1
|
Bashir H, Barkatullah M, Raza A, Mushtaq M, Khan KS, Saber A, Ahmad S. Practices Used to Improve Patient Safety Culture Among Healthcare Professionals in a Tertiary Care Hospital. Glob J Qual Saf Healthc 2024; 7:9-14. [PMID: 38406658 PMCID: PMC10887488 DOI: 10.36401/jqsh-23-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 11/27/2023] [Accepted: 11/30/2023] [Indexed: 02/27/2024]
Abstract
Introduction A patient safety culture primarily refers to the values, beliefs, attitudes, and behaviors within a healthcare setup in a community that assists in prioritizing patient safety and encouraging the reporting of errors and near-misses in that facility. There is a direct impact of patient safety culture on how well patient safety and quality improvement programs work. The aim of this cross-sectional descriptive study was to investigate the practices to improve patient safety culture and adverse event reporting practices among healthcare professionals in a tertiary care hospital located in Mirpur Azad Jammu and Kashmir. Methods In the non-probability convenience sampling of this cross-sectional study, Divisional Headquarters Teaching Hospital in Mirpur, Azad Kashmir used the Agency for Healthcare Research and Quality Surveys on Patient Safety Culture Hospital Survey to collect data about the perceptions of healthcare professionals regarding patient safety culture within their hospital to assess the trends of patient safety culture by obtaining longitudinal data. A pre-validated questionnaire that has undergone a rigorous trial of testing to maximize the reliability and accuracy of the outcomes was distributed among clinical staff (healthcare professionals who interact with patients on a daily basis, such as nurses, doctors, pharmacists, and laboratory technicians) and administrative staff (medical superintendent, deputy medical superintendent, assistant medical superintendent, heads of departments). Results A total of 312 questionnaires were returned (response rate, 76%). The study found that the dimension "supervisor/manager expectation and action promoting safety" had the highest positive response rate (65.16%), and "nonpunitive response" had the lowest (27.4%). Higher scores in "nonpunitive response to error" were associated with lower rates of medication errors, pressure ulcers, and surgical site infections, and higher scores in "frequency of event reporting" were associated with lower rates of medication errors, pressure ulcers, falls, hospital-acquired infections, and urinary tract infections. Conclusion We suggest that in order for hospital staff to continue providing excellent, clinically safe treatment, a well-structured hospital culture promoting patient safety is necessary. Moreover, further study is needed to determine strategies to improve patient safety expertise and awareness, and lower the frequency of adverse occurrences.
Collapse
Affiliation(s)
- Haroon Bashir
- Department of Public Health, Health Services Academy, Islamabad, Pakistan
| | - Maira Barkatullah
- Department of Public Health, Health Services Academy, Islamabad, Pakistan
| | - Arslan Raza
- Department of Public Health, Health Services Academy, Islamabad, Pakistan
| | - Muddasar Mushtaq
- Department of Epidemiology and Biostatistics, Health Services Academy, Islamabad, Pakistan
| | | | - Awais Saber
- School of Health and Life Sciences, Glasgow Caledonian University, London, UK
| | - Shahid Ahmad
- Akson College of Pharmacy, Mirpur University of Science and Technology, Kashmir, Pakistan
| |
Collapse
|
2
|
Dasari P, Sastry JG, Thulasingam M, Fisher J, Chandrasekaran N. Determinants of respectful maternity care at a tertiary care teaching institute in South India: A mixed-methods study. Int J Gynaecol Obstet 2024; 164:721-731. [PMID: 37589210 DOI: 10.1002/ijgo.15034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/16/2023] [Accepted: 07/25/2023] [Indexed: 08/18/2023]
Abstract
OBJECTIVE To determine the proportion of women who experienced disrespect and abuse (D&A) and the type of D&A during labor and postpartum, and to determine the factors significantly associated with D&A. METHODS A cross-sectional mixed-methods study undertaken in tertiary care teaching institute South India. After ethical approval, 380 postpartum women within 72 h of delivery were recruited for the study. The determinants of respectful maternity care (RMC) were assessed quantitatively and qualitatively. For quantitative assessment, they were interviewed using questionnaires adopted from the United States Agency for International Development- Maternal and Child Health Integrated Program (USAID-MCHIP) protocol, which has verification criteria for RMC. As a second method for quantitative assessment, they were asked to rate the care from their perspective on a 10-point score. For the qualitative component, they were asked to identify the healthcare workers associated with D&A by their designation and to answer three open-ended questions. IBM SPSS Statistics 25 (IBM Corporation, Statistical Package for Social Sciences, version 25) was used for analysis. D&A as per RMC standards I-VII and its severity were expressed as frequencies and percentages with 95% confidence interval. Univariate analysis was used to determine the associated factors, and severity was determined by χ2 test. RESULTS The prevalence of D&A was high (85%) according to the RMC standards of the USAID-MCHIP questionnaire, whereas it was only 33% according to women's perspective. The most common type of D&A was non-dignified care. The factors significantly associated with D&A were women over 25 years, those admitted as an emergency referral, having a recommendation letter, and relatives working at the same healthcare facility. CONCLUSION The prevalence of D&A was high as measured by the USAID-MCHIP questionnaire, and the most common type was non-dignified care followed by physical abuse.
