scholarly journals Management of Postpancreatectomy Hemorrhage Following Pancreaticoduodenectomy at a Tertiary Care Center in Nepal

2020 ◽  
Vol 42 (3) ◽  
pp. 26-31
Author(s):  
Nirajan Subedi ◽  
Bishnu Kandel ◽  
Bikal Ghimire ◽  
Prasan BS Kansakar ◽  
Ramesh S Bhandari ◽  
...  
Keyword(s):  
Ct Angiography ◽  
Medical Records ◽  
Care Center ◽  
Tertiary Care ◽  
International Study ◽  
Postpancreatectomy Hemorrhage ◽  
Important Complication ◽  
Time Period ◽  
Classification Management ◽  
And Control

Introduction Postpancreatectomy hemorrhage (PPH) is an important complication which significantly increases morbidity and mortality following pancreaticoduodenectomy (PD). This study aims to find the incidence, classification, management, and mortality associated with PPH following PD. This study also describes the changes in management and outcomes between the period of 2004-2014 and 2015-2019 in our institute as in the later time period there was use of CT angiography and interventional radiology (IR) to identify and control the bleeding site. MethodsThis is a retrospective study in which medical records of patients having PPH following PD between 2004-2019 were analyzed. The grading and classification were done according to the International Study Group of Pancreatic Surgery (ISGPS). Management and outcomes were analyzed using standard descriptive statistics. ResultsA total of 43 patients developed PPH out of 336 PDs. Out of 43 patients, 4 (9.3%) had Grade A, 16 (37.2%) had Grade B and 23 (53.5%) had Grade C PPH. Fifteen (35%) patients were managed conservatively, seven (16.2%) with IR procedure and 21 (48.8%) were reexplored. There were 16 (37.2%) mortalities, out of different factors- intraoperative blood loss >500 ml showed the predictability for mortality (p= 0.01). On comparing two time periods it was seen that the PPH rate was almost similar but the mortality decreased from 58.8% to 23.07%. ConclusionPPH following PD is associated with high mortality. Increased use of IR procedure and CT angiography can decrease the relaparotomy rates and eventually decrease mortality.

scholarly journals Medical Trainee Continuity of Care Following Emergency Department Consultations in a Pediatric Hospital

2016 ◽  
Vol 8 (1) ◽  
pp. 33-38 ◽  
Author(s):  
Kim Bjorklund ◽  
Emily A. Eismann ◽  
Roger Cornwall
Keyword(s):  
Emergency Department ◽  
Continuity Of Care ◽  
Broad Spectrum ◽  
Medical Records ◽  
Care Center ◽  
Tertiary Care ◽  
Well Being ◽  
Tertiary Care Center ◽  
Pediatric Hospital ◽  
Medical Trainee

ABSTRACT Background The importance of continuity of care in training is widely recognized; however, a broad-spectrum assessment across all specialties has not been performed. Objective We assessed the continuity of care provided by trainees, following patient consultations in the emergency department (ED) across all specialties at a large pediatric tertiary care center. Methods Medical records were reviewed to identify patients seen in consultation by a resident or fellow trainee in the ED over a 1-year period, and to determine if the patient followed up with the same trainee for the same condition during the next 6 months. Results Resident and fellow trainees from 33 specialties participated in 3400 ED consultations. Approximately 50% (1718 of 3400) of the patients seen in consultation by a trainee in the ED followed up with the same specialty within 6 months, but only 4.1% (70 of 1718) followed up with the same trainee for the same condition. Trainee continuity of care ranged from 0% to 21% among specialties, where specialties with resident clinics (14.4%) have a greater continuity of care than specialties without resident clinics (2.7%, P < .001). Continuity of care did not differ between fellows (4.2%) and residents (4.0%, P = .87), but did differ between postgraduate years for residents (P < .001). Conclusions Trainee continuity of care for ED consultations was low across all specialties and levels of training. If continuity of care is important for patient well-being and trainee education, efforts to improve continuity for trainees must be undertaken.

scholarly journals Probiotics to Reduce Clostridium difficile Infection: Clinical Experience in a Tertiary Care Center

