scholarly journals Comparison of Perforated Appendicitis Prior to and Post quarantine during COVID19 Pandemic

2021 ◽  
Author(s):  
Haley Lehman ◽  
Jeffrey Turnbull ◽  
Janice Prescod ◽  
Trevor Gohl ◽  
Peter Lopez ◽  
...  
Keyword(s):  
Health Care ◽  
Local Community ◽  
Community Hospital ◽  
Statistical Significance ◽  
Perforated Appendicitis ◽  
Retrospective Chart Review ◽  
Health Care Facilities ◽  
Emergency Department Visits ◽  
P Value ◽  
Number Of Patients

Abstract Background: The SARS-CoV-2 virus has caused patient aversion to health care facilities for fear of contracting the virus. It has been shown that there has been a decreased amount of emergency department visits since the pandemic started1, with an increased presentation of conditions with progressed pathology. At our community hospital, it was anecdotally noted that there was an increase in the number of patients presenting with perforated appendicitis during this time. Our hypothesis is that more patients presented with the progressed finding of perforated appendicitis during rather than prior to the pandemic because of fear of exposure to COVID-19 in the health care setting. Methods: Retrospective chart review of cases of perforated appendicitis at a local community hospital during March 10-December 31, 2019 (cohort A) and March 10-December 31, 2020 (cohort B).Results: A total of three hundred and fifty-two eligible patients received treatment for acute appendicitis at our community hospital. In Cohort A (prior to the pandemic), there were 53 perforations out of 188 patients (53/188) - 28.2%. In cohort B (during the pandemic), there was 61 perforations out of 164 patients (61/164) – 37.2%. Statistically, there was no difference in the rate of perforation between Cohort A and Cohort B, approaching significance (p-value = 0.072). The median age of patients in Cohort A was 38 and in Cohort B it was 43.5 years of age. There was no statistically significant differences between cohorts regarding age (p < 0.23) and sex (p < 0.8). Conclusion: This study found that the number of patients who presented with perforated appendicitis during the pandemic did increase compared to pre-pandemic (37.2% vs 28.2%) but this did not meet statistical significance (p=0.072).

scholarly journals Evaluation of Clinical Job Demands, Job Resources, and a Novel Intervention on Measures of Health Care Worker Stress at a Community Hospital Pre and Post COVID-19

2021 ◽  
Author(s):  
Jessica Sels ◽  
Dylan Carroll ◽  
Douglas Duffee
Keyword(s):  
Health Care ◽  
Health Care Worker ◽  
Local Community ◽  
Community Hospital ◽  
Assessment Tool ◽  
Statistical Significance ◽  
Job Demands ◽  
Self Help ◽  
The Mean ◽  
Care Worker

Abstract: Objective: To explore the relationship and identity of Health Care Worker stressors to a measure of perceived burnout and to a novel intervention tool. Participants and Methods: From July 2019 to June 2020, we surveyed Health Care Workers (HCW) pre and post COVID19 in an independent local community hospital for burnout with the Health Care Provider Wellness Assessment tool. Linear regression and means comparison were used to identify overall job demand and resource perception with burnout, unique stressor portraits by provider subtype and mean survey scores between those who did or did not voluntarily complete at least 14 days of a 28 day novel self-help intervention tool. Results: Regarding the pre COVID-19 data, of 73 respondents, there was statistically significant (p<.01) correlation between overall job demands (directly) and resources (inversely) with burnout intensity. With respect to the HCW stressor characteristic analyses there was statistical significance (p<.05) between the mean frequency occurrence of the top 5 stressors identified by respondent subtype when compared to the mean occurrence of overall individual responses within the corresponding subtype. Finally, although limited by a low number of respondents, the intervention tool analysis suggested a therapeutic trend toward disruption of the stress-burnout relationship. Regarding the post COVID-19 data, 18 respondents did not show statistically significant characterizable stressor portraits (ie stressors were present but not patternable). Conclusion: Unique stressor portraits were identified by HCW subtype which correlated with more intense burnout self-perception. Additionally, there was a trend toward self-help tool efficacy in mitigating burnout

scholarly journals Association of single-nucleotide polymorphisms in the ESR2 and FSHR genes with poor ovarian response in infertile Jordanian women