Collapse
Affiliation(s)
- Papa Dasari
- Department of Obstetrics & Gynaecology, JIPMER, Puducherry, India
| | - Jaya Gowri Sastry
- Global and Women's Health, Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | | | - Jane Fisher
- Division of Social Sciences, Global and Women's Health, Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | | |
Collapse
|
3
|
Ali S, Tyerman J. Palliative Care for the Elderly With Heart Diseases in Tertiary Health care: A Concept Analysis. Am J Hosp Palliat Care 2023:10499091231213606. [PMID: 37963548 DOI: 10.1177/10499091231213606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND The increasing incidence of heart failure (HF) in the elderly leads to increased mortality, hospitalization, length of hospital stay, and health care costs. Older adults often face multiple drug treatments, comorbidities, frailty, and cognitive problems, which require early palliative care. However, these patients do not receive adequate palliative care. OBJECTIVE This concept analysis aimed to develop an in-depth understanding of palliative care for elderly patients with cardiac diseases in tertiary care. DESIGN The analysis was guided by Walker and Avant's method, and databases were searched using keywords, such as palliative care, tertiary care, elderly, and heart. Covidence was used to review the results using the inclusion and exclusion criteria. RESULTS The World Health Organisation's definition of palliative care is widely accepted. Palliative care for older adults with heart disease in tertiary care is preceded by chronic illness, polypharmacy, symptom burden, physical and cognitive decline, comorbidities, and psychosocial/spiritual issues. The main attributes of palliative care for this population include health care professionals and patient education, holistic patient/family-centered care, symptom management, shared decision-making, early integration, advanced care planning, and a multidisciplinary approach. Palliative care improves elderly cardiac patients' and their family satisfaction while reducing readmission, hospital stays, and unnecessary invasive procedures. CONCLUSION Collaboration between hospitals, community organizations, transitional palliative care services, and research has the potential to improve early palliative care and the well-being of the elderly cardiac population. Advanced Practice Nurses (APNs) competencies play a crucial role in promoting palliative care in the elderly HF population.
Collapse
Affiliation(s)
- Sana Ali
- School of Nursing, Faculty of Health Sciences, The University of Ottawa, Ottawa, ON, Canada
| | - Jane Tyerman
- School of Nursing, Faculty of Health Sciences, The University of Ottawa, Ottawa, ON, Canada
| |
Collapse
|
4
|
Ezemenahi SI, Alabi AN, Ogunfowokan O, Nwaneli CU, Aigbokhaode AQ, Eseigbe P. Quality of life of hypertensive men with erectile dysfunction in a tertiary health centre in southern Nigeria. Afr J Prim Health Care Fam Med 2023; 15:e1-e7. [PMID: 37132563 PMCID: PMC10157441 DOI: 10.4102/phcfm.v15i1.3875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 01/18/2023] [Accepted: 03/08/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Erectile dysfunction (ED) is the most common disorder of sexual health seen in men in community studies. A man's sexual health has been found to be a key factor in determining the capacity for maintaining a healthy relationship. AIM This study sought to determine the quality of life of hypertensive men with ED attending the out-patient clinics of Federal Medical Centre (FMC), Asaba, South-South, Nigeria. SETTING This study was conducted in the Out Patients Clinics (OPC) of FMC, Asaba, Delta state, Nigeria. METHODS After obtaining approval from the ethics and research committees in Asaba, 184 consenting hypertensive men who met the eligibility criteria were selected by systematic random sampling to participate in the study from October 2015 to January 2016. This study was a cross-sectional survey. Data were collected with a semi-structured interviewer-administered questionnaire adopted from the international index of Sexual Health Inventory for Men (SHIM) and the World Health Organization Quality of Life Scale (WHOQOL-BREF). The study complied with the principles of Helsinki and Good Clinical Practice. RESULTS The results showed the mean score for physical domain (58.78 ± 24.37), the psychological domain (62.68 ± 25.93), the social domain (50.47 ± 29.09), and the environmental domain (62.25 ± 18.52). Over a fifth, 11 (22.0%), of the respondents with severe ED had poor quality of life. CONCLUSION This study showed that ED is common in hypertensive men and their quality of life was more impaired than those with normal erectile function.Contribution: This study contributes to holistic approaches to patient care.
Collapse
Affiliation(s)
- Silvia I Ezemenahi
- Department of Family Medicine, Faculty of Medicine, Nnamdi Azikiwe University, Awka, Nigeria; and Department of Family Medicine, Faculty of Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi.
| | | | | | | | | | | |
Collapse
|
5
|
Mendoza-Vázquez G, Guzmán-Silahua S, Gamez-Nava JI, Gonzalez-Lopez L, Salazar-Paramo M, Espinoza-Gómez F, Riebeling-Navarro C, Espinel-Bermúdez MC, Nava-Zavala AH. The Hypertriglyceridemic Waist Phenotype Is Associated with Several Cardiovascular Risk Factors in Women with Rheumatoid Arthritis. Healthcare (Basel) 2023; 11. [PMID: 36766980 DOI: 10.3390/healthcare11030405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 02/04/2023] Open
Abstract
Rheumatoid arthritis (RA) associates with cardiovascular risk factors (CVRF) such as dyslipidemias and systemic inflammation. Cardiovascular Disease (CVD) is the leading cause of mortality. The hypertriglyceridemic waist phenotype (HTWP) identifies increased CVRF; however, information about HTWP on RA is scarce. OBJECTIVE To evaluate the association of HTWP with CVRF in RA. MATERIAL AND METHODS Cross-sectional study. Women (125) with RA were included (ACR, 1987). Anthropometry, bioimpedance, body mass index (BMI), disease activity score 28 (DAS28), and health assessment questionnaire disability index (HAQ-Di) were determined. The lipid profile determination includes the atherogenic index (AI) (TC/HDL) and Framingham Risk Score. HTWP is defined as a waist circumference ≥88 cm and triglycerides ≥ 150 mg/dL. Chi-squared and Student's t-tests were applied for comparisons. RESULTS HTWP was found in 38 (30.4%) patients. The subgroup with HTWP had a greater frequency of arterial hypertension (AHT) (57.9 vs. 37.9, p = 0.04), Type 2 DM (23.7 vs. 8.0, p= 0.02), BMI (29.7 ± 3.2, vs. 26.8 ± 4.3, p < 0.001), fat mass (39.3 ± 4.8 vs. 34.7 ± 6.8, p < 0.001), and AI (4.7 ± 1.2 vs. 3.7 ± 1.0, p < 0.001). No differences between DAS28 and HAQ-Di were found. HTWP was associated with the presence of MetS and CVR (p < 0.001 and p = 0.012, respectively). CONCLUSION The HTWP in RA is associated with CVRF, and its potential predictive role should be evaluated in longitudinal studies.
