scholarly journals Evaluation of Safety in Cesarean Myomectomy

2016 ◽  
Vol 8 (2) ◽  
pp. 136-139
Author(s):  
Sabnam S Nambiar ◽  
S Ajith ◽  
Vidya Prabhu ◽  
Beena George
Keyword(s):  
Blood Loss ◽  
Cesarean Section ◽  
Intraoperative Complications ◽  
Psychological Trauma ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Chi Square ◽  
Additional Surgery ◽  
Significant Difference ◽  
Cesarean Myomectomy

ABSTRACT Objectives Cesarean myomectomy (removal of fibroids during cesarean section) prevents an additional surgery, the cost, associated complications, and the physical and psychological trauma. However, there is risk of increased bleeding. Nevertheless, many centers practice it taking optimum precautions. The aim of our study was to compare cesarean myomectomy patients in those women who underwent cesarean section without fibroid removal for (a) blood loss, fall in hemoglobin, blood transfusion requirement; (b) intraoperative and postoperative complications; and (c) duration of hospitalization. Materials and methods We retrospectively studied medical records of cesarean sections done in our institution for women within the past 5 years. A total of 76 patients had documented fibroids, of whom 37 underwent concurrent myomectomy and 39 did not. Data were analyzed using Pearson's Chi-square test for categorical variables and student t test for continuous variables with threshold of significance p < 0.05. Results No significant difference was found in blood loss and intraoperative complications. A small increase was seen in febrile morbidity in myomectomy group, however, with no resultant increase in hospitalization. Conclusion Cesarean myomectomy does not cause increased morbidity. Moreover, it saves the mother an additional surgery of interval myomectomy provided proper selection of cases, adequate preoperative and intraoperative preparedness, and caution are taken into consideration. How to cite this article Nambiar SS, Ajith S, Prabhu V, George B. Evaluation of Safety in Cesarean Myomectomy. J South Asian Feder Obst Gynae 2016;8(2):136-139.

scholarly journals Assessment of production objective and breeding practices of rural goat keepers and implications for a breeding programme in north central Nigeria

2021 ◽  
Vol 43 (2) ◽  
pp. 50-61
Author(s):  
A. Yakubu ◽  
M. M. Achapu
Keyword(s):  
Disease Resistance ◽  
Breeding Programme ◽  
Primary Data ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Chi Square ◽  
System Productivity ◽  
North Central ◽  
Significant Difference ◽  
Breeding Practices

Goat farming is a veritable source of livelihood of many rural families in Africa. This study aimed at determining prevailing production systems and breeding objectives of rural goat producers in north central Nigeria. A total of 180 rural goat keepers corresponding to 60 per State (Nasarawa, Benue and Plateau) were randomly sampled. Primary data (socioeconomics of respondents, reasons for keeping goats, flock structure, management system, productivity and breeding practices) were collected through individual structured questionnaire administration. Cross tabulations and Chi square (÷2) statistics were used to compare categorical variables, while rank means, arithmetic means and standard deviations were calculated for within- and between-state comparisons of the continuous variables. While more goat producers were involved in crop farming in Benue State (43.6%), only 34.5 and 21.8% engaged in farming in Plateau and Nasarawa State, respectively. Goats were kept for income generation, milk, meat and cultural/religious functions by about 61.1, 12.8, 15.0 and 6.1% of the producers while the relative importance given by respondents to the different objectives varied significantly (Chi-square=6.62; P< 0.05) across the States. The average flock sizes of goats for Nasarawa (9.68±5.63), Benue (8.25±4.73) and Plateau (8.80±3.98) were not significantly (P>0.05) different. Semi-intensive system predominated (P<0.01). Productivity indices showed that for age of parturition, number of kids of Sahel doe and lifespan of goats, there was no significant difference (P>0.05). Among all the breeding traits across the three States, only disease resistance varied (P<0.01). Disease resistance, survival, fertility, number of offspring and body size appeared similar (P>0.05) as preference for production traits. However, growth (83.52-97.68 mean ranks) (Plateau State) and cultural importance (75.28-104.70 mean ranks) (Benue State) varied across the States (P<0.05 and P<0.01, respectively). The present information will be useful in understanding the farmers' production objectives, management and breeding practices as a first step in designing a sustainable breeding programme for rural farmers in the study areas.

