The Use of ECMO for the Treatment of Refractory Cardiac Arrest or Postarrest Cardiogenic Shock Following In-Hospital Cardiac Arrest: A 10-Year Experience

2018 ◽  
Vol 34 (8) ◽  
pp. 615-621 ◽  
Author(s):  
Meshe Chonde ◽  
Penny Sappington ◽  
Robert Kormos ◽  
Andrew Althouse ◽  
Arthur Boujoukos
Keyword(s):  
Cardiac Arrest ◽  
Cardiogenic Shock ◽  
Tertiary Care ◽  
Care Facility ◽  
Primary Objective ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Tertiary Care Facility ◽  
Social Security Death Index ◽  
Refractory Cardiac Arrest

Objectives: Extracorporeal membrane oxygenation (ECMO) has been increasingly used in the treatment of refractory cardiac arrest (extracorporeal cardiopulmonary resuscitation [ECPR]) and postarrest cardiogenic shock (PACS). Our primary objective was to determine the 1-year survival of patients who were treated with ECMO for PACS or in ECPR. Methods: We conducted a retrospective analysis of hospitalized patients in a tertiary care facility who underwent treatment with ECMO for ECPR or PACS. Between January 2004 and December 2013, patients were prospectively entered into an institutional registry. One-year follow-up was assessed by electronic medical record or social security death index if clinical follow-up was unavailable. Results: Fifty-one patients were treated with ECMO during the study period. The mean age was 54.0 ± 10.9 years; the majority of patients were men (80.4%). The most common etiology of arrest was acute myocardial infarction (51.0%). Overall, 13 (25.4%) patients survived for at least 1 year. Preexisting coronary artery disease, hypertension, and hyperlipidemia were associated with reduced likelihood of survival. We observed a significant improvement in 1-year mortality in patients treated for PACS when compared to ECPR, 46.7% versus 16.7%, respectively. Conclusion: The use of ECMO for treatment of refractory cardiac arrest or cardiogenic shock may be a suitable treatment in a very select cohort of patients. Our results support a significantly higher 1-year survival in patients with PACS compared to refractory cardiac arrest.

Nurse-Led Neonatal Follow-Up Clinic: A New Emerging Concept in a Developing Country

2020 ◽  
Vol 34 (1-2) ◽  
pp. 19-23
Author(s):  
Poonam Joshi ◽  
Bindu Sarojini ◽  
Meena Joshi ◽  
Anu Thukral
Keyword(s):  
Developing Countries ◽  
Prospective Observational Study ◽  
Tertiary Care ◽  
Newborn Care ◽  
Care Facility ◽  
Essential Newborn Care ◽  
Tertiary Care Facility ◽  
Neonatal Assessment ◽  
The Mean

Objective: To investigate the feasibility and acceptance of nurse-led neonatal follow-up clinic (NLNFC) in a tertiary care facility. Materials and Methods: In a prospective observational study, total 105 stable mother-neonate dyads were independently followed up in both nurse led and neonatologist run follow-up clinics. The outcome was measured in terms of agreement between the nurse and neonatologist in the domains of neonatal assessment, counselling mothers on essential newborn care (ENC) and giving advice ( P < 0.05) and mothers’ acceptability for NLNFC. Results: Agreement between the trained neonatal nurse and neonatologist varied between 87 and 100%. The most unanimity was observed in neonatal assessment and counselling on ENC (93.3%-100%) followed by prescribing treatment (87%). The mean acceptability scores of the mothers for NLNFC was 33.13 ± 2.6 (25-35, maximum possible score 35). Conclusion: Establishing NLNFCs in developing countries is feasible. Nurses can be entrusted with the responsibility of following up stable neonates here and mothers will surely be satisfied with this type of clinic.

What is the Long-Term Follow-Up of Nonoperatively Treated Patients with Appendicitis?

