scholarly journals Complex Liver Resections for Colorectal Metastases: Are They Safe in the Low-Volume, Resource-Poor Caribbean Setting?

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Shamir O. Cawich ◽  
Dexter A. W. Thomas ◽  
Chunilal Ramjit ◽  
Roderick Bhagan ◽  
Vijay Naraynsingh
Keyword(s):  
Inferior Vena ◽  
Health Care Systems ◽  
Vena Cava ◽  
High Volume ◽  
Colorectal Metastases ◽  
Liver Resections ◽  
Resource Poor ◽  
Care Systems ◽  
The Caribbean ◽  
Low Volume

Introduction. Although many authorities suggest that major liver resections should only be carried out in high-volume specialized centres, many patients in the Caribbean do not have access to these health care systems.Presentation of a Case. A 50-year-old woman with a solitary colorectal metastasis invading the inferior vena cava underwent an extended left hepatectomy with caval resection and reconstruction. Several technical maneuvers were utilized that were suited to the resource-poor environment.Conclusion. We suggest that good outcomes can still be attained in the resource-poor, low-volume centres once dedicated and appropriately trained teams are available.

Abstract 45: Global Impact of the Covid-19 Pandemic on Stroke Hospitalizations and Mechanical Thrombectomy Volumes: A Society of Vascular and Interventional Neurology Covid-19 International Collaboration

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Raul Nogueira ◽  
Mohamad AbdalKader ◽  
Muhammad Mustafa Qureshi ◽  
Michael R Frankel ◽  
Diogo Haussen ◽  
...  
Keyword(s):  
Mechanical Thrombectomy ◽  
Systems Of Care ◽  
Health Care Systems ◽  
Control Period ◽  
International Study ◽  
High Volume ◽  
Geographic Variations ◽  
Global Impact ◽  
Care Systems ◽  
Low Volume

Introduction: The COVID-19 pandemic led to profound changes in both the organization of health care systems and the psychosocial behavior of the population worldwide. The extent to which the COVID-19 outbreak disrupted stroke systems of care merits study from a global lens. Methods: We conducted a retrospective, observational, international study, across 6 continents, 40 countries, and 187 comprehensive stroke centers. The study objectives were to measure the global impact of the pandemic on the volumes for mechanical thrombectomy (MT), stroke and intracranial hemorrhage (ICH) hospitalizations over a 3-month period at the height of the pandemic (March 1 to May 31, 2020) compared with two control 3-month periods prior (immediately preceding and one year prior). A secondary objective was to examine whether these changes in volume were impacted by COVID-19 and baseline hospital center stroke volumes. Third, we evaluated the relationships between stroke and COVID-19 diagnoses. Results: There were 26,699 stroke admissions in the 3 months immediately before compared to 21,576 admissions during the pandemic months, representing a 19.2% (95%CI,-19.7 to -18.7) decline. There were 5,191 MT procedures in the 3 months preceding compared to 4,533 procedures during the pandemic, representing a 12.7% (95%CI,-13.6 to -11.8) drop. Significant reductions were also seen in relation to the prior year control period. The decreases were noted across centers with high, intermediate, and low COVID-19 hospitalization burden, and also across high, intermediate, and low volume stroke centers. High-volume COVID-19 centers (-20.5%) had greater declines in MT volumes than mid- (-10.1%) and low-volume (-8.7%) centers. There was a 1.5% stroke rate across 54,366 COVID-19 hospitalizations. SARS-CoV-2 infection was noted in 3.9% (784/20,250) of all stroke admissions. Conclusions: The COVID-19 pandemic was associated with a global decline in the volume of overall stroke hospitalizations, MT procedures, ischemic stroke/TIA and ICH admission volumes. Despite geographic variations, these volume reductions were observed regardless of COVID-19 hospitalization burden and pre-pandemic stroke and MT volumes. Centers with higher COVID-19 inpatient volumes experienced steeper declines.

scholarly journals EXPRESS: Global Impact of the COVID-19 Pandemic on Stroke Hospitalizations and Mechanical Thrombectomy Volumes

2021 ◽  
pp. 174749302199165
Author(s):  
Raul Nogueira ◽  
Mohamad Abdalkader ◽  
Muhammed M Qureshi ◽  
MR Frankel ◽  
Ossama Yassin Mansour ◽  
...  
Keyword(s):  
Mechanical Thrombectomy ◽  
Health Care Systems ◽  
International Study ◽  
High Volume ◽  
Geographic Variations ◽  
Global Impact ◽  
Icd 10 ◽  
Care Systems ◽  
Low Volume ◽  
One Year

