scholarly journals Role of Glabellar flap in midfacial reconstruction.

JMS SKIMS ◽  
2020 ◽  
Vol 23 (2) ◽  
Author(s):  
Haroon Rashid Zargar ◽  
Mir Mohsin ◽  
Hilal Ahmed Bhat ◽  
Raheeb Ahmed Shah ◽  
Sheikh Adil Bashir ◽  
...  
Keyword(s):  
Local Anesthesia ◽  
Care Center ◽  
Donor Site ◽  
Tertiary Care ◽  
Donor Site Morbidity ◽  
Advancement Flap ◽  
Care Hospital ◽  
Patient Demographics ◽  
Included Patient

Aims: Reconstruction of midface always poses a challenge to a Plastic surgeon as one has to address the convexities and concavities which are somewhat unique to this area. Various local flaps have been used for achieving these goals. This study was conducted to evaluate the indications, feasibility and outcome of midfacial reconstruction using Glabellar flaps at a tertiary care center. Materials and Methods: This is a prospective observational study conducted in the Department of Plastic and Reconstructive Surgery of a tertiary care hospital between January 2016 to December 2019. All the patients who underwent midfacial reconstruction with Glabellar flaps during this period and consented to be a part of this study were included. Patient demographics, wound etiology and area, flap size and its mode of transfer, number of surgeries required, type of anesthesia used, comorbid conditions, complications if any and the results of reconstruction were recorded. All the patients were followed up till May 2020. Results: Thirteen patients were managed with Glabellar flaps. Majority of the patients (n=9, 69.23%) were males, with a mean age of 34 years. Most common cause of wounds was animal bite/maul (n=5, 38.46%). Glabellar flap was most commonly used as V-Y rotation advancement flap in nine patients (69.23%). Most of the cases (n=9, 69.23%) was operated under local anesthesia. Donor site was closed primarily in V-Y or linear fashion in 12 cases, and skin grafted only in 1 case. Majority (n=12, 92.3%) of the patients graded reconstruction results as Good-Excellent. Conclusions: Glabellar flap is an excellent option for reconstruction of midfacial defects with minimal donor site morbidity and can be performed safely under local anesthesia.

scholarly journals Otolaryngology Consult Protocols in the Setting of COVID-19: The University of Pittsburgh Approach

2021 ◽  
pp. 000348942110059
Author(s):  
Harish Dharmarajan ◽  
Michael A. Belsky ◽  
Jennifer L. Anderson ◽  
Shaum Sridharan
Keyword(s):  
Tertiary Care ◽  
Healthcare Providers ◽  
Length Of Hospital Stay ◽  
Care Hospital ◽  
University Of Pittsburgh ◽  
Prior Review ◽  
Patient Demographics ◽  
Included Patient ◽  
Chief Complaints ◽  
The University

Objective: To analyze trends in otolaryngology consultations and provide algorithms to guide management during the COVID-19 pandemic. Methods: A retrospective cohort study at a single institution tertiary care hospital. A total of 95 otolaryngology consultations were performed from March 1, 2020 to April 26, 2020 (COVID-era) and 363 were performed from September 1, 2019 to February 29, 2020 (pre-COVID-era) at the UPMC Oakland campus. Data collected included patient demographics, COVID-19 status, reason for consult, location of consult, type of consult, procedures performed, need for surgical intervention, length of hospital stay and recommended follow up. Results: Patient populations in the pre-COVID-era and COVID-era were similar in terms of their distribution of demographics and chief complaints. Craniofacial trauma was the most common reason for consultation in both periods, followed by vocal fold and airway-related consults. We saw a 21.5% decrease in the rate of consults seen per month during the COVID-era compared to the 6 months prior. Review of trends in the consult workflow allowed for development of several algorithms to safely approach otolaryngology consults during the COVID-19 pandemic. Conclusions: Otolaryngology consultations provide valuable services to inpatients and patients in the emergency department ranging from evaluation of routine symptoms to critical airways. Systematic otolaryngology consult service modifications are required in order to reduce risk of exposure to healthcare providers while providing comprehensive patient care.

TO DETERMINE THE ROLE OF CA125 IN THE DIAGNOSIS OF ACUTE APPENDICITIS

2020 ◽  
Vol 4 (7) ◽  
Author(s):  
Vinod Kumar ◽  
Bhupen Songra ◽  
Richa Jain ◽  
Deeksha Mehta
Keyword(s):  
Acute Appendicitis ◽  
Clinical Diagnosis ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Ca 125 ◽  
Care Hospital ◽  
Serum Samples ◽  
Roc Curve Analysis ◽  
Surgery Department