Collapse
|
6
|
Kammerer E, Eszczuk J, Caldwell K, Dunn J, Appelman-Eszczuk S, Dunn J, MacNeil M, Ali S. A Qualitative Study of the Pain Experiences of Children and Their Parents at a Canadian Children's Hospital. Children (Basel) 2022; 9:children9121796. [PMID: 36553240 PMCID: PMC9777277 DOI: 10.3390/children9121796] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/15/2022] [Accepted: 11/18/2022] [Indexed: 11/24/2022]
Abstract
Current literature is lacking in describing families' experiences in being involved in children's pain management. This study sought to understand children and their parents' experiences with pain management at a tertiary care children's hospital. Twelve child-parent dyads were recruited to participate in the study from January to August 2022. Children and their parents chose whether to be interviewed together or separately. Transcripts were analyzed using inductive, data-driven codes. Codes and themes were developed using a codebook and member-checking. Three main themes were identified: a. Painful experiences can have a significant positive or negative effect on families' lives and healthcare trajectories; b. There can be a mismatch between families' expectations of pain management and how they perceive the pain was managed; c. Families feel that they must advocate for better pain care, but often feel too intimidated to do so, or worry that their concerns will be dismissed by healthcare professionals. Families want healthcare professionals to proactively manage their children's pain, supporting the shaping of early positive memories of the child's healthcare interactions. Healthcare providers must further recognize that poorly treated pain can significantly impact families' lives and should both seek and be receptive to child and parent input for better pain care.
Collapse
Affiliation(s)
- Elise Kammerer
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 1C9, Canada
- Women and Children’s Health Research Institute, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Joshua Eszczuk
- Faculty of Kinesiology, University of Alberta, Edmonton, AB T6G 2H9, Canada
| | - Katie Caldwell
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada
| | - Jacob Dunn
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada
| | | | - Jennifer Dunn
- Alberta Health Services, Edmonton, AB T6G 2B7, Canada
| | - Megan MacNeil
- Women and Children’s Health Research Institute, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 1C9, Canada
- School of Public Health, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Samina Ali
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 1C9, Canada
- Women and Children’s Health Research Institute, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 1C9, Canada
- Correspondence:
| |
Collapse
|
7
|
Chebil D, Belhadj M, Aidi M, Hannachi H, Barhoumi T, Merzougui L. Patients' perception of the quality of care at the Ibn Al Jazzar University Hospital in Kairouan, Tunisia. Tunis Med 2022; 100:618-625. [PMID: 36571730 PMCID: PMC9744126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AIM This study aims to evaluate the level of satisfaction of patients hospitalized at Ibn Al Jazzar University Hospital of Kairouan in 2018. METHODS It's a descriptive cross-sectional study including all patients hospitalized at Ibn Al Jazzar University Hospital in Kairouan over a period of three months, from January 1 to March 31, 2018. The survey was conducted using a questionnaire made up of 27 items to explore seven specific dimensions of satisfaction. RESULTS A total of 640 patients was included in the study. The overall satisfaction rate was 41.7%. The dimensions of globality and hospital stay were the least appreciated by hospitalized patients with respective satisfaction rates of 14.4% and 18.3%. Access to care was the most appreciated area with a satisfaction rate of 58.9%. the lowest satisfaction rates, among the items studied at the Kairouan University Hospital in 2018 were: «the places of visits» (9%), «the quality of the catering» (20%), « tranquillity" (23%), and "attentiveness of staff to patient needs" (23%). CONCLUSION At Ibn Al Jazzar University hospital of Kairouan, patient satisfaction was low regarding the quality of the services provided, particularly for areas related to the conditions of stay and the globality of care. Intervention measures based on these shortcomings should be undertaken.
Collapse
Affiliation(s)
- Dhekra Chebil
- 1. Service de médecine préventive, Hôpital Universitaire Ibn Al Jazzar de Kairouan, Tunisie.,2. Faculté de médecine de Sousse, Université de Sousse, Tunisie.
| | - Maha Belhadj
- 2. Faculté de médecine de Sousse, Université de Sousse, Tunisie.
| | - Mokhtar Aidi
- 3. Hôpital universitaire Ibn Al Jazzar de Kairouan, Tunisie.
| | - Hajer Hannachi
- 1. Service de médecine préventive, Hôpital Universitaire Ibn Al Jazzar de Kairouan, Tunisie.
| | | | - Latifa Merzougui
- 1. Service de médecine préventive, Hôpital Universitaire Ibn Al Jazzar de Kairouan, Tunisie.,2. Faculté de médecine de Sousse, Université de Sousse, Tunisie.