Background: The COVID-19 pandemic led to profound changes in the organization of health care systems worldwide. Aims: We sought to measure the global impact of the COVID-19 pandemic on the volumes for mechanical thrombectomy (MT), stroke, and intracranial hemorrhage (ICH) hospitalizations over a 3-month period at the height of the pandemic (March 1 to May 31, 2020) compared with two control 3-month periods (immediately preceding and one year prior). Methods: Retrospective, observational, international study, across 6 continents, 40 countries, and 187 comprehensive stroke centers. The diagnoses were identified by their ICD-10 codes and/or classifications in stroke databases at participating centers. Results: The hospitalization volumes for any stroke, ICH, and MT were 26,699, 4,002, and 5,191 in the 3 months immediately before versus 21,576, 3,540, and 4,533 during the first 3 pandemic months, representing declines of 19.2% (95%CI,-19.7 to -18.7), 11.5% (95%CI,-12.6 to -10.6), and 12.7% (95%CI,-13.6 to -11.8), respectively. The decreases were noted across centers with high, mid, and low COVID-19 hospitalization burden, and also across high, mid, and low volume stroke/MT centers. High-volume COVID-19 centers (-20.5%) had greater declines in MT volumes than mid- (-10.1%) and low-volume (-8.7%) centers (p<0.0001). There was a 1.5% stroke rate across 54,366 COVID-19 hospitalizations. SARS-CoV-2 infection was noted in 3.9% (784/20,250) of all stroke admissions. Conclusion: The COVID-19 pandemic was associated with a global decline in the volume of overall stroke hospitalizations, MT procedures, and ICH admission volumes. Despite geographic variations, these volume reductions were observed regardless of COVID-19 hospitalization burden and pre-pandemic stroke/MT volumes.

A survey of vascular specialists’ practice patterns of inferior vena cava filter placement and retrieval

Vascular ◽  
2018 ◽  
Vol 27 (3) ◽  
pp. 291-298 ◽  
Author(s):  
Anand Brahmandam ◽  
Laura Skrip ◽  
Bauer Sumpio ◽  
Jeffrey Indes ◽  
Alan Dardik ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Practice Patterns ◽  
Statistical Significance ◽  
Tertiary Care ◽  
Vena Cava ◽  
High Volume ◽  
Filter Placement ◽  
Vena Cava Filters ◽  
Low Volume

Objectives The placement of inferior vena cava filters (IVCF) continues to rise. Vascular specialists adopt different practices based on local expertise. This study was performed to assess the attitudes of vascular specialists towards the placement and retrieval of IVCF. Methods An online survey of 28 questions related to practice patterns regarding IVCF was administered to 1429 vascular specialists. Vascular specialists were categorized as low volume if they place less than three IVCF per month and high volume if they place at least three IVCF per month. The responses of high volume and low volume were compared using two-sample t-tests and Chi-square tests. Results A total of 259 vascular specialists completed the survey (18% response rate). There were 191 vascular surgeons (74%) and 68 interventional radiologists (26%). The majority of responders were in academic practice (67%) and worked in tertiary care centers (73%). The retrievable IVCF of choice was Celect (27%) followed by Denali (20%). Forty-two percent used a temporary IVCF and left it in situ instead of using a permanent IVCF. Eighty-two percent preferred placing the tip of the IVCF at or just below the lowest renal vein. Thirty-one percent obtained a venous duplex of the lower extremities prior to retrieval while 24% did not do any imaging. There were 132 (51%) low volume vascular specialists and 127 (49%) high volume vascular specialists. Compared to low volume vascular specialists, significantly more high volume vascular specialists reported procedural times of less than 30 min for IVCF retrieval (57% vs. 42%, P = 0.026). There was a trend for high volume to have fewer unsuccessful attempts at IVCF retrieval but that did not reach statistical significance ( P = .061). High volume were more likely to have attempted multiple times to retrieve an IVCF (66% vs. 33%, P < .001), and to have used bronchoscopy forceps (32% vs. 14%, P = .001) or a laser sheath (14% vs. 2%, P < .001) for IVCF retrieval. In general, vascular specialists were not comfortable using bronchoscopy forceps (65%) or a laser sheath (82%) for IVCF retrieval. Conclusions This study underscores significant variability in vascular specialists practice patterns regarding IVCF. More studies and societal guidelines are needed to define best practices.

scholarly journals Characteristics of Critically Ill Patients with COVID-19 Compared to Patients with Influenza—A Single Center Experience

2021 ◽  
Vol 10 (10) ◽  
pp. 2056
Author(s):  
Frank Herbstreit ◽  
Marvin Overbeck ◽  
Marc Moritz Berger ◽  
Annabell Skarabis ◽  
Thorsten Brenner ◽  
...  
Keyword(s):  
Influenza A ◽  
Health Care Systems ◽  
Severe Disease ◽  
Tertiary Care ◽  
Care Facility ◽  
High Volume ◽  
Single Center Experience ◽  
Severe Influenza ◽  
Tertiary Care Facility ◽  
Care Systems

