Choosing wisely and the use of antibiotics in ophthalmic surgery: There is more than meets the eye

2018 ◽  
Vol 28 (6) ◽  
pp. 625-632
Author(s):  
Andrea Grosso ◽  
Piero Ceruti ◽  
Giuseppe Scarpa ◽  
Franco Giardini ◽  
Giorgio Marchini ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
State Of The Art ◽  
Tertiary Care ◽  
Standard Of Care ◽  
Day Surgery ◽  
Choosing Wisely ◽  
Eye Care ◽  
Ophthalmic Surgery ◽  
Tertiary Care Centers

Background: One of the directions of modern ophthalmology is toward an odontoiatric model, and new settings of eye care are becoming the standard of care: one day surgery and also office-based therapies. Methods: Retrospective analysis of three tertiary-care centers in Italy and analysis of the literature. Results: We provide readers with state-of-the-art measures of prophylaxis in ophthalmic surgery. Discussion and conclusion: Role of antibiotics is criticized in the light of stewardship antimicrobial paradigm.

scholarly journals The Role of the Primary-Care Physician in Treating Relapses in Multiple Sclerosis Patients

2009 ◽  
Vol 11 (3) ◽  
pp. 122-126 ◽  
Author(s):  
Sarah A. Morrow ◽  
Marcelo Kremenchutzky
Keyword(s):  
Multiple Sclerosis ◽  
Primary Care ◽  
Primary Care Physicians ◽  
Tertiary Care ◽  
Care Physician ◽  
Diagnosis And Treatment ◽  
High Prevalence ◽  
Tertiary Care Centers ◽  
Multiple Sclerosis Patients

Multiple sclerosis (MS) is a common disabling neurologic disease with an overall prevalence in Canada of 240 in 100,000. Multiple sclerosis clinics are located at tertiary-care centers that may be difficult for a patient to access during an acute relapse. Many relapses are evaluated by primary-care physicians in private clinics or emergency departments, but these physicians' familiarity with MS is not known. Therefore, a survey was undertaken to determine the knowledge and experience of primary-care physicians regarding the diagnosis and treatment of MS relapses. A total of 1282 licensed primary-care physicians in the catchment area of the London (Ontario, Canada) Multiple Sclerosis Clinic were identified and mailed a two-page anonymous survey. A total of 237 (18.5%) responses were obtained, but only 216 (16.8%) of these respondents were still in active practice. Of these 216 physicians, only 9% reported having no MS patients in their practice, while 70% had one to five patients, 16.7% had six to ten, and 1.9% had more than ten (3.7% did not respond to this question). Corticosteroids were recognized as an MS treatment by 49.5% of the respondents, but only 43.1% identified them as a treatment for acute relapses. In addition, 31% did not know how to diagnose a relapse, and only 37% identified new signs or symptoms of neurologic dysfunction as indicating a potential relapse. Despite the high prevalence of MS in Canada, primary-care physicians require more education and support from specialists in MS care regarding the diagnosis and treatment of MS relapses.

scholarly journals Carcinoma of the Breast in Low Resource Setting: A Surgical Case Series from Rural India

2021 ◽  
Vol 8 (1) ◽  
pp. 78-86
Author(s):  
Royson Dsouza ◽  
Anish Jacob Cherian ◽  
Mrudula Rao ◽  
Nandakumar Menon
Keyword(s):  
Rural Women ◽  
Tertiary Care ◽  
Case Series ◽  
Standard Of Care ◽  
Comprehensive Management ◽  
Common Cancer ◽  
Resource Limited ◽  
Resource Setting ◽  
Low Resource Setting ◽  
Tertiary Care Centers

The burden of breast cancer has been on the rise world over and has become the most common cancer among women in urban India and the second most common cancer in rural women after carcinoma cervix. There is a considerable delay in presentation associated with a lack of access to adequate and timely surgical intervention. Consequently, most patients present to tertiary care centers in advanced or inoperable stages. Many subsets of these patients can be managed adequately in resource-limited rural surgical centers. In this series of patients diagnosed with carcinoma breast, we have outlined comprehensive management that is possible in resource-constrained settings. The challenges in adhering to the standard of care and strategies to overcome these limitations have been discussed with a relevant review of the literature.

scholarly journals Retinoblastoma: A retrospective analysis of 141 patients from 1983 to 2013 at a tertiary care hospital in Nagpur, India

2019 ◽  
Vol 08 (03) ◽  
pp. 195-197
Author(s):  
Rohit S. Kabre ◽  
Krishna M. Kamble
Keyword(s):  
Retrospective Analysis ◽  
Tertiary Care Hospital ◽  
External Beam Radiotherapy ◽  
Tertiary Care ◽  
Standard Of Care ◽  
Invasive Disease ◽  
Care Hospital ◽  
Medical College ◽  
Unilateral Disease ◽  
Clinical Records

