Pathology Review of Outside Material: When Does It Help and When Can It Hurt?

2011 ◽  
Vol 29 (19) ◽  
pp. 2724-2727 ◽  
Author(s):  
Lauren B. Smith
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Well Being ◽  
Clinical Situation ◽  
Definitive Treatment ◽  
Representative Case ◽  
Doctor Patient Communication ◽  
Clinical Benefits ◽  
Problematic Situations ◽  
Pathology Review

Purpose Pathology review is performed for patients when care is transferred to a tertiary care center after diagnostic tissue has been obtained. While it has many benefits, this practice can lead to unforeseen difficulties in doctor-patient communication and patient well-being, especially if a diagnosis is overturned or modified years after treatment. The aim of this analysis is to identify clinical situations in which pathology review can result in challenging discussions between patients and oncologists. Patients Representative case scenarios are presented in the subspecialty area of hematopathology. Analysis of the clinical benefits and possible harm to patients, pathologists, and treating oncologists that may ensue from pathology review is performed. Results Pathology review may result in a valuable second opinion and expert subclassification. However, problematic situations may arise with pathology review, especially if the patient has already undergone definitive treatment and is referred to an academic institution in remission. Difficulties can also arise when patients do not understand the limitations of diagnosing disease on small biopsies. The patient may receive a different diagnosis or it may become apparent that the diagnosis could have been made more expeditiously. These discrepancies must be communicated to the patient and may cause confusion and distress. Conclusion Pathology review can be beneficial or potentially harmful depending on the clinical situation. Preliminary recommendations are provided for selecting patients for review. Limiting pathology review to certain clinical situations and encouraging patients to get second opinions before initial treatment at local referral centers may be helpful in minimizing reassignment of diagnoses after definitive treatment.

scholarly journals Medical Trainee Continuity of Care Following Emergency Department Consultations in a Pediatric Hospital

2016 ◽  
Vol 8 (1) ◽  
pp. 33-38 ◽  
Author(s):  
Kim Bjorklund ◽  
Emily A. Eismann ◽  
Roger Cornwall
Keyword(s):  
Emergency Department ◽  
Continuity Of Care ◽  
Broad Spectrum ◽  
Medical Records ◽  
Care Center ◽  
Tertiary Care ◽  
Well Being ◽  
Tertiary Care Center ◽  
Pediatric Hospital ◽  
Medical Trainee

ABSTRACT Background The importance of continuity of care in training is widely recognized; however, a broad-spectrum assessment across all specialties has not been performed. Objective We assessed the continuity of care provided by trainees, following patient consultations in the emergency department (ED) across all specialties at a large pediatric tertiary care center. Methods Medical records were reviewed to identify patients seen in consultation by a resident or fellow trainee in the ED over a 1-year period, and to determine if the patient followed up with the same trainee for the same condition during the next 6 months. Results Resident and fellow trainees from 33 specialties participated in 3400 ED consultations. Approximately 50% (1718 of 3400) of the patients seen in consultation by a trainee in the ED followed up with the same specialty within 6 months, but only 4.1% (70 of 1718) followed up with the same trainee for the same condition. Trainee continuity of care ranged from 0% to 21% among specialties, where specialties with resident clinics (14.4%) have a greater continuity of care than specialties without resident clinics (2.7%, P < .001). Continuity of care did not differ between fellows (4.2%) and residents (4.0%, P = .87), but did differ between postgraduate years for residents (P < .001). Conclusions Trainee continuity of care for ED consultations was low across all specialties and levels of training. If continuity of care is important for patient well-being and trainee education, efforts to improve continuity for trainees must be undertaken.

scholarly journals Profile of Paediatric Poisoning at a Tertiary Care Center in Karnataka

2014 ◽  
Vol 2 (2) ◽  
pp. 142-145
Author(s):  
DK Dnyanesh ◽  
Suma Dnyanesh ◽  
Roopa Bellad
Keyword(s):  
Urban Areas ◽  
Care Center ◽  
Tertiary Care ◽  
Gastric Lavage ◽  
Acute Poisoning ◽  
Definitive Treatment ◽  
Accidental Poisoning ◽  
Age Group ◽  
Tertiary Care Center ◽  
Paediatric Patients

