Connecting in COVID 19: Neurology tele-follow-up experience in the pandemic (Preprint)

2020 ◽  
Author(s):  
Room 707 ◽  
MV Padma Srivastava ◽  
Kameshwar Prasad ◽  
Manjari Tripathi ◽  
Achal Kumar Srivastava ◽  
...  
Keyword(s):  
Neurological Diseases ◽  
Tertiary Care ◽  
Outpatient Services ◽  
Successful Communication ◽  
Novel Approach ◽  
Voice Calls ◽  
Temporary Closure ◽  
The City ◽  
Made In

BACKGROUND The lockdown due to COVID-19 pandemic led to temporary closure of routine hospital services. This prompted the initiation of teleconsult follow-up in our department. OBJECTIVE The study outlines the experience of tele-follow-up at a tertiary care teaching hospital in India, and the perspective of neurologists about this novel approach. METHODS The tele-follow-up was started from 26th March 2020. Data of follow up appointments was provided by the medical record section. The faculty and senior residents conducted the tele-follow-up. Communication was made via voice calls. The data for initial ten days was analyzed to find the utility and experience of the new service. Subsequent data up to August was taken to observe the temporal evolution of the practice. RESULTS In the initial ten working days, data of 968 patients was provided for tele-follow-up. A successful communication was made in 50.3% patients (contact with patients: 27.7% and family members 22.6%). The phone numbers which were not contactable/invalid/not available constituted 36.8% of the data. In subsequent months, the successful tele-follow-ups increased to 68.9% (range: 64.0%-71.5%). The utility of tele-follow-up was perceived as good by 71.4% of neurologists. Majority of neurologists (71.4%) observed that >90% of patients were continuing medications. Patients outside the city constituted 50-75% of the list. The survey revealed that all neurologists felt the need to continue tele-follow-up for far off stable patients post lock down and resumption of regular outpatient services. CONCLUSIONS The survey established the feasibility and utility of teleconsult for follow up of patients with neurological diseases who were attending the regular outpatient services before the pandemic.

scholarly journals Connecting in COVID 19: Neurology tele-follow-up experience

2020 ◽  
Author(s):  
Deepti Vibha ◽  
MV Padma Srivastava ◽  
Kameshwar Prasad ◽  
Manjari Tripathi ◽  
Achal Kumar Srivastava ◽  
...  
Keyword(s):  
Neurological Diseases ◽  
Tertiary Care ◽  
Outpatient Services ◽  
Successful Communication ◽  
Novel Approach ◽  
Voice Calls ◽  
Temporary Closure ◽  
The City ◽  
Made In

Introduction: The lockdown due to COVID-19 pandemic led to temporary closure of routine hospital services. This prompted the initiation of teleconsult follow-up in our department. The study outlines the experience of tele-follow-up at a tertiary care teaching hospital in India, and the perspective of neurologists about this novel approach. Methods: The tele-follow-up was started from 26th March 2020. Data of follow up appointments was provided by the medical record section. The faculty and senior residents conducted the tele-follow-up. Communication was made via voice calls. The data for initial ten days was analyzed to find the utility and experience of the new service. Results: In the initial ten working days, data of 968 patients was provided for tele-follow-up. A successful communication was made in 50.3% patients (contact with patients: 27.7% and family members 22.6%). The phone numbers which were not contactable/invalid/not available constituted 36.8% of the data. A total of 35 faculty and residents conducted the tele-follow-up. The utility of tele-follow-up was perceived as good by 71.4% of neurologists. Majority of neurologists (71.4%) observed that ≥90% of patients were continuing medications. Patients outside the city constituted 50-75% of the list. The survey revealed that all neurologists felt the need to continue tele-follow-up for far off stable patients post lock down and resumption of regular outpatient services. Conclusion: The survey established the feasibility and utility of teleconsult for follow up of patients with neurological diseases who were attending the regular outpatient services before the lock down.