| |
Collapse
|
8
|
Nøst TH, Woodhouse A, Dale LO, Hara KW, Steinsbekk A. Participants' experiences from group-based treatment at multidisciplinary pain centres - a qualitative study. Scand J Pain 2022; 22:365-373. [PMID: 34453878 DOI: 10.1515/sjpain-2021-0099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 08/13/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aim of the study was to explore the experiences of participants in non-pharmacological group-based treatments delivered as part of a randomised controlled trial at Norwegian tertiary care pain centres. METHODS Individual semi-structured interviews with 15 persons were conducted. The data were analysed with a descriptive thematic cross-case analysis based on the method of systematic text condensation. RESULTS All participants talked about some aspects of the group-based treatments as a positive experience, but mainly the outcome was in line with their expectations; they hoped it would reduce their pain but did not expect it. There were no clear-cut differences in the experiences between the participants from the two different intervention groups. The content was experienced as both relevant and interesting but also to introduce concepts that were difficult to grasp and understand. Similarly, the experiences of participating in a group-based treatment were mostly stimulating but could also be challenging because of an expectancy of sharing personal stories. Although experiencing few changes to their pain they came away with techniques and lessons that were valuable to them. CONCLUSIONS In this study, taking part in group-based treatment was perceived as giving positive and valuable lessons, due to relevant content and learning from the professionals and fellow participants, but without any clear indication of reduced pain. Approval from ethical committee number 10260 REK Midt. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT04057144.
Collapse
Affiliation(s)
- Torunn Hatlen Nøst
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Norwegian Advisory Unit on Complex Symptom Disorders, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
| | - Astrid Woodhouse
- Norwegian Advisory Unit on Complex Symptom Disorders, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lars-Oskar Dale
- Norwegian Advisory Unit on Complex Symptom Disorders, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
| | - Karen Walseth Hara
- Norwegian Advisory Unit on Complex Symptom Disorders, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- The Norwegian Labour and Welfare Service of Trøndelag, Trondheim, Norway
| | - Aslak Steinsbekk
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Digital health care unit, Norwegian Centre for E-Health Research, Tromsø, Norway
| |
Collapse
|
9
|
Chellaiyan DVG, Gupta S, Britto JJ, Kamble B. Job Satisfaction among Resident Doctors of a Tertiary Care Hospital in South Delhi. Indian J Occup Environ Med 2022; 26:151-156. [PMID: 36408434 PMCID: PMC9674073 DOI: 10.4103/ijoem.ijoem_319_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 01/04/2022] [Accepted: 03/12/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Doctors' job satisfaction is crucial to the health service to ensure commitment, effective training, service provision, and retention. Job satisfaction matters to doctors for their happiness, fulfilment, service to patients, and duty to employers. The quality of performance in the health sector to a large extent depends on whether healthcare providers are job-satisfied or dissatisfied. OBJECTIVES This study assessed the level and factors determining job satisfaction among resident doctors in a federal tertiary institution. MATERIAL AND METHODS A cross-sectional study was conducted among the resident doctors of a government tertiary care hospital. Data were collected using a self-reported questionnaire consisting of 49 items under seven domains of job satisfaction, where higher values indicated a higher level of satisfaction. The average scores of items were computed to construct factor scores for each individual. A Chi-square test was applied. RESULTS The proportion of job satisfaction among resident doctors was found to be 80.9%. On adjustment, the odds of being satisfied were found to be higher in the older age groups, among males, and doctors posted in clinical departments. CONCLUSION Most respondents in this study were satisfied with their jobs with minorities satisfied with their monetary and infrastructure facilities. There is a need to address these issues to enhance healthcare quality, especially in the public sector.
Collapse
Affiliation(s)
- D Vinoth Gnana Chellaiyan
- Department of Community Medicine, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education (CARE), Kelembakkam, Kancheepuram District, Tamil Nadu, India
| | - Sujata Gupta
- Department of Community Medicine, Government Medical College, Kathua, Jammu and Kashmir, India
| | - J Jennifer Britto
- Department of Obstetrics and Gynceology, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, OMR- Kelambakkam, Chennai, Tamil Nadu, India,Address for correspondence: Dr. Jennifer Britto J, Assistant Professor, Department of Obstetrics and Gynceology, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, OMR- Kelambakkam, Chennai - 603 103, Tamil Nadu, India. E-mail:
| | - Bhusan Kamble
- Department of Community Medicine All India Institute of Medical Sciences, BiBi Nagar, Telangana, India
| |
Collapse
|
10
|
Abstract
The emergence of targeted and precision therapies has increased treatment options for people living with cancer. Of particular note is the development and approval of chimeric antigen receptor (CAR) T-cell therapies that involve the use of a patient's own immune system to treat cancers that have proven resistant to other approaches. Keeping abreast of treatment changes and practice guidelines is a challenge for all healthcare professionals, and the pressure of doing so becomes most acute with innovations in cancer therapeutics that have the potential to extend or save lives. Though uncommon, step changes like CAR T-cell therapy pose a challenge, often requiring completely new ways of thinking about efficacy evidence, basic science, ethics and service delivery. At a time when patients are able and empowered to readily access information about novel and exploratory treatments, healthcare professionals need to feel informed enough to help patients with life-changing or life-limiting cancers who approach them for advice. This article gives an overview of the basic principles of CAR T-cell therapy including how it is delivered, who is eligible to receive it in the UK, and a brief outline of current evidence of its efficacy and safety. The information is intended to provide healthcare professionals with an introduction to CAR T-cell therapy to help them advise potentially eligible patients or those already undergoing treatment about what to expect.