Objectives: To determine the profile and outcome of paediatric patients presenting with poisoning to a tertiary care center in Karnataka. Methods: Retrospectively we studied the PICU records of all the paediatric patients who presented with acute poisoning during the 4-years period from Feb 2010 to Jan 2014. All children aged less than 18 years with a definite history and suspected cases of poisoning were included. Results: 106 patients presented with acute poisoning during the study period. The majority of our patients were in the 0 - 6 year age group. Poisoning in this age group was most common with higher frequency in males, the ratio being 1.2:1. The agents most frequently used were hydrocarbons (43.1%), pyrethrine compounds 15.5%, Organo-Chlorine compounds 12.1%drugs, Organo-Phospherous compounds 12.1%, drugs 1.8%. In 1 - 6 year age group 54.7% cases were accidental in nature, whereas in the 12 - 18 year group 93.3% were suicidal. All patients were symptomatic and needed symptomatic or definitive treatment. 21 patients required mechanical ventilation. Almost 3/4th of patients underwent Gastric lavage. Specific antidote was given to 41 patients. 2 patients of OP poisoning died. Conclusion: Our study concluded that accidental poisoning is common in 0-6 year children, the common substance being used in rural areas was kerosene and in urban areas it was found to be pyrethrin compounds. Lack of awareness of parents regarding appropriate storage of these dangerous household products is the main cause. Measures should be taken to educate the parents and public in order to decrease the poisoning cases. Suicidal cases are increasing in adolescents and precipitating factors like exam fear, exam failure, love failure and parental pressure regarding studies needs counseling of both parents and childrenDOI: http://dx.doi.org/10.3126/ijasbt.v2i2.10140Int J Appl Sci Biotechnol, Vol. 2(2): 142-145 

Changes in the Antenatal Utilization of High-Risk Obstetric Services and Stillbirth Rate during the COVID-19 Pandemic

2021 ◽  
Author(s):  
Megan C. Oakes ◽  
Fan Zhang ◽  
Lori Stevenson ◽  
Bree Porcelli ◽  
Ebony B. Carter ◽  
...  
Keyword(s):  
High Risk ◽  
Study Design ◽  
Linear Models ◽  
Care Center ◽  
Tertiary Care ◽  
Perinatal Outcomes ◽  
Well Being ◽  
Primary Objective ◽  
Stillbirth Rate ◽  
Obstetric Services

Objective The primary objective of this study was to evaluate coronavirus 2019 (COVID-19) pandemic–related changes in the antenatal utilization of high-risk obstetric services. Our secondary objective was to characterize change in stillbirth rate during the pandemic. Study Design This is a retrospective, observational study performed at a single, tertiary care center. Maternal-Fetal Medicine (MFM) visits, ultrasounds, and antenatal tests of fetal well-being during the pandemic epoch (2020), which spans the first 12 weeks of the year to include pandemic onset and implementation of mitigation efforts, were compared with the same epoch of the three preceding years visually and using general linear models to account for week and year effect. An analysis of stillbirth rate comparing the pandemic time period to prepandemic was also performed. Results While there were decreased MFM visits and antenatal tests of fetal well-being during the pandemic epoch compared with prepandemic epochs, only the decrease in MFM visits by year was statistically significant (p < 0.001). The stillbirth rate during the pandemic epoch was not significantly different when compared with the prepandemic period and accounting for both week (p = 0.286) and year (p = 0.643) effect. Conclusion The COVID-19 pandemic resulted in a significant decrease in MFM visits, whereas obstetric ultrasounds and antenatal tests of fetal well-being remained unchanged. While we observed no change in the stillbirth rate compared with the prepandemic epoch, our study design and sample size preclude us from making assumptions of association. Our findings may support future work investigating how changes in prenatal care for high-risk obstetric patients influence perinatal outcomes. Key Points

scholarly journals Impact of COVID-19 Pandemic on Neurosurgical Practice in a Tertiary Care Center in India

2020 ◽  
Author(s):  
Rahul Singh ◽  
Anurag Sahu ◽  
Kulwant Singh ◽  
Ravi Shankar Prasad ◽  
Nityanand Pandey ◽  
...  
Keyword(s):  
Negative Impact ◽  
Health Care Systems ◽  
Care Center ◽  
Tertiary Care ◽  
Admission Rate ◽  
Virtual Learning ◽  
Well Being ◽  
Resident Training ◽  
Management Approach ◽  
Tertiary Care Center

