Demonstrating competence in Endoscopic Retrograde Cholangiopancreaticography (ERCP): recently credentialed operator’s performance for deep biliary cannulation over 1 year period from tertiary care hospital in Pakistan

Abstract Objective: To measure the success rate of endoscopic retrograde cholangiopancreaticography biliary cannulation of a recently credentialed endoscopist at a tertiary hospital. Methods: The clinical audit was conducted at the Aga Khan University Hospital. Karachi, and comprised data of all patients who underwent endoscopic retrograde cholangiopancreaticography under the care of a single operator during 2016. Data was retrospectively extracted from patient charts by an assistant blinded to the study. Data extracted included demographics, admission type, details and indication for the procedure, diagnosis, cannulation outcome, duct clearance, complications, follow-up surgical intervention, radiological imaging and mortality post-endoscopy. Data was analysed using SPSS 19. Results: Of 143 procedures performed, 102(71.3%) were included. The mean age was 52±17 years and 54(52.9%) of them were females. Most common indication was choledocholithiasis in 70(68.6%). The average procedure time was 41.5±5.5 minutes. Cannulation success rate was 96(94.1%). Complications included post-procedure pancreatitis in 5(4.9%), minimal bleeding in 8(7.8%) and oesophageal perforation in 1(0.98%). There was no procedure-related mortality. Conclusion: The success rate was high and complications were low Continuous...

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Is it Worth to Repeat Endoscopic Retrograde Cholangiopancreaticography after Failed Precut? Short Report from a Tertiary Care Hospital in North India

Journal of Digestive Endoscopy ◽

10.4103/jde.jde_29_17 ◽

2017 ◽

Vol 08 (03) ◽

pp. 129-131

Author(s):

Kumar Shwetanshu Narayan ◽

Gaurav Kumar Gupta ◽

Sandeep Nijhawan ◽

Sudhakar Pandey ◽

Bhanwar Singh Dhandhu ◽

...

Keyword(s):

Success Rate ◽

Tertiary Care ◽

Common Bile Duct Stones ◽

North India ◽

Short Report ◽

Care Hospital ◽

Endoscopic Retrograde ◽

Biliary Cannulation ◽

Precut Sphincterotomy ◽

Median Interval

ABSTRACT Aim: The aim of this study is to determine the success rate of biliary cannulation in cases where endoscopic retrograde cholangiopancreatography (ERCP) is repeated after failed precut sphincterotomy. Materials and Methods: In this retrospective study, consecutive ERCPs performed between August 2013 and June 2017 were included. Data was analyzed for indication of ERCP, success rate at initial cannulation attempt, use of precut sphincterotomy, biliary access rate after precut, repeat ERCP rate, and associated complications. Results: A total of 1872 ERCPs were included in the study. Of these, 55% were done for common bile duct stones, 37% for malignant biliary obstruction, and 8% for biliary leak. During the initial ERCP, 84.9% cases had successful biliary cannulation. Nearly 86.8% cases undergoing precut sphincterotomy achieved biliary access. Repeat ERCP was done in 28 cases after a median interval of 3 days and biliary cannulation was achieved in 78.5% cases. Conclusion: Repeat ERCP after 3 days in cases of failed initial precut sphincterotomy should be practiced and recommended as this allows definitive biliary therapy in majority of such patients and prevents morbidity and mortality from other invasive alternative therapies.

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Donor awareness: key to successful voluntary blood donation

F1000Research ◽

10.12688/f1000research.1-29.v1 ◽

2012 ◽

Vol 1 ◽

pp. 29 ◽

Cited By ~ 4

Author(s):

Rateesh Sareen ◽

Gajendra N Gupta ◽

Akanksha Dutt

Keyword(s):

