scholarly journals Incidence and Reasons for a Surgical Cancellation at a Hospital in Rwanda

2021 ◽  
Vol 4 (3) ◽  
pp. 379-386
Author(s):  
Thierry Uwera ◽  
Joselyne Mukantwari ◽  
David Ryamukuru ◽  
Lilian A. Omondi
Keyword(s):  
American Association ◽  
Perioperative Nurses ◽  
Gynecology And Obstetrics ◽  
Number Of Patients ◽  
Cancellation Rate ◽  
A Prospective Study ◽  
Study Hospital ◽  
Insight Into ◽  
Costly Event ◽  
Surgical Operations

BackgroundSurgery cancellation is a challenging and costly event resulting in operating theatre inefficiency and psychological and financial problems for the patients and their families. This study aimed to find out the incidence and reasons for surgical cancellation at a Rwandan hospital.MethodsA retrospective study was conducted on 736 patients’ files obtained from theatre registry lists of surgical operations done from January to March 2017. The American Association of Perioperative Nurses (AORN) checklist for documenting cancelled surgical cases was used to establish the rate and reasons for cancellation. Data were analyzed using frequency and percentage descriptive statistics.ResultsOut of the 736 surgeries booked, 179 (24.3%) were cancelled as follows: Orthopedic and general surgeries (28.2%) respectively, gynecology and obstetrics (27.4%), urology surgeries (15.5%), maxillofacial surgeries (15.9%), ENT (15.6%) and plastic surgeries (13.3%). Time constrain/long list (19.6%), acute change in medical status (10.6%), non-turn-up of the patient (8.4%), and abnormal lab findings (7.8%) were the most prevalent reasons.ConclusionThe surgical cancellation rate at the study hospital was 24%, increasing with the number of patients booked and the type of surgical procedure. A prospective study is required to gain more insight into the reason for cancellations, mostly amenable to mitigation measures.Rwanda J Med Health Sci 2021;4(3):379-386

scholarly journals Mild bleeders: Diagnosis is elusive in large number of patients

2016 ◽  
Vol 8 ◽  
pp. 201649 ◽  
Author(s):  
Mrinalini Kotru ◽  
Deepti Mutereja ◽  
Abhishek Purohit ◽  
Seema Tyagi ◽  
Manoranjan Mahapatra ◽  
...  
Keyword(s):  
Platelet Function ◽  
Complete Blood Count ◽  
Bleeding Tendency ◽  
Thrombin Time ◽  
Bleeding Disorders ◽  
Platelet Aggregometry ◽  
Number Of Patients ◽  
Pertinent Question ◽  
Common Clinical Presentation ◽  
A Prospective Study

Abstract. Background: Bleeding is a common clinical presentation. Even patients with mild bleeding disorders are extensively investigated for ascertaining the cause. The present study was conducted in order to evaluate the extent of the possibility of diagnosis in mild bleeding disorders.Material and Methods: This was a prospective study of patients referred for work up of mild bleeding for a period of 13 months. A complete blood count, peripheral smear examination, Prothrombin time, Partial Thromboplastin time and Thrombin Time, Platelet Aggregometry test, tests for von Willebrand’s disease and Platelet function 3 availability were measured. Results: 164 patients presented with mild bleeding, in 114 of the  patients a single site of bleeding was present. Epistaxis was the most common presentation (39%). Cutaneous bleeding (petechiae and purpura) was the next common site. History of a major bleeding tendency in the family was present only in 11 patients. The investigations showed that VWD (17/164), followed by clotting disorders (CD) mainly mild hemophilia (15/164) were the most common diagnosable cause. There were also 4 cases of hypofibrinogenemia. The disorders of platelets (Platelet function defects/PFD) were the least common (9/164). Rest 123 (75%) patients could not be diagnosed on the basis of these investigations and were labeled as  Bleeding disorders – Unclassified (BDC). Conclusion: n our study, 75% of the patients with mild bleeding remained undiagnosed even after extensive laboratory workup, thus raising a very pertinent question that is it necessary that all mild bleeders submit to a broad battery of investigations, as the diagnosis continues to be elusive despite extensive workup.