Infections with SARS-CoV-2 spread worldwide early in 2020. In previous winters, we had been treating patients with seasonal influenza. While creating a larger impact on the health care systems, comparisons regarding the intensive care unit (ICU) courses of both diseases are lacking. We compared patients with influenza and SARS-CoV-2 infections treated at a tertiary care facility offering treatment for acute respiratory distress syndrome (ARDS) and being a high-volume facility for extracorporeal membrane oxygenation (ECMO). Patients with COVID-19 during the first wave of the pandemic (n = 64) were compared to 64 patients with severe influenza from 2016 to 2020 at our ICU. All patients were treated using a standardized protocol. ECMO was used in cases of severe ARDS. Both groups had similar comorbidities. Time in ICU and mortality were not significantly different, yet mortality with ECMO was high amongst COVID-19 patients with approximately two-thirds not surviving. This is in contrast to a mortality of less than 40% in influenza patients with ECMO. Mortality was higher than estimated by SAPSII score on admission in both groups. Patients with COVID-19 were more likely to be male and non-smokers than those with influenza. The outcomes for patients with severe disease were similar. The study helps to understand similarities and differences between patients treated for severe influenza infections and COVID-19.

scholarly journals Mortality and Survival Rates after Elective Hepatic Surgery in a Low-Volume Centre Are Comparable to Those of High-Volume Centres

ISRN Surgery ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
I. E. Nygård ◽  
K. Lassen ◽  
J. Kjæve ◽  
A. Revhaug
Keyword(s):  
Overall Survival ◽  
Liver Resection ◽  
Survival Rates ◽  
Disease Free Survival ◽  
High Volume ◽  
Colorectal Metastases ◽  
Rank Test ◽  
Cox Proportional Hazard ◽  
Kaplan Meier ◽  
Low Volume

Background. Over the last decades, liver resection has become a frequently performed procedure in western countries because of its acceptance as the most effective treatment for patients with selected cases of metastatic tumours. The purpose of this study was to evaluate the results after hepatic resections performed electively in our centre since 1979 and compare the results to those of larger high-volume centres. Methods. Medical records of all patients who underwent liver resection from January 1979 to December 2011 were reviewed. Disease-free survival and overall survival were determined by Kaplan-Meier analysis. Risk factors for complications were tested with the log-rank test and the Cox proportional hazard model. Complications were classified according to the modified Clavien classification system. Results. 290 elective liver resections were performed between January 1979 and December 2011. There were 171 males (59.0%) and 119 females (41.0%). Median age was 63 years, range 1–87. Overall survival ranged from 0 to 383 months, with a median of 31 months. Five-year survival rate for patients who underwent liver resection for colorectal metastases was 35.8% (34/95). Discussion. Hepatic resections are safely performed at a low-volume centre, with regard to perioperative- and in-house mortality and 5-year survival rates.

scholarly journals Percutaneous Treatment to Inferior Vena Cava Perforation by Intracardiac Echocardiography Catheter after an Unsuccessful Conservative Approach

2021 ◽  
pp. 84-90
Author(s):  
Fabricio Vassallo ◽  
Rodrigo França ◽  
Carlos Volponi Lovatto ◽  
Bruno Carvalho ◽  
Alessandra Cardoso ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Vena Cava ◽  
Vascular Complications ◽  
High Volume ◽  
Percutaneous Treatment ◽  
Intracardiac Echocardiography ◽  
Conservative Approach ◽  
Established Treatment ◽  
Intracardiac Echocardiogram

Catheter ablation is a well-established treatment for drug refractory arrhythmia, and intracardiac echocardiography is one of the tools used for this purpose. Despite a high volume of procedures performed worldwide, the incidence of vascular complications is still very low. We describe a case report of a percutaneous treatment to an inferior vena cava perforation by an intracardiac echocardiogram catheter after the failure of a conservative approach.

scholarly journals Health Risk Factors And Health Care Systems In Latin America And The Caribbean: A Cross-Sectional Multiple Regression And ANOVA Analysis

2014 ◽  
Vol 5 (2) ◽  
pp. 117-128
Author(s):  
Rina Samant ◽  
Sonia Samant
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Life Expectancy ◽  
Health Risk ◽  
Child Mortality ◽  
Health Care Systems ◽  
Health Risk Factors ◽  
Care Systems ◽  
The Caribbean ◽  
Per Capita

The purpose of this research is to examine the effect of health risk factors and health care systems on child mortality and life expectancy in Latin America and the Caribbean (LAC). Cross-sectional multiple regression and Analysis of Variance (ANOVA) are used to study the association between health risk factors such as incidence of tuberculosis and diabetes, and health care systems such as number of hospital beds per capita, and number of physicians per capita on life expectancy and child mortality. Data are obtained from the World Bank. For the purpose of this study, the LAC region is defined as the area from Mexico to the southern end of South America, as well as islands in the Caribbean Sea and the Gulf of Mexico. The conclusions of the study are that higher life expectancy is associated with higher per capita incomes and health expenditures. On the other hand, higher child mortality is associated with greater prevalence of communicable diseases and poor maternal pre-natal conditions. The macro policy implication is to focus on economic development and health care expenditure. The micro policy implication is to allocate more resources for maternal care, preventive care and eradication of communicable diseases. 

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