Collapse
|
11
|
Metzinger C, Antonios S, Kallail KJ, Okut H, Zackula R, Cline B. Analysis of Patient Handoff Between Providers at a Tertiary Urban Medical Center. Kans J Med 2021; 14:192-196. [PMID: 34367488 PMCID: PMC8343488 DOI: 10.17161/kjm.vol1415170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 04/14/2021] [Indexed: 12/21/2022] Open
Abstract
Introduction Few studies have quantified the total number of attending and consulting physicians involved in inpatients’ care, and no other research quantifies the total number of all providers participating in inpatients’ care. The purpose of this study was to calculate the number of attending hand-offs, the attending encounter time, and the total number of providers participating in inpatients’ care for all admitted patients at a tertiary urban medical center. Methods The study design was an observational retrospective cohort. Subjects included pediatric and adult patients who were admitted to and discharged from Ascension Via Christi St. Francis (AVCSF) in Wichita, Kansas between November 1, 2019 and January 31, 2020. Data were abstracted from the Cerner Electronic Medical Record. Variables included: patient demographics, admitting diagnosis, diagnosis related group (DRG), admission service, and duration of inpatient stay. Provider variables abstracted included provider type and provider specialty. Categorical variables were presented as frequencies and percentages, while continuous variables were presented as means ± standard deviation. Results The sample included information from 200 patient charts. Patients’ ages ranged from 5 to 94 years, with a mean of 61 years. Approximately 52% were female and 74.9% were admitted to a surgical service. The length of all inpatients’ stays ranged from less than 1 day to 31 days, with a mean of 4 days. Seventy-six different DRGs were recorded. The most frequent attending specialties were hospital medicine, internal medicine, general surgery, and interventional cardiology. Consulting physicians had more patient encounters than any other healthcare provider. For all inpatients, an average of two attending physicians participated in care over the duration of their stay with a range of one to six attending physicians. There was an average of one hand-off between attending physicians. Patients had an average of five consulting physicians, two resident physicians, two physician assistants, and two nurse practitioners during a stay. There was an average of 10 total providers, with a range of one to 46 total providers participating in care. Conclusions Understanding the provider data surrounding an inpatient stay is a foundational step in assessing the quality of the provider-inpatient encounter and potential areas for improvement. In this study, the average number of attending physicians and handoffs was reasonable; however, the total number of providers involved in care was relatively high. Assessment of staffing and scheduling requirements by hospital administration could identify areas of improvement to reduce the potential for medical error caused by multiple providers being involved in patient care.
Collapse
Affiliation(s)
| | - Sam Antonios
- Ascension Via Christi St. Francis, Wichita, KS.,Department of Internal Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - K James Kallail
- Department of Internal Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS.,Office of Research, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Hayrettin Okut
- Office of Research, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Rosey Zackula
- Office of Research, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Brianna Cline
- Department of Internal Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS
| |
Collapse
|
12
|
Shahid S, Raza M, Junejo S, Maqsood S. Clinical features and outcome of COVID-19 positive children from a tertiary healthcare hospital in Karachi. J Med Virol 2021; 93:5988-5997. [PMID: 34228363 PMCID: PMC8427002 DOI: 10.1002/jmv.27178] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/22/2021] [Accepted: 07/01/2021] [Indexed: 12/28/2022]
Abstract
As the coronavirus disease 2019 (COVID‐19) pandemic continues to evolve, differences in epidemiological and clinical features among pediatrics have been noticed across different countries. We describe the spectrum of COVID‐19 in pediatric patients treated in tertiary health care. We conducted a retrospective chart review of pediatric patients admitted to Indus Hospital & Health care network, Korangi campus, Karachi; from April 1st, 2020 to July 31st, 2020. A total of 141 COVID‐19 cases were reported, males were 81 (57%) and the median age was 8 (0.3–17) years. Moderate and severe infections were noted in 36(26%), and 17(12%) children respectively. Fever (50%) was the most common clinical feature. The SF ratio less than 264 was significantly associated with severe disease (p < .05). Lab investigations that differed significantly across disease severity groups included IL‐6 levels (p < .01) and Prothrombin time (p < .05). Majority of children were advised home isolation 89 (63%), 29 (20.5%) were admitted while mortality was observed in 10 (7%) children. No significant difference was observed between children with and without malignancy. Pre‐existing comorbidities are significantly associated with COVID‐19 infections among children. Reduced SF ratio, elevated Prothrombin time, and interleukin‐6 levels are associated with greater disease severity.
Collapse
Affiliation(s)
- Saba Shahid
- Department of Pediatrics, The Indus Hospital & Health network, Karachi, Pakistan
| | - Mohammad Raza
- Department of Pediatrics, The Indus Hospital & Health network, Karachi, Pakistan
| | - Samina Junejo
- Department of Pediatrics, The Indus Hospital & Health network, Karachi, Pakistan
| | - Sidra Maqsood
- Indus hospital Research Centre, Indus Hospital and Health network, Karachi, Pakistan
| |
Collapse
|
13
|
Fadare JO, Obimakinde AM, Aina FO, Araromi EJ, Adegbuyi TA, Osasona OE, Agbesanwa TA. Anti-Cholinergic Drug Burden Among Ambulatory Elderly Patients in a Nigerian Tertiary Healthcare Facility. Front Pharmacol 2021; 12:580152. [PMID: 33584317 PMCID: PMC7878669 DOI: 10.3389/fphar.2021.580152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 01/04/2021] [Indexed: 01/25/2023] Open
Abstract
Background: The use of drugs with anticholinergic effects among elderly patients is associated with adverse clinical outcomes. There is paucity of information about anticholinergic drug burden among Nigerian elderly population. Objectives: To determine the anticholinergic drug burden among elderly Nigerian patients. Methods: This was a retrospective cross-sectional study conducted among elderly patients (aged 65 and above) who visited the Family Medicine outpatients' clinics of the Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria between July 1 and October 31, 2018. Information extracted from the case files included patient's age, sex, diagnoses, and list of prescribed medications. Medicines with anticholinergic effects were identified and scored using the anticholinergic drug burden calculator (http://www.acbcalc.com). Results: The medical records of 400 patients were analyzed with females accounting for 60.5% of the study population. The mean age of participants was 73 ± 7.4 years with only 28 (7%) of patients having more than two co-morbid conditions. Polypharmacy was identified in 152 (38%) of the patients while 147 (36.7%) had drugs with anticholinergic effects prescribed. The anticholinergic burden was high in 60 (15%) patients. Polypharmacy was significantly associated with having more than two diagnosed conditions and high anticholinergic burden (p value of < 0 .001 and 0.013 respectively). There was significant correlation between total number of prescribed drugs and count of diagnoses (r = 0.598; p < 0 .000) and between total number of prescribed drugs and number of drugs with anticholinergic effects (r = 0 .196; p < 0 .000). Conclusion: The anticholinergic burden in this group of elderly Nigerian patients was low; majority (67%) had no exposure to drugs with anticholinergic effects with only 15% having high anticholinergic burden. Polypharmacy and multiple diagnosed conditions were positively associated with high anticholinergic burden. Based on the positive and significant correlations found in this study, a reduction in the number of prescribed medicines especially those with significant anticholinergic effects used for secondary indications may lessen the anticholinergic burden among the elderly.
