Pancreaticoduodenectomy: Impact of Volume on Outcomes at a Tertiary Care Center. Our Experience in Single Institute of Nepal.

Abstract BackgroundPancreaticoduodenectomy is a complex high risk surgical procedure usually done for malignant disease carrying significant postoperative morbidity and mortality. An audit and analysis of rate of postoperative morbidity and mortality and the impact of case volume can provide information about the lacunas in patient care and methods to improve it for safe and early discharge of patients. This study was conducted to find out demographic profile, the rate of perioperative morbidities, mortality and impact of case volume on patients undergoing pancreaticoduodenectomy for malignant disease which may serve as a guide to uplift the patient care in our center.MethodsRetrospective analysis of prospectively collected data of patients undergoing pancreaticoduodenectomy from 2015 to 2019 was performed. A total of 62 patients were included in the study. Patients clinic-demographic details, intraoperative and postoperative events were recorded. Rate of various postoperative morbidities and mortality and year wise trend of these factors were analyzed.ResultsMost of the patients were in sixth decade of life (38.7%) with male preponderance (61.3%). Pancreatic cancer was most commonly seen followed by cholangiocarcinoma (46.8%). SSI (32.3%), intraabdominal collection (25.8%), anastomotic leak (14.5%), pancreatic fistula (22.6%), postpancreatectomy hemorrhage (8.1% ) were the major postoperative events. Mortality was found in 12.9% patients. ConclusionThere has been a decrease in rate of all these postoperative adverse events and improvement in the intraoperative blood loss and surgical duration with advancing years and increasing number of cases.

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Impact of Rapid PCR Influenza Testing on the Rate of Inpatient Admissions During Influenza Season at a Tertiary-Care Center

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.830 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s263-s264

Author(s):

Jordan Polistico ◽

Avnish Sandhu ◽

Teena Chopra ◽

Erin Goldman ◽

Jennifer LeRose ◽

...

Keyword(s):

Influenza Season ◽

Care Center ◽

Tertiary Care ◽

The United States ◽

Turnaround Time ◽

Care Hospital ◽

Tertiary Care Center ◽

Pediatric Hospital ◽

Rapid Pcr ◽

The Impact

Background: Influenza causes a high burden of disease in the United States, with an estimate of 960,000 hospitalizations in the 2017–2018 flu season. Traditional flu diagnostic polymerase chain reaction (PCR) tests have a longer (24 hours or more) turnaround time that may lead to an increase in unnecessary inpatient admissions during peak influenza season. A new point-of-care rapid PCR assays, Xpert Flu, is an FDA-approved PCR test that has a significant decrease in turnaround time (2 hours). The present study sought to understand the impact of implementing a new Xpert Flu test on the rate of inpatient admissions. Methods: A retrospective study was conducted to compare rates of inpatient admissions in patients tested with traditional flu PCR during the 2017–2018 flu season and the rapid flu PCR during the 2018–2019 flu season in a tertiary-care center in greater Detroit area. The center has 1 pediatric hospital (hospital A) and 3 adult hospitals (hospital B, C, D). Patients with influenza-like illness who presented to all 4 hospitals during 2 consecutive influenza seasons were analyzed. Results: In total, 20,923 patients were tested with either the rapid flu PCR or the traditional flu PCR. Among these, 14,124 patients (67.2%) were discharged from the emergency department and 6,844 (32.7%) were admitted. There was a significant decrease in inpatient admissions in the traditional flu PCR group compared to the rapid flu PCR group across all hospitals (49.56% vs 26.6% respectively; P < .001). As expected, a significant proportion of influenza testing was performed in the pediatric hospital, 10,513 (50.2%). A greater reduction (30% decrease in the rapid flu PCR group compared to the traditional flu PCR group) was observed in inpatient admissions in the pediatric hospital (Table 1) Conclusions: Rapid molecular influenza testing can significantly decrease inpatient admissions in a busy tertiary-care hospital, which can indirectly lead to improved patient quality with easy bed availability and less time spent in a private room with droplet precautions. Last but not the least, this testing method can certainly lead to lower healthcare costs.Funding: NoneDisclosures: None

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

Journal of Psychosexual Health ◽

10.1177/26318318211032386 ◽

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.

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Reduced Socioeconomic Disparities in Cleft Care After Implementing a Cleft Nurse Navigator Program

The Cleft Palate-Craniofacial Journal ◽

10.1177/10556656211005646 ◽

2021 ◽

pp. 105566562110056

Author(s):

Connor Wagner ◽

Carrie E. Zimmerman ◽

Carlos Barrero ◽

Christopher L. Kalmar ◽

Paris Butler ◽

...

