scholarly journals Changes to Foot and Ankle Surgical Care During the COVID-19 Pandemic

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0019
Author(s):  
Alessandra L. Falk ◽  
James Hunker ◽  
Mani Kahn ◽  
Yi Guo ◽  
Chaiyaporn Kulsakdinun
Keyword(s):  
New York ◽  
Ankle Instability ◽  
Elective Surgery ◽  
Care Center ◽  
Tertiary Care ◽  
New York State ◽  
Surgical Care ◽  
Foot And Ankle ◽  
First Case ◽  
Orthopedic Care

Category: Other; Ankle Introduction/Purpose: On March 1, 2020, the first case of novel coronavirus (COVID-19) in New York City (NYC) was confirmed. By March 16, the NYC mayor and New York State Governor issued executive orders to postpone elective surgeries. At our tertiary care academic medical care center in the Bronx, the densely populated community of 1.4 million saw many COVID-19 positive cases. In response, the hospital quickly accommodated these patients, while maintaining outpatient orthopedic care. Consequently, only emergent orthopedic cases were granted permission to rapidly proceed to surgery. Most foot and ankle cases were deemed amenable to non-surgical or delayed surgical care. The purpose of this study is to characterize a series of patients with foot and ankle pathology whose orthopedic care was altered due to the pandemic. Methods: This is a retrospective chart review from February 2020-May 2020 encompassing the time that elective surgery was on hold and one month prior, to capture those patients were scheduled for surgery prior to the pandemic. Included were patients with foot and ankle pathology that required urgent orthopedic care, who were seen in the foot and ankle clinic, fracture clinic, and subsequently in the general orthopedic clinic that was instituted on an emergent bases. Excluded were patients who required intervention to address elective foot and ankle issues such as osteoarthritis, or ankle instability, and those were referred to an outside institution for further treatment. Throughout the pandemic, contact was made with patients either directly in clinic, via a telehealth portal or telephone. Descriptive statistics are taken. Results: Of the 17 patients included in this series, 11 (65%) patients were managed non operatively. Of these, 4 chose nonoperative management due to shared decision making between the patient and surgeon. 2 patients could not have surgery due to complications related to COVID-19. As the zenith of the pandemic passed 2 patients remained fearful of infection and therefore chose non operative management. 3 patients that had been in contact with the orthopedic department refused further imaging. 6 patients were managed operatively. 2 patients had surgery during the peak of the pandemic, both of whom tested positive for COVID and who failed conservative management. 4 patients had delayed surgery. Of these four cases, 3 were malunion corrections that would have benefitted from more prompt surgery. Conclusion: There was an overall decrease in foot & ankle cases. Non- emergent foot and ankle surgery was delayed to divert resources to patients who were stricken with the COVID-19 virus. While every attempt was made to provide the appropriate care for all, a personalized approach to foot and ankle health was developed to address health concerns, preferences, and logistics. As the course of this global pandemic is still uncertain, it is imperative to have a strategy in place to deal with urgent cases, should a second wave of cases once again affect our ability to provide routine care.

scholarly journals Response of an Obstetric Unit during the Coronavirus Disease of 2019 (COVID-19) Pandemic: Experiences from a Tertiary Care Center

2020 ◽  
Vol 10 (03) ◽  
pp. e281-e287
Author(s):  
Sangeeta Kumaraswami ◽  
Tana S. Pradhan ◽  
Sorana Vrabie-Wolf ◽  
Sadaf Lodhi ◽  
Geetha P. Rajendran ◽  
...  
Keyword(s):  
New York ◽  
Care Center ◽  
Tertiary Care ◽  
New York State ◽  
York State Department ◽  
Obstetrical Care ◽  
Expert Opinions ◽  
Department Of Health ◽  
Delivery Unit ◽  
Westchester County

Abstract Objective To describe our experiences in preparing our obstetric unit in Westchester County, New York, during the COVID-19 (coronavirus disease of 2019) pandemic. We focus on describing our timeline, continuously evolving actions, observations, and challenges. Methods With guidance from the New York State Department of Health (NYSDOH), our institutional epidemiologist, and key multidisciplinary faculty members, we evaluated emerging national data as well as expert opinions to identify issues and challenges to create action plans. Results We created and modified policies for our patients presenting for obstetrical care on the labor and delivery unit to accommodate their unique needs during this pandemic. Conclusion The COVID-19 pandemic has posed many unique challenges. Balancing communication, risks of infection to providers, patient autonomy and rights, and resources for testing and personal protective equipment were among the valuable lessons learnt. We have shared our experiences and described our observations and challenges in Westchester County, New York.