2021 ◽  
Vol 48 (1) ◽  
pp. 69-79
Author(s):  
Amer Mahmoud Sindiani ◽  
Osamah Batiha ◽  
Esra’a Al-zoubi ◽  
Sara Khadrawi ◽  
Ghadeer Alsoukhni ◽  
...  
Keyword(s):  
Single Nucleotide Polymorphisms ◽  
Statistical Significance ◽  
Ovarian Response ◽  
Control Group ◽  
P Value ◽  
Case Group ◽  
Nucleotide Polymorphisms ◽  
Poor Ovarian Response ◽  
Single Nucleotide ◽  
Number Of Patients

Objective: Poor ovarian response (POR) refers to a subnormal follicular response that leads to a decrease in the quality and quantity of the eggs retrieved after ovarian stimulation during assisted reproductive treatment (ART). The present study investigated the associations of multiple variants of the estrogen receptor 2 (ESR2) and follicle-stimulating hormone receptor (FSHR) genes with POR in infertile Jordanian women undergoing ART.Methods: Four polymorphisms, namely ESR2 rs1256049, ESR2 rs4986938, FSHR rs6165, and FSHR rs6166, were investigated in 60 infertile Jordanian women undergoing ART (the case group) and 60 age-matched fertile women (the control group), with a mean age of 33.60±6.34 years. Single-nucleotide polymorphisms (SNPs) were detected by restriction fragment length polymorphism and then validated using Sanger sequencing.Results: The p-value of the difference between the case and control groups regarding FSHR rs6166 was very close to 0.05 (p=0.054). However, no significant differences were observed between the two groups in terms of the other three SNPs, namely ESR2 rs1256049, ESR2 rs4986938, and FSHR rs6165 (p=0.561, p=0.433, and p=0.696, respectively).Conclusion: The association between FSHR rs6166 and POR was not statistically meaningful in the present study, but the near-significant result of this experiment suggests that statistical significance might be found in a future study with a larger number of patients.

scholarly journals Endovascular Versus Open Versus Hybrid Revascularisation In Infra Inguinal Disease – 2 Years Prospective Study in A Tertiary Care Center in South India

2020 ◽  
Vol 11 (SPL2) ◽  
pp. 97-101
Author(s):  
Senthilnathan T. T. ◽  
Manoj Prabakar R. ◽  
Subramaniyan S. R. ◽  
Marunraj G. ◽  
Saravanan B. ◽  
...  
Keyword(s):  
Risk Factors ◽  
Prospective Study ◽  
Statistical Significance ◽  
Care Center ◽  
Tertiary Care ◽  
Individual Risk ◽  
P Value ◽  
Acute Limb Ischemia ◽  
Number Of Patients ◽  
Treatment Procedures

Our aim is to share the clinical experience of , open and combined hybrid in infra inguinal disease and compare the results. A prospective study of 150 patients undergoing infra inguinal procedures was done, a period ranging from October 2017 to June 2019 with 3 months follow up. A number of patients undergoing CT , Digital Subtraction (DSA) were recorded. A number of cases undergoing Angioplasty, Catheter Directed (CDT), Open Surgical Bypass were noted. Cases of acute limb ischemia were excluded and chronic cases included in our study, age 35-85 years, sex distribution male 134(89.3%) and female 16(10.7%) cases. Similarly, individual risk factors were stratified. Ct was done in 60 (40%) and DSA in 90 (60%) cases. Diagnostic variables : left occlusion 42 (28%), right occlusion 55(36.7%), left tibial occlusion 18 (12%) and right tibial occlusion 35(23.3%). Treatment procedure variables : CDT and Angioplasty 1(0.7%), angioplasty 87(58%), angioplasty and bypass 8(5.3%), bypass 35(23.3%), CDT 15 (10%), CDT and bypass 4(2.7%). The results of the analysis were compared and statistical significance P-value were calculated by chi-square tests, SPSS software. Statistic significance was seen for risk factors CAD (0.001), Smoking (0.008), Hypertension (0.000) on comparison to treatment procedures and for corresponding clinical diagnosis (0.002), investigation modality (0.000) and treatment procedures.

scholarly journals MEDICAL GRADUATES?