Blood Donors ◽

Blood Donation ◽

Tertiary Care ◽

Tertiary Hospital ◽

Statistical Technique ◽

Study Data ◽

Blood Bank ◽

Western India ◽

Care Hospital ◽

Proactive Measures

Context: The current regulatory requirements for donor eligibility pose a challenge to blood centers in recruitment of voluntary blood donors, particularly in a developing country like India where awareness of the general population is low and myths about blood donation are prevalent. This study evaluates the reasons and rates of donor deferral in a tertiary hospital-based blood bank in western India.Aim: To find rates and reasons for deferral of voluntary blood donors in a city in western India.Settings and design: A retrospective study was done on blood donors during a 3-month period. Data collection was done by electronic records of blood donors.Materials and Methods: The study was conducted retrospectively at a tertiary care hospital in western India. All those who donated whole blood between 1st January 2011 and 31st March 2011 were included in the study. Data was collected using local blood bank software.Statistical analysis used: No statistical technique used as it is a data article.Results: 60.5% of donors were young, below 30 years of age. Donors were predominantly male (91.6%). Voluntary donors comprised 88% of the donors. Total deferral rate was 22.36%, with 17.29% permanent deferrals and 82.71% temporary deferrals. Main reasons for deferral were anemia 39.42%, low body weight 14.29%, hypertension 10.73%, age below 18 years 10.73% and history of medication 6.09%. The common causes of deferral between our study and other similar studies are the same.Conclusion: We concluded that majority of the donor population belongs to 18–30-year-old age group. This is encouraging with a voluntary blood donation initiative. Donor self exclusion and strict donor selection criteria application should be addressed by more proactive measures to make blood donation a safe and pleasurable experience.

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The Success Rate of Endotracheal Intubation in the Emergency Department of Tertiary Care Hospital in Ethiopia, One-Year Retrospective Study

Emergency Medicine International ◽

10.1155/2021/9590859 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Ayalew Zewdie ◽

Dejene Tagesse ◽

Selam Alemayehu ◽

Tesfaye Getachew ◽

Menbeu Sultan

Keyword(s):

Emergency Department ◽

Success Rate ◽

Endotracheal Intubation ◽

Addis Ababa ◽

Tertiary Care ◽

Tertiary Hospital ◽

Rapid Sequence Intubation ◽

Care Hospital ◽

Success Rates ◽

First Pass

Background. Emergency medical care starts with airway assessment and intervention management. Endotracheal intubation is the definitive airway management in the emergency department (ED) for patients requiring a definitive airway. Successful first pass is recommended as the main objective of emergency intubation. There exists no published research regarding the success rates or complications that occur within Ethiopian hospitals emergency department intubation practice. Objective. This study aimed to assess the success rate of emergency intubations in a tertiary hospital, Addis Ababa, Ethiopia. Methodology. This was a single institute retrospective documentation review on intubated patients from November 2017 to November 2018 in the emergency department of Addis Ababa Burn Emergency and Trauma Hospital. All intubations during the study period were included. Data were collected by trained data collectors from an intubation documentation sheet. Result. Of 15,933 patients seen in the department, 256 (1.6%) patients were intubated. Of these, 194 (74.9%) were male, 123 (47.5%) sustained trauma, 65 (25.1%) were medical cases, and 13(5%) had poisoning. The primary indications for intubation were for airway protection (160 (61.8%)), followed by respiratory failure (72(27.8%)). One hundred and twenty-nine (49.8%) had sedative-only intubation, 110 (42.5%) had rapid sequence intubation, and 16 (6.2%) had intubation without medication. The first-pass success rate in this sample was 70.3% (180/256), second-pass 21.4% (55/256), and third-pass 7.4% (19/256), while the overall success rate was 99.2% (254/256). Hypoxia was the most common complication. Conclusion. The intubation first-pass success rate was lower than existing studies, but the overall intubation success rate was satisfactory.

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Mothers’ experiences of labour in a tertiary care hospital

Health SA Gesondheid ◽

10.4102/hsag.v13i1.257 ◽

2008 ◽

Vol 13 (1) ◽

pp. 55-62 ◽

Cited By ~ 6

Author(s):

M S Maputle ◽

A Nolte

Keyword(s):