2019 ◽  
Vol 85 (5) ◽  
pp. 462-465
Author(s):  
Andrew Felber ◽  
Deven Catalano ◽  
Caitlin Stafford ◽  
Todd D. Francone ◽  
Patricia L. Roberts ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Care Facility ◽  
Nonoperative Treatment ◽  
Interval Appendectomy ◽  
Tertiary Care Facility ◽  
Long Term Follow Up ◽  
Mean Time ◽  
Emergent Surgery

In this study, we determine outcomes after nonoperative treatment of appendicitis. First, we abstracted data for patients discharged with a diagnosis of appendicitis from a tertiary care facility from August 1, 2007, through June 30, 2017. For patients treated nonoperatively, we collected additional medical treatment for appendicitis, future surgical treatment, and date of last follow-up. In our study, we identified 487 patients treated for appendicitis. From this group, 66 patients were successfully treated nonoperatively. Eight patients (12%) had an interval appendectomy at a mean follow-up time of two months. Of the 58 remaining patients, 20 (34%) did not have any further appendicitis-related issues over a mean follow-up period of 25 months. A total of 38 (66%) had recurring or additional concerns requiring further treatment or emergent surgery within a mean time of four months. A large proportion, 76 per cent (n = 29), required unscheduled or emergent appendectomy. There were more patients diagnosed with an abscess (55%) in the group that had further appendicitis issues. In conclusion, nonoperative treatment of appendicitis is associated with significant likelihood of future appendicitis-related treatment or emergency surgery (66%). In addition, patients diagnosed with an abscess are at particularly high risk of future appendicitis-related issues.

Clinical Outcomes of Endoscopic and Endoscopic-Assisted Resection of Inverted Papillomas: A 15-Year Experience

2007 ◽  
Vol 21 (5) ◽  
pp. 591-600 ◽  
Author(s):  
Bradford A. Woodworth ◽  
Geeta A. Bhargave ◽  
James N. Palmer ◽  
Alexander G. Chiu ◽  
Noam A. Cohen ◽  
...  
Keyword(s):  
Demographic Data ◽  
Tertiary Care ◽  
Case Series ◽  
Care Facility ◽  
Recurrence Rates ◽  
Time To Recurrence ◽  
Tertiary Care Facility ◽  
Inverted Papillomas

Background The endoscopic resection of sinonasal inverted papillomas (IPs) has been well described. However, the majority of published reports in the literature are small case series with limited clinical follow-up. The aim of this retrospective study was to review the experience with the endoscopic and endoscopic-assisted resection of IPs at a major academic tertiary care facility and assess long-term outcomes. Methods A retrospective review of endoscopic and endoscopic-assisted resections of IP was performed. Charts were reviewed for standard demographic data, operative technique, adjuvant approaches, complications, and postoperative follow-up times. Results One hundred fourteen patients (average age, 56 years) underwent endoscopic or endoscopic-assisted resection for IPs with a mean disease-free follow-up of 40 months (7–135 months). Seventeen patients developed disease after endoscopic or endoscopic-assisted resection for a recurrence rate of 15%. Average time to recurrence was 23 months. Combined approaches were used when indicated in 34% (39/114) of patients, including adjuvant osteoplastic flap, midface degloving, trephine, or Caldwell-Luc approaches. Four patients (4%) had cerebrospinal fluid leaks that were successfully repaired endoscopically. Conclusion In this large series of endoscopically resected IPs with extensive clinical follow-up, recurrences occurred an average of 23 months after the procedure. This emphasizes the importance of long-term endoscopic follow-up to detect recurrences in all patients. Endoscopic or endoscopic-assisted resection of IPs is a valid technique in this series with recurrence rates comparable with open approaches.

Mortality in Patients with Primary Unipolar Depression, Secondary Unipolar Depression, and Bipolar Affective Disorder: A Comparison with General Population Mortality

1988 ◽  
Vol 17 (4) ◽  
pp. 351-360 ◽  
Author(s):  
Donald W. Black ◽  
George Winokur ◽  
Amelia Nasrallah
Keyword(s):  
Affective Disorder ◽  
Bipolar Affective Disorder ◽  
Tertiary Care ◽  
Geographical Area ◽  
Care Facility ◽  
Unipolar Depression ◽  
Mortality Data ◽  
Initial Portion ◽  
Tertiary Care Facility

Mortality data are presented from a two to fourteen year follow-up of 705 primary unipolar depressives, 302 secondary unipolar depressives, and 586 patients with bipolar affective disorder (BAD) hospitalized at a tertiary care facility. Death ascertainment was made through a record-linkage process. Using sex- and age-standardized mortality ratios (SMRs), the mortality experience of the study population was compared with that of Iowa, the geographical area served by the admitting medical facility for this study group. Results show that risk for all-cause mortality was most pronounced during the first two years following hospital discharge, although secondary unipolar depressives continued to show a significant excess of deaths throughout the entire follow-up period. Deaths occurring from natural causes were significantly excessive only during the initial portion of the follow-up. Deaths from unnatural causes were significantly excessive throughout follow-up except for patients with bipolar affective disorder.

scholarly journals Long-Term Follow-Up After Fat Graft Myringoplasty: Do Size and Location Matter?

