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

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.

Download Full-text

A Framework for Determining the Return on Investment of Simulation-Based Training in Health Care

INQUIRY The Journal of Health Care Organization Provision and Financing ◽

10.1177/0046958016687176 ◽

2017 ◽

Vol 54 ◽

pp. 004695801668717

Author(s):

Hatim Bukhari ◽

Pamela Andreatta ◽

Brian Goldiez ◽

Luis Rabelo

Keyword(s):

Health Care ◽

Return On Investment ◽

Cardiopulmonary Arrest ◽

Medical Center ◽

Academic Medical Center ◽

Tertiary Care ◽

Survival Rates ◽

Wide Range ◽

Simulation Based

This article describes a framework that has been developed to monetize the real value of simulation-based training in health care. A significant consideration has been given to the incorporation of the intangible and qualitative benefits, not only the tangible and quantitative benefits of simulation-based training in health care. The framework builds from three works: the value measurement methodology (VMM) used by several departments of the US Government, a methodology documented in several books by Dr Jack Phillips to monetize various training approaches, and a traditional return on investment methodology put forth by Frost and Sullivan, and Immersion Medical. All 3 source materials were adapted to create an integrated methodology that can be readily implemented. This article presents details on each of these methods and how they can be integrated and presents a framework that integrates the previous methods. In addition to that, it describes the concept and the application of the developed framework. As a test of the applicability of the framework, a real case study has been used to demonstrate the application of the framework. This case study provides real data related to the correlation between the pediatric patient cardiopulmonary arrest (CPA) survival rates and a simulation-based mock codes at the University of Michigan tertiary care academic medical center. It is important to point out that the proposed framework offers the capability to consider a wide range of benefits and values, but on the other hand, there are several limitations that has been discussed and need to be taken in consideration.

Download Full-text

The Impact of the COVID-19 Pandemic on an Israeli Acute Care Surgery Unit: Fewer Patients, More Disease

The American Surgeon ◽

10.1177/00031348211011132 ◽

2021 ◽

pp. 000313482110111

Author(s):

Yossi Maman ◽

Adam Lee Goldstein ◽

Uri Neeman ◽

Yonatan Lessing ◽

Lior Orbach ◽

...

Keyword(s):

Health Care ◽

Care Center ◽

Tertiary Care ◽

Acute Care Surgery ◽

Charlson Comorbidity Index Score ◽

Apache Ii Score ◽

Number Of Patients ◽

Significant Difference ◽

Care Surgery ◽

The Impact

Background The COVID-19 pandemic has transformed and affected every aspect of health care. Like any catastrophic event, the stress on hospitals to maintain a certain level of function is immense. Acute surgical pathologies cannot be prevented or curtailed; therefore, it is important to understand patterns and outcomes during catastrophes in order to optimize care and organize the health care system. Methods In a single urban tertiary care center, a retrospective study examined the first complete lockdown period of Israel during the COVID-19 pandemic. This was compared to the same time period the previous year. Results During the pandemic, time to hospitalization was significantly decreased. There was also an overall reduction in surgical admissions yet with a higher percentage being hospitalized for further treatment (69.2% vs 23.5%). The patients admitted during this time had a higher APACHE-II score and Charlson comorbidity index score. During the pandemic, time to surgery was decreased, there were less laparoscopic procedures, and more RBC units were used per patient. There were no differences in overall complications, except when sub-analyzed for major complications (9.7% vs 6.3%). There was no significant difference in overall in-house mortality or morbidity. Length of hospitalization was significantly decreased in the elderly population during the pandemic. Conclusion During the COVID-19 pandemic, despite a significantly less number of patients presenting to the hospital, there was a higher percentage of those admitted needing surgical intervention, and they were overall sicker than the previous year.

Download Full-text

Outpatient versus inpatient superficial parotidectomy: clinical and pathological characteristics

Journal of Otolaryngology - Head and Neck Surgery ◽

10.1186/s40463-020-00484-9 ◽

2021 ◽

Vol 50 (1) ◽

Cited By ~ 1

Author(s):

Daniel J. Lee ◽

David Forner ◽

Christopher End ◽

Christopher M. K. L. Yao ◽

Shireen Samargandy ◽

...