2015 ◽  
Vol 22 (02) ◽  
pp. 153-158
Author(s):  
Fatima Mukhtar ◽  
Abuzar Aziz ◽  
Shayan Rashid Khawaja ◽  
Akasha Amjad ◽  
Alina Haider
Keyword(s):  
Health Care ◽  
Prolonged Exposure ◽  
Medical Profession ◽  
Health Planning ◽  
Statistical Significance ◽  
Cross Sectional Study ◽  
Health Care Facilities ◽  
Cross Sectional ◽  
Medical Graduates ◽  
Care Facilities

A universal challenge faced by developing countries these days is the inequitabledistribution of health professionals, which compromises the capacity of the health system todeliver efficient and effective health care. Availability of reliable data on medical graduatesis important for health planning and development of policies and plans dealing with healthworkforce labour market. Objectives: To determine the proportion of medical graduates whoremained affiliated with the profession three to six years after graduation from a private medicalschool, To find out the specialty selection and practice location of these graduates, and todetermine the association between their gender and affiliation with the profession. Methods:A cross-sectional study was undertaken at the Lahore Medical & Dental College from March toMay 2014 selecting graduates through convenience sampling. The graduates were contactedthrough e-mail, Facebook and telephone. After obtaining voluntary informed consent fromthe respondents, a pre-tested structured questionnaire was used to collect information.Thedata was recorded and analysed using the statistical package for social sciences version 16.0.Chi-square test is used to test statistical significance between respondent’s gender and theiraffiliation with the medical profession at p < 0.05. Results: A large proportion 98(88%) ofmedical graduates remained affiliated with the profession. Those who didn’t pursue it were allfemales (p < 0.05). Majority 86(88%) were located in Pakistan. A greater proportion worked inthe tertiary health care facilities 65(94%). The popular specialty being pursued was medicine24(24%). Conclusion: Female medical graduates should be provided opportunities for parttime work.Medical schools should provide early and prolonged exposure of students to primaryhealth care facilities, in order to increase their uptake of rural postings.

scholarly journals Developing a Model of Distributed, Decentralized Digitally Connected Cancer Control Program

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 240s-240s
Author(s):  
M. Kuriakose ◽  
P. Sebastian ◽  
S. Balasubramanian ◽  
R. Sadanandan
Keyword(s):  
Health Care ◽  
Cancer Care ◽  
Cancer Control ◽  
Control Program ◽  
Health Care Facilities ◽  
The State ◽  
Cancer Centers ◽  
Number Of Patients ◽  
Out Of Pocket Expenses ◽  
Cancer Control Program

