Development of a Clinical Care Pathway for Severe Epistaxis at a Tertiary-Care Medical Center

2014 ◽  
Vol 151 (1_suppl) ◽  
pp. P38-P39
Author(s):  
Jason I. Kass ◽  
Peter S. Vosler ◽  
Eric W. Wang ◽  
Carl H. Snyderman
Keyword(s):  
Care Pathway ◽  
Medical Center ◽  
Clinical Care ◽  
Tertiary Care ◽  
Tertiary Care Medical Center ◽  
Severe Epistaxis ◽  
Clinical Care Pathway

scholarly journals Canadian Nationwide Survey on Pediatric Malnutrition Management in Tertiary Hospitals

Nutrients ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 2635
Author(s):  
Koen Huysentruyt ◽  
Kim Brunet-Wood ◽  
Robert Bandsma ◽  
Leah Gramlich ◽  
Bonnie Fleming-Carroll ◽  
...  
Keyword(s):  
Health Care Professionals ◽  
Care Pathway ◽  
Clinical Care ◽  
Tertiary Care ◽  
Nationwide Survey ◽  
Nutritional Screening ◽  
Pediatric Hospitals ◽  
Adoption And Implementation ◽  
Clinical Care Pathway

Background: Disease-associated malnutrition (DAM) is common in hospitalized children. This survey aimed to assess current in-hospital practices for clinical care of pediatric DAM in Canada. Methods: An electronic survey was sent to all 15 tertiary pediatric hospitals in Canada and addressed all pillars of malnutrition care: screening, assessment, treatment, monitoring and follow-up. Results: Responses of 120 health care professionals were used from all 15 hospitals; 57.5% were medical doctors (MDs), 26.7% registered dietitians (RDs) and 15.8% nurses (RNs). An overarching protocol for prevention, detection and intervention of pediatric malnutrition was present or “a work in progress”, according to 9.6% of respondents. Routine nutritional screening on admission was sometimes or always performed, according to 58.8%, although the modality differed among hospitals and profession. For children with poor nutritional status, lack of nutritional follow-up after discharge was reported by 48.5%. Conclusions: The presence of a standardized protocol for the clinical assessment and management of DAM is uncommon in pediatric tertiary care hospitals in Canada. Routine nutritional screening upon admission has not been widely adopted. Moreover, ongoing nutritional care of malnourished children after discharge seems cumbersome. These findings call for the adoption and implementation of a uniform clinical care pathway for malnutrition among pediatric hospitals.

Successful Implementation of a Clinical Care Pathway for Management of Epistaxis at a Tertiary Care Center

2016 ◽  
Vol 155 (5) ◽  
pp. 879-885 ◽  
Author(s):  
Peter S. Vosler ◽  
Jason I. Kass ◽  
Eric W. Wang ◽  
Carl H. Snyderman
Keyword(s):  
Care Pathway ◽  
Clinical Care ◽  
Care Center ◽  
Tertiary Care ◽  
Successful Implementation ◽  
Tertiary Care Center ◽  
Clinical Care Pathway

Schwere Epistaxis stoppen – Klinischer Behandlungspfad zahlt sich aus

2017 ◽  
Vol 22 (04) ◽  
pp. 178-179
Author(s):  
Maria Weiß
Keyword(s):  
Head And Neck ◽  
Care Pathway ◽  
Clinical Care ◽  
Care Center ◽  
Tertiary Care ◽  
Neck Surgery ◽  
Successful Implementation ◽  
Tertiary Care Center ◽  
Klinischer Behandlungspfad ◽  
Clinical Care Pathway

Vosler PE et al. Successful Implementation of a Clinical Care Pathway for Management of Epistaxis at a Tertiary Care Center. Otolaryngology – Head and Neck Surgery 2016; 155: 879–885 Die meisten Fälle von Nasenbluten lassen sich leicht in den Griff bekommen – schwere Blutungen aus der Arteria sphenopalatina (SPA) oder unter Antikoagulation können aber eine Herausforderung darstellen. US-amerikanische HNO-Ärzte haben jetzt einen klinischen Behandlungspfad zum Management der schweren Epistaxis entwickelt, den sie in einem Tertiär-Krankenhaus evaluierten.

scholarly journals EVALUATION OF FACTORS ASSOCIATED WITH MORTALITY AMONGST PATIENTS ADMITTED TO A TERTIARY CARE MEDICAL CENTER FOR COVID-19 INFECTION

2021 ◽  
Vol 77 (18) ◽  
pp. 3123
Author(s):  
Anish Samuel ◽  
Ashesha Mechineni ◽  
Robin Craven ◽  
Wilbert Aronow ◽  
Mourad Ismail ◽  
...  
Keyword(s):  
Medical Center ◽  
Tertiary Care ◽  
Factors Associated ◽  
Tertiary Care Medical Center

Retrospective Review and Proof of Concept of Asia’s First Mobile Stroke Unit Experience in Kovai Medical Center and Hospital