Tertiary Care ◽

Tertiary Hospital ◽

Study Data ◽

Limpopo Province ◽

Care Hospital ◽

Open Communication ◽

Qualitative Research Study ◽

Care Approach ◽

Centered Care ◽

Care Guidelines

The purpose of the study was to explore and describe experiences of mothers during childbirth in a tertiary hospital in the Limpopo Province. This was achieved through a qualitative research study which was exploratory, descriptive, contextual and inductive in nature. A sample of 24 mothers participated in this study. Data obtained from unstructured in-depth interviews were analysed according to the protocol by Tesch (1990, cited in Cresswell, 1994:155). Five themes were identified, namely mutual participation and responsibility sharing, dependency and decision-making; information sharing and empowering autonomy and informed choices; open communication and listening; accommodative/non-accommodative midwifery actions; and maximising human and material infrastructure. The themes indicated experiences that foster or promote dependency on midwifery care. Guidelines on how to transform this dependency into a mother-centered care approach during childbirth are provided. Opsomming Die doel van die studie was om moeders se belewenis van kindergeboorte in ’n tersiêre hospitaal in die Limpopo Provinsie te verken en te beskryf. Dit is gedoen deur middel van kwalitatiewe navorsing wat verkennend, beskrywend, en kontekstueel was. ‘n Steekproef van 24 moeders het aan die studie deelgeneem. Inligting is verkry deur middel van ongestruktureerde in-diepte onderhoude. Hierdie inligting is geanaliseer aan die hand van Tesch (1990: aangehaal in Creswell, 1994:155) se protokol. Die volgende kategorieë is geïdentifiseer, wedersydse deelname en gedeelde verantwoordelik- hede, afhanklikheid en besluitneming, deel van inligting, bemagtiging tot outonomie en ingeligte keuse, oop kommunikasie en luister, akkommoderende/nie-akkommoderende vroedvrou-aksies en bevordering van menslike en materiële infrastrukture. Die resultate van die onderhoude het belewenisse blootgelê wat dui op die bevordering van afhanklikheid in vroedvrouversorging. Riglyne om hierdie afhanklikheid te verander in ‘n moedergesentreerde benadering word verskaf.

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Transpancreatic precut papillotomy versus double-guidewire technique in difficult biliary cannulation: prospective randomized study

Endoscopy ◽

10.1055/s-0043-118000 ◽

2017 ◽

Author(s):

Harutoshi Sugiyama ◽

Toshio Tsuyuguchi ◽

Yuji Sakai ◽

Rintaro Mikata ◽

Shin Yasui ◽

...

Keyword(s):

Success Rate ◽

Pancreatic Duct ◽

Medical Information ◽

Randomized Study ◽

University Hospital ◽

Information Network ◽

Endoscopic Retrograde ◽

Biliary Cannulation ◽

Significant Difference ◽

Difficult Biliary Cannulation

Abstract Background and study aims Difficult biliary cannulation and unintentional pancreatic duct cannulation are thought to be important contributors to pancreatitis occurring after endoscopic retrograde cholangiopancreatography. Our aim was to compare and evaluate the rates of success and complications of transpancreatic precut papillotomy (TPPP) and the double-guidewire technique (DGT), both with prophylactic pancreatic stenting. Patients and methods From April 2011 to March 2014, patients with difficult biliary cannulation, in whom we planned to first position a guidewire in the pancreatic duct, were enrolled, and 68 patients were prospectively randomly allocated to two groups (TPPP 34, DGT 34). We evaluated the rates of success and complications for each group. Results TPPP had a significantly higher success rate (94.1 %) than DGT (58.8 %). The rate of post-ERCP pancreatitis was 2.9 % in both groups. There was no significant difference between the two groups in the overall rate of complications related to cannulation. Conclusion If biliary cannulation cannot be achieved, TPPP should be selected first after unintentional pancreatic duct cannulation.University Hospital Medical Information Network identifier: UMIN000008200

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Healthcare associated infections caused by non-fermenting Gram negative rods (NFGNR): six years of experience of a tertiary hospital

Bangladesh Journal of Medical Microbiology ◽

10.3329/bjmm.v7i2.19326 ◽

2013 ◽

Vol 7 (2) ◽

pp. 06-12

Author(s):

Zahidul Hasan ◽

Md. Kamrul Islam ◽

Arifa Hossain

Keyword(s):

Blood Stream Infection ◽

Tertiary Care ◽

Blood Stream ◽

Tertiary Hospital ◽

Healthcare Associated Infections ◽

Care Hospital ◽

Gram Negative ◽

Acinetobacter Spp ◽

Tract Infections ◽

Healthcare Associated

Recently non-fermenting Gram negative rods (NFGNR) are playing an important role in healthcare associated infections. This observational study in a tertiary care hospital of Dhaka city conducted during 01August 2007 to 30 June 2013 found that 34.8% isolated organisms from patients with healthcare associated infections were NFGNR. Majority (74.3 %) of these infections were occurring inside critical care areas. Pseudomonas and Acinetobacter together constituted 79.6% of the total NFGNR whereas Burkholderia cephacia complex (15.4%), Stenotrophomonas (4.3%) and Chryseobacterium species (0.7%) combined constituted remaining 20.4%. Out of total NFGNRs, Pseudomonas was responsible for highest number of catheter associated urinary tract infections (55.6%), ventilator associated pneumonia (46.3%), respiratory tract infection (65.8%) and surgical site infection (70.6%). Blood stream infection was predominantly caused by Burkholderia cephacia complex (33.5%) and Acinetobacter spp. (39.5%). Other than colistin most of the organisms were resistant to antibiotics commonly recommended for NFGNR.DOI: http://dx.doi.org/10.3329/bjmm.v7i2.19326 Bangladesh J Med Microbiol 2013; 07(02): 6-12

