Feasibility of Pancreaticoduodenectomy in a Nonuniversity Tertiary Care Center: What Are the Key Elements of Success?

2011 ◽  
Vol 77 (5) ◽  
pp. 545-551 ◽  
Author(s):  
Amit Khithani ◽  
Derick Christian ◽  
Kevin Lowe ◽  
A. Joe Saad ◽  
Jeffrey D. Linder ◽  
...  
Keyword(s):  
Operative Time ◽  
Care Center ◽  
Tertiary Care ◽  
High Volume ◽  
Team Approach ◽  
Tertiary Care Center ◽  
Key Factors ◽  
Estimated Blood Loss ◽  
Volume Outcome ◽  
The Mean

It is advocated that a favorable outcome for pancreaticoduodenectomy (PD) is related to a high volume at university centers. This article examines the specific elements that allow an equivalent outcome from PD in a nonuniversity tertiary care center (NUTCC). The study was performed to: 1) evaluate the outcome of PDs done at a NUTCC; 2) study the components of the process that are required to attain success in a NUTCC; and 3) provide a new look at the volume-outcome relationships in complex surgeries in a novel nonuniversity setting. Medical records of patients who underwent PD by a single surgeon between September 2005 and August 2008 at a high-volume NUTCC were analyzed. The records were reviewed with respect to preoperative and postoperative data, 30-day mortality, morbidity, and histopathology data. A total of 122 patients underwent PD. The mean age was 68.2 years. Jaundice was the most common presenting symptom in 57 per cent (69 patients). Thirty-nine patients (32%) underwent a pylorus-preserving PD. The mean operative time was 237 minutes. The mean estimated blood loss was 480 mL. The mean length hospital stay was 13 days. Thirty-day mortality was 3.2 per cent (four patients) and overall morbidity was 49 per cent. The key factors in developing a team dedicated to the care of the patient undergoing PD are discussed. A center of excellence can be developed in a NUTCC resulting in outcomes that meet and indeed may exceed nationally reported benchmarks. The key elements to success include a team approach to the patient undergoing PD.

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

2015 ◽  
Vol 16 (4) ◽  
pp. 231-236 ◽  
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

A study of peripartum cardiomyopathy in a tertiary care center in India

2017 ◽  
Vol 6 (2) ◽  
pp. 523 ◽  
Author(s):  
Aditi V. Joshi ◽  
Michelle N. Fonseca ◽  
Deepali S. Kharat-Kapote
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Fetal Outcome ◽  
Peripartum Cardiomyopathy ◽  
Early Interventions ◽  
Tertiary Care Center ◽  
Common Risk Factor ◽  
The Mean ◽  
Time Of Presentation ◽  
Underlying Pathogenesis

Background: Peripartum cardiomyopathy is an idiopathic and reversible form of dilated cardiomyopathy. The aim of the study was to study the mean age of presentation of peripartum cardiomyopathy in pregnant patients over a period of 1 year in a tertiary health care and study the maternal and fetal outcome of patients with peripartum cardiomyopathy.Methods: A retrospective observational study with total of 22 patients with peripartum cardiomyopathy was diagnosed in a total of 10,279 deliveries conducted at LTMMC, Sion hospital between September 2014 to February 2016.Results: Our study revealed that most of the affected patients were young with the mean age at presentation being 26.8±4.29 years. Most of the patients were diagnosed in the postpartum period (63.6%). the most common risk factor was pre-eclampsia (22.7%) followed by anemia (18.2%). The mean Ejection fraction at the time of presentation was 25.3±9.8%. There were 2 (9.1%) intrauterine fetal deaths and 1 neonatal death.Conclusions: There is a need for more multi-centric studies in order to understand the underlying pathogenesis and to determine the possible early interventions to help provide better pregnancy outcome.

Long-Term Hearing Outcomes following Total Ossicular Reconstruction with Titanium Prostheses

2019 ◽  
Vol 161 (1) ◽  
pp. 123-129 ◽  
Author(s):  
C. Burton Wood ◽  
Robert Yawn ◽  
Anne Sun Lowery ◽  
Brendan P. O’Connell ◽  
David Haynes ◽  
...  
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Case Series ◽  
Ossicular Chain ◽  
Tertiary Care Center ◽  
Ossicular Chain Reconstruction ◽  
The Mean ◽  
Hearing Outcomes

Objective(1) Characterize a large cohort of patients undergoing total ossicular chain reconstruction with titanium prosthesis. (2) Analyze long-term hearing outcomes of the same cohort.Study DesignCase series with chart review.SettingTertiary care center.Subject and MethodsThis study reviews patients who underwent total ossicular chain reconstruction (OCR) with titanium prostheses (TORPs) at a single tertiary care center from 2005 to 2015. Patient charts were reviewed for demographic data, diagnosis, and operative details. Patients were included in statistical analysis if length of follow-up was 2 years or more. Evaluation of hearing improvement was made by comparing preoperative air-bone gap (ABG) and ABG at follow-up at 2 years.ResultsIn total, 153 patients were identified who met inclusion criteria. The mean age of included patients was 40 years (range, 6-89 years). Sixty patients (39%) had a history of OCR, and 120 patients (78%) had a diagnosis of cholesteatoma at the time of OCR. Preoperatively, the mean ABG was 36 ± 12, whereas the mean ABG at 2-year follow-up improved to 26 ± 13. This was statistically significant ( P < .0001) using a Wilcoxon matched-pairs signed rank test. Twelve patients (8%) required revision OCR. Two revisions were performed due to prosthesis extrusion (<1%).ConclusionTitanium prostheses lead to significant improvement in hearing over long periods. The results are sustained as far out as 5 years following surgery. In addition, rates of revision surgery with titanium TORPs are low. Based on this series, there are no readily identifiable predictors for outcomes following total OCR.