Keyword(s):

Care Center ◽

Tertiary Care ◽

Fistula Formation ◽

Secondary Outcome ◽

Complication Rates ◽

Superficial Parotidectomy ◽

Outpatient Procedure ◽

Tumor Pathology ◽

Outpatient Group ◽

Significant Difference

Abstract Background Superficial parotidectomy has a potential to be performed as an outpatient procedure. The objective of the study is to evaluate the safety and selection profile of outpatient superficial parotidectomy compared to inpatient parotidectomy. Methods A retrospective review of individuals who underwent superficial parotidectomy between 2006 and 2016 at a tertiary care center was conducted. Primary outcomes included surgical complications, including transient/permanent facial nerve palsy, wound infection, hematoma, seroma, and fistula formation, as well as medical complications in the postoperative period. Secondary outcome measures included unplanned emergency room visits and readmissions within 30 days of operation due to postoperative complications. Results There were 238 patients included (124 in outpatient and 114 in inpatient group). There was no significant difference between the groups in terms of gender, co-morbidities, tumor pathology or tumor size. There was a trend towards longer distance to the hospital from home address (111 Km in inpatient vs. 27 in outpatient, mean difference 83 km [95% CI,- 1 to 162 km], p = 0.053). The overall complication rates were comparable between the groups (24.2% in outpatient group vs. 21.1% in inpatient, p = 0.56). There was no difference in the rate of return to the emergency department (3.5% vs 5.6%, p = 0.433) or readmission within 30 days (0.9% vs 0.8%, p = 0.952). Conclusion Superficial parotidectomy can be performed safely as an outpatient procedure without elevated risk of complications. Graphical abstract

Download Full-text

Comparative Morbidity Profile of Elective vs Therapeutic Neck Dissection

Otolaryngology ◽

10.1177/01945998211008915 ◽

2021 ◽

pp. 019459982110089

Author(s):

Quinn Dunlap ◽

James Reed Gardner ◽

Amanda Ederle ◽

Deanne King ◽

Maya Merriweather ◽

...

Keyword(s):

Neck Dissection ◽

Surgical Complications ◽

Chart Review ◽

Care Center ◽

Tertiary Care ◽

Retrospective Chart Review ◽

Neck Surgery ◽

Continuous Variables ◽

Significant Difference ◽

History Of

Objective Neck dissection (ND) is one of the most commonly performed procedures in head and neck surgery. We sought to compare the morbidity of elective ND (END) versus therapeutic ND (TND). Study Design Retrospective chart review. Setting Academic tertiary care center. Methods Retrospective chart review of 373 NDs performed from January 2015 to December 2018. Patients with radical ND or inadequate chart documentation were excluded. Demographics, clinicopathologic data, complications, and sacrificed structures during ND were retrieved. Statistical analysis was performed with χ2 and analysis of variance for comparison of categorical and continuous variables, respectively, with statistical alpha set a 0.05. Results Patients examined consisted of 224 males (60%) with a mean age of 60 years. TND accounted for 79% (n = 296) as compared with 21% (n = 77) for END. Other than a significantly higher history of radiation (37% vs 7%, P < .001) and endocrine pathology (34% vs 2.6%, P < .001) in the TND group, no significant differences in demographics were found between the therapeutic and elective groups. A significantly higher rate of structure sacrifice and extranodal extension within the TND group was noted to hold in overall and subgroup comparisons. No significant difference in rate of surgical complications was appreciated between groups in overall or subgroup analysis. Conclusion While the significantly higher rate of structure sacrifice among the TND population represents an increased morbidity profile in these patients, no significant difference was found in the rate of surgical complications between groups. The significant difference seen between groups regarding history of radiation and endocrine pathology likely represents selection bias.

Download Full-text

Promoting COVID-19 vaccination among healthcare personnel: a multifaceted intervention at a tertiary care center in Japan

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2021.325 ◽

2021 ◽

pp. 1-26

Author(s):

Akane Takamatsu ◽

Hitoshi Honda ◽

Tomoya Kojima ◽

Kengo Murata ◽

Hilary Babcock

Keyword(s):