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Prognostic Factors for the Outcome of Salivary Gland Holmium: YAG Laser Intraductal Lithotripsy

Ear Nose & Throat Journal ◽

10.1177/01455613211010075 ◽

2021 ◽

pp. 014556132110100

Author(s):

Shuo-Jen Wang ◽

Lung-Che Chen ◽

Yi-Chih Lin ◽

Yen-Chun Chen ◽

Luong Huu Dang ◽

...

Keyword(s):

Logistic Regression ◽

Salivary Gland ◽

Success Rate ◽

Operative Time ◽

Tertiary Care ◽

Operation Time ◽

Laser Lithotripsy ◽

Successful Outcome ◽

Care Hospital ◽

Yag Laser

Objectives: Holmium: YAG laser has gained its popularity throughout the years and is used to treat sialolithiasis, which helps to overcome the limitations of traditional sialendoscopic lithotripsy for larger-sized salivary stones. However, little information is available regarding factors predicting the success rate of Holmium: YAG laser intraductal lithotripsy. The purpose of this study is to investigate the factors affecting the success rates of Holmium: YAG laser lithotripsy for salivary stones treatment in a tertiary care hospital. Methods: A retrospective study conducted in patients receiving sialolithiasis surgery under sialendoscopy from May 2013 to March 2015 at Mackay Memorial Hospital, Taiwan. Data on various factors, including patients’ age, gender, glands, size of largest stone, multiple stones (≥2 stones), location of the stone (distal duct, middle duct, proximal duct, and hilum), and operative time. The success of the surgery defined as patients without any complaints such as swelling or tenderness. Logistic regression and Fisher exact tests were employed to examine these factors on the success rate. Results: Fifty-four patients who received sialendoscopy surgery with a mean age of 35.74 years old recruited. Logistic regression identified the operation time exceeding 210 minutes showed 23.497 folds higher odd ratio of having a result of operation failure ( P < .05). Conclusion: The prolonged operation time is the sole independent factor affecting the successful outcome for salivary gland intraductal laser lithotripsy. We recommend operative time be no more than 210 minutes to increase the success rate in salivary gland Holmium: YAG laser intraductal lithotripsy.

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Knowledge in palliative care of nursing professionals at a Spanish hospital

Revista Latino-Americana de Enfermagem ◽

10.1590/1518-8345.1610.2847 ◽

2017 ◽

Vol 25 (0) ◽

Cited By ~ 8

Author(s):

Elena Chover-Sierra ◽

Antonio Martínez-Sabater ◽

Yolanda Lapeña-Moñux

Keyword(s):

Palliative Care ◽

Basic Education ◽

Statistical Significance ◽

Descriptive Analysis ◽

Tertiary Care ◽

Educational Background ◽

Cross Sectional Study ◽

Study Data ◽

Care Hospital ◽

Cross Sectional

Resume Objective: to determine the level of knowledge in palliative care of nursing staff at a Spanish tertiary care hospital. Method: descriptive, cross-sectional study. Data were collected about the results of the Spanish version of the Palliative Care Quiz for Nurses (PCQN), sociodemographic aspects, education level and experience in the field of palliative care. Univariate and bivariate descriptive analysis was applied. Statistical significance was set at p < 0.05 in all cases. Results: 159 professionals participated (mean age 39.51 years ± 10.25, with 13.96 years ± 10.79 of professional experience) 54.7% possessed experience in palliative care and 64.2% educational background (mainly basic education). The mean percentage of hits on the quiz was 54%, with statistically significant differences in function of the participants’ education and experience in palliative care. Conclusions: although the participants show sufficient knowledge on palliative care, they would benefit from a specific training program, in function of the mistaken concepts identified through the quiz, which showed to be a useful tool to diagnose professionals’ educational needs in palliative care.

