scholarly journals Antiemetic prophylaxis with temozolomide: an audit from a tertiary care center

2019 ◽  
Vol 6 (6) ◽  
pp. 479-483 ◽  
Author(s):  
Vijay M Patil ◽  
Arun Chandrasekharan ◽  
Dilip Harindran Vallathol ◽  
Mridul Malhotra ◽  
Ram Abhinav ◽  
...  
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Significant Proportion ◽  
Nausea And Vomiting ◽  
P Value ◽  
Antiemetic Prophylaxis ◽  
Retrospective Audit ◽  
Time Period ◽  
Chi Squared ◽  
A Prospective Study

Abstract Background In our previous experience, a significant proportion of patients who received 5-HT3 antagonist monotherapy with adjuvant temozolomide (150-200 mg/m2) had chemotherapy-induced nausea and vomiting (CINV). This is an audit comparing the multiple antiemetic therapies in the prevention of temozolomide-associated CINV. Methods This was a retrospective audit. Adult glioma patients treated with temozolomide at a dose of 150-200 mg/m2 between October 2017 and June 2018 were selected for this analysis. Three antiemetic prophylaxis were used in this time period: ondansetron (October 2017 to November 2017), ondansetron + domperidone (December 2017 to February 2018), and ondansetron + olanzapine (March 2018 to June 2018). The rates of nausea and vomiting were compared among the 3 cohorts using the chi-squared test with Bonferroni correction. A P value of less than .016 was considered significant. Results A total of 360 patients were selected for this analysis. There were 91 patients in the ondansetron prophylaxis group (25.3%), 113 (31.4%) in the ondansetron plus domperidone group, and 156 (43.3%) in the ondansetron plus olanzapine group. The overall incidence of nausea and vomiting was 25.0% (n = 90) and 7.2% (n = 26). Overall the rates of nausea (P = .052) and vomiting (P = .481) were similar in all 3 cohorts. However, the rates of grade 2 and above nausea (P = .012) and vomiting (P = .015) were significantly lower in the olanzapine group. Conclusion The combination of ondansetron with olanzapine leads to a statistically significant decrease in the rate of moderate-to-severe emesis and nausea and needs to be explored in a prospective study.

scholarly journals Inpatient and Emergency Room Ophthalmology Consultations at a Tertiary Care Center

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Daniel J. Oh ◽  
Levi N. Kanu ◽  
Judy L. Chen ◽  
Ahmad A. Aref ◽  
William F. Mieler ◽  
...  
Keyword(s):  
Emergency Room ◽  
Clinical Care ◽  
Care Center ◽  
Tertiary Care ◽  
Significant Proportion ◽  
Field Evaluation ◽  
Consulting Services ◽  
Wide Range ◽  
A Prospective Study ◽  
The University

Background. An ophthalmology consultation service is of significant benefit to patients in the hospital and is an instructive component of a residency education program. Ophthalmology consultations in a hospital present unique challenges to those seen in an outpatient clinic, for which the consulting ophthalmologist should be prepared. The purpose of this study was to profile the emergency room and inpatient ophthalmology consultations seen at an academic institution. Methods. A prospective study of 581 patients was conducted on inpatient and emergency room ophthalmology consultations at the University of Illinois at Chicago over twelve months. Characteristics such as the consulting service, type of and reason for consultation, subspecialty staffing service, diagnosis, and suitability for in-hospital evaluation were recorded. Results. Consultations were received from either inpatient wards (59.4%) or the Emergency Department (40.6%). The most common inpatient consulting services were internal medicine (22%), followed by neurosurgery (16%) and neurology (7%). All the consultations were categorized as acute (72.3%), chronic (6.0%), or screening (21.7%). Consultations categorized as screening included papilledema (31.0%), fungemia (20.6%), syndromic evaluation (19.8%), visual field evaluation (17.5%), and miscellaneous evaluation (11.1%). We classified the ophthalmic diagnoses into 63 unique diagnoses. Amongst the ophthalmic subspecialties, neuro-ophthalmologic diagnoses were the most common (32.0%), followed by retina (20.1%) and cornea (19.4%). Neuro-ophthalmology had the highest proportion of screening consultations (36.6%), while glaucoma had the least overall number of consultations (10.1%), and the least proportion of screening consultations (3.6%). A significant proportion of nonacute consultations (19.0%) was deemed to be more suitable for outpatient evaluation. Discussion. Consultation databases can be useful in preparing trainees for in-hospital clinical care. A wide range of ocular pathologies may present to the ophthalmology consultant, from acute trauma to screening for systemic syndromes. Some consultations may be more suitable for outpatient evaluation which may help optimize patient care.