Collapse
Affiliation(s)
- Joseph O. Fadare
- Department of Pharmacology and Therapeutics, College of Medicine, Ekiti State University, Ado-Ekiti, Nigeria
- Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Abimbola Margaret Obimakinde
- Department of Community Medicine, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Family Medicine, University College Hospital Ibadan, Ibadan, Nigeria
| | - Felix O. Aina
- Department of Family Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Ebisola J. Araromi
- Department of Pharmacology and Therapeutics, College of Medicine, Ekiti State University, Ado-Ekiti, Nigeria
| | | | - Oluwatoba E. Osasona
- Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Tosin A. Agbesanwa
- Department of Family Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| |
Collapse
|
14
|
Glyn TC, Ho MWJ, Lambert AP, Thomas JDJ, Douek IF, Andrews RC, King RJ. Patients with morbid obesity should not be routinely screened for Cushing's syndrome: Results of retrospective study of patients attending a specialist weight management service. Clin Obes 2020; 10:e12358. [PMID: 31994330 DOI: 10.1111/cob.12358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 01/15/2020] [Accepted: 01/16/2020] [Indexed: 11/30/2022]
Abstract
Cushing's syndrome (CS) is a rare condition which results in multi-system involvement and can lead to significant morbidity and mortality. Screening for CS in patients with obesity has been suggested to identify undiagnosed or occult cases. This study was performed to determine whether CS screening is indicated in a tier 3 weight management centre in the UK. A retrospective review of all patients referred to the weight management service between 2013 and 2016 inclusive was undertaken. A final cohort of 569 patients was obtained. Clinic letters and laboratory databases were used to obtain demographic information, patient characteristics and biochemical results. A total of 387 patients were screened using the 1 mg overnight dexamethasone suppression test (ODST) and 182 patients were screened with two 24-hour urinary free cortisol (UFC) collections. A total of 27 patients had an initial abnormal result, of which 16 underwent further testing and had normal results. Six were reviewed and did not demonstrate any clinical features of CS. Five did not attend their clinic appointments but there were neither concerning features within their referrals, nor subsequent diagnoses of CS made. No patients from this cohort were diagnosed with CS. This study does not support routine CS screening of patients affected by severe obesity referred to a specialist tier 3 weight management service. Clinical assessment should be undertaken first and further investigations performed only if deemed necessary.
Collapse
Affiliation(s)
- Tessa Carlin Glyn
- Taunton Weight Management Service, Musgrove Park Hospital, Taunton, UK
| | - May Wai-Jing Ho
- Taunton Weight Management Service, Musgrove Park Hospital, Taunton, UK
| | | | | | | | | | - Rhodri James King
- Taunton Weight Management Service, Musgrove Park Hospital, Taunton, UK
| |
Collapse
|
15
|
Geake J, Ballard E, O'Rourke P, Wainwright CE, Reid DW, Bell SC. Centralised versus outreach models of cystic fibrosis care should be tailored to the needs of the individual patient. Intern Med J 2020; 50:232-235. [PMID: 32037704 DOI: 10.1111/imj.14724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/31/2019] [Accepted: 07/31/2019] [Indexed: 11/28/2022]
Abstract
Cystic fibrosis (CF) is a common life-limiting genetic condition. As the disease progresses access to specialist tertiary multi-disciplinary care services may become necessary. For patients living in regional/remote Australia, accessing such services may be a challenge. Here, we describe long-term outcomes for CF patients according to their access to specialist CF centre care in childhood.