Background and context: Traditional method of managing cancer through establishing large comprehensive cancer centers are ineffective in developing country setting that has poorly developed primary health care facilities. These larger cancer centers become victims of their success and attract increasing number of patients from distant places, overstretching the resources and increasing out-of-pocket expenses for the patients. Increasing the number of cancer centers also is not effective as each unit by itself will not have the critical mass of expertise to offer comprehensive cancer care. In addition, for sustainability and improved resource utilization, the cancer care needs to be integrated with the existing health care system. The state with a population ∼ 33.3 million has 19 cancer treatment facilities distributed throughout the coastal districts. The cancer incidence rate of the state is 128 per 100,000, which is the fourth highest in the country. Aim: To develop a model for distributed, decentralized digitally connected cancer control program for the state of Kerala, India. Strategy/Tactics: A model for distributed, decentralized digitally connected cancer care that offers resource stratified cancer care and integrate with the existing health care. Program/Policy process: The distributed cancer care network for the state that will be digitally connected using a recently introduced e-health program to interconnect the cancer care as well as to integrate with the existing healthcare network. The cancer centers will be stratified in 4 levels. Level 1 would be 3 apex cancer centers with most advanced infrastructure and serves as quaternary centers and coordinate cancer care in 3 zones. The Level 2 cancer centers established at medical colleges and cancer centers in major private medical hospitals offer comprehensive cancer care in a geographic area and serve as tertiary cancer referral centers. Level 3 centers are located in the district and Taluk hospitals that offers primary cancer care for common cancers including palliative daycare chemotherapy. Level 4 units are established as part of the national health mission in primary and family health centers which provide the important task of cancer surveillance and improving cancer literacy for the public with peoples participation. Outcomes: The expected outcomes are downstaging of cancer, developing a resource-stratified referral pathway that minimize treatment delay, provide cancer care within 90 minutes of travel and lowering out-of-pocket expenses. What was learned: Planning of the program involved participation of major stakeholders of cancer and health care of the state as well as NGO.

scholarly journals High Dose and Low Dose Oxytocin Regimens as Determinants of Successful Labor Induction: A multicenter comparative study

2019 ◽  
Author(s):  
MELESE GEZAHEGN TESEMMA ◽  
Demisew Amenu Sori ◽  
Desta Hiko Gemeda
Keyword(s):  
Low Dose ◽  
Statistical Significance ◽  
Labor Induction ◽  
Induction Of Labor ◽  
P Value ◽  
High Dose ◽  
Bishop Score ◽  
Delivery Time ◽  
Number Of Patients ◽  
Successful Induction

Abstract Background: Induction of labor by Oxytocin is a routine obstetric procedure. However, little is known regarding the optimal dose of oxytocin so as to bring successful induction. This study was aimed at comparing the effects of high dose versus low dose oxytocin regimens on success of induction. Methods: Hospital-based comparative cross-sectional study was conducted in four selected hospitals in Ethiopia from October 1, 2017 to May 30, 2018. A total of 216 pregnant women who undergo induction of labor at gestational age of 37 weeks and above were included. Data were entered into Epi-data version 3.1 and then exported to SPSS version 20 for cleaning and analysis. Chi-square test and logistic regression were done to look for determinants of successful induction. The result was presented using 95% confidence interval of crude and adjusted odds ratios. P-value < 0.05 was used to declare statistical significance. Result: The mean “Induction to delivery time” was 5.9 hours and 6.3 hours for participants who received high dose Oxytocin and low dose Oxytocin respectively. Higher successful induction (72.2% versus 61.1%) and lower Cesarean Section rate (27.8% vs. 38.9) were observed among participants who received low dose Oxytocin compared to high dose. Favourable bishop score [AOR 4.0 95% CI 1.9, 8.5], elective induction [AOR 0.2 95% CI 0.1, 0.4], performing artificial rupture of membrane [AOR 10.1 95% CI 3.2, 32.2], neonatal birth weight of < 4Kg [AOR 4.3, 95% CI 1.6, 11.6] and being parous [AOR 2.1 95% CI 1.1, 4.0] were significantly associated with success of induction. Conclusions: In this study, Different oxytocin regimens didn’t show significant association with success of induction. But, high dose oxytocin regimen was significantly associated with slightly shorter induction to delivery time. Favourable bishop score, emergency induction, performing artificial rupture of membrane and delivery to non-macrosomic fetuses were positive determinants of successful induction.We recommend researchers to conduct multicenter research on a large number of patients that controls confounders to see the real effects of different oxytocin regimens on success of labor induction.