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S384-S384
Author(s):  
Maggie Box ◽  
Kristine Ortwine ◽  
Keyword(s):  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Primary Outcome ◽  
Care Center ◽  
Tertiary Care ◽  
Concomitant Administration ◽  
Antibiotic Exposure ◽  
Time Period ◽  
Probiotic Preparation ◽  
Hospital Acquired

Abstract Background There is conflicting clinical data regarding the efficacy of probiotics to prevent Clostridium difficile infection (CDI). The goal of this study is to compare rates of hospital acquired Clostridium difficile infection (HA-CDI) among patients receiving antibiotics with or without concomitant administration of probiotics. Methods This retrospective, cohort study compares hospitalized patients who received antibiotics alone vs. antibiotics plus a multi-strain probiotic preparation of lactobacillus over a six month time period. Probiotics were given at the discretion of the physician. The primary outcome was incidence in HA-CDI (defined as onset after hospital day three) between groups. Results A total of 1,576 patients met selection criteria, with 927 patients receiving antibiotics alone and 649 patients receiving antibiotics plus probiotics. HA-CDI rates were 0.9% and 1.8% (P = 0.16), respectively. In a subgroup analysis of patients in the antibiotic only group, patients who received similar antibiotic exposure as the probiotics group (n = 284) had no difference in rates of HA-CDI (1.8% vs. 1.8%; P = 1.0). Conclusion Probiotic administration did not decrease rates of HA-CDI in our institution. We recommend prioritizing resources to other CDI reduction measures such as decreasing antibiotic exposure and preventing transmission. Disclosures All authors: No reported disclosures.

Epidemiology and Control of Pertussis Outbreaks in a Tertiary Care Center and the Resource Consumption Associated With These Outbreaks

2009 ◽  
Vol 30 (5) ◽  
pp. 467-473 ◽  
Author(s):  
Surbhi Leekha ◽  
Rodney L. Thompson ◽  
Priya Sampathkumar
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Public Health Problem ◽  
Clinical Syndrome ◽  
Resource Consumption ◽  
Healthcare Personnel ◽  
Infection Prevention And Control ◽  
Tertiary Care Center ◽  
Healthcare Facilities ◽  
And Control

Objective.To describe the epidemiology and control of 2 separate outbreaks of pertussis at a large tertiary care center and the resource consumption associated with these outbreaks.Design.Descriptive study.Setting.The Mayo Clinic in Rochester, Minnesota, a tertiary care center catering to both referral patients and patients from the community.Methods.We reviewed routine and enhanced surveillance data collected by infection prevention and control practitioners during the outbreaks. Pertussis was diagnosed either on the basis of a nasopharyngeal specimen positive for Bordetella pertussis by use of polymerase chain reaction (PCR) or on the basis of a compatible clinical syndrome along with an epidemiologic link to PCR-confirmed cases.Results.Two pertussis outbreaks, the first community based and the second hospital based (ie, due to transmission among healthcare personnel), occurred during the period from October 2004 through October 2005. In the first outbreak from November 2004 through March 2005, there were 109 cases diagnosed; 105 (96%) of these cases were diagnosed on the basis of a nasopharyngeal specimen positive for B. pertussis by use of PCR. Adolescents 10-19 years of age were most affected (77 cases [71%]). Only 13 cases (12%) occurred among healthcare personnel; however, many healthcare personnel required postexposure prophylaxis. A second outbreak of 122 cases occurred during the period from July through October 2005; of these 122 cases, 96 (79%) were diagnosed on the basis of a nasopharyngeal specimen positive for B. pertussis by use of PCR, and 64 (52%) involved healthcare personnel. There were many instances of transmission among healthcare personnel and from patients to healthcare personnel, but no documented transmission from healthcare personnel to Patients. The outbreaks were controlled by aggressive case finding, treatment of those infected, prophylaxis of all healthcare personnel and patients who had contact with both probable and confirmed cases, implementation of educational efforts, and compliance with respiratory etiquette. Vaccination of healthcare personnel against pertussis began in October 2005.Conclusion.Pertussis remains a public health problem. Outbreaks in healthcare facilities consume the resources of those facilities in terms of personnel, testing, treatment of cases, and prophylaxis of those individuals who were in contact with those cases. Adult vaccination may reduce the disease burden.

scholarly journals Incidence and Predictive Factors for Prolonged Use of Opioid Medication After Foot and Ankle Surgery