2020 ◽  
Vol 3 (2) ◽  
pp. 116-123
Author(s):  
Mathew Cherian ◽  
Pankaj Mehta ◽  
Shriram Varadharajan ◽  
Santosh Poyyamozhi ◽  
Elango Swamiappan ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Retrospective Review ◽  
Stroke Unit ◽  
Care Pathway ◽  
Clinical Care ◽  
Stroke Care ◽  
First Year ◽  
Proof Of Concept ◽  
Mobile Stroke Unit ◽  
Clinical Care Pathway

Background: We review our initial experience of India’s and Asia’s first mobile stroke unit (MSU) following the completion of its first year of operation. We outline the clinical care pathway integrating the MSU services using a case example taking readers along our clinical care workflow while highlighting the challenges faced in organizing and optimizing such services in India. Methods: Retrospective review of data collected for all patients from March 2018 to February 2019 transported and treated within the MSU during the first year of its operation. Recent case example is reviewed highlighting complete comprehensive acute clinical care pathway from prehospital MSU services to advanced endovascular treatment with focus on challenges faced in developing nation for stroke care. Results: The MSU was dispatched and utilized for 14 patients with clinical symptoms of acute stroke. These patients were predominantly males (64%) with median age of 59 years. Ischemic stroke was seen in 7 patients, hemorrhagic in 6, and 1 patient was classified as stroke mimic. Intravenous tissue plasminogen activator was administered to 3 patients within MSU. Most of the patients’ treatment was initiated within 2 h of symptom onset and with the median time of patient contact (rendezvous) following stroke being 55 mins. Conclusion: Retrospective review of Asia’s first MSU reveals its proof of concept in India. Although the number of patients availing treatment in MSU is low as compared to elsewhere in the world, increased public awareness with active government support including subsidizing treatment costs could accelerate development of optimal prehospital acute stroke care policy in India.

scholarly journals Evaluation of post-ERCP pancreatitis after biliary stenting with self-expandable metal stents vs. plastic stents in benign and malignant obstructions

2021 ◽  
Vol 09 (06) ◽  
pp. E888-E894
Author(s):  
Nichol S. Martinez ◽  
Sumant Inamdar ◽  
Sheila N. Firoozan ◽  
Stephanie Izard ◽  
Calvin Lee ◽  
...  
Keyword(s):  
Pancreatic Duct ◽  
Medical Center ◽  
Tertiary Care ◽  
Plastic Stents ◽  
Metal Stents ◽  
Limited Data ◽  
Sems Group ◽  
Tertiary Care Medical Center ◽  
Stent Type ◽  
Pancreatic Duct Stent

Abstract Background and study aims There are conflicting data regarding the risk of post-ERCP pancreatitis (PEP) with self-expandable metallic stents (SEMS) compared to polyethylene stents (PS) in malignant biliary obstructions and limited data related to benign obstructions. Patients and methods A retrospective cohort study was performed of 1136 patients who underwent ERCP for biliary obstruction and received SEMS or PS at a tertiary-care medical center between January 2011 and October 2016. We evaluated the association between stent type (SEMS vs PS) and PEP in malignant and benign biliary obstructions. Results Among the 1136 patients included in our study, 399 had SEMS placed and 737 had PS placed. Patients with PS were more likely to have pancreatic duct cannulation, pancreatic duct stent placement, double guidewire technique, sphincterotomy and sphincteroplasty as compared to the SEMS group. On multivariate analysis, PEP rates were higher in the SEMS group (8.0 %) versus the PS group (4.8 %) (OR 2.27 [CI, 1.22, 4.24]) for all obstructions. For malignant obstructions, PEP rates were 7.8 % and 6.6 % for SEMS and plastic stents, respectively (OR 1.54 [CI, 0.72, 3.30]). For benign obstructions the PEP rate was higher in the SEMS group (8.8 %) compared to the PS group (4.2 %) (OR 3.67 [CI, 1.50, 8.97]). No significant differences between PEP severity were identified based on stent type when stratified based on benign and malignant. Conclusions PEP rates were higher when SEMS were used for benign obstruction as compared to PS. For malignant obstruction, no difference was identified in PEP rates with use of SEMS vs PS.

Optimizing Outcomes After Cleft Palate Repair: Design and Implementation of a Perioperative Clinical Care Pathway

2021 ◽  
pp. 105566562110174
Author(s):  
Thomas R. Cawthorn ◽  
Anna R. Todd ◽  
Nina Hardcastle ◽  
Adam O. Spencer ◽  
A. Robertson Harrop ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Cleft Palate ◽  
Care Pathway ◽  
Clinical Care ◽  
Oral Intake ◽  
Opioid Consumption ◽  
Complication Rates ◽  
Cleft Palate Repair ◽  
Palate Repair ◽  
Clinical Care Pathway

