scholarly journals P73 Trends in ultrasound guided musculoskeletal injections at one tertiary care centre over 6 years

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Kunal Lall ◽  
Vivian Ejindu ◽  
Patrick D. W Kiely
Keyword(s):  
Soft Tissue ◽  
Time Pressure ◽  
Waiting Times ◽  
Tertiary Care ◽  
Fold Increase ◽  
Ultrasound Guided ◽  
Tertiary Care Centre ◽  
The Impact ◽  
Effective Service

Abstract Background Ultrasound (US) has brought many benefits into rheumatologic practice, delivery of targeted injections into joints, bursae and other structures. Whilst many joints may be accurately injected in clinic, guided by clinical landmarks, US permits injections into anatomically less accessible sites. We have assessed trends in the number and type of requests for US guided joint or soft tissue injections from the rheumatology department over the last 6 years, and the impact on waiting times. Methods Details of all requests for US guided joint or soft tissue injections were obtained from the St George’s PACS system from 1 January 2013 - 31 December 2018. Review of patient records was conducted to determine whether the referral was routine or urgent, the waiting time between referral and appointment, the joint or structure to be injected, and whether an injection into the requested site was actually performed. Results Table 1 shows the total number of out-patient attendances in rheumatology per year from 2013 - 2018, the number of referrals for US-guided injection, the proportion requested urgently and waiting times for routine and urgent cases. Over 6 years requests for US guided injections have risen 2.3-fold, from <1% to nearly 2% of all out-patient attendances. Of 1834 requests, no injections were given in 420 instances (23%), due to patient preference or lack of indication at time of US. In 2018 of all joint or tendon/bursa injections initiated in rheumatology, 260 (38%) were given in routine clinic time without delay, and 420 (62%) were requested by US with a delay of over 2 months. Conclusion Over 6 years a 33% increase in out-patient clinic workload has been accompanied by a disproportionate 2.3-fold increase in requests for US guided injections, representing >50% of injections initiated by the service. One explanation may be time pressure in clinic. This trend has not been matched by increased radiology capacity, with urgent requests now waiting >6 weeks. This has implications for quality of care, staffing and effective service delivery. The trend to fewer injections in clinic will continue if clinicians become increasingly reliant on radiology colleagues. Disclosures K. Lall None. V. Ejindu None. P.D.W. Kiely None.

scholarly journals The impact of cataract surgery upon visual acuity and quality of life in patients with cataract in Tripura

2020 ◽  
Vol 8 (1) ◽  
pp. 167
Author(s):  
Monali Acharya ◽  
Subrata Baidya ◽  
Rituparna Das ◽  
Phani Sarkar ◽  
Himadri Choudhury
Keyword(s):  
Quality Of Life ◽  
Visual Acuity ◽  
Cataract Surgery ◽  
Tertiary Care ◽  
General Function ◽  
Tertiary Care Centre ◽  
Cross Sectional ◽  
Level Of Satisfaction ◽  
The Impact

Background: The major cause of blindness in India is cataract. Blindness leads to poverty due to reduced productive activity and this leads to reduced quality of life. This study was aimed at evaluating the visual acuity (VA) change pre and post cataract surgery, the post-surgical quality of life (QOL) outcomes and level of satisfaction estimation.Methods: This was a cross sectional, hospital based study carried out in a tertiary care centre in Tripura. It included 200 patients over a period of 1.5 years to compare the VA, QOL, psychosocial status and satisfaction level pre and post cataract surgery. Indian vision function questionnaire 33 (INDVFQ33) was used to assess QOL.Results: Out of 200 patients, in 53% preoperative VA ranged from >20/400 - <20/200 while in 5% patients it was only perception of light. Postoperatively 80% of the patient achieved best corrected VA (BCVA) of 20/30 or better, 18% patient attained BCVA ranging from 20/40 to 20/60. Only 2% had a BCVA of 20/60 or worst.  QOL parameters like mean pre and post -operative general function score, psychosocial scale and visual function scale showed improvement following cataract surgery. 69% of the patients were satisfied with the cataract surgery, whereas 31% were not completely satisfied.Conclusions: The study revealed that there was a marked improvement in VA post cataract surgery and it also influenced the QOL in all scales.