scholarly journals 2005. Successful Implementation of a Procalcitonin Algorithm Associated with Reduction in Antibiotic Days

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S672-S673
Author(s):  
John B McCoury ◽  
Randolph V Fugit ◽  
Mary T Bessesen
Keyword(s):  
Patient Characteristics ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Categorical Variables ◽  
Successful Implementation ◽  
Continuous Variables ◽  
Chi Square ◽  
Clinician Training ◽  
Significant Difference ◽  
Mortality Table

Abstract Background Randomized controlled trials of procalcitonin (PCT)-based algorithms for antibacterial therapy have been shown to reduce antimicrobial use and improve survival. Translation of PCT algorithms to clinical settings has often been unsuccessful. Methods We implemented a PCT algorithm, supported by focus groups prior to introduction of the PCT test in April 2016 and clinician training on the PCT algorithm for testing and antimicrobial management after test roll-out. The standard PCT algorithm period (SPAP) was defined as October 1, 2017 to March 31, 2018. The antimicrobial stewardship team (AST) initiated an AST-supported PCT algorithm (ASPA) in August 2018. The AST prospectively evaluated patients admitted to ICU for sepsis and ordered PCT per algorithm if the primary medical team had not ordered them. The ASPA period was defined as October 1, 2018–March 31, 2019. The AST conducted concurrent review and feedback for all antibiotic orders during both periods, using PCT result when available. We compared patient characteristics and outcomes between the two periods. The primary outcome was adherence to the PCT algorithm, with subcomponents of appropriate PCT orders and antimicrobial discontinuation. Secondary outcomes were total antibiotic days, excess antibiotic days avoided, ICU and hospital length of stay (LOS), 30-day readmission and mortality. Continuous variables were analyzed with Student t-test. Categorical variables were analyzed with chi-square or Mann–Whitney test, as appropriate. Results There were 35 cases in the SPAP cohort and 57 cases in the ASPA cohort. There were no differences in demographics or infection site (Table 1). Baseline PCT was ordered in 57% of the SPAP cohort and 90% of the ASPA cohort (P = 0.0006) (Table 2). Follow-up PCT was performed in 23% of SPAP and 76% of ASPA (P < 0.0001). Antibiotics were discontinued per algorithm in 2/35 (7%) in the SPAP cohort and 25/57 (44%) in the ASPA cohort (P < 0.0001). Total antibiotic days was 7 (IQR 4–10) in the SPAP cohort and 5 (IQR 2–7) in the ASPA cohort (P = 0.02). There was no significant difference in LOS, ICU LOS, 30-day readmission, or mortality (Table 4). Conclusion A PCT algorithm successfully implemented by an AST was associated with a significant decrease in total antibiotic days. There were no differences in mortality or LOS. Disclosures All authors: No reported disclosures.

Abstract TP236: Eval to Groin Puncture Times: Efficiencies and Deficiencies of Live Physician vs Telemedicine Triage

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
David Rosenbaum-Halevi ◽  
Sujan T Reddy ◽  
Alyssa D Trevino ◽  
Muhammad Bilal Tariq ◽  
Mahan Shahrivari ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Chi Square ◽  
Specific Level ◽  
Site Specific ◽  
Exact Test ◽  
Wilcoxon Rank Sum Test ◽  
Significant Difference ◽  
A Site