Abstract 220: Impact of a Cardiology-managed, Non-emergency Department, Outpatient Observation Unit

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
Karen Cajiao ◽  
Joseph Wallins ◽  
Peter Zimetbaum ◽  
Michael Gavin
Keyword(s):  
Emergency Department ◽  
Discharge Rate ◽  
Medical Center ◽  
Tertiary Care ◽  
Direct Access ◽  
Observation Units ◽  
Phone Calls ◽  
Final Disposition ◽  
Made In

Background: With the progress emergency department (ED) observation units have made in reducing admissions for cardiac conditions, we previously reported a discharge rate of only 23.7% (n=1,549/6,546) from our ED, without an observation stay, for these patients. We opened a Cardiac Direct Access (CDAc) unit at a tertiary care urban medical center hypothesizing that cardiologists can reduce testing and observation stays for appropriate cardiac patients. Methods: Patients are referred to the CDAc for evaluation on an emergent (same day) or urgent (within 7 day) basis. We performed a retrospective review of 629 consecutive patients referred to the CDAc between November 2016 and June 2017. Final disposition was determined using charge data. The 30-day return rate to an ED, hospital, or the CDAc was determined by follow-up phone calls and chart review. Results: Patients were referred by non-cardiologists (n=403/629, 64%) and cardiologists (n=226/629, 36%). The most common indications for evaluation were chest pain, arrhythmia, and suspected heart failure. Disposition of patients evaluated in the CDAc are reported in the figure. The mean length of stay in CDAc observation was 22+/-13 hours. Among the 574 patients discharged from the CDAc, 62 (11%) were seen in an ED and/or hospitalized, while 31 (5.4%) were seen in the CDAc within 30 days. Conclusion: A CDAc unit may serve as a high value alternative to the ED. Further research can help assess comparative cost-effectiveness and refine patient selection.

scholarly journals Progress in the development of general practice / family medicine in the city of Saint Petersburg (Russian Federation)

2020 ◽  
Vol 23 (4) ◽  
pp. 19-31
Author(s):  
Uel Gillan ◽  
Rob McQuiston ◽  
Oliver Slevin
Keyword(s):  
Family Medicine ◽  
Russian Federation ◽  
Comprehensive Evaluation ◽  
Early Years ◽  
Pilot Studies ◽  
Saint Petersburg ◽  
Family Practitioners ◽  
The City ◽  
Made In

In previous years, indeed in some respects preceding the establishment of the Russian Federation, consideration had been given to the establishment of new approaches to general medical practice in Russia. Particular attention centred upon the establishment of Family Medicine and the preparation of doctors as Family Practitioners to advance this initiative. A number of pilot studies were initiated, including in the city of Saint Petersburg. These were intended to provide real-world opportunities to test and develop new and more effective approaches to primary health care that would more efficiently integrate with secondary care. The authors were involved in the initial pilot studies in the mid to late 1990s and subsequent follow-up projects to further advance the initiatives in the early years of the 21st century (20022010). This brief paper reports on a review of progress made in respect of the above initiatives. It is not at this time a comprehensive evaluation of the healthcare systems as they now operate. The authors nevertheless present some indications of satisfactory progress across a range of practices, some insights into challenges that have arisen, and some suggestions that might be helpful in the current rounds of strategic planning for health.

scholarly journals A novel approach to meet the unmet need for family planning

2018 ◽  
Vol 8 (1) ◽  
pp. 169
Author(s):  
Subrata Samanta ◽  
Sujoy Dutta ◽  
Sudipta Samanta ◽  
Agrima Mullick
Keyword(s):  
Family Planning ◽  
Post Partum ◽  
Tertiary Care ◽  
Unmet Need ◽  
Contraceptive Device ◽  
Care Hospital ◽  
Expulsion Rate ◽  
Satisfaction Rate ◽  
Novel Approach

