Geographic Area ◽

Streptococcal Infections ◽

Invasive Group ◽

Icd 10 ◽

Group A

ABSTRACTObjectivesThe aim of this study was to describe the clinical and laboratory characteristics of invasive group A streptococcal infections in a geographic area that sees a high volume of cases.MethodsWe conducted a health records review of consecutive patients presenting to the Thunder Bay Regional Health Sciences Centre Emergency Department (ED) in 2016–2017 with a diagnosis of invasive group A streptococcal infection using ICD-10 codes. Patient demographics, host characteristics, triage vital signs, laboratory values, culture sites, and disposition were described using univariate and bivariate statistics.ResultsForty-four adult cases were identified over 2 years, with a median age of 44 years (interquartile range, 35–52). The most prevalent risk factors were diabetes mellitus (45%), current or previous alcohol abuse (39%), and current or previous intravenous drug use (34%). The two most abnormal triage vitals signs were a heart rate ≥ 100 beats per minute in 32 (73%) cases and a respiratory rate ≥ 20 breaths per minute in 27 (63%) cases. The temperature was ≥ 38°C in only 14 (32%) of cases. The C-reactive protein (CRP) was always elevated when measured, and greater than 150 mg/L in 20 (71%) of cases. One-third of patients had an ED visit in the preceding 7 days before the diagnosis of invasive group A Streptococcus.ConclusionsInvasive group A streptococcal infections often present insidiously in adult patients with mild tachycardia and tachypnea at triage. The CRP was the most consistently abnormal laboratory investigation.

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