Pneumocystis carinii Pneumonitis in Young Immunocompetent Infants

PEDIATRICS ◽  
1980 ◽  
Vol 66 (1) ◽  
pp. 56-62
Author(s):  
Sergio Stagno ◽  
Linda L. Pifer ◽  
Walter T. Hughes ◽  
Dana M. Brasfield ◽  
Ralph E. Tiller
Keyword(s):  
Influenza A ◽  
Pneumocystis Carinii ◽  
Open Lung Biopsy ◽  
Influenza B ◽  
Severe Respiratory Distress ◽  
Number Of Patients ◽  
Circulating Antigens ◽  
Cytomegalovirus Pneumonia ◽  
Syncytial Virus ◽  
A Prospective Study

Of 67 infants enrolled in a prospective study of infant pneumonia ten (14%) had evidence of Pneumocystis carinii infection. Diagnosis was achieved by demonstrating circulating P carinii antigens by counterimmunoelectrophoresis in all ten cases and by histopathology in the only infant who underwent an open lung biopsy. Antigenemia did not occur in 64 control infants (P = .003), nor in 57 patients of similar age who were hospitalized with pneumonitis due to Chlamydia trachomatis, respiratory syncytial virus, cytomegalovirus, adenovirus, and influenza A and influenza B viruses. None of the ten infants with P carinii pneumonitis had evidence of a primary immunodeficiency nor had any received immunosuppressive medication. These patients were hospitalized at a mean age of 6 weeks (range 2 to 12) and their illness was characterized by its afebrile course, presentation in crisis with severe respiratory distress, apnea, tachypnea, cough, increased IgM, and bilateral pulmonary infiltrates with hyperaeration. The clinical features of P carinii pneumonitis were indistinguishable from those of C trachomatis and cytomegalovirus pneumonia. Treatment with trimethoprim-sulfamethoxazole was associated with rapid disappearance of circulating antigens; however, the small number of patients studied did not permit an analysis of its clinical efficacy. These results indicate that P carinii singly or in combination with other infectious agents may be an important cause of pneumonitis in young, immunocompetent infants with no underlying illnesses.

scholarly journals Effects of Pulsed Versus Conventional Versus Combined Radiofrequency for the Treatment of Trigeminal Neuralgia: A Prospective Study

2017 ◽  
Vol 6 (20;6) ◽  
pp. E873-E881
Author(s):  
Ghaydaa A. Ghaydaa A.
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Prospective Study ◽  
University Hospital ◽  
Gasserian Ganglion ◽  
Pulsed Radiofrequency ◽  
Group Setting ◽  
Idiopathic Trigeminal Neuralgia ◽  
Number Of Patients ◽  
A Prospective Study

Background: During radiofrequency bursts of energy are applied to nervous tissue. The clinical advantages of this treatment remain unclear. Objectives: We compared the effectiveness and pain relief for idiopathic trigeminal neuralgia (TN) after continuous radiofrequency (CRF), pulsed radiofrequency (PRF), and combined continuous and pulsed radiofrequency (CCPRF) treatment of the Gasserian ganglion (GG). Study Design: We conducted a randomized prospective study. Forty-three patients were included. Eleven patients were treated with PRF at 42°C for 10 minutes (PRF group), 12 patients received CRF for 270 seconds at 75 °C (CRF group), and 20 patients received PRF for 10 minutes at 42°C followed by CRF for at 60°C for 270 seconds (CCPRF group). Setting: Assuit University Hospital, Pain and Neurology outpatient clinics. Methods: Patients were assessed for pain, satisfaction, and consumption of analgesics at baseline and 7 days, one month, 6 months, 12 months, and 24 months after the procedure. The incidence of complications, anesthesia dolorosa, weakness of muscles of mastication, numbness, and technical complications, was evaluated after the procedure. Results: Excellent pain relief was achieved after 6, 12, and 24 months, respectively in 95%, 85%, and 70% of patients with CCPRF; 75%, 75%, and reduced to 50% among patients with CRF; and 82%, reduced to 9.1%, and 0% of patients with PRF. No complications were recorded in 75% of patients in the CCPRF and PRF groups. There was one case of anesthesia dolorosa, 4 cases of masseter muscle weakness, and 5 cases of severe numbness recorded in the CRF group. Limitation: There was a small number of patients in each group. Conclusion: The best results were observed in the CCPRF group, followed by the CRF group, and then the PRF group.