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

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

Supine versus prone PCNL in lower calyceal stone: Comparative study in a tertiary care center

2020 ◽  
pp. 039156032096240
Author(s):  
Sunirmal Choudhury ◽  
Paragmani Talukdar ◽  
Tapan Kumar Mandal ◽  
Tapas Kumar Majhi
Keyword(s):  
Prone Position ◽  
Care Center ◽  
Tertiary Care ◽  
Renal Calculus ◽  
P Value ◽  
Tertiary Care Center ◽  
Stone Free Rate ◽  
The Mean ◽  
Hemoglobin Drop ◽  
Free Rate

Introduction: Renal calculus disease is an age old disease of human being. PCNL (Percutaneous nephrolithotomy) stands as a gold standard treatment for large renal calculus which is traditionally being done in prone position. Objective: To evaluate the safety and efficacy of supine PCNL versus prone PCNL comparing intraoperative time, requirement of relook PCNL, post op hemoglobin drop, post operative hospital stay, post operative complication, SFR ( stone free rate). Methods and materials: It is a prospective study done in Urology department in a tertiary care center in Eastern India between October 2017 and October 2018. A total of 84 patients with lower calyceal renal stones underwent PCNL, 42 of them in supine and 42 in prone position. Lower calyceal stone, size measuring 1 to 2 cm were included in the study. Results: The mean intra operative time was 91.76 min in supine group and 85.43 min in prone group with a p value of 0.115. The mean hemoglobin drop was 1.11 g/dl and 1.18 g/dl in supine and prone position, respectively ( p value 0.75). The mean post operative hospital stay was 4.1 and 3.86 days in supine and prone group ( p value 0.58), respectively. Two patients in each group require relook PCNL. Stone free rate at 1 month was 95.23% and 90.47% ( p value 0.9), respectively in case of supine and prone group. Conclusion: Supine PCNL is feasible, comparable to prone PCNL in respect to operative parameters with relatively higher stone free rate though statistically insignificant.

scholarly journals MON-667 Prevalence and Predictors of Diabetic Retinopathy Among Type 2 Diabetes Patients at a Tertiary Care Center

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Khaled Ahmed Baagar ◽  
Fahmi Khan ◽  
Mahmoud Zirie ◽  
Sara Darwish ◽  
Ahmed K A Mohammed ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Diabetic Retinopathy ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center ◽  
Vitamin D Levels ◽  
Significant Difference ◽  
The Mean

Abstract Objective: Diabetic retinopathy (DR) is one of the most common microvascular complications of type 2 diabetes (T2D). The reported prevalence of DR from different populations in the last decade was 13 - 38.1%. A report from our center 17 years ago showed that DR prevalence was 43.6%. With the all accumulated evidence showing that diabetes control decreases DR risk and the introduction of new drugs that helped better T2D control, we aimed to assess the current prevalence and predictors of DR among patients with T2D attending out-patient department at our tertiary care center. Methods: We conducted a cross-sectional study involving 638 patients. We collected information about their baseline characteristics, confirmed DR with its severity and maculopathy diagnosis, age at T2D diagnosis, duration of T2D, and averages of HbA1C, blood pressure (BP), cholesterol, and vitamin D levels over the previous year. A statistical analysis was performed using the software SPSS 23.0. A multivariate logistic regression analysis examined the independent predictors of DR development. Results: The mean age of the patients was 55.8 ± 10.3 years, and 42.8% were males. The mean BMI was 32.4 ± 12.4 kg/m2 with 58% had obesity. The mean duration of T2D was 11.5 ± 7.7 years, and the mean age at T2D diagnosis was 44.0 ± 9.98 years. The mean HbA1C was 8.3 ± 1.6 % with 77% had average HbA1C above 7% and 51.3% had average HbA1c above 8%. The mean systolic and diastolic BP were 136.37 ± 15.01 mmHg and 74.12 ± 8.078 mmHg, respectively. DR was diagnosed in 223 cases (35%). Of the 638 patients, 24.5% had non-proliferative DR, 9.2% had proliferative DR, and 4.2% had maculopathy. There was no significant difference in DR prevalence between males (36%) and females (34.1%) (P = 0.59). Predictors of DR development were age above 40 years, duration of T2D more than 10 years, early age of T2D diagnosis, average HbA1C more than 8%, and hypertension. Discussion: T2D is a major health challenge to our community with its very high prevalence. The prevalence of DR in T2D patients attending our institution was significant (more than one-third, 35%) in comparison to reports from other centers. However, we showed an improvement in DR development in our patients from 43.6% to 35%, probably due to better T2D and BP control. Similar to previous reports, T2D patients with older age, long T2D duration, younger age at T2D diagnosis, uncontrolled diabetes, and uncontrolled BP were more likely to develop DR. Conclusion: Physicians treating T2D patients should ensure regular retina screening especially for those with risk factors for DR. Also, they should fix the modifiable risk factors of DR; diabetes and BP control. References: (1) Alaboud et al. Saudi Med J 2016; Vol. 37 (12): 1408–1411.doi: 10.15537/smj.2016.12.17062. (2) Lim MC et al. Ann Acad Med Singapore. 2008 Sep;37(9):753–9. (3) Hammes H-P et al. PLoS ONE 10(7): e0132492. doi:10.1371/journal. pone.0132492