Introduction: Telemedicine (TM) is increasingly implemented in community hospitals acute ischemic stroke (AIS). The efficiency of TM to facilitate thrombectomy (IAT) is unknown. We addressed this question by studying our spoke hospitals which are staffed by both in-person (IP) consultation (Day: 8am-5pm) and TM (Night: 5pm-8am) to analyze differences between TM and IP and comparing to our university hub which has IP staffing day and night. Methods: We performed a retrospective analysis from 3/2016 to 3/2019 of all IAT cases directly admitted to 4 IAT capable centers (1 hub + 3 spokes) in our system. Demographic, clinical, and time metrics were analyzed. Primary outcome was door to groin (DTG) time. Continuous variables were analyzed with Wilcoxon rank sum test, and categorical variables with chi-square or Fischer’s exact test. Results: Table 1 summarizes the cohort. Eval to tPA (ETPA) time was faster at spokes vs hub (p < 0.0001), with no significant difference in DTG between spoke and hub (p= 0.444). At spokes, while DTPA times were no different between IP and TM at spokes, IP achieved faster DTG times (p<0.0001) (Fig.1A). DTG was equal during day vs. night at the hub. At the spokes, day (IP) DTG times were faster than night (TM) at some but not all spokes (Fig.1B). TPA administration did not delay DTG at either the hub or the spokes (Fig. 1C). At spokes, TM-TPA cases were associated with faster DTG than TM-noTPA (Fig. 1D). Conclusions: While no difference is noted between TM and IP in rapid TPA treatment, our data show delayed DTG at spokes during the TM day and night service. While DTG in TM was prolonged, differences in spoke metrics imply that availability of staff and resources play a significant role. Further analysis is needed to identify factors that prolong DTG at a site-specific level.

Abstract 3: Association of Video- vs. Text-Based Informed Consent With Multicenter Registry Enrollment

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
Alexander C Fanaroff ◽  
Shuang Li ◽  
Vincent Miller ◽  
Laura Webb ◽  
Ann Marie Navar ◽  
...  
Keyword(s):  
Informed Consent ◽  
Management Practices ◽  
Categorical Variables ◽  
Rank Test ◽  
Continuous Variables ◽  
Chi Square ◽  
Lipid Management ◽  
Significant Difference ◽  
Activation Times ◽  
Multicenter Registry

Background: Low patient participation in clinical research undermines the generalizability of findings. Conducting informed consent by video rather than a traditional text format may enhance the appeal of research and break down barriers to participation. Methods: The Patient and Provider Assessment of Lipid Management (PALM) Registry enrolled patients at U.S. cardiology, endocrinology, and primary care clinics to evaluate cholesterol management practices. PALM investigators developed an iPad-based video informed consent tool that included video segments totaling 8 minutes which patients navigated though a “game-ified” interface. At sites whose IRB did not approve the video tool, participants read a 6-page text consent form on the iPad. Characteristics of sites and site activation times were compared between sites that did and did not use the video consent tool using Pearson’s chi-square test for categorical variables and Wilcoxon’s signed rank test for continuous variables. Results: Of 140 sites that enrolled 7904 patients in PALM, 60 (42.9%) used the video informed consent tool. Compared with sites using text consent, sites using the video consent tool were more often rural (16.7 vs. 3.8%, p = 0.01) and used a central IRB (91.7 vs. 80.0%, p = 0.06). Sites using video consent enrolled a greater proportion of patients who were ≥ 75 years old (27.5 vs. 23.6%, p < 0.001) or non-white (17.7 vs. 14.2%, p < 0.001). Sites using video consent had shorter times from site approach to first patient enrollment ( Figure ). Median (IQR) enrollment was 33 (12, 98) patients at sites using video consent versus 24 (12, 86) at sites using text consent only (p = 0.54); there was also no significant difference in median weekly enrollment rate (2.9 [1.1, 7.5] vs. 2.8 [1.3, 6.6], p = 0.73). Conclusions: In this early experience with video consent in a multicenter registry, availability of video informed consent was associated with greater enrollment of older and non-white patients, faster speed to first patient enrolled, and numerically but not significantly more rapid enrollment compared with text informed consent.

