scholarly journals S3274 Comparison of Referral Patterns and Indications for High Resolution Manometry Between High Volume and Low Volume Tertiary Care Centers

2021 ◽  
Vol 116 (1) ◽  
pp. S1349-S1349
Author(s):  
Janki Luther ◽  
Manasa Sagaram ◽  
Hadi Atassi ◽  
Benjamin D. Rogers ◽  
C. Prakash Gyawali
Keyword(s):  
High Resolution ◽  
Tertiary Care ◽  
High Volume ◽  
Referral Patterns ◽  
High Resolution Manometry ◽  
Low Volume ◽  
Tertiary Care Centers

Referral Patterns for Children with Chronic Diseases

PEDIATRICS ◽  
1992 ◽  
Vol 90 (1) ◽  
pp. 71-74 ◽  
Author(s):  
Ingeborg R. Blancquaert ◽  
Inta Zvagulis ◽  
Katherine Gray-Donald ◽  
I. Barry Pless
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
General Practitioners ◽  
Congenital Heart ◽  
Long Term Care ◽  
Tertiary Care ◽  
Term Care ◽  
Referral Patterns ◽  
Tertiary Care Centers

A sample of 1377 physicians were surveyed by mailed questionnaire to study to what extent primary care physicians are involved in the long-term care of children with chronic disorders. The sample included all pediatricians practicing in the province of Quebec and a stratified random sample of general practitioners (10% sample in urban areas and 25% sample in rural areas). A response rate of 81% was achieved. Referral patterns were studied for asthma, congenital heart disease, and diabetes. Although pediatricians referred their patients less frequently than general practitioners, referral patterns depended mainly on the clinical condition. "No routine referral" was the most popular management strategy for asthma, whereas for congenital heart disease and diabetes more than 20% of physicians referred their patients for all aspects of care. Rural physicians tended to assume patient care to a greater extent than did urban physicians. Most pediatricians referred patients directly to subspecialists practicing in tertiary care centers, whereas general practitioners often sent patients to pediatricians practicing elsewhere, or to other specialists. These data suggest that the availability of medical resources in the community and accessibility to tertiary care centers also influence physicians' involvement in the long-term care of these children.

scholarly journals Hospital case-volume is associated with case-fatality after aneurysmal subarachnoid hemorrhage

2018 ◽  
Vol 14 (3) ◽  
pp. 282-289 ◽  
Author(s):  
Antti Lindgren ◽  
Sarah Burt ◽  
Ellie Bragan Turner ◽  
Atte Meretoja ◽  
Jin-Moo Lee ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Treatment Modality ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Tertiary Care ◽  
Case Fatality ◽  
High Volume ◽  
Day Case ◽  
Case Volume ◽  
Hospital Case ◽  
Low Volume

Background Inverse association between hospital case-volume and case-fatality has been observed for various nonsurgical interventions and surgical procedures. Aims To study the impact of hospital case-volume on outcome after aneurysmal subarachnoid hemorrhage (aSAH). Methods We included aSAH patients who underwent aneurysm coiling or clipping from tertiary care medical centers across three continents using the Dr Foster Stroke GOAL database 2007–2014. Hospitals were categorized by annual case-volume (low volume: <41/year; intermediate: 41–70/year; high: >70/year). Primary outcome was 14-day in-hospital case-fatality. We calculated proportions, and used multiple logistic regression to adjust for age, sex, differences in comorbidity or disease severity, aneurysm treatment modality, and hospital. Results We included 8525 patients (2363 treated in low volume hospitals, 3563 treated in intermediate volume hospitals, and 2599 in high-volume hospitals). Crude 14-day case-fatality for hospitals with low case-volume was 10.4% (95% confidence interval (CI) 9.2–11.7%), for intermediate volume 7.0% (95% CI 6.2–7.9%; adjusted odds ratio (OR) 0.63 (95%CI 0.47–0.85)) and for high volume 5.4% (95% CI 4.6–6.3%; adjusted OR 0.50 (95% CI 0.33–0.74)). In patients with clipped aneurysms, adjusted OR for 14-day case-fatality was 0.46 (95% CI 0.30–0.71) for hospitals with intermediate case-volume and 0.42 (95% CI 0.25–0.72) with high case-volume. In patients with coiled aneurysms, adjusted OR was 0.77 (95% CI 0.55–1.07) for hospitals with intermediate case-volume and 0.56 (95% CI 0.36–0.87) with high case-volume. Conclusions Even within a subset of large, tertiary care centers, intermediate and high hospital case-volume is associated with lower case-fatality after aSAH regardless of treatment modality, supporting centralization to higher volume centers.