scholarly journals Clinical course and prognosis of dilated cardiomyopathy in children

2019 ◽  
Vol 7 (11) ◽  
pp. 4218
Author(s):  
Iranna S. Hirapur ◽  
Ravindran Rajendran ◽  
Jayaranganath . ◽  
Manjunath Nanjappa
Keyword(s):  
New York ◽  
Dilated Cardiomyopathy ◽  
Clinical Course ◽  
Care Center ◽  
Nyha Class ◽  
Tertiary Care ◽  
Heart Association ◽  
Paediatric Population ◽  
Class Iii ◽  
Serious Disease

Background: Epidemiology and clinical course of dilated cardiomyopathy (DCM) in children and infants are not well established. Thus, this study aims to investigate the clinical course and prognosis of DCM in childrenMethods: This was a single-center, prospective, observational study conducted at a tertiary-care center in India between February 2011 and September 2012. A total of 31 patients admitted to the paediatric department diagnosed with DCM were included in the study. Patients were divided into three groups based on the age at the time of diagnosis: 0-3 years, >3-12 years and >12-16 years. Among the study population, 28 patients were followed up for a mean period of 1.44 years and three patients were lost to follow-up.Results: Of the 31 patients, 11 patients were male with a mean age of 8.9±6 years and 20 patients were female with a mean age of 8.3±6 years. All patients were presented with same characteristics of New York heart association (NYHA) class III-IV dyspnoea and fatigue. Among 28 patients who were followed-up for a mean period of 1.44 years, 20(71.4%) patients died and eight patients were on follow up. Of the eight patients, five patients were with NYHA class III symptoms and three patients were with NYHA class I-II symptoms.Conclusions: Dilated cardiomyopathy in children is a very serious disease with a grave prognosis. Patients with NYHA III-IV symptoms have a very high mortality rate and potential use of other therapies remains to be fully evaluated in paediatric population.

scholarly journals The burden of urological disease in Zomba, Malawi: A needs assessment in a sub-Saharan tertiary care center

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Tristan Juvet ◽  
James R. Hayes ◽  
Sarah Ferrara ◽  
Duncan Goche ◽  
Robert D. Macmillan ◽  
...  
Keyword(s):  
Urinary Retention ◽  
Urethral Stricture ◽  
Care Center ◽  
Tertiary Care ◽  
Surgical Care ◽  
Sub Saharan Africa ◽  
Care Hospital ◽  
General Anesthetic ◽  
Urethral Stricture Disease ◽  
Sub Saharan

Introduction: A large part of the developing world continues to lack access to surgical care. Urology remains one of the least represented surgical subspecialties in global health. To begin understanding the burden of urological illness in sub-Saharan Africa, we sought to characterize all patients presenting to a tertiary care hospital in Malawi with a urological diagnosis or related complaint in the past year. Methods: Retrospective review of the surgical clinic and surgical theater record books at Zomba Central Hospital (ZCH) was performed over a one-year time span. Patients presenting with urological diagnoses or undergoing a urological procedure under local or general anesthetic in the operating theater were identified and entered into a database. Results: A total of 440 clinical patients were reviewed. The most common clinical presentations were for urinary retention (34.7%) and lower urinary tract symptoms (15.5%); 182 surgical cases were reviewed. The most common diagnoses for surgical patients were urethral stricture disease (22%), bladder masses (17%), and benign prostatic hyperplasia (BPH) symptoms (14.8%). Urethral stricture-related procedures, including direct visual internal urethrotomy and urethral dilatation were the most common (14.2% and 7.7%). BPH-related procedures, including simple prostatectomy and transurethral resection of the prostate were the second most common (6.7% and 8.2%). Conclusions: Urethral stricture disease, BPH, and urinary retention represent the clinical diagnoses with the highest burden of visits. Despite these numbers, few definitive procedures are performed annually. Further focus on urological training in sub-Saharan Africa should focus on these conditions and their surgical management.

scholarly journals Role of HLA-B Alleles and Clinical Presentation of B27 Negative Spondyloarthritis Patients from Mumbai, Western India

2014 ◽  
Vol 2014 ◽  
pp. 1-5
Author(s):  
Devaraj J. Parasannanavar ◽  
Anjali Rajadhyaksha ◽  
Kanjaksha Ghosh
Keyword(s):  
New York ◽  
Indian Subcontinent ◽  
Care Center ◽  
Tertiary Care ◽  
Joint Involvement ◽  
Western India ◽  
Seronegative Spondyloarthritis ◽  
Si Joint ◽  
Negative Controls