scholarly journals A Retrospective Analysis of the Prevalence of Distribution of Oral Mucosal Lesions (OMLs) among the People Of Delhi NCR

2019 ◽  
Vol 3 (4) ◽  
pp. 154-158
Author(s):  
Simran Kaur ◽  
Aseem Singh ◽  
Rahul Singh
Keyword(s):  
Health Education ◽  
Descriptive Analysis ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Chi Square ◽  
The People ◽  
Significant Difference ◽  
Oral Mucosal Lesions ◽  
Study Population ◽  
Mucosal Lesions

INTRODUCTION: The presence of Oral Mucosal Lesions (OMLs) in one’s oral mucosa can lead to unwanted consequences and mostly are due to tobacco use. AIM: To  document the prevalence of OMLs among patients of Delhi NCR and provide health education counselling to those under the grip of this evil practice.  MATERIAL AND METHODS: We retrospectively analyzed the data of a total of 402 subjects visiting various screening camps in Delhi NCR and recalled a total of 174 patients, out of which 161 reported back to us for further diagnosis and screening of OMLs. The examination of patients in the camp were an ADA type III examination. All patients we given a health education while tobacco users were also given a specialized one-on-one health education regarding the tobacco and its ill effects as well as techniques for cessation. A descriptive analysis of the sample was first performed using means (±standard deviation (SD)) for continuous variables  and frequencies (proportions) for categorical variables. The chi-square test was used for statistical analysis and to find significant difference, if any. RESULTS: Among the 402 subjects screened, the mean age was 33.24±6.74 Years and most of the study population belonged to the age group of 25-60 Years [178(44.3%)]. 301(74.8%) of the study population were males. The main chief complaint was periodontal problem [187(46.5%)], while 15 patients (3.73%) came for regular check-up. The prevalence of leukoplakia was found to be 8.70% and OSMF was found to be 6.21%. A significant difference was seen among gingivitis with respect to age and gender (p<.05), leukoplakia and frictional keratosis was seen significant in relation to gender. In all significant cases, Males were more prone to get these OMLs as compared to females CONCLUSION: It is advised that regular Oral Health Drives and counselling sessions be arranged for the people of elhi NCR to reduce the burden of the OMLs.

scholarly journals Comparison of Visuospatial Skill Development Between Preclinical and Clinical Undergraduate Students Using Dentinal Pin Placement Exercise

2021 ◽  
Vol 30 (03) ◽  
pp. 147-151
Author(s):  
Alia Ahmed ◽  
◽  
Usman Anwer Bhatti
Keyword(s):  
Undergraduate Students ◽  
Dental Students ◽  
Two Dimensions ◽  
Categorical Variables ◽  
P Value ◽  
Psychomotor Skills ◽  
Continuous Variables ◽  
Chi Square ◽  
Significant Difference ◽  
Second Year

OBJECTIVE: The objective of this study was to compare visuospatial and psychomotor skills of second year pre-clinical dental students with final year dental students using an exercise in dentinal pin placement. METHODOLOGY:A total of 120 BDS undergraduate students who had completed second or final year Operative dentistry rotation were included. While students from second and final year who had not consented to participate or had missed the practical demonstration or whose dentinal pins were misplaced after becoming loose from the tooth were excluded. Participating students placed the dentinal pins, following which Adobe Photoshop (version CC 2014) was used to analyze the photographs of the taken radiographs in two dimensions. Parameters assessed were pulpal perforations, periodontal perforations and pin angulation. Independent sample t-test was used to compare continuous variables while chi-square test was used for testing association for categorical variables. RESULTS: Final year students fared better in all categories of pin placement except periodontal perforation which was the same for both years. Statistically significant difference in the angulation for pin placement were observed between the two student groups in mesiodistal direction (p value =0.001) and in buccolingual direction (p value <.001). CONCLUSION: There is a significant difference in the psychomotor and visuospatial skill of second year pre-clinical when compared with the final year clinical undergraduate students. KEYWORDS: curriculum, dental, learning, operative, students.