Abstract Objectives The aim of the study is to determine the magnitude of repercussions of coronavirus disease 2019 (COVID-19) pandemic on neurosurgical specialty and formulate a management approach. Materials and Methods This combined retrospective and prospective study was done in neurosurgical specialty of IMS–BHU, Varanasi, India, a tertiary care center, between January 1, 2020 and May 31, 2020. Analysis of impact on neurosurgical emergency and electives was done over before pandemic, during lockdown 1 and 2 and during lockdown 3 and 4 timelines. Effects of COVID-19 pandemic on psychology of neurosurgical team (50 members) and on patient party (88) were also evaluated. Virtual learning and webinars as a substitute to residential neurosurgical training were analyzed by a questionnaire given to 13 neurosurgeons of our department. Statistical Analysis Ordinary one-way ANOVA (analysis of variance) and unpaired t-test were used according to data analyzed. p < 0.05 was considered statistically significant. GraphPad Prism software was used for this analysis. Results On an average 8.22 admissions per day were done in neurosurgical emergency before pandemic. After lockdown these figures reduced to 3.2 admissions per day during lockdown 1 and 2 and to 5.36 admissions per day during lockdown 3 and 4. There was significant reduction in neurotrauma admission rate during lockdown (p < 0.0001) at our center. There was 76% reduction in emergency neurosurgical operated cases during pandemic. There was significant reduction in outpatient department (OPD) attendance per day, OPD admissions per day (p < 0.0001), and total elective surgeries (p < 0.0001) during lockdown. Of 50 neurosurgical team members (neurosurgeons, nursing, and ground staff) interviewed, 90% of them had the fear of contacting the COVID-19 disease, fear of well-being of family and children, and difficulty in transport. Three out of 13 neurosurgeons (23.1%) agreed on change in practice based on what they learned from virtual teaching and webinars and only two of them (15.4%) accepted improvement of skills based on virtual learning. Conclusion The COVID-19 pandemic is causing a significant impact on health care systems worldwide. For conserving resources elective surgical procedures should be limited. This pandemic has a negative impact on neurosurgical resident training program and psychology of both neurosurgical unit and patients.

scholarly journals A study of HIV/AIDS awareness among the ICTC clients in a tertiary care center

2021 ◽  
Vol 8 (2) ◽  
pp. 146-151
Author(s):  
Yashaswini M K ◽  
Archana Rao K ◽  
Sangeetha S
Keyword(s):  
Hiv Transmission ◽  
Care Center ◽  
Tertiary Care ◽  
Well Being ◽  
Unprotected Sex ◽  
The Public ◽  
Aids Awareness ◽  
Proper Training ◽  
Living With Hiv ◽  
Hiv Aids

HIV/AIDS poses a significant and one of the most genuine general well-being challenges. For HIV anticipation in the Indian scenario, the main plausible and financially savvy approach that can be adapted is proper training about HIV/AIDS and its various aspects. The present study was embraced to survey the degree of information and awareness about HIV/AIDS among clients attending ICTC facility in our hospital.A total of 200 clients, of age &#62;18yrs, attending the ICTC for HIV testing were studied over a period of 3 months. A questionnaire was prepared in regards to the methods of transmission, preventive techniques, mentality towards patient living with HIV/ AIDS and the source of HIV/ AIDS. The response of clients to the questionnaire was recorded.Among 200 participants, 97% were aware that unprotected sex is a mode of HIV transmission and 64% were aware that infected blood transfusion, use of unsterile needles and syringes contribute to other modes of HIV transmission. It was also noted that uneducated clients had a false perception that HIV can be transmitted by drinking water from same glass and by mosquito bite and this was statistically significant compared to educated individuals. The main source of acquiring positive information among the clients regarding HIV was observed to be television (32.5%). Stigma among the general public was mostly due to fear of contracting the illness. There is a requirement for more noteworthy endeavours toward making data with respect to HIV/AIDS accessible to all. The level of awareness regarding HIV/AIDS needs to be elevated among the public.

scholarly journals Pediatric Dental Emergency Pattern and Dental Care Provided during COVID-19 Pandemic Lockdown at a Tertiary Care Center in Kathmandu, Nepal

2021 ◽  
Vol 2 (1) ◽  
pp. 3-11
Author(s):  
Senchhema Limbu ◽  
Parajeeta Dikshit ◽  
Manisha Malla ◽  
Lokesh Verma ◽  
Anju Khapung
Keyword(s):  
Dental Care ◽  
Pediatric Patients ◽  
Care Center ◽  
Tertiary Care ◽  
Definitive Treatment ◽  
Age Group ◽  
Cross Sectional ◽  
Common Diagnosis ◽  
Dental Hospital ◽  
Dental Emergency