Objective: To evaluate the development process and clinical impact of implementing a standardized perioperative clinical care pathway for cleft palate repair. Design: Medical records of patients undergoing primary cleft palate repair prior to pathway implementation were retrospectively reviewed as a historical control group (N = 40). The historical cohort was compared to a prospectively collected group of patients who were treated according to the pathway (N = 40). Patients: Healthy, nonsyndromic infants undergoing primary cleft palate repair at a tertiary care pediatric hospital. Interventions: A novel, standardized pathway was created through an iterative process, combining literature review with expert opinion and discussions with institutional stakeholders. The pathway integrated multimodal analgesia throughout the perioperative course and included intraoperative bilateral maxillary nerve blocks. Perioperative protocols for preoperative fasting, case timing, antiemetics, intravenous fluid management, and postoperative diet advancement were standardized. Main Outcome Measures: Primary outcomes include: (1) length of hospital stay, (2) cumulative opioid consumption, (3) oral intake postoperatively. Results: Patients treated according to the pathway had shorter mean length of stay (31 vs 57 hours, P < .001), decreased cumulative morphine consumption (77 vs 727 μg/kg, P < .001), shorter time to initiate oral intake (9.3 vs 22 hours, P = .01), and greater volume of oral intake in first 24 hours postoperatively (379 vs 171 mL, P < .001). There were no differences in total anesthesia time, total surgical time, or complication rates between the control and treatment groups. Conclusions: Implementation of a standardized perioperative clinical care pathway for primary cleft palate repair is safe, feasible, and associated with reduced length of stay, reduced opioid consumption, and improved oral intake postoperatively.

scholarly journals Increase in recruitment upon integration of trial into a clinical care pathway: an observational study

2021 ◽  
Vol 8 (1) ◽  
pp. e000967
Author(s):  
Kay Por Yip ◽  
Simon Gompertz ◽  
Catherine Snelson ◽  
Jeremy Willson ◽  
Shyam Madathil ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Hospital Admissions ◽  
Care Pathway ◽  
Clinical Care ◽  
Intensive Therapy ◽  
Respiratory Support ◽  
Trial Recruitment ◽  
Recruitment Process ◽  
Support Unit ◽  
Clinical Care Pathway

IntroductionMany respiratory clinical trials fail to reach their recruitment target and this problem exacerbates existing funding issues. Integration of the clinical trial recruitment process into a clinical care pathway (CCP) may represent an effective way to significantly increase recruitment numbers.MethodsA respiratory support unit and a CCP for escalation of patients with severe COVID-19 were established on 11 January 2021. The recruitment process for the Randomised Evaluation of COVID-19 Therapy-Respiratory Support trial was integrated into the CCP on the same date. Recruitment data for the trial were collected before and after integration into the CCP.ResultsOn integration of the recruitment process into a CCP, there was a significant increase in recruitment numbers. Fifty patients were recruited over 266 days before this process occurred whereas 108 patients were recruited over 49 days after this process. There was a statistically significant increase in both the proportion of recruited patients relative to the number of COVID-19 hospital admissions (change from 2.8% to 9.1%, p<0.0001) and intensive therapy unit admissions (change from 17.8% to 50.2%, p<0.001) over the same period, showing that this increase in recruitment was independent of COVID-19 prevalence.DiscussionIntegrating the trial recruitment process into a CCP can significantly boost recruitment numbers. This represents an innovative model that can be used to maximise recruitment without impacting on the financial and labour costs associated with the running of a respiratory clinical trial.

Utility of electroencephalography: Experience from a U.S. tertiary care medical center

2016 ◽  
Vol 127 (10) ◽  
pp. 3335-3340 ◽  
Author(s):  
Kapil Gururangan ◽  
Babak Razavi ◽  
Josef Parvizi
Keyword(s):  
Medical Center ◽  
Tertiary Care ◽  
Tertiary Care Medical Center

Nosocomial Methicillin-Resistant and Methicillin-SusceptibleStaphylococcus AureusPrimary Bacteremia: At What Costs?

1999 ◽  
Vol 20 (6) ◽  
pp. 408-411 ◽  
Author(s):  
Murray A. Abramson ◽  
Daniel J. Sexton
Keyword(s):  
Hospital Stay ◽  
Medical Center ◽  
A Priori ◽  
Tertiary Care ◽  
Length Of Hospital Stay ◽  
Bloodstream Infections ◽  
Methicillin Resistant ◽  
Tertiary Care Medical Center ◽  
Matching Criteria ◽  
Nested Case Control

Objective:To determine the attributable hospital stay and costs for nosocomial methicillin-sensitive Staphylococcus aureus (MSSA) and methicillin-resistantS aureus(MRSA) primary bloodstream infections (BSIs).Design:Pairwise-matched (1:1) nested case-control study.Setting:University-based tertiary-care medical center.Patients:Patients admitted between December 1993 and March 1995 were eligible. Cases were defined as patients with a primary nosocomialS aureusBSI; controls were selected according to a priori matching criteria.Measurements:Length of hospital stay and total and variable direct costs of hospitalization.Results:The median hospital stay attributable to primary nosocomial MSSA BSI was 4 days, compared with 12 days for MRSA (P=.023). Attributable median total cost for MSSA primary nosocomial BSIs was $9,661 versus $27,083 for MRSA nosocomial infections (P=.043).Conclusion:Nosocomial primary BSI due toS aureussignificantly prolongs the hospital stay. Primary nosocomial BSIs due to MRSA result in an approximate threefold increase in direct cost, compared with those due to MSSA.

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