Collapse
Affiliation(s)
- James Geake
- Department of Respiratory and Sleep Medicine, Lyell McEwin Hospital, Adelaide, South Australia, Australia.,Department of Respiratory and Sleep Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Emma Ballard
- Department of Lung Inflammation and Infection, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Peter O'Rourke
- Department of Lung Inflammation and Infection, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Claire E Wainwright
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - David W Reid
- Department of Lung Inflammation and Infection, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Scott C Bell
- Department of Lung Inflammation and Infection, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Brisbane, Queensland, Australia
| |
Collapse
|
16
|
van Krugten FCW, Goorden M, van Balkom AJLM, Spijker J, Brouwer WBF, Hakkaart‐van Roijen L. Indicators to facilitate the early identification of patients with major depressive disorder in need of highly specialized care: A concept mapping study. Depress Anxiety 2018; 35:346-352. [PMID: 29575387 PMCID: PMC6282616 DOI: 10.1002/da.22741] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 02/01/2018] [Accepted: 02/09/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Early identification of the subgroup of patients with major depressive disorder (MDD) in need of highly specialized care could enhance personalized intervention. This, in turn, may reduce the number of treatment steps needed to achieve and sustain an adequate treatment response. The aim of this study was to identify patient-related indicators that could facilitate the early identification of the subgroup of patients with MDD in need of highly specialized care. METHODS Initial patient indicators were derived from a systematic review. Subsequently, a structured conceptualization methodology known as concept mapping was employed to complement the initial list of indicators by clinical expertise and develop a consensus-based conceptual framework. Subject-matter experts were invited to participate in the subsequent steps (brainstorming, sorting, and rating) of the concept mapping process. A final concept map solution was generated using nonmetric multidimensional scaling and agglomerative hierarchical cluster analyses. RESULTS In total, 67 subject-matter experts participated in the concept mapping process. The final concept map revealed the following 10 major clusters of indicators: 1-depression severity, 2-onset and (treatment) course, 3-comorbid personality disorder, 4-comorbid substance use disorder, 5-other psychiatric comorbidity, 6-somatic comorbidity, 7-maladaptive coping, 8-childhood trauma, 9-social factors, and 10-psychosocial dysfunction. CONCLUSIONS The study findings highlight the need for a comprehensive assessment of patient indicators in determining the need for highly specialized care, and suggest that the treatment allocation of patients with MDD to highly specialized mental healthcare settings should be guided by the assessment of clinical and nonclinical patient factors.
Collapse
Affiliation(s)
- F. C. W. van Krugten
- Erasmus School of Health Policy & ManagementErasmus University RotterdamRotterdamThe Netherlands
| | - M. Goorden
- Erasmus School of Health Policy & ManagementErasmus University RotterdamRotterdamThe Netherlands
| | - A. J. L. M. van Balkom
- Department of PsychiatryVU University Medical CenterAmsterdamThe Netherlands,GGZ inGeestAmsterdamThe Netherlands
| | - J. Spijker
- Behavioural Science InstituteRadboud University Medical CenterNijmegenThe Netherlands,Pro Persona Mental Health CareNijmegenThe Netherlands
| | - W. B. F. Brouwer
- Erasmus School of Health Policy & ManagementErasmus University RotterdamRotterdamThe Netherlands
| | - L. Hakkaart‐van Roijen
- Erasmus School of Health Policy & ManagementErasmus University RotterdamRotterdamThe Netherlands
| | | |
Collapse
|
17
|
Nombela-Monterroso K, González-Chordá VM, Roman P. Descriptive study of the Specialized Care of the Spanish Health System. Rev Saude Publica 2018; 52:5. [PMID: 29412372 PMCID: PMC5802722 DOI: 10.11606/s1518-8787.2018052000289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 02/02/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The objective of this study is to analyze the trend of the Key Indicators of the National Health System of Spain and its autonomous communities, related to Specialized Care, from the publication of the Law of Cohesion and Quality. METHODS This is an ecological study of temporary series of Spain and its autonomous communities from 2003 to 2014. We have analyzed 10 indicators related to Specialized Care (percentage of expenditure, professionals, waiting lists, surgical activity, average duration, infections, and mortality) using the Prais-Winsten regression method. We have obtained data from the health information system of the Spanish Ministry of Health, Social Services, and Equality. RESULTS Specialized care expenditure (APC = 0.059, 95%CI 0.041-0.074), number of medical professionals (APC = 0.0006, 95%CI 0.0003-0.0009) and nursing professionals (APC = 0.001, 95%CI 0.0005-0.0016), hospital infections (APC = 0.0003, 95%CI 0.0002-0.0004), and in-hospital mortality (APC = 0.0008, 95%CI 0.0006-0.001) had an increasing trend in Spain. Average duration presented a decreasing trend (APC = -0.0017, 95%CI -0.002- -0.0014). The trend of waiting lists (specialized appointment and non-urgent surgical interventions) was static. The trend of these indicators varied in the Autonomous Communities. CONCLUSIONS We have observed a non-compliance with the principles of equity and quality of the services offered. Increased aging, technological development, and inadequate strategies taken to reduce health costs may be the main causes.
Collapse
Affiliation(s)
| | | | - Pablo Roman
- Universidad Jaume I. Departamento de Enfermería. Castellón, España
- Universidad de Almería. Departamento de Enfermería, Fisioterapia y Medicina. Almería, España
| |
Collapse
|
18
|
Bouslama M, Haussen DC, Aghaebrahim A, Grossberg JA, Walker G, Rangaraju S, Horev A, Frankel MR, Nogueira RG, Jovin TG, Jadhav AP. Predictors of Good Outcome After Endovascular Therapy for Vertebrobasilar Occlusion Stroke. Stroke 2017; 48:3252-3257. [PMID: 29089457 DOI: 10.1161/strokeaha.117.018270] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 09/05/2017] [Accepted: 09/08/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Endovascular therapy is increasingly used in acute ischemic stroke treatment and is now considered the gold standard approach for selected patient populations. Prior studies have demonstrated that eventual patient outcomes depend on both patient-specific factors and procedural considerations. However, these factors remain unclear for acute basilar artery occlusion stroke. We sought to determine prognostic factors of good outcome in acute posterior circulation large vessel occlusion strokes treated with endovascular therapy. METHODS We reviewed our prospectively collected endovascular databases at 2 US tertiary care academic institutions for patients with acute posterior circulation strokes from September 2005 to September 2015 who had 3-month modified Rankin Scale documented. Baseline characteristics, procedural data, and outcomes were evaluated. A good outcome was defined as a 90-day modified Rankin Scale score of 0 to 2. The association between clinical and procedural parameters and functional outcome was assessed. RESULTS A total of 214 patients qualified for the study. Smoking status, creatinine levels, baseline National Institutes of Health Stroke Scale score, anesthesia modality (conscious sedation versus general anesthesia), procedural length, and reperfusion status were significantly associated with good outcomes in the univariate analysis. Multivariate logistic regression indicated that only smoking (odds ratio=2.61; 95% confidence interval, 1.23-5.56; P=0.013), low baseline National Institutes of Health Stroke Scale score (odds ratio=1.09; 95% confidence interval, 1.04-1.13; P<0.0001), and successful reperfusion status (odds ratio=10.80; 95% confidence interval, 1.36-85.96; P=0.025) were associated with good outcome. CONCLUSIONS In our retrospective case series, only smoking, low baseline National Institutes of Health Stroke Scale score, and successful reperfusion status were associated with good outcome in patients with posterior circulation stroke treated with endovascular therapy.