 Introduction: Pediatric dental management is difficult in its own way which was even more challenging during COVID-19 outbreak and lockdown period. Constrained dental providing clinics and hospitals severely compromised the pediatric dental needs and services. Objective: The aim of this study was to describe pattern of dental emergencies encountered and services provided to the pediatric patients visiting a dental hospital during the first lockdown period in Kathmandu, Nepal. Methods: A cross sectional study was done from 24 March 2020 to 21 July 2020 among the pediatric patients who visited dental hospital during lockdown. Data was collected from questionnaire and dental case history sheet, and statistically analyzed in Statistical Package of Social Sciences (SPSS) version 20. Results: Of the total 172 pediatric patients of mean age 8.3± 2.60 years, majority were males (59.3%) and of 6-12 age group (76.2%). Major complain was mobile/retained teeth (38.4%) and most common diagnosis was exfoliating mobility (23.3%). According to American Dental Association (ADA, 2020) guidelines, urgent dental care (46.5%) followed by non-emergency dental care (43.6%) were mostly found. The predominant procedures were emergency (68.6%) and least was elective (9.3%) and treatment given to majority was extraction (51.8%).There was a statistically significant association between age group and pediatric dental care (ADA). Conclusions: The findings of this study regarding dental emergency encountered and definitive treatment received even during pandemic lockdown can be helpful in finding out how dental care was provided and can be applicable in similar future pandemics.

scholarly journals Prevalence and Health related effects of Internet Addiction on Medical students in a Tertiary care center

2020 ◽  
Vol 32 (1) ◽  
pp. 145-150
Author(s):  
Garima Kaur ◽  
Sarama Saha ◽  
Anindya Das ◽  
Manisha Naithani
Keyword(s):  
Medical Students ◽  
Internet Addiction ◽  
Negative Impact ◽  
Care Center ◽  
Tertiary Care ◽  
Well Being ◽  
Internet Usage ◽  
Health Profile ◽  
Related Factors ◽  
Health Related

Background: Internet usage has increased exponentially in recent years. This growing use of internet has become worrisome as to whether to consider this excessive use as an addiction and if it negatively impacts one’s physical, mental and social health Aim: To investigate the prevalence of internet addiction and its association with health related factors in Medical students. Methods and Materials: A cross-sectional study was conducted with a sample size of 250. The students were asked to self-administer a semi-structured proforma regarding internet usage, Young’s IAT and Duke’s Health Profile. Young’s IAT was used to measure the addition level. Duke’s Health Profile was used to assess the physical, mental and social status. Result: 250 students participated in the study, 62% male and 38% female. 86% were found to be average online user and 1.2% had scores of category of Internet addiction. There was a significantly positive association between monthly expenditure and Young Score Grade. Those falling in category of Internet Addiction had low physical, mental and general health score and high Anxiety and Depression Score. Conclusion: From this study it can be concluded that internet addiction may have negative impact on physical, mental and social well-being of Medical students.

scholarly journals Association of Psychiatric Disorders in Children and Adolescents with Epilepsy in a Tertiary Care Hospital in Bangladesh

2021 ◽  
Author(s):  
Mohammad Monir Hossain ◽  
Shaheen Akhter ◽  
MM Rahman ◽  
Kanij Fatema ◽  
MIS Mullik ◽  
...  
Keyword(s):  
Psychiatric Disorders ◽  
Care Center ◽  
Tertiary Care ◽  
Well Being ◽  
Behavioral Disorder ◽  
Care Hospital ◽  
Children And Adolescent ◽  
Number Of Children ◽  
Diagnostic And Statistical Manual ◽  
Epileptic Children

Abstract Background Psychiatric disorders are important aspects of epilepsy and have received increasing attention in the last several years. Although a significant number of children are afflicted with epilepsy with psychiatric comorbidities, the actual burden was not evaluated sufficiently. Objective To determine the types and frequency of psychiatric disorders in children with epilepsy. Materials and Methods This hospital-based case-control study was conducted at the outpatient department of a tertiary care center in Dhaka, Bangladesh, from September 2018 to August 2019. In total, 68 epileptic children, ranging from 5 to 17 years of age, were enrolled as cases. A similar number of nonepileptic children of age, sex, and sociodemographic status matched were enrolled as control. Parent, teacher, and self-version of Bengali Development and Well-Being Assessment (DAWBA) were used to assess the psychiatric disorders, and the diagnosis was assigned as Diagnostic and Statistical Manual (DSM)-V of Mental Disorders. Results Higher proportion of psychiatric illness were found significantly among the cases (83.8% vs. 16.2%; p < 0.001) and broad categories of disorders, namely, neurodevelopmental (30.9% vs. 1.5%, p < 0.001), emotional (48.5% vs. 7.4%, p < 0.001) and behavioral disorder (19.1% vs. 7.4%, p = 0.043) compared with controls. There was a significant relationship between psychiatric disorders with the duration of epilepsy of the respondents (p = 0.032). Conclusions This study result showed the significant association of psychiatric disorders with epilepsy among children and adolescent population. Thus, psychiatric disorders should be properly addressed during treatment of epilepsy.