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0001
Author(s):  
Jamal Ahmad
Keyword(s):  
Morbid Obesity ◽  
Care Center ◽  
Tertiary Care ◽  
Female Gender ◽  
Wound Complication ◽  
Anatomical Location ◽  
Time Period ◽  
Number Of Patients ◽  
Ankle Surgery ◽  
A Prospective Study

Category: Other Introduction/Purpose: The purpose of this study is to evaluate the incidence and factors predictive for patients’ needs for opioid pain medication longer than 2 weeks after orthopaedic foot/ankle surgery in a single surgeon’s practice at a tertiary care center. We hypothesize that the number of patients that require opioids for pain management after 2 weeks post-operatively is low, but certain patient factors may be predictive for those individuals that request these medications at this time period. Methods: This is a prospective study of patients that received orthopaedic foot/ankle surgery between August 2016 and November 2017 by a single surgeon. Inclusion criteria involved surgical patients lacking chronic use of opioids. Patients regularly taking opioids pre-operatively were excluded from this study. Patients’ charts were reviewed for their age, weight, and medical co-morbidities. The diagnosis and procedure(s) that each patient received was recorded. Postoperatively, all patients received 60 tablets of opioids for one to be taken every 6 hours as needed for pain within 2 weeks from surgery. Every patient’s postsurgical course was examined for those that asked for and received opioids after 2 weeks from surgery. This event was defined as prolonged post-operative use of opioids. Results: Of 285 opioid-naïve patients that enrolled in this study and received foot/ankle surgery, 35 (12.3%) asked for and received opioids after 2 weeks from surgery. Three of these 35 patients asked for and received opioids after 4 weeks from surgery. No patients asked for and received opioids after 4 weeks from surgery. Age and anatomical location of surgery were not significantly prognostic for a post-surgical wound complication (P>0.05). Those patients of female gender, morbid obesity, and psychiatric conditions such as anxiety and depression were significantly predictive of requesting opioids after 2 weeks from surgery (P<0.05). Those individuals that received revision foot and/or ankle surgery trended towards a higher likelihood of requesting opioids after 2 weeks from surgery (P<0.15). Conclusion: This study demonstrates that the number of patients that require prolonged post-operative use of opioid medicine after orthopaedic foot and/or ankle surgery is low. However, this research shows that female patients with certain medical conditions such as morbid obesity and psychiatric illness are significantly likely to request opioids after 2 weeks from surgery. This is highly important when providing patients with realistic expectations of pain from foot/ankle surgery and the effectiveness and duration of opioids that help treat such pain.

scholarly journals Determination of Unclaimed Prescriptions at an Outpatient Department, Songklanagarind Hospital

1999 ◽  
Vol 12 (6) ◽  
pp. 433-440 ◽  
Author(s):  
Sudaruk Leu ◽  
Kulpus Eng
Keyword(s):  
Health Care Providers ◽  
Medical Records ◽  
Drug Class ◽  
Emergency Services ◽  
Care Center ◽  
Tertiary Care ◽  
Care Providers ◽  
Use Of Emergency Services ◽  
Improve Patient

Unclaimed prescriptions are an initial indication of noncompliance. Although the patients receive the best treatment, they may fail to take their medicines. As a result, the illness may not be relieved and this can lead to hospitalization or use of emergency services. This study was conducted to determine the characteristics and reasons for unclaimed prescriptions in a 680-bed and tertiary care center from July to October 1997. Patients' data were collected from medical records and from questionnaires that asked for the reasons prescriptions were not claimed. During the four-month period, 695 unclaimed prescriptions were identified, accounting for approximately 0.67% of all prescriptions filled. Results showed that patients least likely to claim a prescription included women, those who visited the hospital during official hours, those who had chronic disease, and those who went to see internal medicine physicians. Three most common diseases were those involving respiratory system (8.6%), musculoskeletal system (6.3%), and genitourinary system (6.0%). More than half (56.5%) were treated with the essential drugs. Neuromuscular agent was the most frequent drug class of unclaimed prescriptions, followed by respiratory agent, dermatological agent, and vitamins and minerals. Of the 695 patients, 152 patients responded to the questionnaires. Sixty-one patients indicated that they had received their medications later on and, therefore, were excluded from the analysis. Thus, 61 questionnaires were analyzed. The most important reason patients did not claim their prescriptions was cost (22.0%). The next most frequently mentioned reasons were forgetfulness (12.1%), business (11.0%), and lack of communication (8.8%). These patients need to be counseled about the importance of taking their medicines. In addition, health care providers should develop strategies to improve patient compliance with their medications.