scholarly journals Comparing Resident Outcomes in Cataract Surgery at Different Levels of Experience: A retrospective case series

2020 ◽  
Author(s):  
Mathias Melega ◽  
Rodrigo Lira ◽  
Iuri Silva ◽  
Bruna Ferreira ◽  
Hermano Filho ◽  
...  
Keyword(s):  
Intraoperative Complications ◽  
Corneal Thickness ◽  
Case Series ◽  
Statistical Analyses ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Retrospective Case ◽  
Exact Test ◽  
First Semester ◽  
Significant Difference

Abstract BackgroudTo evaluate outcomes of resident-performed cataract surgeries in different training levels in a retrospective case series.MethodsA total of 730 surgeries performed by residents were evaluated into three groups: surgeries performed during residents’ first semester of training in phacoemulsification (S1), surgeries performed during the second semester (S2), and surgeries performed during the third semester (S3). The primary outcome was the incidence of intraoperative complications in each group. Secondary outcomes were the comparisons between initial and final corrected distance visual acuity (CDVA), intraocular pressure (IOP), endothelial cell density (ECD), and central corneal thickness (CCT) in each group. Descriptive statistical analyses were employed in the presentation of the results using central tendency and variance measurements. The groups’ continuous variables were compared using the t-test or ANOVA (parametric variables) or the Mann-Whitney or Kruskal-Wallis tests (non-parametric variables). Statistical analyses of the categorical variables were performed using Fisher’s exact test or the chi-squared test.ResultsThe rate of complications within six weeks of follow up was 24 out of 102 eyes (23.53%) in the S1 group, 63 out of 301 eyes (20.93%) in the S2 group, and 37 out of 327 (11.31%) in the S3 group (p = 0.001). There was no significant difference in CDVA (p = 0.298), ECD (p = 0.067), IOP (p = 0.217), or CCT (p = 0.807) between the groups.ConclusionsWhen measured by rates of complications and by the aforementioned parameters, surgical competency was found to improve as surgical experience and frequency increased. Therefore, this study identified some patterns of skill development that can be applied to teaching strategies and better assist surgeons in training.

scholarly journals 382. Difference in Pathogens Between Hip and Knee Prosthetic Joint Infection

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S198-S198
Author(s):  
Michael Henry ◽  
Milan Kapadia ◽  
Joseph Nguyen; Barry Brause ◽  
Andy O Miller
Keyword(s):  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Chi Square ◽  
Prosthetic Joint ◽  
Significant Difference ◽  
History Of ◽  
The Difference ◽  
Student’S T

Abstract Background There is contradicting evidence characterizing the difference in pathogens that cause hip and knee prosthetic joint infection (PJI). A possible difference in microbiology may inform choice in antibiotic etiology, prophylaxis, and empiric treatment. We sought to analyze a large cohort of PJIs to see whether there was a significant difference in pathogen between joints. Methods A retrospective cohort of hip and knee PJIs, from 2008 to 2016, were identified by ICD code and surgical codes. The PJI pathogen was identified from synovial or intra-articular tissue cultures. The Student’s t-test was used to compare continuous variables. Chi-square tests were used to compare the categorical variables to joint. Results 807 PJI cases were identified including 444 knees and 363 hips. There were no significant differences between hip and knee PJIs in age, sex, history of PJI, rheumatoid arthritis, Charlson comorbidity index and laterality. There was a higher frequency of diabetes in knee PJIs (25.3%) compared with hip PJIs (15.7%), P < 0.001. No significant difference was found in the prevalence of fungal, staphylococcal (including Staphylococcus aureus), streptococcal, or enterococcal pathogens between hip and knee PJIs. Conclusion In this single-center cohort, hip and knees PJIs are infected with similar pathogens. Multiple site studies are needed to characterize the microbiology of PJIs at a larger scale. Disclosures All authors: No reported disclosures.