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Success Rate of Endoscopic Sphenopalatine Artery Ligation for the Management of Refractory Posterior Epistaxis Patients in a Tertiary Care Hospital: A Descriptive Cross-sectional Study

Journal of Nepal Medical Association ◽

10.31729/jnma.5855 ◽

2020 ◽

Vol 58 (232) ◽

Author(s):

Meenakshi Basnet ◽

Bibek Ghimire ◽

Akriti Shrestha ◽

Gyan Raj Aryal

Keyword(s):

Success Rate ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Cross Sectional Study ◽

Medical Emergency ◽

Care Hospital ◽

Sectional Study ◽

Artery Ligation ◽

Cross Sectional ◽

Sphenopalatine Artery

Introduction: Epistaxis is a common medical emergency with 5% to 15% of patients admitted for epistaxis will require surgical management as nasal packing has high failure rates. A modern endoscopic technique like Endoscopic Sphenopalatine Artery Ligation has increased in popularity for managing intractable posterior epistaxis. It has less complication and a high success rate. The study conducted to estimate the success rate of Endoscopic Sphenopalatine Artery Ligation of refractory posterior epistaxis among admitted patients in a tertiary care hospital. Methods: This is a descriptive cross-sectional study conducted from June 2019 to June 2020 at the Department of Otorhinolaryngology, Nobel Medical College and Teaching Hospital among the patient with refractory posterior epistaxis with the help of retrospective data. A convenient sampling method was used. These patients underwent endoscopic sphenopalatine artery cauterization for recurrent/intractable posterior epistaxis. Ethical clearance was taken from the Institutional Review Board. Data were analyzed in Statistical Package for the Social Sciences. Results: Out of the total patient with refractory posterior epistaxis who underwent Endoscopic Sphenopalatine Artery Ligation, the overall success rate was 39 (95.12%). Among them, 25 (60.97%) males and 16 (39.02%) females underwent endoscopic sphenopalatine artery ligation. Twenty (48.78%) of them were unilateral whilst 21 (51.21%) were bilateral disease. About 2 (4.8%) cases had re-bleeding within 48 hours which was managed conservatively. Hypertension was found to be the most common comorbid condition followed by diabetes, chronic kidney. Conclusions: From our study, we conclude that the success rate for Endoscopic Sphenopalatine Artery Ligation in a patient with refractory posterior epistaxis was high.

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Vancomycin-resistance Enterococcal Colonization in Hospitalized Patients in Relation to Antibiotic Usage in a Tertiary Care Hospital of North India

Journal of Laboratory Physicians ◽

10.4103/0974-2727.163123 ◽

2015 ◽

Vol 7 (02) ◽

pp. 108-111 ◽

Cited By ~ 1

Author(s):

Tuhina Banerjee ◽

Shampa Anupurba ◽

Joel Filgona ◽

Dinesh K Singh

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Tertiary Care ◽

Significant Risk ◽

Antibiotic Use ◽

Antibiotic Usage ◽

Hospitalized Patients ◽

University Hospital ◽

North India ◽

Care Hospital

ABSTRACT Background: Alarming rise of vancomycin-resistant enterococci (VRE) is a global cause of concern. Several factors have been held responsible for such rise, of which antibiotic usage is a prominent one. Objectives: This study was undertaken to determine the intestinal VRE colonization rate amongst hospitalized patients in relation to use of various antibiotics in the Intensive Care Unit (ICU) of a tertiary care university hospital, India. Materials and Methods: Stool samples were collected weekly from all the patients in the adult ICU for a period of 6 months and processed for isolation and phenotypic and genotypic characterization of VRE isolates. Patient and treatment details were noted and cases (those with VRE in stool) and controls (those without VRE in stool) were compared statistically. Further, a multivariate analysis was done to identify those antibiotics as independent risk factors for VRE colonization. Results: VRE colonization was found in 34.56% (28/81) of the patients studied, with the majority 75% (21/28) carrying the vanA gene. The cases had significantly more (P < 0.05) duration of hospital stay and antibiotic exposure. Intake of metronidazole, vancomycin, and piperacillin-tazobactam were identified as significant risk factors both in univariate and multivariate analysis. Conclusion: A potential reservoir of VRE was thus revealed even in low VRE prevalence setting. Based on this high colonization status, restriction of empirical antibiotic use, reviewing of the ongoing antibiotic policy, and active VRE surveillance as an integral part of infection control strategy were suggested.

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