Keyword(s):

Cleft Palate ◽

Cleft Lip ◽

Care Center ◽

Tertiary Care ◽

Multidisciplinary Care ◽

Socioeconomic Disparities ◽

Outpatient Appointment ◽

Nurse Navigator ◽

Insured Patients ◽

The Impact

Objective: To evaluate the impact of a Cleft Nurse Navigator (CNN) program on care for patients with cleft lip and cleft palate and assess the programs efficacy to reduce existing socioeconomic disparities in care. Design: Retrospective review and outcomes analysis (n = 739). Setting: Academic tertiary care center. Patients: All patients presenting with cleft lip and/or cleft palate (CL/P) born between May 2009 and November 2019 with exclusions for atypical clefts, submucous cleft palates, international adoption, and very late presentation (after 250 days of life). Interventions: Multidisciplinary care coordination program facilitated by the CNN. Main Outcome Measures: Patient age at first outpatient appointment and age at surgery, reported feeding issues, weight gain, and patient-cleft team communications. Results: After CNN implementation, median age at outpatient appointment decreased from 20 to 16 days ( P = .021), volume of patient-cleft team communications increased from 1.5 to 2.8 ( P < .001), and frequency of reported feeding concerns decreased (50% to 35%; P < .001). In the pre-CNN cohort, nonwhite and publicly insured patients experienced delays in first outpatient appointment ( P < .001), cleft lip repair ( P < .011), and cleft palate repair ( P < .019) compared to white and privately insured patients, respectively. In the post-CNN cohort, there were no significant differences in first appointment timing by race nor surgical timing on the basis of racial identity nor insurance type. Conclusions: A variety of factors lead to delays in cleft care for marginalized patient populations. These findings suggest that a CNN can reduce disparities of access and communication and improve early feeding in at-risk cohorts.

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Abstract 14747: Dwindling Trends of Cardiology Admissions Amidst Covid-19 Pandemic in a Tertiary Care Center of Pakistan

Circulation ◽

10.1161/circ.142.suppl_3.14747 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Jamshed Ali ◽

Osman Faheem ◽

Pirbhat Shams ◽

ghufran adnan ◽

Maria Khan

Keyword(s):

Care Center ◽

Tertiary Care ◽

Electronic Record ◽

Medical Attention ◽

Care Hospital ◽

Record System ◽

Admission Rates ◽

Cardiovascular Morbidity And Mortality ◽

Number Of Patients ◽

The Impact

Introduction: Social containment measures have been adopted globally to control COVID-19 outbreak. Reduction in hospital visits and inpatient admission rates have become cause for concern. Through this study we aimed to analyze the impact of SARS-CoV-2 virus Outbreak on cardiology inpatient admissions at a tertiary care hospital in Pakistan. Hypothesis: COVID-19 pandemic has resulted in significant decline in cardiology admissions. Methods: We conducted a retrospective study at our center. Admission log was accessed via electronic record system. Comparison was made for same months of 2019 and 2020 with regard to cardiology inpatient admissions. Results: A total of 239 patients were admitted to cardiology services in 2019 period and 106 in 2020 period with resultant reduction of 55.6%. Number of patients admitted to the coronary care unit were 179 and 78 respectively where as the numbers declined to 28 from 60 for cardiac step down. Reduction for admission numbered to 52.4% for males and 38.89% for females. 9.3% patients left against medical advice in 2019 and 3.4% in 2020. Conclusions: Our study concludes that numbers of cardiology admissions have dwindled. Possible explanation for this can be implementation of social containment and fear of acquiring infection. This has raised a question of whether a significant number of cardiovascular morbidity and mortality has occurred without seeking medical attention and has went unrecorded during the pandemic. This calls for stringent diagnostic measures in future to diagnose previously unrecorded burden.

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Histopathological spectrum of neoplastic and non-neoplastic breast lesions: A three years study in rural tertiary care center.