Background: the present study was under taken to determine the role of CA-125 in the diagnosis of acute appendicitis (AA), to prevent its complications and also in preventing negative appendicectomies in tertiary care hospital. Methods: The study was conducted at a tertiary care and research center between 01/03/2018 to 30/06/2019. Patients admitted to the surgery department with diagnosis of AA were considered for the study. After informed consent, a, standardized history was obtained as a case Performa. Serum samples from all the cases with clinical diagnosis of AA were obtained and stored. Only the cases with histopathologically approved AA were included in the study. Cases operated for clinical diagnosis of AA, but not histopathologically proven AA was not included in the study. CA125 levels in cases with definitive diagnosis of AA were measured. Results: In present study, ROC curve analysis revealed the sensitivity of 87.27 % and specificity of 90.91 % when the CA 125 cut-off value of > 16.8 was taken to diagnose acute appendicitis. AUC was 0.911 with a standard error of 0.0292. Conclusion: In this study we have observed that CA125 showed a positive correlation with acute appendicitis, that was statistically not significant (P>0.05). We didn’t evaluate the correlation with the disease severity. We consider that CA125 can be used as a marker in acute appendicitis cases although further research is still needed. Keywords: CA125, Acute Appendicitis, Surgery.

Coexistence of Metallo Beta Lactamase Resistant Gene Variants Among Clinical Isolates in Tertiary Care Hospital

2021 ◽  
Vol 18 (4) ◽  
pp. 429-436
Author(s):  
Santhiya K. ◽  
Jayanthi S. ◽  
Ananthasubramanian M. ◽  
Appalaraju B.
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Medical Science ◽  
Geographical Location ◽  
Carbapenem Resistance ◽  
Clinical Isolates ◽  
Care Hospital ◽  
Detection Rates ◽  
Carbapenem Resistant ◽  
Global Threat

Background: Carbapenem-resistant Enterobacteriaceae (CRE) has emerged as a global threat with mortality risk ranging from 48%-71% worldwide. The emergence of MBL resistance is threatening as carbapenem is one of the last line antibiotics. A total 24 variants of NDM resistance raises a concern to the clinicians and epidemiologists worldwide. Objective: The study aims at identifying MBL resistance (NDM, IMP, VIM, GIM, SPM, and SIM) and its coexistence in clinical isolates in a single tertiary care center. Methodology: Forty five clinical isolates characterized phenotypically for Carbapenem resistance obtained from PSG Institute of Medical Science and Research (PSG IMSR), Coimbatore, between February to March 2018 were taken for analysis. Result: Out of the 45 Clinical isolates, 38 isolates (84%) were detected as MBL carriers. VIM, NDM, GIM, and SPM were the predominant resistance genes, with detection rates of 48.8%, 28.8%, 24.4%, and 22.2% respectively. Fifteen isolates were observed to harbor more than one MBL gene in coexistence. Two isolates - U42 and R714 (K. pneumoniae) were found to harbor all 5 MBL variants in combination. Conclusion: 33% of clinical isolates harboring multiple MBL variants is a concern in clinical settings. The presence of SPM and GIM gene amongst isolates in this geographical location within India is an indicator demanding continuous monitoring of these resistance determinants.

The role of the clinical pharmacist in guiding adjuvant hormonal therapy in patients with breast cancer

2021 ◽  
pp. 107815522110293
Author(s):  
Amanda V Pirolli ◽  
Tatiana Brusamarello ◽  
Stella S Everton ◽  
Vânia M S Andrzejevski
Keyword(s):  
Breast Cancer ◽  
Hormone Therapy ◽  
Hormonal Therapy ◽  
Clinical Pharmacist ◽  
Tertiary Care ◽  
Structured Interview ◽  
Care Hospital ◽  
Adjuvant Hormonal Therapy ◽  
Breast Cancers

Breast cancer is the most prevalent type of cancer among women, affecting about 2.1 million worldwide and is responsible for the highest number of cancer-related deaths among women. Approximately 80% of breast cancers express on the surface of hormone receptor cells, such as progesterone and estrogen. In these cases, Adjuvant Hormonal Therapy (AHT) is indicated for a period of five to ten years and consists of taking a daily oral pill. The two most used drugs in AHT are tamoxifen and Aromatase Inhibitors. One of the issues most faced by individuals who are subjected to long periods of treatment is the lack of medication adherence and, consequently, therapeutic inefficiency. It is believed that the monitoring by the pharmacist can contribute to the reduction of errors inherent to the medication, making the treatment more effective and improving the patient's quality of life. The present study aimed to know the perception of patients who live with breast cancer and who do AHT in relation to the educational performance of the clinical pharmacist. This is a qualitative, descriptive and exploratory study, carried out from March to October 2020, with 15 women undergoing treatment at the oncology unit of a tertiary-care hospital in south of Brazil. The data were obtained through a semi-structured interview using an instrument composed of two parts, one referring to the characterization of the participants and the other with the guiding question of the research: "How do you perceive the role of the pharmacist in relation to the guidelines for the use of adjuvant hormonal therapy?". The method of theoretical saturation was used to perform the sample closure and the thematic analysis was used to analyze the data. The participants were between 32 and 74 years old, seven were on tamoxifen therapy and eight on anastrozole, ten were on the first year of treatment, two on the second and three on the third year. The themes that emerged were: pharmacist-patient interaction as a safety factor in hormone therapy; role of the pharmacist in the development of strategies for self-management of the patients during hormone therapy; and, challenges for the pharmacist in relation to hormone therapy through continued guidance. It was evident that the pharmacist's educational action encouraged the participants to carry out the treatment in a more confident and assertive manner according to their particularities and beliefs.