scholarly journals DRUG UTILIZATION ANALYSIS OF ANTI-SNAKE VENOM AT A TERTIARY CARE CENTER IN CENTRAL MAHARASHTRA: A 3-YEAR RETROSPECTIVE STUDY

2018 ◽  
Vol 11 (8) ◽  
pp. 134
Author(s):  
Ketan Y Asawale ◽  
Mukesh C Mehta ◽  
Pravin S Uike
Keyword(s):  
Snake Venom ◽  
Care Center ◽  
Tertiary Care ◽  
Public Health Problem ◽  
World Health ◽  
Definitive Treatment ◽  
Major Public Health Problem ◽  
Prescribing Pattern ◽  
Bite Marks ◽  
The World

Objectives: In India, snakebite is a major public health problem. Anti-snake venom serum (ASVS) is the definitive treatment for poisonous snakebites. However, the non-availability of effective ASVS to treat the specific types of snakebite envenomation encountered in various regions of the world has become a critical health issue at global level. In the present observational descriptive study, we observed the prescribing pattern and rationality of ASVS and the dosage of ASVS at our hospital and compared them with the standard guidelines in the treatment of snakebite cases with the aim to observe optimum utilization of ASVS.Methods: Data collection of registered cases of snakebite of 3 years from January to December 2012, 2013, and 2014 was carried out between January 2015 and December 2015.Results: A total of 935 cases were studied. ASVS treatment was given to 774 cases of snakebite, out of which 161 had no bite marks and 613 patients had bite marks. Majority (615 [79.45%]) of cases were treated with 1–20 vials of ASVS during total stay at center. Overall, 899 cases were discharged, among them 606 cases were not followed the World Health Organization guidelines. 29 cases succumbed and seven were referred to other center. The mortality observed during the 3 years was 3.10%.Conclusion: We observed individualized treatment for treatment with ASVS, thereby reducing the use of ASVS. Thus, we conclude that individualized approach depending on locally predominant snakes for the treatment of snakebite based on the degree of envenomation is a way by which the scarce ASVS can be used optimally.

scholarly journals A cross-sectional study at tertiary care center in Assam

2021 ◽  
Vol 0 ◽  
pp. 1-4
Author(s):  
Uttam Kumar Mondal ◽  
Pritikar Dowerah ◽  
Ranajit Mukherjee
Keyword(s):  
Sickle Cell ◽  
Sickle Cell Trait ◽  
Care Center ◽  
Tertiary Care ◽  
Clinical Manifestations ◽  
Definitive Treatment ◽  
Beta Thalassemia ◽  
Target Cells ◽  
Hemoglobin E ◽  
Chronic Anemia

Objectives: The objectives of the study were to find out the prevalence, epidemiology, and clinicohematological profile of hemoglobinopathies. Material and Methods: During the period of September 2010–August 2011, an observational study was done in the Department of Pediatrics, Assam Medical College and Hospital, Dibrugarh. Children (<12 years) suffering from chronic anemia were the study population. Results: Hemoglobinopathies were noted in 72 (35.0%) out of 206 chronic anemia cases, of which sickle cell disease (SCD) was found in 23 cases (11.2%), beta-thalassemia major (BTM) in 21 cases (10.2%), hemoglobin E (HbE)-β thalassemia in 12 cases (5.8%), HbE disease was seen in 10 cases (4.8%), and HbE trait and sickle cell trait (SCT) in 3 cases each. Overall hemoglobinopathy was most commonly seen among teagarden community in Assam. Clinical presentation ranged from completely asymptomatic to congestive heart failure. In majority cases, decreased mean Hb (%) and mean corpuscular volume were found. Anisopoikilocytosis, reticulocytosis, and target cells were frequently noted in peripheral blood smear. Conclusion: Chronic anemia cases should be screened for hemoglobinopathies as these genetic disorders are commonly seen in Assam. SCD and BTM are the major types of hemoglobinopathies. Heterozygous hemoglobinopathies (HbE trait and SCT) had lesser clinical manifestations. As the definitive treatment of hemoglobinopathies is still difficult to avail in this region, genetic counseling should be considered for hemoglobinopathy patients and their families as well, to prevent new cases.

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