Background: Post-partum intra-uterine contraceptive device is one of the important methods of spacing to meet up the unmet need of family planning. The low complication rate, ease and certainty of insertion and one-time adoption advantages made it an option of family planning by Government of India. In the background of recent trends in family planning, the study aims to establish the efficacy and draw-backs of PP-IUCD among the clients in a tertiary care hospital of West Bengal.Methods: Prospective observational study on 1680 women during January 2016 to December 2016, where the PP-IUCD was given to the patients after vaginal delivery or Cesarean section and were followed up to 3 months.Results: During the study 1.37% patients did not turnup in either follow-up. The most common complication encountered was missing thread (4.64% at 6th week follow-up and 6.67% at 3rd month follow-up). Expulsion rate was much lower (2.02% at 6th week and 2.5% at 3rd month). Heavy bleeding per-vagina was in 1.55% at 6th week and 2.08% at 3rd month. Pain abdomen was .83% at 6th week and 1.67% at 3rd month. Incidence of perforation and failure was both nil at either follow-up. Dysmenorrhea was complained 2.44% at 6th week and 3.33% at 3rd month. Overall satisfaction rate at 6th week (86.05%) was higher than non-satisfaction (13.95%). This was also true for 3rd month where satisfaction rate (77.85%) was higher than non-satisfaction rate (22.15%).Conclusions: PP-IUCD appears to be a safe, efficacious, acceptable and accessible method of contraception.

Failure of a Traffic Control “Fatality” Sign to Affect Pedestrians' and Motorists' Behavior

2004 ◽  
Vol 95 (3) ◽  
pp. 757-760
Author(s):  
W. Andrew Harrell ◽  
Maria David-Evans ◽  
John Gartrell
Keyword(s):  
Significant Influence ◽  
Traffic Control ◽  
Traffic Sign ◽  
The City ◽  
Made In

The behavior of 643 pedestrians and 1749 motorists at two signal-controlled intersections was observed over a 2-mo. period of observation in March and November. One intersection had a coffin-shaped traffic sign with the wording “Fatality” erected during the first month of observation (March). The second intersection was identical in traffic and pedestrian volume but lacked a “Fatality” sign in either March or November. “Fatality” signs are erected and maintained by the City of Edmonton for 6 mo. whenever a pedestrian death has occurred, and they are intended to raise the awareness of both pedestrians and motorists concerning the risks at dangerous intersections. This sign had been removed for nearly 3 mo. when a follow-up observation was made in November. While female pedestrians and pedestrians over the age of 50 years showed greater caution at both intersections, the presence or absence of the “Fatality” sign had no statistically significant influence on safety. Similarly, the presence or absence of a sign did not significantly influence motorists' behavior. Of motorists 7.6% ran either amber or red traffic control lights at the two intersections. The “Fatality” sign did not affect the rates of these violations.

scholarly journals Emergency Department Ophthalmology Consultations in a Tertiary Care Hospital

2019 ◽  
Vol 11 (01) ◽  
pp. e25-e29 ◽  
Author(s):  
Michael Heiferman ◽  
Saira Khanna ◽  
David Gu ◽  
Samantha Agron ◽  
Sarah Eichinger ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Clinic Visit ◽  
Senior Resident ◽  
Care Hospital ◽  
Common Diagnosis ◽  
Made In