Abstract Purpose: There is scarcity of data regarding clinical presentation and outcome of retinoblastoma patients in India. Objectives: The objective of this study was to assess the clinical profile of retinoblastoma patients in a tertiary care hospital in India from 1983 to 2013. Subjects and Methods: A retrospective analysis of clinical records of 141 patients with retinoblastoma registered from 1983 to 2013 at Government Medical College, Nagpur, India, was conducted. Demographics, clinical features, modes of treatment, and outcome of the patients were assessed. Results: Majority of patients (81 [57.45%]) presented in the age group of 1–3 years and were males. One hundred and fourteen patients (80.85%) had unilateral disease, while rare presentations of trilateral/quadrilateral retinoblastoma were also noted. Proptosis was seen in 81 (57.45%) patients as presenting symptom. Eighty-nine patients (63.12%) had locally invasive disease-involving sites. Forty-four patients (31.19%) developed distant metastasis. Surgical management and external beam radiotherapy were followed in majority of patients. Trend of increased usage of chemotherapy was seen from the mid-1990s. One hundred and twelve patients (79.43%) died with the disease. Conclusions: Data from this study show late diagnosis, leading to poor outcome for patients with advanced retinoblastoma, which is in accordance with data from other developing countries. Even though management of patients changed in accordance with changing standard of care over the decade, mortality remained high.

Organ Donation and Transplantation: A Survey of Critical Care Health Professionals in Nontransplant Hospitals

2005 ◽  
Vol 15 (1) ◽  
pp. 69-77 ◽  
Author(s):  
Susan Marie Chernenko ◽  
Louise Jensen ◽  
Christine Newburn-Cook ◽  
David L. Bigam
Keyword(s):  
Critical Care ◽  
Organ Donation ◽  
Tertiary Care ◽  
Potential Donor ◽  
Hospital Administrators ◽  
Donation Process ◽  
Care Health ◽  
Tertiary Care Centers ◽  
Descriptive Survey

Context Exploration of the role of critical care professionals in improving organ donation within Canada has been limited to tertiary care centers while donor potential in smaller nontransplant hospitals remains unknown. Objective To gain an understanding of the knowledge, attitudes, and perceived barriers that healthcare professionals in 5 nontransplant hospitals in Alberta have toward organ donation and transplantation, and to identify factors that influenced participation in the donation process. Design A descriptive survey of critical care professionals. Setting Five nontransplant hospitals in Alberta, Canada. Results Of the 135 respondents, 98 were critical care nurses, 32 were physicians, and 5 were hospital administrators. Respondents were least knowledgeable about transplant statistics and religious beliefs regarding donation, although overall, attitudes reflected positive support for organ donation. Respondents exhibited reluctance in approaching a potential donor family, and believed inadequate resources were allocated for organ donation. Conclusions Educational programs are needed to increase knowledge of organ donation and transplantation as well as the development of an in-house coordinator program in nontransplant hospitals for critical care personnel.

scholarly journals Successful treatment of primary intracranial sarcoma with the ICE chemotherapy regimen and focal radiation in children

2016 ◽  
Vol 17 (3) ◽  
pp. 298-302 ◽  
Author(s):  
Lucie Lafay-Cousin ◽  
Gillian Lindzon ◽  
Michael D. Taylor ◽  
Walter Hader ◽  
Cynthia Hawkins ◽  
...  
Keyword(s):  
Cerebral Hemisphere ◽  
Right Hemisphere ◽  
Tertiary Care ◽  
Standard Of Care ◽  
Neurofibromatosis Type ◽  
Tumor Location ◽  
Duration Of Symptoms ◽  
Intratumoral Hemorrhage ◽  
Tertiary Care Centers ◽  
The Right

OBJECT Primary CNS sarcomas are very rare pediatric tumors with no defined standard of care. METHODS This study was a retrospective review of children diagnosed with a primary CNS sarcoma and treated at 2 Canadian tertiary care centers between 1995 and 2012. This report focuses on patients with cerebral hemispheric tumor location due to their specific clinical presentation. RESULTS Fourteen patients with nonmetastatic primary CNS sarcoma were identified; in 9 patients, tumors were located in the cerebral hemisphere and 7 of these patients presented with intratumoral hemorrhage. One infant who died of progressive disease postoperatively before receiving any adjuvant therapy was not included in this study. The final cohort therefore included 8 patients (4 males). Median patient age at diagnosis was 11.8 years (range 5.8–17 years). All tumors were located in the right hemisphere. Duration of symptoms prior to diagnosis was very short with a median of 2 days (range 3–7 days), except for 1 patient. Three (37.5%) patients had an underlying diagnosis of neurofibromatosis Type 1 (NF1). Gross-total resection was achieved in 5 patients. The dose of focal radiation therapy (RT) ranged between 54 Gy and 60 Gy. Concomitant etoposide was administered during RT. ICE (ifosfamide, carboplatin, etoposide) chemotherapy was administered prior to and after RT for a total of 6–8 cycles. Seven of the 8 patients were alive at a median time of 4.9 years (range 1.9–17.9 years) after treatment. CONCLUSIONS In this retrospective series, patients with primary CNS sarcomas located in the cerebral hemisphere most commonly presented with symptomatic acute intratumoral hemorrhage. Patients with NF1 were overrepresented. The combination of adjuvant ICE chemotherapy and focal RT provided encouraging outcomes.

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