scholarly journals A 3-year review of MRI safety incidents within a UK independent sector provider of diagnostic services

BJR|Open ◽  
2019 ◽  
Vol 1 (1) ◽  
pp. bjro.20180006
Author(s):  
Darren Hudson ◽  
Andrew P Jones
Keyword(s):  
Systematic Approach ◽  
Reporting System ◽  
Instructional Materials ◽  
Mri Safety ◽  
Screening Process ◽  
Number Of Patients ◽  
Incident Reports ◽  
Independent Sector ◽  
The Uk ◽  
Insight Into

A review of MRI safety incidents conducted over a 3-year period for a large independent sector diagnostic imaging provider in the UK. The review took a systematic approach using reports logged on an internal incident reporting system that were then categorised and analysed for themes and trends. Notable cases and actions taken are also described from within the period. MRI safety-related events made up 7.5% of the total number of incident reports submitted and 15.5% of all MRI-related reports. The MR safety-related incidence report rate was 0.05% (1 per 1987 patients), which is relatively low considering the number of patients seen in our facilities each day. Internal MRI safety events indicated the main trends to be around referral of contraindicated devices (32% of reports) and failure in the screening process (21.5%—either due to unexpected implants or being unable to confirm safety). To improve practice and work to reduce incidents, advice and instructional materials were developed. The review suggests a potential approach to categorisation of MRI-related safety events which could allow comparisons to be made across organisations, helping to look for trends and guide learning. It also provides insight into the state of MRI safety within the organisation, a rationale for some of the interventions introduced to improve safety, and discussion around common issues arising in MRI safety.

International neuroblastoma staging system stage 1 neuroblastoma: a prospective study and literature review.

1996 ◽  
Vol 14 (7) ◽  
pp. 2174-2180 ◽  
Author(s):  
B H Kushner ◽  
N K Cheung ◽  
M P LaQuaglia ◽  
P F Ambros ◽  
I M Ambros ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Staging System ◽  
Cytotoxic Therapy ◽  
Staging Systems ◽  
International Neuroblastoma Staging System ◽  
A Prospective Study ◽  
Stage 1 ◽  
To Receive ◽  
Insight Into

PURPOSE To gain insight into the management of non-metastatic neuroblastoma by examining clinical and biologic features of International Neuroblastoma Staging System (INSS) stage 1 tumors. METHODS Patients were staged by both the INSS and the Evans staging system and were evaluated for biologic prognostic factors. Patients with INSS stage 1 received no cytotoxic therapy. The literature was reviewed for clinical and biologic data about INSS stage 1. RESULTS We evaluated 10 consecutive patients (median age, 17.5 months) with INSS stage 1; all remain disease-free (median follow-up duration, > 5 years). Tumors were in the abdomen (n = 6), chest (n = 3), or pelvis (n = 1). Neuroblastoma involved margins of resection in six tumors. Poor-prognostic biologic findings included tumor-cell diploidy (n = 2) and unfavorable Shimada histopathology (n = 2). Two patients were to receive chemotherapy for, respectively, a tumor deemed unresectable and a tumor classified as Evans stage III; second opinions resulted in surgical management alone in each case. Published reports confirm that some INSS stage 1 patients (1) are at risk for overtreatment, and (2) have poor-prognostic biologic findings yet do well. CONCLUSION Surgery alone suffices for INSS stage 1 neuroblastoma, even if biologic prognostic factors are unfavorable, microscopic disease remains after surgery, and tumor size is suggestive of "advanced-stage" status in other staging systems. Attempts to resect regionally confined neuroblastomas should take precedence over immediate use of cytotoxic therapy; otherwise, some patients may receive chemotherapy or radiotherapy unnecessarily.