Seronegative spondyloarthritis (SpA) are variably associated with HLA-B*27 antigen. HLA-B*27 negative SpA has also been reported from different parts of the world. There is paucity of data on this entity from Indian subcontinent. We studied 100 consecutively diagnosed HLA-B27 negative spondyloarthritis patients from a tertiary care center in India. Modified New York Criteria for ankylosing spondylitis (AS) and ESSG criteria for SpA were used for diagnosing patients. HLA-B*27 typing was done by an in-house PCR-SSP technique in SpA patients to exclude B*27 positive patients and PCR-SSOP technique was used to type 100 B*27 negative SpA patients and 100 controls from the same ethnicity. Frequency of B*07 was significantly increased (B*07: % PF 54 versus 18; OR 5.348; 95% CI 2.808–10.186;Pvalue 1.14E− 07), whereas frequency of B*40 was significantly decreased (B*40: % PF 17 versus 32; OR 0.435; 95% CI 0.222–0.850;Pvalue 0.013) when compared with B*27 negative controls. Among 100 SpA patients, 47 were undifferentiated spondyloarthritis and 33 patients were reactive arthritis patients. 40% of the patients were suffering from polyarticular arthritis, 35% had pauciarticular arthritis with knee joint, hip joint, ankle joint, and SI joint involvement. We conclude that B*07 was significantly associated with B27 negative spondyloarthropathy from Western India and majority of B*27 negative patients were uSpA.

scholarly journals Risk factors on admission and condition at discharge of 529 consecutive COVID-19 patients at a tertiary care center in Santiago, Chile

2020 ◽  
Author(s):  
Cesar Maquilon ◽  
Jonas Gongora ◽  
Monica Antolini ◽  
Bernardita Alvarado ◽  
Nicolas Valdes ◽  
...  
Keyword(s):  
Health Insurance ◽  
Research Question ◽  
Care Center ◽  
Invasive Mechanical Ventilation ◽  
Tertiary Care ◽  
Ventilatory Support ◽  
High Sensitivity ◽  
Quality Adjusted Life Year ◽  
Risk Of Death ◽  
First Case

Abstract Background: The first case of COVID-19 was reported in Chile on March 3, 2020. Public and private hospitals were managed in a centralized manner. On May 30, Chile had 99,668 cases, 1054 deaths, 1383 ICU patients, 1174 patients on invasive mechanical ventilation (IMV), and 51 patients on non-invasive ventilation (NIMV). Research question: What are the variables associated with condition at discharge?Method: We performed a retrospective cohort study of 529 patients with a positive RT-PCR for SARS CoV-2who were consecutively discharged between March 14 and June 4, 2020, at Clínica Dávila, Santiago. Patients were analyzed according to laboratory variables on admission, Quality-Adjusted Life Year (QALY) score, health insurance, and type of respiratory support. Condition at discharge was survivor, non-survivor, or transfer to another center. Differences were evaluated by Chi-square test, Student’s t test, or Mann–Whitney U test. Logistic regression analysis was performed to identify variables that were predictive of condition at discharge.Results: Median (interquartile range, IQR) age was 49 (37–62) years, and the median (IQR) stay in the hospital was 6 (3–10) days. A total of 352 patients (66.5%) had respiratory symptoms, 177 (33.4%) had other symptoms or diagnoses on admission, and 116 required ventilatory support; 448 (84.7%) were survivors, 54 (10.2%) were non-survivors, and 27 (5.1%) were transferred. The median ages of the survivors and non-survivors were 46 (36–59) and 75.5 (66–84), respectively.Having state health insurance increased the risk of death by 2.8-fold (OR, 2.825; 95% CI: 1.383–5.772; P = 0.004). Multivariate analysis revealed the following predictive variables: age ≥ 60 years (OR, 15.3; 95% CI: 7.25–32.2; P = .001); PaO2/FiO2 on admission ≤ 200 vs > 200 (OR, 5,205; CI 95%: 1,942–13,94); high-sensitivity troponin, ≥ 15 vs <15 ng /L (OR, 5,163; 95% CI: 1.95–13,64; P = .001); and QALY ≤ 15 vs > 15 points (OR, 14,011; 95% CI: 4,826–40,679; P=.001).Interpretation: The variables analyzed and patient’s clinical evolution may allow assignment of ICU beds to patients with the greatest chance of survival, especially in countries or regions where this resource is limited.