scholarly journals Poststroke Cognitive Decline: A Longitudinal Study from a Tertiary Care Center

2019 ◽  
Vol 10 (03) ◽  
pp. 459-464 ◽  
Author(s):  
Rameshwar Nath Chaurasia ◽  
Jitendra Sharma ◽  
Abhishek Pathak ◽  
Vijay Nath Mishra ◽  
Deepika Joshi
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Decline ◽  
Care Center ◽  
Tertiary Care ◽  
Rank Test ◽  
P Value ◽  
Stroke Patients ◽  
Stroke Registry ◽  
Chi Squared ◽  
The Difference

Abstract Objectives Poststroke cognitive decline (PSCD) is a serious disabling consequence of stroke. The purpose of this study is to find the prevalence of PSCD and sociodemographic and clinical determinants of risk factors of PSCD. Materials and Methods This study was a prospective, hospital-based study conducted on 200 stroke patients from stroke registry during October 2015 to April 2017. Detailed clinical evaluation was done. Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores were used to determine PSCD after 3 and 6 months as per the Diagnostic and Statistical Manual of Mental Disorders V. Chi-squared test was used to find the association between two variables. The Wilcoxon signed-rank test was used to compare the difference in cognitive impairment between two follow-ups at 3 and 6 months, respectively. A p-value < 0.05 was considered statistically significant. Results The prevalence of PSCD measured by MoCA scale at 3 and 6 months was 67 and 31.6%, respectively. By MMSE scale, cognitive decline prevalence at 3 months was found to be 87 (46.3%), which reduced to 22 (17.1%) at 6 months. The association between MMSE scale and type of stroke was significant at 3 months. Conclusion One-third of the stroke patients developed PSCD within 3 months of onset of stroke, with different levels of severity. The major predictors of new-onset poststroke cognitive impairment were diabetes and hypertension. The prevalence of PSCD reduced significantly at 6 months of stroke on follow-up.

scholarly journals Incidence and Predictive Factors for Prolonged Use of Opioid Medication After Foot and Ankle Surgery

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0001
Author(s):  
Jamal Ahmad
Keyword(s):  
Morbid Obesity ◽  
Care Center ◽  
Tertiary Care ◽  
Female Gender ◽  
Wound Complication ◽  
Anatomical Location ◽  
Time Period ◽  
Number Of Patients ◽  
Ankle Surgery ◽  
A Prospective Study

Category: Other Introduction/Purpose: The purpose of this study is to evaluate the incidence and factors predictive for patients’ needs for opioid pain medication longer than 2 weeks after orthopaedic foot/ankle surgery in a single surgeon’s practice at a tertiary care center. We hypothesize that the number of patients that require opioids for pain management after 2 weeks post-operatively is low, but certain patient factors may be predictive for those individuals that request these medications at this time period. Methods: This is a prospective study of patients that received orthopaedic foot/ankle surgery between August 2016 and November 2017 by a single surgeon. Inclusion criteria involved surgical patients lacking chronic use of opioids. Patients regularly taking opioids pre-operatively were excluded from this study. Patients’ charts were reviewed for their age, weight, and medical co-morbidities. The diagnosis and procedure(s) that each patient received was recorded. Postoperatively, all patients received 60 tablets of opioids for one to be taken every 6 hours as needed for pain within 2 weeks from surgery. Every patient’s postsurgical course was examined for those that asked for and received opioids after 2 weeks from surgery. This event was defined as prolonged post-operative use of opioids. Results: Of 285 opioid-naïve patients that enrolled in this study and received foot/ankle surgery, 35 (12.3%) asked for and received opioids after 2 weeks from surgery. Three of these 35 patients asked for and received opioids after 4 weeks from surgery. No patients asked for and received opioids after 4 weeks from surgery. Age and anatomical location of surgery were not significantly prognostic for a post-surgical wound complication (P>0.05). Those patients of female gender, morbid obesity, and psychiatric conditions such as anxiety and depression were significantly predictive of requesting opioids after 2 weeks from surgery (P<0.05). Those individuals that received revision foot and/or ankle surgery trended towards a higher likelihood of requesting opioids after 2 weeks from surgery (P<0.15). Conclusion: This study demonstrates that the number of patients that require prolonged post-operative use of opioid medicine after orthopaedic foot and/or ankle surgery is low. However, this research shows that female patients with certain medical conditions such as morbid obesity and psychiatric illness are significantly likely to request opioids after 2 weeks from surgery. This is highly important when providing patients with realistic expectations of pain from foot/ankle surgery and the effectiveness and duration of opioids that help treat such pain.