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

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

scholarly journals Enhancing Patient Experience in Office-Based Laryngology Procedures With Passive Virtual Reality

OTO Open ◽  
2021 ◽  
Vol 5 (1) ◽  
pp. 2473974X2097502
Author(s):  
Joseph Chang ◽  
Sen Ninan ◽  
Katherine Liu ◽  
Alfred Marc Iloreta ◽  
Diana Kirke ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Local Anesthesia ◽  
Controlled Trial ◽  
Care Center ◽  
Tertiary Care ◽  
Depression Scale ◽  
Control Group ◽  
Procedure Time ◽  
Pain Scores ◽  
Distress Scale

Objectives Virtual reality (VR) has been used as nonpharmacologic anxiolysis benefiting patients undergoing office-based procedures. There is little research on VR use in laryngology. This study aims to determine the efficacy of VR as anxiolysis for patients undergoing in-office laryngotracheal procedures. Study Design Randomized controlled trial. Setting Tertiary care center. Methods Adult patients undergoing office-based larynx and trachea injections, biopsy, or laser ablation were recruited and randomized to receive standard care with local anesthesia only or local anesthesia with adjunctive VR. Primary end point was procedural anxiety measured by the Subjective Units of Distress Scale (SUDS). Subjective pain, measured using a visual analog scale, satisfaction scores, and procedure time, and baseline anxiety, measured using the Hospital Anxiety and Depression Scale (HADS), were also collected. Results Eight patients were randomized to the control group and 8 to the VR group. SUDS scores were lower in the VR group than in the control group with mean values of 26.25 and 53.13, respectively ( P = .037). Baseline HADS scores did not differ between groups. There were no statistically significant differences in pain, satisfaction, or procedure time. Average satisfaction scores in VR and control groups were 6.44 and 6.25, respectively ( P = .770). Average pain scores were 3.53 and 2.64, respectively ( P = .434). Conclusion This pilot study suggests that VR distraction may be used as an adjunctive measure to decrease patient anxiety during office-based laryngology procedures. Procedures performed using standard local anesthesia resulted in low pain scores and high satisfaction scores even without adjunctive VR analgesia. Level of Evidence 1

Abstract 448: Impact of Novel Healthcare Facility First Responder Training on Resuscitation Task Self-Efficacy Measures

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Les R Becker ◽  
Cheryl Camacho ◽  
Sheryl J Titus ◽  
Janet L Thorne ◽  
Munish Goyal
Keyword(s):  
Ambulatory Care ◽  
Self Efficacy ◽  
Repeated Measures ◽  
Care Center ◽  
Tertiary Care ◽  
Sudden Cardiac Arrest ◽  
Healthcare Facility ◽  
Care Hospital ◽  
Ambulatory Care Setting ◽  
Before And After

Introduction: When sudden cardiac arrest occurs in non-resuscitation focused care settings, bedside clinicians may not intervene prior to dedicated resuscitation team arrival. As perceived self-efficacy (SE) contributes to cognitive functioning, facilitating effective intervention, we developed and evaluated a mock code training approach, First Five (FF) , to enhance bedside responders’ resuscitation task SE using an entity’s defibrillator and manikin. Self-efficacy is knowing that one can perform actions in principle and envision performing the steps to reach a goal. Hypotheses: Participants’ resuscitation SE will improve after FF training; 2) Inpatient (IP) and Ambulatory Care Center (ACC) providers will differ in their pre-SE and post-SE in response to FF training. Methods: Participants enrolled from ACCs and medical-surgical IP units at a large, urban tertiary care hospital from May 2018 to April 2019 completed a de-identified 10-point Likert-scale SE survey before and after they were trained to perform initial bedside resuscitation tasks (Figure 1 x-axis labels). Matched, complete, pre/post data for 85 in-hospital and 107 ACC participants were analyzed via repeated measures multivariate analysis of variance. Results: Patterns of reported change in the seven resuscitation task SE measures of IP personnel differed significantly from those of ACC personnel [Pillai’s Trace = .222, F(7,184)=7.483, p=.0005, partial η 2 = .222]. In both settings, post-session SE measures increased significantly from pre-session SE measures [Pillai’s Trace = .588, F(7,184)=37.438, p=.0005, partial η 2 = .588]. Moreover, though ACC providers consistently reported lower pre-training SE resuscitation task scores, post-training scores from both settings were comparable (Figure 1). Conclusions: First Five training is effective in enhancing resuscitation task SE among inpatient and ambulatory care setting providers that are not resuscitation-focused.

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