International Journal Of Medical Science And Clinical Invention ◽

10.18535/ijmsci/v7i01.09 ◽

2020 ◽

Vol 7 (01) ◽

pp. 4721-4725

Author(s):

Dr. Sanjeev Kumar Singh ◽

Dr. Geeta Maurya ◽

Dr. Pinki Pandey ◽

Dr. Rashmi

Keyword(s):

Invasive Ductal Carcinoma ◽

Ductal Carcinoma ◽

Care Center ◽

Benign Lesion ◽

Tertiary Care ◽

Age Distribution ◽

Morbidity And Mortality ◽

Histopathological Diagnosis ◽

Breast Lesions ◽

Neoplastic Lesions

Background: Breast tumours are very common cause of morbidity and mortality worldwide specially in developing countries. Breast lesions show broad spectrum of disease patterns in respect to benign, malignant, and non-neoplastic. Breast cancer is one of the most frequently occurring cancer among women. Objective: To study the frequency, age distribution, clinical and histological patterns of neoplastic and non-neoplastic lesions of breast in this rural population. Material and methods: This observational study was conducted over a duration of three years. In which we studied 210 cases of breast lesions. Specimens were received in department of pathology. Grossing, tissue processing, staining done according to standard protocol. Haematoxylin and eosin (H&E) stained sections were examined under microscope to categorise different type of lesions in the form of non-neoplastic and neoplastic. Results: Out of 210 breast lesions, fibroadenoma was the commonest (114 cases) benign lesion. While invasive ductal carcinoma (70 cases) was commonest in malignant category. Non neoplastic lesions stand on third place, study showed 6 cases out of 210 total cases, in which acute mastitis (4 cases) was most common. Benign tumours were mostly seen in 2nd and 3rd decade and malignant tumour mainly in 5th and 6th decade Conclusion: Early histopathological diagnosis of breast lesions is very important to differentiate between benign and malignant lesions. Large number of cases of invasive ductal carcinoma (>33% of all cases) were seen in our study, which is a serious concern. So, generation of awareness among women is need of time to reduce the morbidity and mortality specially in Indian rural setup

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Polysomnographic Outcomes After Observation for Mild Obstructive Sleep Apnea in Children Younger Than 3 Years

Otolaryngology ◽

10.1177/0194599820954383 ◽

2020 ◽

pp. 019459982095438

Author(s):

Kathleen M. Sarber ◽

Douglas C. von Allmen ◽

Raisa Tikhtman ◽

Javier Howard ◽

Narong Simakajornboon ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Care Center ◽

Tertiary Care ◽

Apnea Hypopnea Index ◽

Optimal Timing ◽

Obstructive Apnea ◽

Obstructive Sleep ◽

Mild Obstructive Sleep Apnea ◽

The Impact

Objective Mild obstructive sleep apnea (OSA), particularly in young children, is often treated with observation. However, there is little evidence regarding the outcomes with this approach. Our aim was to assess the impact of observation on sleep for children aged <3 years with mild OSA. Study Design Case-control study. Setting Pediatric tertiary care center. Methods We reviewed cases of children (<3 years old) diagnosed with mild OSA (obstructive apnea-hypopnea index, 1-5 events/h) who were treated with observation between 2012 and 2017 and had at least 2 polysomnograms performed 3 to 12 months apart. Demographic data and comorbid diagnoses were collected. Results Twenty-six children met inclusion criteria; their median age was 7.2 months (95% CI, 1.2-22.8). Nine (35%) were female and 24 (92%) were White. Their median body mass index percentile was 39 (95% CI, 1-76). Comorbidities included cardiac disease (42.3%), laryngomalacia (42.3%), allergies (34.6%), reactive airway disease (23.1%), and prematurity (7.7%). The obstructive apnea-hypopnea index significantly decreased from 2.7 events/h (95% CI, 1-4.5) to 1.3 (95% CI, 0-4.5; P = .013). There was no significant improvement in median saturation nadir (baseline, 86%; P = .76) or median time with end-tidal carbon dioxide >50 mm Hg (baseline, 0 minutes; P = .34). OSA resolved in 8 patients (31%) and worsened in 1 (3.8%). Only race was a significant predictor of resolution per regression analysis; however, only 2 non-White children were included. Conclusion In our cohort, resolution of mild OSA occurred in 31% of patients treated with 3 to 12 months of observation. The presence of laryngomalacia, asthma, and allergies did not affect resolution. Larger studies are needed to better identify factors (including race) associated with persistent OSA and optimal timing of intervention for these children. Level of Evidence 4.