Clinical Profile of Critically Ill Patients Presenting to Emergency Department of Tertiary Level Hospital of Nepal

2019 ◽  
Vol 41 (1) ◽  
pp. 67-74
Author(s):  
Shubha K Shrestha ◽  
Bishwas Pradhan ◽  
Yogendra M Shakya ◽  
Hem R Paneru
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
University Teaching ◽  
Chronic Obstructive ◽  
Optimal Care ◽  
Obstructive Pulmonary Disease ◽  
Number Of Patients ◽  
Common Diagnosis ◽  
The Common ◽  
A Prospective Study

Introduction: Among critically ill patients presenting to Emergency Room (ER) of Tribhuwan University Teaching Hospital (TUTH), a number of patients have to either remain in ER or have to be referred outside due to unavailability of critical care beds. Studies have shown significant association between delayed admission and mortality rates along with increased length of stay and higher cost. This study aimed to present an audit of critically ill patients presenting to ER of TUTH. Methods: This was a prospective study conducted over a period of one month. All patients presenting to ER of TUTH were triaged and critically ill patients were shifted to Red area of the ER. All patients ≥16 years of age shifted to Red area during the study period were enrolled in our study. Results: Out of 3718 patients presenting to ER during the study period, the number of critically ill patients ≥16 years of age was 526 i.e. 14.14% of total patients. Among them, the common diagnosis were Cerebrovascular Accidents (CVA) followed by Intoxication, Acute Exacerbation (AE) of Chronic Obstructive Pulmonary Disease (COPD), Pneumonia and Chronic Kidney Disease (CKD) respectively. Almost 20% of these patients were admitted, 31% were referred and 40% were shifted for observation. The median length of ER stay was 6 hours (Mean: 8.5 hrs; Range: 20 min to 70 hr 15 min). Conclusion: Among critically ill patients presenting to our ER, almost 1/5th of the patients were admitted whereas more than 2/3rd were either referred or remained in our ER. This data highlights the need for solutions to provide optimal care for the acute phase management of the critically ill patients.

scholarly journals Early Postoperative Arrhythmias after Paediatric Cardiac Surgery

2018 ◽  
Vol 6 (1) ◽  
pp. 22-28
Author(s):  
Kazi Zahidul Hoque ◽  
Akhand Tanzih Sultana ◽  
Mamun Mia ◽  
Masumul Gani Chowdhury ◽  
Makbul Hossein
Keyword(s):  
Risk Factors ◽  
Body Weight ◽  
Cardiac Surgery ◽  
Postoperative Period ◽  
Significant Risk ◽  
Radical Change ◽  
Paediatric Cardiac Surgery ◽  
Number Of Patients ◽  
Paediatric Age ◽  
A Prospective Study

Background: The radical change in techniques in paediatric cardiac surgery has dramatically reduced the morbidity and mortality. The different varieties of arrhythmia that are frequently observed in postoperative period in our country are still not well documented.Objectives: To determine the incidence and risk factors of arrhythmia immediately after cardiac surgery in paediatric age group.Materials and method: It was a prospective study. A total of 100 paediatric patients (age <18 years) who underwent cardiac surgery at Dhaka Shishu Hospital between 2013 and 2016 were selected purposivelyResults: Out of 100 patients maximum 41% were from 13-72 months age group. The mean age was 49.73±37.17 months with range of 0.5-231 months, 58% patients were male and rest were female. Postoperatively 31% subjects were arrhythmic and of these the highest number of patients suffered from junctional ectopic tachycardia. Out of these 100 patients, 39% were diagnosed as VSD followed by TOF (35%). Among 31 arrhythmic patients 59.83%, 41.93% and 3.22% manifested onset of arrhythmia at 1st, 1st to 2nd and 2nd to 7th postoperative period respectively. In this study age, body weight, cyanosis, CPB time, postoperative acidosis, ventilation support days, hypertension on arrival in ICU as well as ICU stay days were recognized as significant risk factors (p <0.05).Conclusion: Proper and careful monitoring of younger patient with lower body weight undergoing corrective cardiac surgery with long cardiopulmonary bypass (CPB) time may reduce the episodes of post operative arrhythmia. These patients may require high inotropic support post operatively. So, medical prevention and early diagnosis as well as proper management may improve the operative outcome.Delta Med Col J. Jan 2018 6(1): 22-28