scholarly journals Impact of COVID-19 pandemic on stroke admissions in Qatar

2021 ◽  
Vol 3 (1) ◽  
pp. e000084
Author(s):  
Naveed Akhtar ◽  
Salman Al Jerdi ◽  
Ziyad Mahfoud ◽  
Yahia Imam ◽  
Saadat Kamran ◽  
...  
Keyword(s):  
Hospital Admissions ◽  
Small Vessel Disease ◽  
Tertiary Care ◽  
Relative Increase ◽  
Large Vessel ◽  
Tertiary Care Centre ◽  
Transient Ischaemic Attacks ◽  
Stroke Mimics ◽  
Coronary Syndromes ◽  
The Impact

IntroductionThe COVID-19 pandemic has resulted in a dramatic unexplained decline in hospital admissions due to acute coronary syndromes and stroke. Several theories have emerged aiming to explain this decline, mostly revolving around the fear of contracting the disease and thus avoiding hospital visits.AimsIn this study, we aim to examine the impact of the COVID-19 pandemic on stroke admissions to a tertiary care centre in Qatar.MethodsThe Hamad General Hospital stroke database was interrogated for stroke admissions between September 2019 and May 2020. The number of stroke admissions, stroke subtypes and short-term outcomes was compared between the ‘pre-COVID-19’ period (September 2019 to February 2020) and the COVID-19 pandemic period (March to May 2020).ResultsWe observed a significant decline in monthly admissions in March (157), April (128) and May (135) compared with the pre-COVID-19 6-month average (229) (p=0.024). The reduction in admissions was most evident in functional stroke mimics. The average admissions decreased from 87 to 34 per month (p=0.0001). Although there were no significant differences in admissions due to ischaemic stroke (IS), intracranial haemorrhage or transient ischaemic attacks between the two periods, we noted a relative decrease in IS due to small vessel disease and an increase in those due to large vessel atherosclerosis in March to May 2020.ConclusionsThe decline in overall stroke admissions during the COVID-19 pandemic is most likely related to concerns of contracting the infection, evidenced mainly by a decline in admissions of stroke mimics. However, a relative increase in large vessel occlusions raises suspicion of pathophysiological effects of the virus, and requires further investigation.

scholarly journals A pilot study comparing pattern of damage sustained among instruments from different surgical units in a tertiary care centre in Nepal – reappraising the role of instrument reprocessing in retaining their value

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 102
Author(s):  
Sunil Munakomi ◽  
Roshan Shah ◽  
Sangam Shrestha
Keyword(s):  
Tertiary Care ◽  
Health Spending ◽  
Pivotal Role ◽  
World Health ◽  
Tertiary Care Centre ◽  
Surgical Equipment ◽  
Surgical Units ◽  
Wear And Tear ◽  
Health Organization

Background: The quality of instruments plays a pivotal role in governing safe operating room culture. The reprocessing system followed in the institution determines their durability thereby ensuring patient safety as well as minimizing health spending. Rigorous reprocessing in a centralized instrument reprocessing department by well trained staff following formulated guidelines helps to achieve the target of “safe surgery saves lives” as formulated by the World Health Organization. Methods: We sought to determine the patterns of wear and tear sustained among sets of surgical equipment from two surgical units that had been sent to the repair department within a year of their purchase. Analysis of similar changes in the joints of the instrument, as well as pattern of fractures sustained was performed. Results: All patterns of wear and tear were common in both the general surgical arm and neurosurgical counterpart, with the exception of fractures and mal-alignments. Similar study was performed examining changes in the joints. Stains were the most commonly observed change pattern in both sets of instruments. Fractures were most frequent in the working ends in both sets of instruments. Conclusion: There is an alarming incidence of wear and tear patterns in the instruments used in the surgical units, even within the first year of their use. This supports the strict implementation of reprocessing guidelines by well trained workers and their quality assessments via audit checks. The quality of the purchased instruments also plays a pivotal role.