scholarly journals Role of antibiotic prophylaxis in clean and clean contaminated elective surgery

2016 ◽  
Vol 11 (4) ◽  
Author(s):  
Muhammad Waris Farooka ◽  
Wasim Hayat Khan ◽  
Hasan Parvez ◽  
Mahmood Ayyaz
Keyword(s):  
Antibiotic Prophylaxis ◽  
Third World ◽  
Elective Surgery ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center ◽  
Clean Contaminated ◽  
Single Blind ◽  
Better Than

Antibiotic prophylaxis is a recognized concept in surgery. We studied the need for prophylaxis in clean and clean contaminated surgery in the setting of third world tertiary care center. A randomized single blind study was conducted with three arms. 278 patients of ASA and 2 were included in this study. They were randomized to prophylaxis with Cefuroxime, triple regime and placebo. The placebo wing was terminated prematurely due to unacceptable infection rate and Cefuroxime was found to be equal or better than triple regime in our study.

scholarly journals LB15. Measles Outbreak in New York State (NYS) Outside of New York City, 2018–2019

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S999-S1000
Author(s):  
Dina Hoefer ◽  
Patricia S Ruppert ◽  
Elizabeth Rausch-Phung ◽  
Elizabeth Dufort ◽  
Manisha Patel ◽  
...  
Keyword(s):  
New York ◽  
Care Center ◽  
Severe Disease ◽  
New York State ◽  
Preterm Births ◽  
The United States ◽  
Case Definition ◽  
Urgent Care ◽  
Hospitalized Children ◽  
Material Support

Abstract Background The United States is experiencing one of the largest and longest measles outbreaks since elimination was declared in 2000 and is at risk of losing this status. Most cases occurring in NYS were reported in undervaccinated communities. Methods We included all confirmed NYS measles cases (excluding NYC) from outbreak counties from October 1, 2018 to July 25, 2019. We used the CSTE measles case definition requiring an acute febrile rash illness and either laboratory confirmation or direct epidemiologic linkage to a lab-confirmed case. For each case, demographic and clinical characteristics were obtained. A medical record review was completed for those reported to have an encounter at a hospital, emergency department, or urgent care center. Results There were 371 cases of measles reported, including 11 internationally imported cases. Most occurred in Rockland county (n = 283); followed by Orange (n = 55), Westchester (n = 18), Sullivan (n = 14) and Greene (n = 1) (Figures 1 and 2). The median age was 5.5 years; 79% of all cases occurred among children younger than 18 years of age (Figure 3). Most cases (79%) had not received any doses of measles vaccine. Of the 371 cases, 263 (71%) were children who had received 0 doses of measles, mumps, rubella vaccine (MMR), 218 (83%) of whom were over 1 year of age (Table 1). There have been no deaths or documented cases of encephalitis. Twenty-eight (8%) patients were diagnosed with pneumonia and 25 (7%) patients were hospitalized. Among 17 hospitalized children, 5 (29%) were admitted to the intensive care unit (ICU) (ages 1 day to 7 years). There were two preterm births at 34 and 25 weeks gestation to women with measles while pregnant. During October 1, 2018–July 31, 2019, providers in outbreak counties vaccinated 72,465 individuals with MMR, a 46% increase from the same period the year prior. Conclusion Unvaccinated children were identified as the largest group affected and experienced severe complications; nearly 30% of hospitalized children were admitted to an ICU. These data support the critical need for continued education and outreach on the risks of measles and the value of vaccination to prevent continued circulation in undervaccinated communities and potential further cases of severe disease. Disclosures Kirsten St. George, MAppSc, PhD, Akonni Biosystems (Other Financial or Material Support), ThermoFisher (Grant/Research Support), Zeptometrix (Other Financial or Material Support, royalty generating collaborative agreement); others, no disclosures reported..