scholarly journals Cardiac diseases in pregnancy: clinical profile and feto-maternal complications

2017 ◽  
Vol 6 (11) ◽  
pp. 4934
Author(s):  
Latika R. Mehta ◽  
Jagruti Shah
Keyword(s):  
Heart Disease ◽  
Cardiac Disease ◽  
Care Center ◽  
Tertiary Care ◽  
Team Approach ◽  
Cardiac Diseases ◽  
Tertiary Care Center ◽  
Maternal Complications ◽  
Fetal Complications ◽  
In Pregnancy

Background: Pregnancy in woman with heart disease increases the risk of maternal and fetal complications. About 1% of pregnant women have concomitant cardiac disease. The present research was conducted to study the profile of cardiac diseases in pregnancy and its associated complications.Methods: A prospective analysis was carried out of 55 pregnancies of women with cardiac disease from at a tertiary care center. Standard Ante-natal care was furnished to all patients subjective to their requirements. Condition of patient during labour as well as the progress of labour was closely monitored. Fetal and maternal outcome after delivery as well as development of any complication was noted and treated accordingly. Data was analyzed using SPSS software ver. 21.0.Results: In present study, RHD constituted 71% cases while CHD constitutes 11% of all cases of heart disease. Other etiologies were dilated cardiomyopathies (DCM) (12.7%), IHD (3.6%) and arrhythmias (18%). Most common anomaly associated with RHD cases was mitral stenosis (75%) either isolated or along with other valvular pathologies. Most common CHD was atrial septal defect seen in 4 out of 6 cases. A total of 8 patients (16%) developed complications of which, 4 had postpartum hemorrhage, 2 developed pulmonary oedema, 1 had arrhythmia and 1 patient developed septic shock and multi organ failure. A total of 74% babies were healthy while IUGR and intrauterine deaths were seen in 22% cases and 4% cases respectively.Conclusions: Rheumatic heart disease is the predominant type of cardiac disease in pregnancy. Maternal and perinatal outcome can be improved by team approach at tertiary care center. Counselling for contraception and family planning and follow up during subsequent pregnancies is mandatory.

Remote video auditing in the endoscopy unit for evaluation of duodenoscope reprocessing in a tertiary care center

Endoscopy ◽  
2020 ◽  
Vol 52 (10) ◽  
pp. 864-870
Author(s):  
Kara L. Raphael ◽  
Ellen McNoble ◽  
Jessica Goldbeck ◽  
Megan Stiles ◽  
Larry S. Miller ◽  
...  
Keyword(s):  
Care Setting ◽  
Care Center ◽  
Compliance Rate ◽  
Tertiary Care ◽  
Significant Proportion ◽  
Video Camera ◽  
Turnover Time ◽  
Tertiary Care Center ◽  
The Mean ◽  
Tertiary Care Setting

Background A significant proportion of duodenoscope-transmitted infections have resulted from errors related to reprocessing. Remote video auditing (RVA) is a tool that can monitor reprocessing compliance but it has not been previously evaluated in a tertiary care setting. The aims of this study were to evaluate: 1) RVA feasibility in a tertiary care setting (defined as the ability to audit every step of duodenoscope reprocessing without delaying the next procedure due to unavailability of duodenoscopes); and 2) the use of RVA as a compliance monitoring tool. Methods This was a prospective study at a tertiary care center. A video camera with offsite monitoring was installed in March 2018. Auditors delivered a compliance score after each procedure. The duodenoscope was not used until it passed the audit. Feasibility and compliance data were collected from April 2018 to August 2019 after a 1-month run-in phase. Both per-step compliance and overall 100 % compliance rates were measured. Results Of 743 duodenoscope reprocessing procedures, 32 666 individual steps were audited and 99.9 % of the steps were fully viewable. The mean time per audit was 38.3 minutes, the mean duodenoscope turnover time was 76.1 minutes, and there were no delays to the next procedure due to unavailability of duodenoscopes. The per-step compliance rate was 99.5 % but the overall 100 % compliance rate was 90.3 %. Conclusions The use of RVA in duodenoscope reprocessing was feasible and promoted sustained high-level compliance in a tertiary care center.

Sign in / Sign up

Export Citation Format

Share Document