scholarly journals EVALUATION AND SELECTION OF CANDIDATES FOR LIVER TRANSPLANTATION: AN ECONOMIC PERSPECTIVE

2020 ◽  
Vol 57 (1) ◽  
pp. 31-38 ◽  
Author(s):  
Santiago RODRÍGUEZ ◽  
Fabio Da MOTTA ◽  
Giacomo BALBINOTO NETO ◽  
Ajacio BRANDÃO
Keyword(s):  
Liver Transplantation ◽  
Care Center ◽  
Tertiary Care ◽  
Deceased Donor ◽  
Waiting List ◽  
Transplant Center ◽  
Number Of Patients ◽  
Common Problems ◽  
Selection Of

ABSTRACT BACKGROUND: Over the next 20 years, the number of patients on the waiting list for liver transplantation (LTx) is expected to increase by 23%, while pre-LTx costs should raise by 83%. OBJECTIVE: To evaluate direct medical costs of the pre-LTx period from the perspective of a tertiary care center. METHODS: The study included 104 adult patients wait-listed for deceased donor LTx between October 2012 and May 2016 whose treatment was fully provided at the study transplant center. Clinical and economic data were obtained from electronic medical records and from a hospital management software. Outcomes of interest and costs of patients on the waiting list were compared through the Kruskal-Wallis test. A generalized linear model with logit link function was used for multivariate analysis. P-values <0.05 were considered statistically significant. RESULTS: The costs of patients who underwent LTx ($8,879.83; 95% CI 6,735.24-11,707.27; P<0.001) or who died while waiting ($6,464.73; 95% CI 3,845.75-10,867.28; P=0.04) were higher than those of patients who were excluded from the list for any reason except death ($4,647.78; 95% CI 2,469.35-8,748.04; P=0.254) or those who remained on the waiting list at the end of follow-up. CONCLUSION: Although protocols of inclusion on the waiting list vary among transplant centers, similar approaches exist and common problems should be addressed. The results of this study may help centers with similar socioeconomic realities adjust their transplant policies.

scholarly journals The Impact of the Introduction of MELD on the Dynamics of the Liver Transplantation Waiting List in São Paulo, Brazil

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Eleazar Chaib ◽  
Eduardo Massad ◽  
Bruno Butturi Varone ◽  
Andre Leopoldino Bordini ◽  
Flavio Henrique Ferreira Galvão ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Deceased Donor ◽  
Sao Paulo ◽  
Meld Score ◽  
Waiting List ◽  
São Paulo ◽  
Clear Trend ◽  
Number Of Patients ◽  
Liver Transplantations ◽  
The Impact

Until July 15, 2006, the time on the waiting list was the main criterion for allocating deceased donor livers in the state of São Paulo, Brazil. After this date, MELD has been the basis for the allocation of deceased donor livers for adult transplantation. Our aim was to compare the waitlist dynamics before MELD (1997–2005) and after MELD (2006–2012) in our state. A retrospective study was conducted including the data from all the liver transplant candidate waiting lists from July 1997 to December 2012. The data were related to the actual number of liver transplantations (Tr), the incidence of new patients on the list (I), and the number of patients who died while being on the waitlist (D) from 1997 to 2005 (the pre-MELD era) and from 2006 to 2012 (the post-MELD era). The number of transplantations from 1997 to 2005 and from 2006 to 2012 increased nonlinearly, with a clear trend to levelling to equilibrium at approximately 350 and 500 cases per year, respectively. The implementation of the MELD score resulted in a shorter waiting time until liver transplantation. Additionally, there was a significant effect on the waitlist dynamics in the first 4 years; however, the curves diverge from there, implying a null long-range effect on the waitlist by the MELD scores.

scholarly journals Retrospective Analysis of Early Impact of COVID-19 on Systemic Cancer Treatment—A Pilot Study

2021 ◽  
Vol 42 (01) ◽  
pp. 015-020
Author(s):  
Anakha Pattiyeil ◽  
Febin Antony ◽  
Sunu L Cyriac ◽  
Anilkumar Jose ◽  
Jini M. P.
Keyword(s):  
Cancer Care ◽  
Medical Oncology ◽  
Care Center ◽  
Tertiary Care ◽  
Significant Drop ◽  
Relaxation Phase ◽  
Number Of Patients ◽  
Increased Risk ◽  
The Impact