Objective The main objective of this article is to characterize ophthalmology consultations in the emergency department (ED) of a tertiary care hospital and identify specific ways to modify the curriculum for ophthalmology and emergency medicine residency programs to train residents to effectively manage eye-related consultations. Design This is a retrospective chart review study of ED encounters between January 1, 2008 and January 1, 2017 during which ophthalmology was consulted. Setting Single-center urban tertiary care center. Participants All adult patients who were seen by the ophthalmology consultation service in the ED during the study time period. Main Outcome Measured We identified the reason for and timing of ophthalmology consultation; diagnoses made in the ED and follow-up ophthalmology clinic visit; procedures resulting from consultation; and communication with a senior resident, fellow, or attending. Results We identified 3,583 consecutive ED encounters with an ophthalmology consultation over a 9-year period. About 51.1% of patients were female and mean age of patients was 49 years. Blurry vision/vision loss was the most common reason for consultation (24.8%) and posterior vitreous detachment was the most common diagnosis made in the ED by the ophthalmology team (11.0%). Of the patients with documented follow-up ophthalmology clinic visits, 96.7% of diagnoses made at the first ophthalmology clinic visit were the same as those determined in the ED. About 12.7% of visits resulted in a procedure with the most common being eyelid laceration repairs, pars plana vitrectomy, and laser retinopexy. Overall, 40.4% of visits required communication with a senior resident, fellow, or attending. The frequency of residents seeking assistance from more senior ophthalmologists decreased over the course of the academic year (p < 0.0001). Conclusions This study provides data that ophthalmology residency training programs can use to more effectively prepare residents for consultations in the ED. Furthermore, identifying the reasons for consultation and subsequent diagnoses can guide the education of emergency medicine physicians to improve their ability to diagnose and triage ophthalmologic presentations.

scholarly journals NEUROLOGICAL PROFILE

2018 ◽  
Vol 25 (11) ◽  
Author(s):  
Shaheen Ahmed Mughal ◽  
Muslim Ali Lakhiar ◽  
Awais Bashir Larik ◽  
Abdul Qayoom Memon
Keyword(s):  
Rural Areas ◽  
Neurological Diseases ◽  
Neuromuscular Disorders ◽  
Tertiary Care ◽  
Small Towns ◽  
Care Hospital ◽  
Female Ratio ◽  
Spinal Cord Disorders ◽  
The City ◽  
Male To Female

Objectives: To determine the Neurological profile of patients residing in therural areas of Sindh during their visit to a tertiary care hospital in Nawabshah. Study Design:Retrospective observational study. Setting: Outpatient Department of Neurology at the PeoplesUniversity of Medical & Health Sciences for Women (PUMHSW), Nawabshah. Period: From14.4.2014 to 31.3.2015. Methods: A questionnaire regarding different Neurological disorderswas developed and data about patients presenting in OPD were registered. The data collectedwas tabulated and analyzed using SPSS 19. Results: A total of 861 patients were registered.Out of these 409 (47.5%) were male and 452 (52.5%) were females with male to female ratio of0.9. The age ranged from 06 months to 90 years and the mean age was 31.57± SD 16.7 7. Out of861 patients 477 (55.4%) visited neurology OPD on their own, 314 (36.47%) on the advice of theirfamily and friends and only 70(8.13%) were referrals by the general practitioners. Majority of thepatients 475 (55.17%) were the residents of villages and small towns while 386 (44.83%) wereresiding in the city of Nawabshah. The frequency of major category of neurological disordersincluding Headache, Epilepsies, Stroke, Neuromuscular disorders, Movement disorders,Spinal cord disorders, Dementias, Psychiatric disorders and Miscellaneous group was 33.%,19.%, 7%, 9%, 4%, 1%, 2%, 16% and 9% respectively. Conclusion: Neurological diseases arecommon among patients residing in the rural areas of Sindh. Headaches, epilepsies, stroke,psychiatric, neuromuscular and miscellaneous disorders were frequent presentations. Lack ofadequate referrals by the general physicians needs to be addressed emphatically. This studyprojects the burden of neurological problems in the under served areas.

Data Management in an Epidemiological Study : Experiences from the Iowa 500 Field Follow-up and Family Study

1980 ◽  
Vol 19 (01) ◽  
pp. 37-41
Author(s):  
R. F. Woolson ◽  
M. T. Tsuang ◽  
L. R. Urban
Keyword(s):  
Data Management ◽  
Epidemiological Study ◽  
Family Study ◽  
Data Sets ◽  
Data Handling ◽  
Management Decisions ◽  
Numerous Data ◽  
Made In

We are now conducting a forty-year follow-up and family study of 200 schizophrenics, 325 manic-depressives and 160 surgical controls. This study began in 1973 and has continued to the present date. Numerous data handling and data management decisions were made in the course of collecting the data for the project. In this report some of the practical difficulties in the data handling and computer management of such large and bulky data sets are enumerated.