Biopsy forceps disruption paired with bougie dilation of esophageal strictures lengthens time to repeat intervention

2020 ◽  
Author(s):  
Tricia Hengehold ◽  
Benjamin D Rogers ◽  
Farhan Quader ◽  
C Prakash Gyawali
Keyword(s):  
Electronic Medical Records ◽  
Medical Records ◽  
Care Center ◽  
Tertiary Care ◽  
Balloon Dilation ◽  
Biopsy Forceps ◽  
Kaplan Meier ◽  
Esophageal Strictures ◽  
Foregut Surgery

Summary Esophageal strictures commonly cause dysphagia and require treatment with endoscopic dilation using balloons or bougies. We aimed to determine whether biopsy forceps disruption of strictures at time of dilation increases time to repeat intervention or duration of intervention-free follow-up. We performed a retrospective analysis of 289 adults (age 61.0 ± 0.8 years, 66.4% female) who underwent dilation of an esophageal stricture at our tertiary care center between 2014 and 2016. Exclusions consisted of endoscopic intervention within the preceding 6 months, prior foregut neoplasia, achalasia, radiofrequency ablation, endoscopic mucosal resection, endoscopic submucosal dissection, or foregut surgery. Demographics, clinical presentation, dilation technique, and follow-up were abstracted from electronic medical records. We compared time to repeat dilation and duration of intervention-free follow-up between treatment subgroups. Balloon dilation was performed more often than bougie dilation (76.8 vs. 17.6%); biopsy forceps disruption was performed in 23.2%. Over a median follow-up of 52.9 months, 135 patients (46.7%) underwent repeat dilation. Age, body mass index, gender, and use of antisecretory medications did not influence need for repeat dilation (P = ns for each). Bougie dilation with biopsy forceps disruption prolonged time to repeat dilation in all patients (P ≤ 0.02), particularly in those with gastroesophageal reflux disease (P ≤ 0.03), compared with bougie dilation alone and balloon dilation with or without disruption. On Kaplan–Meier analysis, bougie dilation with biopsy forceps resulted in longer intervention-free follow-up compared with dilation alone (P = 0.03). We conclude that stricture disruption with biopsy forceps increases time to repeat intervention with bougie but not balloon dilation.

scholarly journals Clinicopathological profile of colorectal polyps: retrospective analysis from tertiary care center in Southern India

2019 ◽  
Vol 7 (9) ◽  
pp. 3396
Author(s):  
Prudhvi K. Chandolu ◽  
Venkatakrishnan L. ◽  
Vidhyalakshmi S.
Keyword(s):  
Retrospective Analysis ◽  
Care Center ◽  
Tertiary Care ◽  
Colorectal Polyps ◽  
Tubular Adenoma ◽  
Time Period ◽  
Screening Strategies ◽  
Clinicopathological Profile ◽  
Advanced Adenomas ◽  
The Right

Background: Colorectal Cancer is the fourth most commonly diagnosed and chronological changes in colorectal polyps and cancer is important in efficacy of screening strategies. In this study, we aimed to compare clinicopathological features of colorectal polyps and also aimed to characterise the distribution and the pathological features of polyps during an 18-year period divided in to two groups.Methods: This is retrospective analysis of cases that underwent colonoscopy and found to have colorectal polyps were re-viewed retrospectively for 18 year period are retrieved. 18 year period was divided in to 2001 to 2010 and 2011 to 2018.Results: Among 4230 patients underwent colonoscopy between January 2001 and September 2018, 1356 were excluded; of the remaining 2874, 986 were found to have 1,272 polyps. 306 patients had 412 polyps in 2001 to 2010 group and 680 patients had 860 polyps in 2011 to 2018 group. Adenomas on the left sided colon were significantly higher in the first time period (40.2% vs 30%, p <0.0003). Polyps on the right sided colon were significantly higher in the second time period (37.3% vs 36.9%, p <0.0005). The most common histology in the both periods is tubular adenoma. Histology of adenomas with high grade dysplasia were significantly more in first period (12.4% vs 7.6%, p <0.005).Conclusions: Our data shows shift in polyps from left side to right side colon in recent years. There was no significant change in shift in advanced adenomas from left side to right side of colon.