Abstract Introduction Cancer care during the coronavirus disease 2019 (COVID-19) pandemic is challenging as the patients are at an increased risk of developing complications compared with the general population. Objectives This study was conducted to assess the impact of COVID-19 pandemic and nationwide lockdown on systemic cancer care. Materials and Methods This comparative descriptive study was conducted in the Department of Medical Oncology and Haematology in a tertiary care center in India. The study compared and analyzed the consecutive patient data of two different units in the Department of Medical Oncology in the pre-COVID phase (PCP) and post lockdown relaxation phase (PLRP). We represented the categorical data in frequency and percentage, and chi-squared test was used to analyze the variables. Results Patients were categorized based on demographic, disease-related, and hospital visit-related parameters and a significant drop noted in patients who utilized a prebooking facility (p = 0.0001), in the number of patients aged >50 years (p = 0.004), number of patients who presented with hematological malignancies (p = 0.006), and who came for follow-up (p = 0.0001). The other parameters remained statistically insignificant. Conclusions During PLRP, active systemic cancer care seems to have been less affected, whereas follow-up of patients and visits of elderly patients were significantly reduced. If the pandemic remains under control, cancer care may not get compromised. This shows the importance of flattening the curve for quality management of other diseases during a pandemic.

Study of Hemoptysis in a Tertiary Care Center of Province 1: Causes and Recurrences

2020 ◽  
Vol 5 (2) ◽  
pp. 1050-1054
Author(s):  
Ram Hari Ghimire ◽  
Ashima Ghimire ◽  
Rupesh Kumar Shreewastav ◽  
Sushil Yadav ◽  
Bidesh Bidesh Bista
Keyword(s):  
Diagnostic Yield ◽  
Care Center ◽  
Tertiary Care ◽  
Clinical Profile ◽  
Tertiary Care Centre ◽  
Medical College ◽  
Number Of Patients ◽  
Chest Clinic ◽  
Telephone Calls

Introduction: Hemoptysis is a common but distressing and alarming symptom in a patient. Data related to detail clinical profile and follow up study of hemoptysis are lacking. Objective: This study was carried out to see the clinical profile of patients with hemoptysis and to study the recurrences in tertiary care centre of province 1 within the study period. Methodology: This was a prospective observational study conducted at the department of Pulmonary, Critical Care and Sleep Medicine of Nobel Medical College and Teaching Hospital, Biratnagar, Nepal. The study was carried out between 30th January 2017 to 1st February 2020. For follow up of recurrences of hemoptysis, the patients were asked for regular chest clinic follow up and regular telephone calls made to the patients, in case, patients could not attend the chest clinic for any reason. Results: A total of 150 patients were enrolled over the last 3 years. Among them 75% were male. The maximum number of patients (27%) were between 31-40 years of age group. Old sequelae of pulmonary tuberculosis (PTB) (32%) and bronchiectasis (28%) were the commonest cause of hemoptysis. Lung cancer (10%) and active PTB (10%) were other causes of hemoptysis. CT scan of the chest provided the highest (84%) diagnostic yield. Most of the cases were having mild hemoptysis (50%). 17% of the patients in our study had recurrences of hemoptysis. Conclusion: Old PTB sequelae with bronchiectasis (fibrobronchiectasis) were the commonest cause of hemoptysis. Conservative management worked most effectively in controlling hemoptysis, if used properly.

Liver Transplantation for Iatrogenic Porta Hepatis Transection

2009 ◽  
Vol 75 (4) ◽  
pp. 313-316 ◽  
Author(s):  
Victor Zaydfudim ◽  
J. Kelly Wright ◽  
C. Wright Pinson
Keyword(s):  
Liver Transplantation ◽  
Laparoscopic Cholecystectomy ◽  
Surgical Complication ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center ◽  
Porta Hepatis ◽  
Postoperative Course ◽  
United Network

Iatrogenic porta hepatis transection is a rare but devastating surgical complication. There are no systematic studies examining the best treatment strategy in patients with this injury. We report two cases of transection of all three portal structures, one during an open right adrenalectomy and another during a laparoscopic cholecystectomy, both of which were transferred to our tertiary care center hours postinjury. Diagnostic imaging and exploration revealed nonsalvageable livers, and both patients underwent total hepatectomies and portocaval shunting. Donor livers were available 12 to 20 hours after United Network for Organ Sharing Status 1 listing and both patients survived their postoperative course with 2- and 6-year follow up to date. Two-stage total hepatectomy with portocaval shunting followed by liver transplantation should be considered for patients presenting with porta hepatis transection.

scholarly journals Disability and Deformity in Patients of Hansen’s Disease Attending a Tertiary Care Center in Nepal