scholarly journals Symptoms of depression in patients with cancer of the head and neck undergoing radiotherapy treatment: a prospective study

2012 ◽  
Vol 20 (2) ◽  
pp. 362-368 ◽  
Author(s):  
Juliana Maria de Paula ◽  
Helena Megumi Sonobe ◽  
Adriana Cristina Nicolussi ◽  
Márcia Maria Fontão Zago ◽  
Namie Okino Sawada
Keyword(s):  
Head And Neck ◽  
Healthcare Professionals ◽  
Adherence To Treatment ◽  
Patients With Cancer ◽  
Symptoms Of Depression ◽  
Number Of Patients ◽  
The Social ◽  
A Prospective Study ◽  
Radiotherapy Treatment

This study aimed to investigate the frequency of symptoms of depression in patients with cancer of the head and neck undergoing radiotherapy treatment, in the initial, middle and final stages of the treatment. This is a prospective exploratory quantitative study of 41 patients with head and neck cancer, undergoing radiotherapy treatment in the Oncology Outpatient Clinic of the Beneficência Portuguese Hospital of Ribeirão Preto. Data were collected through the Beck Depression Inventory instrument, and analyzed quantitatively by means of the Statistical Package for the Social Sciences. Symptoms of dysphoria were found to increase throughout the treatment, as well as the number of patients with depression. The results show the importance for the healthcare professionals to detect the prevalence and the levels of the symptoms of depression, since these symptoms tend to increase and may lead to consequences such as a lack of adherence to treatment and a decrease in the quality of life of these patients.

Epidural Anesthesia for Caesarean Section and Occurrence of Horner’s Syndrome

2017 ◽  
Vol 71 (2) ◽  
pp. 128-130
Author(s):  
Sasho Spasovski ◽  
Atanas Sivevski ◽  
Dafina Karadjova ◽  
Igor Samardziski
Keyword(s):  
Epidural Anesthesia ◽  
Empirical Method ◽  
Horner’S Syndrome ◽  
Negative Consequences ◽  
Negative Effects ◽  
Horner's Syndrome ◽  
Gynecology And Obstetrics ◽  
Number Of Patients ◽  
The University

Abstract Recently, specifically in the last decade, at the University Clinic of Gynecology and Obstetrics, the number of patients treated with epidural analgesia for painless childbirth, which in some percentage ends in Caesarian section (35%), has increased. The increased use of the epidural anesthesia and analgesia is due to the fact that it is one of the most popular ways of childbirth today. This situation is a result of the benefits that epidural anesthesia has for the patient, which consist of allowing the pregnant woman to be conscious during childbirth and to feel and see her child coming into the world, accompanied with smaller intensity of intraoperative and postoperative pain. However, the results or the effects in practice have shown that in certain insignificant percentage patients can have negative consequences from the received analgesia (anesthesia) such as: headache, cases of durra puncture, epidural abscess or hematoma, neurological outbursts etc. But, the subject of this analysis or the aim of this study is the appearance of Horner’s syndrome, as one of the negative effects of the epidural anesthesia, which even though rarely (only in 1% of the cases) can appear as a result of the epidural anesthesia. In the case study using the historic, comparative and empirical method we will try through a specific case to determine the causes for the occurrence of the Horner’s syndrome, how it should be treated and what are the consequences for the patient.

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