Medical Center ◽

Care Center ◽

Tertiary Care ◽

Vaccination Rate ◽

Multifaceted Intervention ◽

Vaccine Hesitancy ◽

Healthcare Personnel ◽

Tertiary Care Center ◽

Post Intervention ◽

Post Vaccination

Abstract Objective The COVID-19 vaccine may hold the key to ending the pandemic, but vaccine hesitancy is hindering the vaccination of healthcare personnel (HCP). Design Before-after trial Participants and setting Healthcare personnel at a 790-bed tertiary care center in Tokyo, Japan. Interventions A pre-vaccination questionnaire was administered to HCP to examine their perceptions of the COVID-19 vaccine. Then, a multifaceted intervention involving (1) distribution of informational leaflets to all HCP, (2) hospital-wide announcements encouraging vaccination, (3) a mandatory lecture, (4) an educational session about the vaccine for pregnant or breastfeeding HCP, and (5) allergy testing for HCP at risk of allergic reactions to the vaccine was implemented. A post-vaccination survey was also performed. Results Of 1,575 HCP eligible for enrollment, 1,224 (77.7%) responded to the questionnaire, 43.5% (n =533) expressed willingness to be vaccinated, 48.4% (n = 593) were uncertain, and 8.0% (n=98) expressed unwillingness to be vaccinated. The latter two groups were concerned about the vaccine’s safety rather than its efficacy. Post-intervention, the overall vaccination rate reached 89.7% (1,413/1,575), with 88.9% (614/691) of the pre-vaccination survey respondents who answered “unwilling” or “unsure” eventually receiving a vaccination. In the post-vaccination questionnaire, factors contributing to increased COVID-19 vaccination included information and endorsement of vaccination at the medical center (26.4%; 274/1,037). Conclusions The present, multifaceted intervention increased COVID-19 vaccinations among HCP at a Japanese hospital. Frequent support and provision of information were crucial for increasing the vaccination rate and may be applicable to the general population as well.

Download Full-text

Prehospital Intubations Are Associated with Elevated Endotracheal Tube Cuff Pressures: A Cross-Sectional Study Characterizing ETT Cuff Pressures at a Tertiary Care Emergency Department

Prehospital and Disaster Medicine ◽

10.1017/s1049023x21000297 ◽

2021 ◽

pp. 1-4

Author(s):

Ruo S. Chen ◽

Laurel O’Connor ◽

Matthew R. Rebesco ◽

Kara L. LaBarge ◽

Edgar J. Remotti ◽

...

Keyword(s):

Endotracheal Tube ◽

Cuff Pressure ◽

Care Center ◽

Tertiary Care ◽

Cross Sectional Study ◽

Endotracheal Tube Cuff ◽

Cross Sectional ◽

Tube Cuff ◽

Respiratory Therapists ◽

Significant Difference

Abstract Introduction: Emergency Medical Services (EMS) providers are trained to place endotracheal tubes (ETTs) in the prehospital setting when indicated. Endotracheal tube cuffs are traditionally inflated with 10cc of air to provide adequate seal against the tracheal lumen. There is literature suggesting that many ETTs are inflated well beyond the accepted safe pressures of 20-30cmH2O, leading to potential complications including ischemia, necrosis, scarring, and stenosis of the tracheal wall. Currently, EMS providers do not routinely check ETT cuff pressures. It was hypothesized that the average ETT cuff pressure of patients arriving at the study site who were intubated by EMS exceeds the safe pressure range of 20-30cmH2O. Objectives: While ETT cuff inflation is necessary to close the respiratory system, thus preventing air leaks and aspiration, there is evidence to suggest that over-inflated ETT cuffs can cause long-term complications. The purpose of this study is to characterize the cuff pressures of ETTs placed by EMS providers. Methods: This project was a single center, prospective observational study. Endotracheal tube cuff pressures were measured and recorded for adult patients intubated by EMS providers prior to arrival at a large, urban, tertiary care center over a nine-month period. All data were collected by respiratory therapists utilizing a cuff pressure measurement device which had a detectable range of 0-100cmH2O and was designed as a syringe. Results including basic patient demographics, cuff pressure, tube size, and EMS service were recorded. Results: In total, 45 measurements from six EMS services were included with ETT sizes ranging from 6.5-8.0mm. Mean patient age was 52.2 years (67.7% male). Mean cuff pressure was 81.8cmH2O with a range of 15 to 100 and a median of 100. The mode was 100cmH2O; 40 out of 45 (88.9%) cuff pressures were above 30cmH2O. Linear regression showed no correlation between age and ETT cuff pressure or between ETT size and cuff pressure. Two-tailed T tests did not show a significant difference in the mean cuff pressure between female versus male patients. Conclusion: An overwhelming majority of prehospital intubations are associated with elevated cuff pressures, and cuff pressure monitoring education is indicated to address this phenomenon.