2020 ◽  
pp. 014556132097355
Author(s):  
Alfonso Rodriguez Diaz ◽  
Carlos O’Connor Reina ◽  
Guillermo Plaza ◽  
Elena Rodriguez Posadas ◽  
Francisco Valdeon Arevalo ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Case Series ◽  
Care Facility ◽  
Clinical Results ◽  
Fat Graft ◽  
Closure Rate ◽  
Tertiary Care Facility ◽  
Long Term Follow Up ◽  
Prospective Case Series

Objective: To assess clinical and functional outcomes of a fat graft myringoplasty under local in an office setting. Study Design: Prospective case series. Setting: Tertiary care facility. Patients: Patients with a tympanic membrane (TM) perforation presenting between December 2005 and June 2019. Inclusion criteria included perforation size >25% of the surface of the pars tensa of the TM, entire perforation margins visualized through a transcanal view, and lack of spontaneous closure at the 6-month follow-up. The exclusion criteria were the presence of cholesteatoma, wet appearance of the mucosa in the tympanic cavity, ear discharge in the 3 months before surgery, or signs of ossicular inconsistency. Intervention: In-office fat graft myringoplasty technique under local anesthesia. Main outcome Measures: Complete perforation closure rate and audiometric outcomes. Results: A total of 121 patients underwent the procedure, of whom 21 had bilateral sequential procedures (total 142 ears). Average age was 51.1 ± 18.4 years (range, 3-78 years). The size of perforation was <25% of TM in 39 (27.5%) ears, 25% to 50% of TM in 49 (34.55%) ears, 50% to 75% of TM in 34 (23.91%) ears, and 75% to 100% of TM in 20 (14.10%) ears. Complete perforation closure was evident in 130 (91.55%) of the 142 ears. Preoperative mean air conduction threshold was 59.3 dB (17-95 dB) and significantly improved into 35.6 dB (10-85 dB; P < .0004) after surgery. Preoperative air–bone gap was 30.2 dB (5-70 dB) and also significantly improved into 10.2 dB (5-65 dB; P < .0001) after surgery. Conclusion: In office fat graft myringoplasty, in adult and pediatric patients with variable perforation sizes, is a well-tolerated procedure with very satisfactory clinical results.

scholarly journals First Bite Syndrome After Parotidectomy: A Case Series and Review of Literature

2020 ◽  
pp. 014556132098017
Author(s):  
Vivian Xu ◽  
Kurren S. Gill ◽  
Jared Goldfarb ◽  
Cory Bovenzi ◽  
Roxana Moayer ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Case Series ◽  
Care Facility ◽  
Cervical Region ◽  
Parotid Region ◽  
Tertiary Care Facility ◽  
Upper Cervical ◽  
Potential Risk Factors ◽  
First Bite Syndrome

Introduction: First bite syndrome (FBS) is a rare but potentially debilitating complication observed after surgery involving the upper cervical region. Patients classically complain of severe facial pain in the ipsilateral parotid region with the first few bites of a meal. Objective: The aim of this study is to shed light on the incidence and potential risk factors of FBS, including a series of cases depicting FBS observed after parotidectomy. Methods: Retrospective review of 419 patients who underwent parotidectomy at a single tertiary care facility between December 2016 and June 2020. Results: With a mean follow-up time of 16.5 months, 8 (2%) patients were documented to have symptoms of FBS after parotid gland surgery. Six of these patients underwent partial parotidectomy by dissection of the deep lobe of the parotid (DLP). Conclusion: Patients undergoing dissection of the DLP are particularly at risk for the development of FBS. All patients should be appropriately counseled during informed consent discussions, especially in high-risk cases.