Shift Length and Shift Length Preference Among Acute Care Surgeons

2021 ◽  
pp. 000313482110257
Author(s):  
John Kepros ◽  
Susan Haag ◽  
Karen Lewandowski ◽  
Frank Bauer ◽  
Hirra Ali ◽  
...  
Keyword(s):  
Acute Care ◽  
Trauma Center ◽  
The United States ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Chi Square ◽  
Significant Difference ◽  
And Gender ◽  
High Level ◽  
Shift Length

Background Work hour restrictions have been imposed by the Accreditation Council for Graduate Medical Education since 2003 for medical trainees. Many acute care surgeons currently work longer shifts but their preferred shift length is not known. Methods The purpose of this study was to characterize the distribution of the current shift length among trauma and acute care surgeons and to identify the surgeons’ preference for shift length. Data collection included a questionnaire with a national administration. Frequencies and percentages are reported for categorical variables and medians and means with SDs are reported for continuous variables. A chi-square test of independence was performed to examine the relation between call shift choice and trauma center level (level 1 and level II), age, and gender. Results Data from 301 surgeons in 42 states included high-level trauma centers. Assuming the number of trauma surgeons in the United States is 4129, a sample of 301 gives the survey a 5% margin of error. The median age was 43 years (M = 46, SD = 9.44) and 33% were female. Currently, only 23.3% of acute care surgeons work a 12-hour shift, although 72% prefer the shorter shift. The preference for shorter shifts was statistically significant. There was no significant difference between call shift length preference and trauma center level, age, or gender. Conclusion Most surgeons currently work longer than 12-hour shifts. Yet, there was a preference for 12-hour shifts indicating there is a gap between current and preferred shift length. These findings have the potential to substantially impact staffing models.

Trained Clinician's Documentation of Serious Illness Conversations and Use of Billing CPT 99497

2021 ◽  
pp. 082585972110491
Author(s):  
Jeanette M. Daly ◽  
Megan E. Schmidt ◽  
Kate DuChene Thoma ◽  
Barcey T. Levy
Keyword(s):  
Risk Score ◽  
Mortality Risk ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Care Program ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Chi Square ◽  
Serious Illness ◽  
Significant Difference

Background Advance care planning (ACP) involves patients and family members in discussions with clinicians about their values, goals, and preferences regarding future medical care. Objectives: To (1) assess whether an ACP conversation using the Serious Illness Conversation (SIC) was initiated and documented; (2) assess which components of SIC were documented; (3) determine how frequently clinicians trained to use the SIC guide used ACP billing codes during the study time period, (4) determine whether there was a significant difference in mortality risk score according to documentation of each component of the SIC. Methods; Thirteen clinicians at three family medicine offices were trained in the Serious Illness Care Program and asked to document SICs in the electronic medical record (EMR). A retrospective chart review of SIC components was conducted in the EMRs of patients who presumably had ACP conversations initiated by the trained clinicians. Patients were identified using the billing codes for ACP conversations and through referrals from another study that requires clinicians to have ACP conversations with their patients. Pearson chi-square test for categorical variables and t-tests for continuous variables were conducted. Results: A total of 157 patients were included in this study; 131 patients referred from another ACP study and an additional 26 patients using the billing codes of ACP conversations. Through retrospective chart review, the mean age of patients was 72 years and 54 were male. Sixty-two (40%) charts had one or more SIC components documented. “Explore key topics” was documented most frequently for 58 (38%) patients by the 13 participating clinicians. Mean mortality risk score was 10.7 and higher scores were significantly correlated with more SIC components documented ( rp = 0.217, P = 0.007). Conclusion: Little use of the SIC guide among trained physicians was found in the EMR. It was expected that provision of an EMR template for documenting the SIC would have facilitated documentation of SICs.

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