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The impact of age on the risk of 30-day postoperative morbidity and mortality in patients undergoing surgery for ovarian cancer

Gynecologic Oncology ◽

10.1016/j.ygyno.2015.01.256 ◽

2015 ◽

Vol 137 ◽

pp. 103

Author(s):

H. Mahdi ◽

R. DeBernardo ◽

P.G. Rose

Keyword(s):

Ovarian Cancer ◽

Postoperative Morbidity ◽

Morbidity And Mortality ◽

The Impact

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Initial evaluation of patients diagnosed with pancreatic cancer within a community health system.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.3_suppl.269 ◽

2015 ◽

Vol 33 (3_suppl) ◽

pp. 269-269

Author(s):

Kathryn Tzung-Kai Chen

Keyword(s):

Pancreatic Cancer ◽

Emergency Department ◽

Health System ◽

Community Health ◽

Outpatient Clinic ◽

Care Center ◽

Tertiary Care ◽

Initial Evaluation ◽

Entire Cohort ◽

The Impact

269 Background: The management of pancreatic patients who are referred to a tertiary care center is well described. However, many patients receive their initial evaluation and care at community health systems. We sought to describe how patients present within the community, the patterns of initial evaluation, and the impact on management. Methods: In a period spanning 3 years (2010-2013), 82 patients were newly diagnosed with pancreatic cancer, as identified by a cancer registry at a community health system. Under IRB approval, data regarding patient characteristics, initial evaluation, and management were retrospectively collected from the electronic medical record (EMR) and analyzed. Results: Of the 82 patients, 68 patients had sufficient data available in the EMR for analysis. Thirty-two patients (47%) initially presented to outpatient clinic, and 36 patients (53%) presented to the emergency department. The presenting complaint was identified as abdominal pain in 33 patients (49%), jaundice in 20 patients (29%), and general malaise in 9 patients (13%). Patients who presented through outpatient clinic vs. emergency department received similar initial imaging studies upfront, including CT of the abdomen and pelvis (61% vs. 72%) and abdominal ultrasound (27% vs. 17%). Sixteen percent of those patients evaluated in outpatient clinic were subsequently admitted, compared to 94% of those patients evaluated in the emergency department. Finally, 31% of those presenting in outpatient clinic eventually underwent surgical resection, compared to 8% of those presenting through the ER, and the median time to surgery for the entire cohort was 1.1 months. Conclusions: Within the community, half of all patients present through the emergency department, and the majority of these are admitted for work up and management of symptoms. In contrast, those patients who present through outpatient clinic are less likely to be admitted, and are more likely to undergo definitive resection. This likely represents a disparity on several levels: the acuity of patients presenting to the emergency department vs. clinic, and how they are managed in each setting.

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Hyperparathyroidism in Patients with Primary Aldosteronism: Cross-Sectional and Interventional Data from the GECOH Study

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2011-2183 ◽

2012 ◽

Vol 97 (1) ◽

pp. E75-E79 ◽

Cited By ~ 64

Author(s):

Stefan Pilz ◽

Katharina Kienreich ◽

Christiane Drechsler ◽

Eberhard Ritz ◽

Astrid Fahrleitner-Pammer ◽

...

Keyword(s):

Primary Aldosteronism ◽

Mineralocorticoid Receptor ◽

Care Center ◽

Tertiary Care ◽

Experimental Studies ◽

Mineralocorticoid Receptor Antagonists ◽

Receptor Antagonists ◽

Vitamin D Metabolism ◽

Cross Sectional ◽

The Impact

Context: Experimental studies suggest that aldosterone induces hypercalciuria and might contribute to hyperparathyroidism. Objective: We aimed to test for differences in PTH levels and parameters of calcium and vitamin D metabolism in patients with primary aldosteronism (PA) compared with patients with essential hypertension (EH) and to evaluate the impact of PA treatment on these laboratory values. Design, Setting, and Participants: The Graz Endocrine Causes of Hypertension study includes hypertensive patients referred for screening for endocrine hypertension at a tertiary care center in Graz, Austria. Main Outcome Measures: Differences in PTH levels between patients with PA and EH. Results: Among 192 patients, we identified 10 patients with PA and 182 with EH. PTH levels (mean ± sd in picograms per milliliter) were significantly higher in PA patients compared with EH (67.8 ± 26.9 vs. 46.5 ± 20.9; P = 0.002). After treatment of PA with either adrenal surgery (n = 5) or mineralocorticoid receptor antagonists (n = 5), PTH concentrations decreased to 43.9 ± 14.9 (P = 0.023). Serum 25-hydroxyvitamin D concentrations were similar in both groups. Compared with EH, serum calcium concentrations were significantly lower (2.35 ± 0.10 vs. 2.26 ± 0.10 mmol/liter; P = 0.013), and there was a nonsignificant trend toward an increased spot urine calcium to creatinine ratio in PA [median (interquartile range) 0.19 (0.11–0.31) vs. 0.33 (0.12–0.53); P = 0.094]. Conclusions: Our results suggest that PA contributes to secondary hyperparathyroidism. Further studies are warranted to evaluate whether PTH has implications for PA diagnostics and whether mineralocorticoid receptor antagonists have a general impact on PTH and calcium metabolism.

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