Usefulness of low- and high-volume multiple rapid swallowing during high-resolution manometry

2015 ◽  
Vol 47 (2) ◽  
pp. 103-107 ◽  
Author(s):  
Alessandra Elvevi ◽  
Aurelio Mauro ◽  
Delia Pugliese ◽  
Ivana Bravi ◽  
Andrea Tenca ◽  
...  
Keyword(s):  
High Resolution ◽  
High Volume ◽  
High Resolution Manometry

scholarly journals Two-Year Experience of 14 French Pigtail Catheters Placed by Procedure-Focused Hospitalists

2020 ◽  
Vol 15 (9) ◽  
pp. 526-530
Author(s):  
Joseph Puetz ◽  
Ankur Segon ◽  
Adrian Umpierrez
Keyword(s):  
Interventional Radiology ◽  
Tertiary Care ◽  
High Volume ◽  
Adverse Outcomes ◽  
Patient Comfort ◽  
Radiology Department ◽  
Chest Tubes ◽  
Medical College ◽  
Tertiary Care Centers ◽  
Interventional Radiology Department

BACKGROUND: Recent studies show small-bore chest tubes, commonly 14 French pigtail catheters (PCs), are noninferior to large-bore chest tubes for treating various conditions, and they are associated with better patient comfort. The Medical College of Wisconsin implemented a bedside procedure service (BPS) that has been trained in the placement of PCs as an adjunct to its interventional radiology department. METHODS: The data regarding consults for PC placement was collected by the BPS over a 2-year period. Primary outcomes reviewed were insertion-related complications (IRCs), unsuccessful attempts (UAs), and adverse outcomes (AOs) because the authors believe these represent the safety and effectiveness of the group. It was determined which services consulted the BPS for PC placement, the indications for consults, and a brief review of declined PC consults. RESULTS: Of the 124 accepted consults, the service had 3 IRCs (2.4%), 2 UAs (1.6%), and 3 AOs (2.4%). A total of 18 consults were declined. The BPS was consulted by 12 services with 8 primary reasons for PC placement. CONCLUSIONS: At high-volume, tertiary care centers, and with the support of cardiothoracic surgical and interventional radiology services, procedure-focused hospitalists can safely serve as an adjunct service for PC placement in selected hospitalized patients.

A survey of vascular specialists’ practice patterns of inferior vena cava filter placement and retrieval

Vascular ◽  
2018 ◽  
Vol 27 (3) ◽  
pp. 291-298 ◽  
Author(s):  
Anand Brahmandam ◽  
Laura Skrip ◽  
Bauer Sumpio ◽  
Jeffrey Indes ◽  
Alan Dardik ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Practice Patterns ◽  
Statistical Significance ◽  
Tertiary Care ◽  
Vena Cava ◽  
High Volume ◽  
Filter Placement ◽  
Vena Cava Filters ◽  
Low Volume

Objectives The placement of inferior vena cava filters (IVCF) continues to rise. Vascular specialists adopt different practices based on local expertise. This study was performed to assess the attitudes of vascular specialists towards the placement and retrieval of IVCF. Methods An online survey of 28 questions related to practice patterns regarding IVCF was administered to 1429 vascular specialists. Vascular specialists were categorized as low volume if they place less than three IVCF per month and high volume if they place at least three IVCF per month. The responses of high volume and low volume were compared using two-sample t-tests and Chi-square tests. Results A total of 259 vascular specialists completed the survey (18% response rate). There were 191 vascular surgeons (74%) and 68 interventional radiologists (26%). The majority of responders were in academic practice (67%) and worked in tertiary care centers (73%). The retrievable IVCF of choice was Celect (27%) followed by Denali (20%). Forty-two percent used a temporary IVCF and left it in situ instead of using a permanent IVCF. Eighty-two percent preferred placing the tip of the IVCF at or just below the lowest renal vein. Thirty-one percent obtained a venous duplex of the lower extremities prior to retrieval while 24% did not do any imaging. There were 132 (51%) low volume vascular specialists and 127 (49%) high volume vascular specialists. Compared to low volume vascular specialists, significantly more high volume vascular specialists reported procedural times of less than 30 min for IVCF retrieval (57% vs. 42%, P = 0.026). There was a trend for high volume to have fewer unsuccessful attempts at IVCF retrieval but that did not reach statistical significance ( P = .061). High volume were more likely to have attempted multiple times to retrieve an IVCF (66% vs. 33%, P < .001), and to have used bronchoscopy forceps (32% vs. 14%, P = .001) or a laser sheath (14% vs. 2%, P < .001) for IVCF retrieval. In general, vascular specialists were not comfortable using bronchoscopy forceps (65%) or a laser sheath (82%) for IVCF retrieval. Conclusions This study underscores significant variability in vascular specialists practice patterns regarding IVCF. More studies and societal guidelines are needed to define best practices.

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