Download Full-text

Evaluation of the Anxiety Level of Mothers of Children with Epilepsy during the COVID-19 Pandemic Period

European Neurology ◽

10.1159/000514826 ◽

2021 ◽

pp. 1-8

Author(s):

Halil Celik ◽

Sadettin Burak Acikel ◽

Fatih Mehmet Akif Ozdemir ◽

Erhan Aksoy ◽

Ulkuhan Oztoprak ◽

...

Keyword(s):

Neurological Disease ◽

Chronic Conditions ◽

Care Center ◽

Tertiary Care ◽

Anxiety Level ◽

Childhood And Adolescence ◽

Routine Examination ◽

Significant Difference ◽

Anxiety Levels

Background and Aim: Although anyone can be affected by the COVID-19 pandemic, it may cause additional concern for people with chronic conditions. Epilepsy is the most common neurological disease in childhood and adolescence. The aim of this study was to determine anxiety levels among the mothers of children under follow-up for epilepsy in our clinic during the COVID-19 pandemic. Methods: The study group consisted of the mothers of epilepsy patients who were under follow-up in the pediatric neurology outpatient clinic of the tertiary care center and were scheduled for a routine examination during the COVID-19 pandemic. The mothers’ anxiety levels according to the Beck Anxiety Inventory and their opinions about COVID-19 in relation to their child were assessed and compared based on whether the mother/patient attended their appointments in person and whether the child had frequent or infrequent seizures. Results: There was no statistically significant difference in anxiety level between the mothers of 64 children with epilepsy who attended their appointment during the pandemic and those of the mothers of 52 who did not attend their appointment. However, the mothers of children with frequent seizures had significantly higher anxiety levels. Conclusion: Anxiety level of mothers whose children have frequent seizures was significantly higher compared to mothers whose children have infrequent seizures. It is important to be aware about this point and using telemedicine approach in suitable population and postpone routine outpatient follow-up appointments as much as possible.

Download Full-text

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

Download Full-text

Paradigm Shift in Clinical Practice of Sexual Health in Men During COVID-19 Pandemic

Journal of Psychosexual Health ◽

10.1177/26318318211032386 ◽

2021 ◽

pp. 263183182110323

Author(s):

Aditya Prakash Sharma ◽

Japleen Kaur ◽

Ravimohan S. Mavuduru ◽

Shrawan K. Singh

Keyword(s):

Health Care ◽

Sexual Health ◽

Surgical Procedures ◽

Care Center ◽

Tertiary Care ◽

Health Care Seeking ◽

Care Seeking ◽

Health Seeking ◽

Number Of Patients ◽

The Impact

Sexual health-care seeking behavior and practices have been affected during COVID-19 pandemic. The impact of COVID-19 on this subspecialty is far reaching. This study aimed to assess the impact of COVID-19 on health-care seeking practice pertaining to sexual health in men in our tertiary care center and review the relevant literature regarding impact of COVID-19 on sexual health seeking practice and challenges faced. Outpatient data was analyzed from January 2019 to April 2021. Patients awaiting surgical procedures due to COVID were documented. A narrative synthesis of literature based on systematic search using the keywords sexual health, sexual health seeking, sexual health practice, andrology, and COVID with operators “AND” and “OR” was carried out in three search engines PubMed, Scopus, and Embase. The study outcomes were obtained by comparing data of outpatient attendance and compiling the reviewed literature. The mean attendance fell significantly from 95.11±11.17 to 17.25±13.70 persons (P <.0001) per outpatient clinic, March 2020 being the reference point. Teleconsultation has taken over physical consultation. In 98/949 cases, teleconsult could not be provided despite registration. Over 25 patients were waiting for surgical procedures pertaining to andrology due to shut down of elective services. Similar trends have been reported from other countries. Number of patients seeking consultation for sexual health problems has dramatically decreased during COVID-19 era. Establishment of data safe teleconsultation facility and its widespread advertisement is needed to encourage patients to seek consult.

Download Full-text