Determinants of Therapeutic Routes for Malaria Patients in Ivory Coast

Utafiti ◽  
2019 ◽  
Vol 14 (1) ◽  
pp. 75-91
Author(s):  
Lucie Florence N’goran Kone ◽  
Félix Anon N’Dia ◽  
Akissi Géneviève N’Goran
Keyword(s):  
Health Care ◽  
Ivory Coast ◽  
Sun Exposure ◽  
Urban Health Care ◽  
Health Care Facilities ◽  
Health Care Centre ◽  
Medical Practitioners ◽  
Number Of Patients ◽  
Free Care ◽  
Biomedical Treatment

Abstract Malaria patients in Ivory Coast pursue a wide variety of treatment routes, depending upon how they understand the aetiology of their illness, their association of illness with supernatural causes, their ability to afford standard consultation fees, their access to conventional health care facilities, and their confidence in traditional African therapies. This research took place in the context of the government’s policy of providing free management of ‘simple malaria’ for all. Working with four conventional doctors and four traditional African medical practitioners, treatment choices of 161 malaria patients were analysed at Kennedy-Clouétcha, a busy urban health care centre in Abidjan. Almost half (77) of the patients in the study cited mosquito bites, general poor health, and stagnant water sources as the causes of their malaria. A greater number of patients (84) indicated fatigue, sun exposure, mysticism, and diet as the cause. The scope of therapies sought by these patients covered conventional biomedical treatment, traditional African medicine, and prayer. When patients were not cured through methods of their first resort, they pursued second options for care. Despite the availability of free care in centrally located public health systems, the therapeutic trajectory of many patients diverted away from conventional treatment. The data suggests that a patient’s orientation away from the conventional biomedical model may be best explained by confusions surrounding the diagnostic label ‘simple malaria’.

Redefining the Neck: A Retrospective Review Utilizing Hyoid Suspension

2018 ◽  
Vol 35 (4) ◽  
pp. 198-204
Author(s):  
Sami A. Nizam ◽  
Rhys Branman
Keyword(s):  
Standard Deviation ◽  
Statistical Significance ◽  
Biomechanical Testing ◽  
Retrospective Chart Review ◽  
Mean Difference ◽  
Control Group ◽  
P Value ◽  
Hyoid Suspension ◽  
The Mean ◽  
Experimental Group

Neck contouring is one of the most frequent reasons patients seek cervicofacial rhytidectomy. But what makes for aesthetically pleasing youthful neck? Ellenbogen and Karlin described 5 criteria in their 1980 landmark publication, including having a cervicomental angle between 105° and 120° and a visible subhyoid depression. Recent advances in neck anatomy have revealed the existence of ligamentous like structures attaching the skin and platysma to the hyoid. These have been termed the hyoplatysmal ligament (HPL) and cervicomental suspensory angle ligament by different authors. This study was undertaken to determine whether surgically reestablishing the above structures utilizing a hyoid suspension technique resulted in statistically significant changes in cervicomental contour. A retrospective chart review was performed from January 2014 to present. After December 2016, the second author began utilizing a hyoid suspension technique where the inter- and subplatysmal fat was resected and the HPL was reestablished surgically (hyoid suspension). Cases before this date served as controls if a similar neck manipulation was performed without reestablishing the HPL. In total, 104 charts were queried, of which, 21 charts fit inclusion criteria to serve as controls and 20 as the experimental group. Before and after profile pictures were then compared for differences in cervicomental angle utilizing commercially available imaging software (Canfield Mirror, Parsippany, New Jersey). An unpaired Student t test was then performed to determine whether this 2 groups differed significantly utilizing a P value of .05 to denote statistical significance. The mean difference between pre- and postoperative cervicomental angle for the control group was 17.38° with a standard deviation of 8.05°. The mean difference between pre and postoperative cervicomental angle for the experimental group was 28.75° with a standard deviation of 15.52°. The resulting 11.37° difference in cervicomental angle between the 2 groups was found to be statistically significant with a P value of .0051. Our cosmetic surgical and anatomical knowledge continues to progress. Brant first described a ligamentous structure that attaches the platysma to the hyoid. Through biomechanical testing, he noted this ligament to be one of the weakest in the face and neck. Thereafter, in 2016 Yousif et al and Le Lourn separately described similar procedures to attach the platysma to the hyoid, in effect reestablishing this ligament. Utilizing one simple surgical maneuver, the hyoid suspension reestablishes the HPL. This surgically creates an acute cervicomental angle, resulting in less platysmal displacement postoperatively, with virtually no addition to surgical time or morbidity.