scholarly journals Clinico-physiological profile of patients of pulmonary impairment after tuberculosis at a tertiary care centre

2018 ◽  
Vol 6 (9) ◽  
pp. 2999
Author(s):  
Gajendra V. Singh ◽  
Antriksh Srivastava ◽  
Vinisha Chandra ◽  
Santosh Kumar ◽  
Rishabh Goel
Keyword(s):  
Pulmonary Tuberculosis ◽  
Exercise Tolerance ◽  
Structural Changes ◽  
Tertiary Care ◽  
Uttar Pradesh ◽  
Lung Parenchyma ◽  
Tertiary Care Centre ◽  
Physiological Profile ◽  
Pulmonary Impairment

Background: Pulmonary tuberculosis (TB) is a unique infectious disease that more often results in permanent structural changes in the lung parenchyma. It is by virtue of these changes that the patients even after bacteriological cure continue to suffer the after effects of the disease. Objective of study was to assess the clinico-physiological profile of patients of pulmonary impairment after tuberculosis (PIAT) attending S. N. Medical College, Agra, Uttar Pradesh, India.Methods: Over the time period of 2 years, 350 patients of healed pulmonary tuberculosis were identified and studied about their clinico-physiological profile. This profile included age, sex, category of treatment, pulmonary function test pattern, exercising capacity, exercise tolerance and quality of life.Results: It was found that majority of the patients were males, >60 years of age and had taken Category-II treatment. Most of the patients were having an obstructive pattern on PFT, poor exercise tolerance and exercise capacity and a poor quality of life.Conclusions: Patients of healed pulmonary TB continue to experience respiratory symptoms owing to the permanent anatomical changes in the lung conferred by the disease.

CLINICAL PROFILE OF OUTPATIENTS ATTENDING DERMATOLOGY DEPARTMENT DURING COVID-19 LOCKDOWN RELAXATION PERIOD IN A TERTIARY CARE CENTRE IN SOUTH INDIA – A CROSS-SECTIONAL ANALYTICAL STUDY

2021 ◽  
pp. 13-16
Author(s):  
Afthab Jameela Wahab ◽  
Pavithra Gunasekaran ◽  
P. Mohan ◽  
V. Sudha ◽  
L. Balamurugan ◽  
...  
Keyword(s):  
South India ◽  
Tertiary Care ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Dermatology Department ◽  
Cutaneous Manifestations ◽  
Relaxation Period ◽  
Number Of Patients ◽  
Outpatient Practice ◽  
The Impact

Background - The cutaneous manifestations of the novel coronavirus have been well documented. However, there are few studies that relate to the clinical prole of regular dermatology outpatients seeking treatment during the lockdown relaxation period braving the pandemic. With the Aim - view to determine the changes seen in dermatology outpatient practice, this study analysed the clinical prole of new patients attending the Dermatology Outpatient Department (OPD) during the COVID-19 lockdown relaxation period in a tertiary care centre in a metropolitan suburb in South India. New dermatology outpatients during the months of May, June, July and August Method - 2020 were included in the study. Outpatient data for this period was analysed and compared with corresponding data for the same period in the previous two years. There was a Result – decrease in the OP census, number of patients in the extremes of life as well as those with asymptomatic dermatoses. There was an increase in the number of patients with infections, particularly dermatophytosis. There was also a noteworthy absence of dermatological emergencies. Conclusion - In essence, our study shows the impact of COVID-19 pandemic on the routine dermatology outpatient services with signicant changes in the clinical prole of outpatient practice following lockdown relaxation.

scholarly journals The Integration of Adult Acute Care Surgeons into Pediatric Surgical Care Models Supplements the Workforce without Compromising Quality of Care