2020 ◽  
Vol 19 (1) ◽  
pp. 26-30
Author(s):  
Sagar Mani Jha ◽  
Nabin Bhakta Shakya ◽  
Sunil Shakya ◽  
Manisha Maharjan
Keyword(s):  
Care Center ◽  
Descriptive Analysis ◽  
Tertiary Care ◽  
Lepromatous Leprosy ◽  
Age Group ◽  
Cross Sectional ◽  
Social Wellbeing ◽  
Number Of Patients ◽  
Leprosy Patients

Introduction: Leprosy is responsible for disability and deformity among patients. Nerve damage is one of the main features of leprosy and it is the main cause of disability in the patients. Developing deformity leads to restriction in professional work and hence reduced income as well as it also acts adversely on social wellbeing. The aim of this study was to study the spectrum of Grade 2 disability among all leprosy patients attending outpatient and inpatient according to WHO grading and to find the association with Ridley Joplingclassification. Methods: It was an observational cross sectional hospital based study. All the inpatients and outpatients of leprosy getting treatment and were on follow up in the Department of Dermatology between December 2017 to November 2019 were included. Details of disability and deformity were recorded and were Classified as per WHO grading and Ridley Jopling classification. Cross tab was used in descriptive analysis to compare between different variables and data was analysed in percentage. Results: A total of 88 patients were included in the study. Maximum number of patients 41 (46.7%) belonged to 30 to 50 years of age group. Various degrees of loss of sensation was seen in all patients and total number of patients with Grade 1 disability were 68 (77.3%) and Grade 2 disability were 20 (22.7%). Maximum number of patients 11 (12.5%) with Grade 2 disability was seen in Lepromatous Leprosy. Conclusions: Disability and deformity can occur in any spectrum of disease and intervention as early as possible will help reduce the incidence.

scholarly journals Liver transplantation from 73-year-old cadaveric donor

2017 ◽  
Vol 19 (2) ◽  
pp. 47-51
Author(s):  
M. N. Kornilov ◽  
M. G. Minina ◽  
I. A. Miloserdov ◽  
D. N. Kruglov ◽  
R. S. Chaikin ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Tumors ◽  
Deceased Donor ◽  
Positive Trial ◽  
Organ Shortage ◽  
Number Of Patients ◽  
Expanded Criteria ◽  
Deceased Donors ◽  
Recipient Selection

Orthotopic liver transplantation is the only way to cure chronic liver failure and certain liver tumors. Deceased donor organs are the prevailing source in most transplantation centers. However, there is an organ shortage because of the increasing number of patients in need of transplantation. Using expanded criteria deceased donors is a routine way to overcome organ shortage. The majority of transplantation centers take older donors depending on the local rules. Successful liver transplantation from 73-year-old deceased donor. Recipient suffered from liver neuroendocrine tumor without signs of extrahepatic spread. Liver function is adequate during 90-day follow-up. Liver transplantation from older deceased donors has good outcome according to world experience. Careful donor-recipient selection is the key to success. The first positive trial in our center enlightens the way for further practice.

scholarly journals Evaluation of the Anxiety Level of Mothers of Children with Epilepsy during the COVID-19 Pandemic Period

2021 ◽  
pp. 1-8
Author(s):  
Halil Celik ◽  
Sadettin Burak Acikel ◽  
Fatih Mehmet Akif Ozdemir ◽  
Erhan Aksoy ◽  
Ulkuhan Oztoprak ◽  
...  
Keyword(s):  
Neurological Disease ◽  
Chronic Conditions ◽  
Care Center ◽  
Tertiary Care ◽  
Anxiety Level ◽  
Childhood And Adolescence ◽  
Routine Examination ◽  
Significant Difference ◽  
Anxiety Levels

<b><i>Background and Aim:</i></b> Although anyone can be affected by the COVID-19 pandemic, it may cause additional concern for people with chronic conditions. Epilepsy is the most common neurological disease in childhood and adolescence. The aim of this study was to determine anxiety levels among the mothers of children under follow-up for epilepsy in our clinic during the COVID-19 pandemic. <b><i>Methods:</i></b> The study group consisted of the mothers of epilepsy patients who were under follow-up in the pediatric neurology outpatient clinic of the tertiary care center and were scheduled for a routine examination during the COVID-19 pandemic. The mothers’ anxiety levels according to the Beck Anxiety Inventory and their opinions about COVID-19 in relation to their child were assessed and compared based on whether the mother/patient attended their appointments in person and whether the child had frequent or infrequent seizures. <b><i>Results:</i></b> There was no statistically significant difference in anxiety level between the mothers of 64 children with epilepsy who attended their appointment during the pandemic and those of the mothers of 52 who did not attend their appointment. However, the mothers of children with frequent seizures had significantly higher anxiety levels. <b><i>Conclusion:</i></b> Anxiety level of mothers whose children have frequent seizures was significantly higher compared to mothers whose children have infrequent seizures. It is important to be aware about this point and using telemedicine approach in suitable population and postpone routine outpatient follow-up appointments as much as possible.