scholarly journals Outpatient Cancer Care Delivery in the Context of E-Oncology: A French Perspective on “Cancer outside the Hospital Walls”

Cancers ◽  
2019 ◽  
Vol 11 (2) ◽  
pp. 219 ◽  
Author(s):  
François Bertucci ◽  
Anne-Gaëlle Le Corroller-Soriano ◽  
Audrey Monneur-Miramon ◽  
Jean-François Moulin ◽  
Sylvain Fluzin ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Health Care Professionals ◽  
Care Delivery ◽  
Health Care Facilities ◽  
Point Of View ◽  
Care Providers ◽  
Public Authorities ◽  
Number Of Patients ◽  
Areas Of Interest

In oncology, the treatment of patients outside of hospitals has become imperative due to an increasing number of patients who are older and live longer, along with issues such as medical desertification, oncologist hyperspecialization, and difficulties in financing mounting health expenditures. Treatments have become less “invasive”, with greater precision and efficiency. Patients can therefore receive most of their care outside of hospitals. The development of e-health can address these new imperatives. In this letter, we describe the different e-health tools and their potential clinical impacts in oncology, as already reported at every level of care, including education, prevention, diagnosis, treatment, and monitoring. A few randomized studies have yet demonstrated the clinical benefit. We also comment on issues and limits of “cancer outside the hospital walls” from the point of view of patients, health care professionals, health facilities, and public authorities. Care providers in hospitals and communities will have to adapt to these changes within well-coordinated networks in order to better meet patient expectations regarding increasing education and personalizing management. Ultimately, controlled studies should aim to definitively demonstrate areas of interest, benefits, and incentives, for not only patients, but also caregivers (formal and informal) and health care providers, health care facilities, and the nation.

Adult glyburide ingestions reported to Texas poison control centers, 1998—2005

2007 ◽  
Vol 26 (7) ◽  
pp. 563-571 ◽  
Author(s):  
MB Forrester
Keyword(s):  
Health Care ◽  
Statistical Significance ◽  
Care Facility ◽  
Health Care Facility ◽  
Health Care Facilities ◽  
Poison Control ◽  
Poison Control Center ◽  
Limited Information ◽  
Control Center ◽  
Poison Control Centers

Limited information exists on potentially adverse adult glyburide ingestions reported to poison control centers. Using adult glyburide ingestions reported to Texas poison control centers during 1998—2005, the proportion of cases involving serious outcomes was determined for selected variables and evaluated for statistical significance by calculating the rate ratio (RR) and 95% confidence interval (CI). Of 126 cases identified, 49 (39%) involved serious outcomes. Serious outcomes were significantly more likely to occur with a maximum dose > 24 mg (RR 4.74, 95% CI 1.74—14.90) or >4 tablets (RR 3.27, CI 1.57—7.31), where the circumstances of the exposures involved self-harm or malicious intent (RR 2.44, CI 1.33—4.46), or the patient was already at or en route to a health care facility when the poison control center was contacted (RR 12.89, CI 4.00—66.12) or referred to a health care facility by the poison control center (RR 12.21, CI 3.53—65.01). The severity of the outcome associated with adult glyburide ingestions depended on the dose and the circumstances of the ingestion. The management of patients with severe outcomes was more likely to involve health care facilities. Such information is useful for creating triage guidelines for the management of adult glyburide ingestions. Human & Experimental Toxicology (2007) 26: 563—571.

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