Successful implementation of post-cardiac arrest service in a tertiary care facility

Resuscitation ◽  
2008 ◽  
Vol 77 ◽  
pp. S34
Author(s):  
J. Rittenberger ◽  
F.X. Guyette ◽  
S.A. Tisherman ◽  
M. DeVita ◽  
R. Alvarez ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Tertiary Care ◽  
Care Facility ◽  
Successful Implementation ◽  
Tertiary Care Facility

scholarly journals Neurocognitive Changes in Tertiary Neurosyphilis: A Retrospective Chart Review

2014 ◽  
Vol 41 (4) ◽  
pp. 452-458 ◽  
Author(s):  
Philippe Beauchemin ◽  
Robert Laforce
Keyword(s):  
Chart Review ◽  
Tertiary Care ◽  
Care Facility ◽  
Public Health Problem ◽  
Retrospective Chart Review ◽  
Quality Data ◽  
Major Public Health Problem ◽  
Tertiary Care Facility ◽  
Behavioral Impairments

Context:Since the beginning of the new millennium, prevalence of syphilis has re-increased and is once again, a major public health problem. Neurosyphilis is the extension of syphilitic infection to the nervous system. It is considered by many as a cause of reversible dementia, when treated early. However, scarce data exist on the evolution of cognitive and behavioral impairments in patients affected by tertiary neurosyphilis.Objectives:The aim of this study was to explore the cognitive and behavioral changes in a cohort of patients diagnosed with neurosyphilis.Design:A retrospective study based on systematized chart review between 2000 and 2012 in a large neurological tertiary care facility.Outcome measure:Clinical evaluations by treating physicians.Results:Eighteen patients were identified with tertiary neurosyphilis. Out of this group, only two had systematic neuropsychological follow-up despite physician reports of significant and persistent cognitive and psychiatric changes. For these two cases, only slight improvements were noted in memory and executive skills while improvements in attention were marked. None of our patients had previous psychiatric history yet a large proportion developed symptoms after the infection.Conclusion:Although neurosyphilis is traditionally considered a reversible form of dementia, we found limited support for this claim in our two patients with close follow-up. Quality data on the cognitive and psychiatric changes in the rest of our cohort was dramatically lacking, and this could not be explained by absence of symptoms at presentation. Given the recrudescence of syphilis, we propose a systematic approach to the evaluation and follow-up of this disorder.

Su1337 Disease Progression Is a Risk Factor for Colectomy in Ulcerative Colitis: 10-Years of Follow up in a Tertiary Care Facility

2015 ◽  
Vol 148 (4) ◽  
pp. S-479
Author(s):  
Saloomeh Sahami ◽  
Kadère Konté ◽  
Christianne J. Buskens ◽  
Pieter J. Tanis ◽  
M. Lowenberg ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Risk Factor ◽  
Disease Progression ◽  
Tertiary Care ◽  
Care Facility ◽  
Tertiary Care Facility

Assessing Acute St-Elevation Myocardial Infarction With Prognostic Significance Of The Hyponatramia

2020 ◽  
Vol 11 (3) ◽  
pp. 3251-3260
Author(s):  
Makrand B Mane
Keyword(s):  
Myocardial Infarction ◽  
Ejection Fraction ◽  
Tertiary Care ◽  
Prognostic Significance ◽  
Care Facility ◽  
Early Death ◽  
Public Health Issue ◽  
Care Hospital ◽  
Tertiary Care Facility ◽  
Significant Public Health

Acute Myocardial Infarction (AMI) has become a significant public health issue in developed and developing nations, following extensive diagnostic and management research over recent decades. The study intended to research the prognostic values of inexplicable Hyponatremia in patients with severe STelevation of myocardial infarction, in 100 consecutive patients admitted to Tertiary care hospital. In the analysis, identified patients on admission were diagnosed with or produced Hyponatremia within 72 hours—a lower ejection fraction than those with usual amounts of sodium. The research aimed to evaluate the prognosis significance of Hyponatremia for the estimation of early death in acute ST-elevated myocardial infarction. One hundred straight patients admitted in the Coronary Centre Tertiary Care Facility with severe STelevated myocardial infarction were studied. The data of the study on various risk factors in association with the development of Hyponatremia like as age, sex, use of tobacco, diabetes, hypertension, ejection fraction etc. were analyzed. Thus, the researchers reported that in patients diagnosed with severe ST section escalation, Hyponatremia showed the initial emergence of hyponatremia myocardial infarctions. This condition correlates with the severity of LV dysfunction (in term of LVEF) and can be considered as an individual early death indicator as well as a prediction exacerbates with hyponatremia frequency.

Sign in / Sign up

Export Citation Format

Share Document