2015 ◽  
Vol 81 (9) ◽  
pp. 854-858 ◽  
Author(s):  
Rudy J. Judhan ◽  
Raquel Silhy ◽  
Kristen Statler ◽  
Mija Khan ◽  
Benjamin Dyer ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Acute Care ◽  
Tertiary Care ◽  
Disease Process ◽  
Pediatric Care ◽  
Care Hospital ◽  
Late Night ◽  
General Surgeons ◽  
The Impact

Acute care of children remains a challenge due to a shortage of pediatric surgeons, particularly in rural areas. In our institutional norm, all cases in patients age six and older are managed by dedicated general surgeons. The provision of care to these children by these surgeons alleviates the impact of such shortages. We conducted a five-year retrospective analysis of all acute care pediatric surgical cases performed in patients aged 6 to 17 years by a dedicated group of adult general surgeons in a rural tertiary care hospital. Demographics, procedure, complications, outcomes, length of stay, and time of consultation/operation were obtained via chart review. Elective, trauma related, or procedures performed by a pediatric surgeon were excluded. Descriptive statistics are reported. A total of 397 cases were performed by six dedicated general surgeons during the study period. Mean age was 11.5 ± 3.1 years. In all, 100 (25.2%) were transferred from outlying facilities and 52.6 per cent of consultations/operations occurred at night (7P–7A), of which 33.2 per cent occurred during late night hours (11P–7A). On weekends, 34.0 per cent occurred. Appendectomy was the most commonly performed operation (n = 357,89.9%), of which 311 were laparoscopic (87.1%). Others included incision/drainage (4.5%), laparoscopic cholecystectomy (2.0%), bowel resection (1.5%), incarcerated hernia (0.5%), small bowel obstruction (0.5%), intraabdominal abscess drainage (0.3%), resection of intussusception (0.3%), Graham patch (0.3%), and resection omental torsion (0.3%). Median length of stay was two days. Complications occurred in 23 patients (5.8%), of which 22(5.5%) were the result of the disease process. These results parallel those published by pediatric surgeons in this age group and for the diagnoses treated. Models integrating dedicated general surgeons into pediatric call rotations can be designed such that quality of pediatric care is maintained while providing relief to an overburdened pediatric surgical workforce.

scholarly journals Acute kidney injury requiring dialysis in obstetric patients: management and clinical outcome in case series of 30 patients in a tertiary care centre

2017 ◽  
Vol 6 (7) ◽  
pp. 2997
Author(s):  
Molina U. Patel ◽  
Yuvraj Jadeja ◽  
Niket Patel ◽  
Nayana Patel ◽  
Smruti Vaishnav ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Tertiary Care ◽  
Case Series ◽  
Kidney Injury ◽  
Therapeutic Interventions ◽  
Risk Category ◽  
Care Hospital ◽  
Tertiary Care Centre ◽  
Significant Difference ◽  
The Impact

Background: Acute Kidney Injury is a common medical problem affecting approximately 5% of all hospitalized and 30% of critically ill patients. The incidence in obstetric patients ranges from 1 in 2000 to 1 in 25000 pregnancies. In India till date, the impact of AKI on fetomaternal outcome and pertaining therapeutic interventions is only sparsely studied.Methods: It is a retrospective cross-sectional study. All obstetric patients with AKI on dialysis, admitted to Shree Krishna Hospital, a tertiary care hospital in Karamsad village in Gujarat from January 2013 to August 2015. Multivariate statistical analysis of clinical and laboratory parameters was performed using SPSS program to obtain the results.Results: The incidence of dialysis was 1.6%. HELLP syndrome and pre-eclampsia (80%) was found to be the most common etiology of AKI followed by Congestive cardiac failure (34.5%), hemorrhage and sepsis in 30% resp. All patients were admitted to ICU care. No significant difference was found between SAP II and SOFA monitoring system. Mechanical ventilation was done to support 53.3% and inotropic support was needed by 56.7% patients. According to the RIFLE criteria, majority of the patients fall under risk category followed by injury. 18% of the patients developed End Stage Renal Disease.Conclusions: In view of the multifaceted etiologies and complexity of management of AKI, a multi-disciplinary approach involving nephrologist, intensivists, obstetricians and neonatologists is extremely important.

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