Laparoscopic repair of inguinal hernia: Prospective evaluation at a tertiary care center

2020 ◽  
Vol 23 (2) ◽  
pp. 54-58
Author(s):  
ABM Mahbubur Rahman ◽  
Tamjeed Alam ◽  
AHM Shamsul Alam ◽  
Fahim Ferdaus ◽  
Gazi Gias Uddin
Keyword(s):  
Chronic Pain ◽  
Inguinal Hernia ◽  
Hernia Repair ◽  
Groin Hernia ◽  
Tertiary Care ◽  
Groin Hernia Repair ◽  
Groin Hernias ◽  
Laparoscopic Groin Hernia Repair ◽  
Repair Techniques

Background: Treatment of groin hernias continues to evolve. The emergence of laparoscopic inguinal hernia surgery has challenged the conventional gold standard Lichtenstein’s tension free mesh repair. Laparoscopic technique to achieve surgical correction over groin hernia is increasingly being practiced in our country, and it is imperative to test the overall outcome of this technique in a tertiary care setting. Objectives: Current study was aimed at evaluating the per-operative events, early and late outcomes of laparoscopic groin hernia repair techniques. End points of evaluation were postoperative pain, hospital stay, resumption of normal activities, chronic pain and recurrence. Methods: Within a 2-year period, 45 patients of groin hernias of different clinical types underwent laparoscopic inguinal hernia repair in Bangladesh Medical College Hospital were recruited in this prospective observational study. Preoperative findings, intraoperative course, postoperative and follow-up data were analyzed to evaluate the outcomes. Observations were made regarding operating time, operative hazards, postoperative pain, incidence of early post-operative morbidities, hospital stay, resumption of activities. Total 24 months follow-up was carried out with regards to normal activity, late complications notably chronic groin pain and recurrence. Results: The mean age of 38.1±11.1 years, 27(60%) patients underwent TEP repair whereas, TAPP procedure was carried out in 18 patients (40%). For unilateral hernia repair using TEP technique, mean operative time was 50.3±4.2 mints and 61.7±5.3 mints for direct and indirect variety (D/I), with the corresponding rates for TAPP repair being 65.0±2.2 mints and 72.8±3.2 mints (D/I) respectively. Conversion rate to other operative procedure was 6.67%. The overall surgery related early post-operative morbidity was 7.4% (TEP) and 16.8% (TAPP). 3 out of 45 patients (6.67%) experienced chronic pain in the groin in the study. However, there was no single incidence of recurrence observed during the follow up period. Conclusion: Laparoscopic groin hernia repair techniques are safe and feasible, offers the benefits of minimally invasive surgery and becoming the procedure of choice specially for bilateral and recurrent inguinal hernias. Journal of Surgical Sciences (2019) Vol. 23(2): 54-58

Image-guided translumbar type II endoleak repair: A novel approach

2020 ◽  
Vol 4 ◽  
pp. 9
Author(s):  
Salman Mirza ◽  
Shahnawaz Ansari
Keyword(s):  
Mesenteric Artery ◽  
Inferior Mesenteric Artery ◽  
Endovascular Aneurysm Repair ◽  
Type Ii ◽  
Type Ii Endoleak ◽  
Image Guided ◽  
Novel Approach ◽  
Abdominal Aortic ◽  
Aneurysm Repair

We present a case of a 72-year-old male with an abdominal aortic aneurysm status post-endovascular aneurysm repair (EVAR). Follow-up imaging demonstrated an enlarging type II endoleak and attempts at transarterial coil embolization of the inferior mesenteric artery were unsuccessful. The patient underwent image-guided percutaneous translumbar type II endoleak repair using XperGuide (Philips, Andover, MA USA).

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