scholarly journals Paradigm Shift in Clinical Practice of Sexual Health in Men During COVID-19 Pandemic

2021 ◽  
pp. 263183182110323
Author(s):  
Aditya Prakash Sharma ◽  
Japleen Kaur ◽  
Ravimohan S. Mavuduru ◽  
Shrawan K. Singh
Keyword(s):  
Health Care ◽  
Sexual Health ◽  
Surgical Procedures ◽  
Care Center ◽  
Tertiary Care ◽  
Health Care Seeking ◽  
Care Seeking ◽  
Health Seeking ◽  
Number Of Patients ◽  
The Impact

Sexual health-care seeking behavior and practices have been affected during COVID-19 pandemic. The impact of COVID-19 on this subspecialty is far reaching. This study aimed to assess the impact of COVID-19 on health-care seeking practice pertaining to sexual health in men in our tertiary care center and review the relevant literature regarding impact of COVID-19 on sexual health seeking practice and challenges faced. Outpatient data was analyzed from January 2019 to April 2021. Patients awaiting surgical procedures due to COVID were documented. A narrative synthesis of literature based on systematic search using the keywords sexual health, sexual health seeking, sexual health practice, andrology, and COVID with operators “AND” and “OR” was carried out in three search engines PubMed, Scopus, and Embase. The study outcomes were obtained by comparing data of outpatient attendance and compiling the reviewed literature. The mean attendance fell significantly from 95.11±11.17 to 17.25±13.70 persons (P <.0001) per outpatient clinic, March 2020 being the reference point. Teleconsultation has taken over physical consultation. In 98/949 cases, teleconsult could not be provided despite registration. Over 25 patients were waiting for surgical procedures pertaining to andrology due to shut down of elective services. Similar trends have been reported from other countries. Number of patients seeking consultation for sexual health problems has dramatically decreased during COVID-19 era. Establishment of data safe teleconsultation facility and its widespread advertisement is needed to encourage patients to seek consult.

Combined Peritoneal Dialysis and Hemodialysis: Our Experience Compared to Others

2003 ◽  
Vol 23 (2) ◽  
pp. 157-161 ◽  
Author(s):  
Mamta Agarwal ◽  
Patricia Clinard ◽  
John M. Burkart
Keyword(s):  
Peritoneal Dialysis ◽  
Control Volume ◽  
Combined Therapy ◽  
Care Center ◽  
Combined Treatment ◽  
Tertiary Care ◽  
Clinical Reason ◽  
Combined Modality ◽  
Number Of Patients ◽  
Solute Clearance

Objective To determine the clinical experience of using combined-modality [simultaneous hemodialysis (HD) and peritoneal dialysis (PD)] treatment in patients with end-stage renal disease. Design We reviewed data on 4 patients from our center that were treated with “combined-mode therapy.” We then conducted a retrospective survey by sending questionnaires to nephrologists in the US and Canada by mail and by posting the survey on the Internet. Data queried included number of patients on combined modality, solute clearances, albumin levels pre and post combined therapy, reasons for using combined therapy, duration and success of combined therapy, and reimbursement issues. Setting and Participants Ours is a tertiary-care center. Patients that were not doing well on PD alone were put on combined modality of treatment between 1992 and 1998. Main Outcome Measures Clinical improvement in the indication for which the participant was started on combined modality. Results In response to the survey, data on 27 patients were collected. These data were combined with data on 4 patients from our unit that had previously been treated with combined HD and PD. Most patients were reported to have more than one clinical reason for changing from PD to combined therapy. The main clinical reason for offering combined treatments was inadequate solute clearance (34%), followed by ultrafiltration problems (16%) and neuropathy (11%). Mean duration of time followed on combined treatment was 8.5 ± 0.12 months. Most patients tolerated combined treatment well and were reported to show improvement in the clinical reasons for which they needed the combined modality. Dual access and reimbursement issues were not a problem. There was no single method used for calculating total (HD, PD, and residual renal) solute clearance. No universal total solute clearance goal was reported. Conclusion Hemodialysis and PD are not mutually exclusive. They can be used in combination to achieve targeted solute clearances, to improve certain clinical conditions, and to control volume and blood pressure in a subset of patients. Further evaluation is needed to better establish the long-term outcomes of using combined modality. Total solute clearance goals and methods for determining total solute clearance need to be standardized.

Sign in / Sign up

Export Citation Format

Share Document