scholarly journals Increasing Facemask Compliance among Healthcare Personnel during the COVID-19 Pandemic

2021 ◽  
pp. 1-22
Author(s):  
Rupak Datta ◽  
Keith Glenn ◽  
Anthony Pellegrino ◽  
Jessica Tuan ◽  
Brian Linde ◽  
...  
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Baseline Period ◽  
Healthcare Personnel ◽  
Structured Interviews ◽  
Time Series Regression ◽  
Multimodal Intervention ◽  
Direct Observations ◽  
Chi Squared ◽  
Ancillary Staff

Abstract Objective: Prior studies of universal masking have not measured facemask compliance. We performed a quality improvement study to monitor and improve facemask compliance among healthcare personnel (HCP) during the coronavirus disease 2019 (COVID-19) pandemic. Design: Mixed-methods study Setting: Tertiary care center in West Haven, Connecticut Patients: HCP including physicians, nurses, and ancillary staff Methods: Facemask compliance was measured through direct observations during a 4-week baseline period after universal masking was mandated. Frontline and management HCP completed semi-structured interviews from which a multimodal intervention was developed. Direct observations were repeated during a 14-week period following implementation of the multimodal intervention. Differences between units were evaluated with chi-squared testing using the Bonferroni correction. Facemask compliance between baseline and intervention periods was compared using time series regression. Results: Among 1,561 observations during the baseline period, median weekly facemask compliance was 82.2% (range, 80.8%-84.4%). Semi-structured interviews were performed with 16 HCP. Qualitative analysis informed the development of a multimodal intervention consisting of audit and passive feedback, active discussion, and increased communication from leadership. Among 2,651 observations during the intervention period, median weekly facemask compliance was 92.6% (range, 84.6%-97.9%). There was no difference in weekly facemask compliance between COVID-19 and non-COVID-19 units. The multimodal intervention was associated with an increase in facemask compliance (β=0.023, p=0.002) Conclusions: Facemask compliance remained suboptimal among HCP despite a facility-wide mandate for universal masking. A multimodal intervention consisting of audit and passive feedback, active discussion, and increased communication from leadership was effective in increasing facemask compliance among HCP.

scholarly journals Serum Concentration of Myelin Basic Protein as a Prognostic Marker in Mild-to-moderate Head Injury Patients: A Prospective Study in a Tertiary Care Center

2021 ◽  
Author(s):  
Ashvamedh Singh ◽  
Kulwant Singh ◽  
Anurag Sahu ◽  
R. S. Prasad ◽  
N. Pandey ◽  
...  
Keyword(s):  
Head Injury ◽  
Prospective Study ◽  
Myelin Basic Protein ◽  
Prognostic Marker ◽  
Outcome Prediction ◽  
Basic Protein ◽  
Care Center ◽  
Tertiary Care ◽  
Gcs Score ◽  
A Prospective Study

Abstract Objective To estimate the level of myelin basic protein (MBP) and look for its validity in outcome prediction among mild-to-moderate head injury patients. Materials and Methods It was a prospective study done at the Department of Neurosurgery, Institute of Medical Sciences, Banaras Hindu University from Jan 2018 to July 2019. All patients who presented to us within 48 hours of injury with mild-to-moderate head injury with apparently normal CT brain were include in the study. The serum sample were collected on the day of admission and 48 hours later, and patients were treated with standard protocols and observed 6 months postdischarge. Results Of the 32 patients enrolled, we observed mean MBP level was higher for severity of brain damage, but not associated with age, mode of injury, and radiological diagnosis. Mean MBP levels were not statistically associated with Glasgow coma scale (GCS) score at admission but was correlated to outcome with p < 0.05, with sensitivity of 50% and specificity 72%, that is, patients with good outcome have lower mean MBP levels. Conclusion MBP as per our analysis can be used as a prognostic marker in patients with head injury. It is not the absolute value rather a trend showing rise in serum MBP levels, which carries a significant value in outcome prediction.

scholarly journals Case Study of Pediatric Cerebral Sinus Venous Thrombosis Center of a Low Middle-Income Country