Causes and Effects of Inefficient Operating Room Flow during Working Hours in a University Hospital

2020 ◽  
Vol 103 (9) ◽  
pp. 897-903
Keyword(s):  
Operating Room ◽  
Elective Surgery ◽  
Tertiary Care ◽  
Working Hours ◽  
Turnover Time ◽  
University Hospital ◽  
Or Efficiency ◽  
Average Delay ◽  
First Case ◽  
Cancellation Rate

Background: Operating rooms (ORs) are major source of both hospitals’ revenue and expenses; hence, OR efficiency is not only essential, but challenging for providing high-quality care, whilst utilizing limited resources. Materials and Methods: A prospective, observational study was conducted in a tertiary care university hospital to identify both causes and effects of inefficient OR flow, including the rate of first case tardiness, time delays while patients are in room, turnover time, cancellation rate, and OR-overutilization. Patients scheduled for elective surgery between September 2014 and February 2015 were recruited. Results: Three thousand nine hundred sixty-five elective surgical cases were recruited. The rate of first case tardiness was 48%. The average delay time of the first case was 25±16.6 minutes, with the main cause being late arrivals of surgical teams (97.4%). The rate of time delay while the patients were in room, was 73.2%. This is being associated with both the surgical and the anesthesia teams (83%), as well as positioning and procedures-related to the general anesthesia. The delay in turnover time was 12.9% with an average of 32.3±23.3 minutes, with most common causes being swapping of cases between ORs (22.7%) and delays in transferring patients from the ward (21.7%). The cancellation rate was 11.8%, with General surgery having the highest rate (15.5%) due to insufficient OR time (26.2%). Sixty-four-point-eight percent of the operations continued after working hours, with an average of 121.7±106.1 minutes (range 4 to 670 minutes). Conclusion: The present study identified five process points of OR inefficiency in a university hospital, demonstrating that there are substantial opportunities for enhancement of OR efficiency. Keywords: Efficiency, Operating room, First case, Tardiness, Cancellation, Turnover time, Utilization

Fertility counseling in young adult patients with cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e20570-e20570
Author(s):  
Sonia Evelyn Reichert ◽  
Sadie Sanchez ◽  
Jen Kolb ◽  
Amir S. Steinberg ◽  
Randall F. Holcombe ◽  
...  
Keyword(s):  
New York ◽  
Care Center ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Study Data ◽  
Reproductive Age ◽  
Consent Form ◽  
Fertility Counseling ◽  
Group 5 ◽  
American Society

e20570 Background: In 2008, 450,000 US cancer survivors were of reproductive age (18-45 years). Currently, oncologists receive little training about fertility preservation and counseling for patients. In 2006, the American Society of Clinical Oncology (ASCO) recommended oncologists “discuss the possibility of infertility during their reproductive years prior to chemotherapy.” This study aimed to evaluate adherence to these guidelines and determine if a chemotherapy consent form increased compliance. Methods: At a tertiary care center in New York on April 23, 2012, a specialized chemotherapy consent form, including a fertility risk statement and checkbox, was implemented. A retrospective chart review was conducted 250 days before April 23, 2012 (pre group) and 250 days after April 23, 2012 (post group). This study included patients 18-45 years old with a new malignant diagnosis who received fertility altering therapy. Patients with a prognosis less than 12 months were excludedfrom the study. Data collected included demographics, documentation of fertility discussions, presence of a signed chemotherapy consent form and the use of a fertility risk checkbox prior to initiation of treatment. Results: Of 645 new patient visits, 80 in the pre-group and 53 in the post-group met the inclusion criteria. The mean age (SD) for the pre and post groups was 35.6 (±6.7) and 36.8 (±6.7) respectively. Thirty-five (43.8%) patients had documented fertility counseling in the pre group compared to 16 (30.1%) in the post group. A Cochran–Mantel–Haenszel test determined that these 2 groups were not statistically different (p = 0.250). In the post group, 5 (12.8%) patients had both documented fertility counseling and a consent form; and only 3 (7.6%) patients had evidence of documented counseling, a consent form and the fertility risk box checked. Conclusions: Fertility counseling was documented in less than half of cancer patients for whom this procedure is recommended. The introduction of a specialized chemotherapy consent form did not improve the rates of documented fertility counseling. Further exploration is needed to identify the barriers to fertility counseling and identify the best resources and tools for providers to ensure compliance with ASCO guidelines.

FATAL PULMONARY DISEASE DUE TO PNEUMOCYSTIS CARINII IN A 22-MONTH-OLD CHILD

PEDIATRICS ◽  
1962 ◽  
Vol 30 (5) ◽  
pp. 784-790
Author(s):  
M. L. Dreyfuss
Keyword(s):  
New York ◽  
Pulmonary Disease ◽  
Pneumocystis Carinii ◽  
New York State ◽  
Neoplastic Disease ◽  
Active Infection ◽  
York State ◽  
First Case

A case of fatal pulmonary disease due to Pneumocystis carinii in a child, debilitated but without demonstrable other active infection or neoplastic disease, is reported. This is the first case of its kind to be reported in New York State.

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