scholarly journals Outcomes of carcinosarcoma in a tertiary care institution in India

2018 ◽  
Vol 07 (01) ◽  
pp. 31-33 ◽  
Author(s):  
Anne George Cherian ◽  
Anitha Thomas ◽  
Ajit Sebastian ◽  
Tunny Sebastian ◽  
Vinotha Thomas ◽  
...  
Keyword(s):  
Survival Analysis ◽  
Adjuvant Therapy ◽  
Care Center ◽  
Tertiary Care ◽  
Rank Test ◽  
Uterine Carcinosarcoma ◽  
Treatment Groups ◽  
Kaplan Meier ◽  
Time Period ◽  
Rare Malignancy

Abstract Background: Carcinosarcoma is a rare malignancy, and reports are often mixed along with other sarcomas. The literature on uterine carcinosarcoma per se is sparse. Aims: This study aims to evaluate the demography, survival, and optimal treatment strategy of uterine carcinosarcoma. Settings and Design: A tertiary care center in India. The study design was descriptive with survival analysis. Materials and Methods: The medical records of all 18 patients admitted with uterine carcinosarcoma between January 2011 and December 2015 were reviewed. Baseline characteristics and outcomes were studied. Survival analysis was done using the Kaplan–Meier method and compared between treatment groups using the Log-rank test. Results: The total number of uterine malignancies operated in our center over this time period was 311 of which 18 were carcinosarcomas (5.7%). Median age of presentation was 61 years (36–77 years). Most women (94%) were postmenopausal and 67% of them presented with postmenopausal bleeding. Over half of the patients (56%) presented late (Stage III or IV). Only 11 (61%) had adjuvant treatment and 7 patients had expired at the time of follow-up. The median survival was 284 days (95% confidence interval 107–461). Patients who received adjuvant therapy did better compared to those who did not (P = 0.036). Conclusions: Carcinosarcomas are aggressive tumors of postmenopausal women who present with bleeding or discharge per vaginum. In spite of adequate surgical staging followed by adjuvant therapy, survival remains poor. Improvements in early detection and optimal therapy need to be made.

scholarly journals Experience of hysteroscopy in a rural tertiary care center of Haryana, India

2019 ◽  
Vol 8 (10) ◽  
pp. 3996
Author(s):  
Manisha Upadhyay ◽  
Tek C. Yadav ◽  
Pinkey Lakra ◽  
Sunita Siwach ◽  
Rajiv Mahendru ◽  
...  
Keyword(s):  
Learning Curve ◽  
Reliable Method ◽  
Care Center ◽  
Tertiary Care ◽  
Uterine Cavity ◽  
Tertiary Care Center ◽  
Operative Hysteroscopy ◽  
Less Invasive ◽  
Time Period

Background: During the last few decades hysteroscopy has become a tool of choice for evaluation of uterine cavity due to its “see and treat “benefits. It is more accurate and less invasive. Introduction of hysteroscopy in gynecological practice is the need of time. Aim of our study is to share the experience of hysteroscopy, its learning curve and limitations in a rural tertiary care center of Haryana.Methods: We retrospectively analyzed all the hysteroscopy procedure done from January 2016 to December 2018 from the hospital records.Results: Total 118 hysteroscopy were done but record of only 110 was available. Out of 110, 37(33%) were operative and 73(67%) were diagnostic. 36% were done for AUB, 33%  for infertility, 15% for misplaced cu t, 6% for amenorrhea, 2% in cases of RPL and rest for some less common indications. Out of operative hysteroscopy major procedures done were polypectomy and removal of misplaced Cu-T. Septal resection was also done in 3 cases. Number of operative hysteroscopy has increased over the time period of study.Conclusions: Hysteroscopic evaluation of uterine cavity is a reliable method for both diagnostic and treatment purpose. Proportion of hysteroscopy procedures and its learning curve will improve with persistent effort.

Sign in / Sign up

Export Citation Format

Share Document