2021 ◽  
Vol 27 ◽  
pp. 107602962110228
Author(s):  
Bushra Moiz ◽  
Ronika Devi Ukrani ◽  
Aiman Arif ◽  
Inaara Akbar ◽  
Muhammed Wahhaab Sadiq ◽  
...  
Keyword(s):  
Sinus Thrombosis ◽  
Care Center ◽  
Tertiary Care ◽  
Age Groups ◽  
Activated Protein C ◽  
Positive Association ◽  
Cerebral Venous Sinus Thrombosis ◽  
P Value ◽  
Middle Income ◽  
Duration Of Symptoms

Pediatric cerebral venous sinus thrombosis (CVST) is rare but a potentially fatal disease requiring its understanding in local setting. In this study, we observed the clinical course, management, and outcome of pediatric patients with sinus thrombosis in a tertiary care center at Pakistan. Patients between age 0 to 18 years of both genders diagnosed with sinus thrombosis during 2011 to 2020 were included. Data was collected through in-house computerized system and SPSS version 19 was used for analysis. Of 143492 pediatric admissions, 32 (21 males and 11 females) patients with a median (IQR) age of 4.5 years (0-16) had CVST. This is equivalent to 18.5 CVST events per million pediatric admissions. Adolescents were mostly affected, and the overall mortality was 7%. Primary underlying disorders were infections (59%), hematological neoplasms (12.5%), thrombotic thrombocytopenic purpura (3%) and antiphospholipid syndrome (3%). Activated protein C resistance (44%) was the most common inherited thrombophilia. Twenty-one (66%) patients were anemic with a mean (±SD) hemoglobin of 9.0 g/dL (±2.3). Regression analysis showed a positive association of anemia with multiple sinus involvement ( P-value 0.009) but not with duration of symptoms ( P-value 0.344), hospital stay ( P-value 0.466), age ( P-value 0.863) or gender ( P-value 0.542) of the patients. SARS-COV2 was negative in patients during 2020. Adolescents were primarily affected by sinus thrombosis and infections was the predominant risk factor for all age groups, with a low all-cause mortality. A high index of clinical suspicion is required for prompt diagnosis and intervention.

scholarly journals Transport Factors Affecting the Outcome of Referred Neonates Admitted in A Tertiary Care Hospital

2018 ◽  
Vol 41 (3) ◽  
pp. 159-164 ◽  
Author(s):  
Madhabi Baidya ◽  
Mahfuza Shirin ◽  
Liton Chandra Saha
Keyword(s):  
Perinatal Asphyxia ◽  
Care Center ◽  
Tertiary Care ◽  
Preterm Neonates ◽  
P Value ◽  
Care Hospital ◽  
Cross Sectional ◽  
Neonatal Transport ◽  
Group I ◽  
Group Ii

Background: Adequate neonatal transport is a key component of care of the sick newborns who require referral to tertiary care center. Poor transportation is one of the iatrogenic factors associated with greater neonatal mortality. Neonatal transport is the greatest challenge faced today in our country. The purpose of this study was to find out characteristics of transport of referred neonates and to idention the factors that contribute to mortality.Methodology: This cross sectional study was conducted in Dhaka Shishu (Children) Hospital from June 2013 to November 2013. Both term and preterm neonates who were referred within first seven days of life were included and those with gross congenital abnormalities and left against medical advice were excluded from the study. After enrollment, data were collected using a structured questionnaire including birth details, interventions before transportation, reasons for referral, and details of transportation. Outcome & duration of hospital stay were also recorded. Neonates who were expired considered as group I and who were survived considered as group II. The study variables were analyzed for their association with immediate outcome by applying chi square test and t test. P value <0.05 was considered significant.Results: This study found that out of 332 neonates 181 were expired with 54.5% mortality rate. One eighty one neonates who were expired, considered as group I and one fifty one neonate were survived, considered as group II. The mortality was significantly high in male neonates [RR 0.80 (0.66-0.97)] and neonates those delivered at home [RR 1.34(1.10-1.64)] (p<0.05). Perinatal asphyxia, pre-term low birth weight, neonatal sepsis were the main causes of referral. It was found that transportation without any referral note [RR 1.40 (1.14- 1.71)], no advice regarding maintenance of airway[RR 1.50(1.17- 1.92)]and keeping warm [RR 1.51(1.17-1.950], resuscitation on admission [RR 1.63(1.23-2.17)] and transportation required > 3hours [RR 1.36(1.09-1.69)] were associated with significantly higher mortality among referred transported neonates(p<0.05).Conclusions: This study found that male neonates, home delivery, transportation without any referral note, no advice regarding maintenance of airway and keeping warm, resuscitation needed on admission and prolonged transportation time were significantly associated with mortality of referred transported neonates.Bangladesh J Child Health 2017; VOL 41 (3) :159-164

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