Collapse
Affiliation(s)
- Mehdi Bouslama
- From the Department of Neurology Grady Memorial Hospital and Emory University School of Medicine, Atlanta, GA (M.B., D.C.H., J.A.G., S.R., M.R.F., R.G.N.); Department of Neurology, University of Pittsburgh Medical Center, PA (G.W., A.H., T.G.J., A.P.J.); and Baptist Neurological Institute, Jacksonville, FL (A.A.)
| | - Diogo C Haussen
- From the Department of Neurology Grady Memorial Hospital and Emory University School of Medicine, Atlanta, GA (M.B., D.C.H., J.A.G., S.R., M.R.F., R.G.N.); Department of Neurology, University of Pittsburgh Medical Center, PA (G.W., A.H., T.G.J., A.P.J.); and Baptist Neurological Institute, Jacksonville, FL (A.A.)
| | - Amin Aghaebrahim
- From the Department of Neurology Grady Memorial Hospital and Emory University School of Medicine, Atlanta, GA (M.B., D.C.H., J.A.G., S.R., M.R.F., R.G.N.); Department of Neurology, University of Pittsburgh Medical Center, PA (G.W., A.H., T.G.J., A.P.J.); and Baptist Neurological Institute, Jacksonville, FL (A.A.)
| | - Jonathan A Grossberg
- From the Department of Neurology Grady Memorial Hospital and Emory University School of Medicine, Atlanta, GA (M.B., D.C.H., J.A.G., S.R., M.R.F., R.G.N.); Department of Neurology, University of Pittsburgh Medical Center, PA (G.W., A.H., T.G.J., A.P.J.); and Baptist Neurological Institute, Jacksonville, FL (A.A.)
| | - Gregory Walker
- From the Department of Neurology Grady Memorial Hospital and Emory University School of Medicine, Atlanta, GA (M.B., D.C.H., J.A.G., S.R., M.R.F., R.G.N.); Department of Neurology, University of Pittsburgh Medical Center, PA (G.W., A.H., T.G.J., A.P.J.); and Baptist Neurological Institute, Jacksonville, FL (A.A.)
| | - Srikant Rangaraju
- From the Department of Neurology Grady Memorial Hospital and Emory University School of Medicine, Atlanta, GA (M.B., D.C.H., J.A.G., S.R., M.R.F., R.G.N.); Department of Neurology, University of Pittsburgh Medical Center, PA (G.W., A.H., T.G.J., A.P.J.); and Baptist Neurological Institute, Jacksonville, FL (A.A.)
| | - Anat Horev
- From the Department of Neurology Grady Memorial Hospital and Emory University School of Medicine, Atlanta, GA (M.B., D.C.H., J.A.G., S.R., M.R.F., R.G.N.); Department of Neurology, University of Pittsburgh Medical Center, PA (G.W., A.H., T.G.J., A.P.J.); and Baptist Neurological Institute, Jacksonville, FL (A.A.)
| | - Michael R Frankel
- From the Department of Neurology Grady Memorial Hospital and Emory University School of Medicine, Atlanta, GA (M.B., D.C.H., J.A.G., S.R., M.R.F., R.G.N.); Department of Neurology, University of Pittsburgh Medical Center, PA (G.W., A.H., T.G.J., A.P.J.); and Baptist Neurological Institute, Jacksonville, FL (A.A.)
| | - Raul G Nogueira
- From the Department of Neurology Grady Memorial Hospital and Emory University School of Medicine, Atlanta, GA (M.B., D.C.H., J.A.G., S.R., M.R.F., R.G.N.); Department of Neurology, University of Pittsburgh Medical Center, PA (G.W., A.H., T.G.J., A.P.J.); and Baptist Neurological Institute, Jacksonville, FL (A.A.)
| | - Tudor G Jovin
- From the Department of Neurology Grady Memorial Hospital and Emory University School of Medicine, Atlanta, GA (M.B., D.C.H., J.A.G., S.R., M.R.F., R.G.N.); Department of Neurology, University of Pittsburgh Medical Center, PA (G.W., A.H., T.G.J., A.P.J.); and Baptist Neurological Institute, Jacksonville, FL (A.A.)
| | - Ashutosh P Jadhav
- From the Department of Neurology Grady Memorial Hospital and Emory University School of Medicine, Atlanta, GA (M.B., D.C.H., J.A.G., S.R., M.R.F., R.G.N.); Department of Neurology, University of Pittsburgh Medical Center, PA (G.W., A.H., T.G.J., A.P.J.); and Baptist Neurological Institute, Jacksonville, FL (A.A.).
| |
Collapse
|
19
|
Lu F, Soares KC, He J, Javed AA, Cameron JL, Rezaee N, Pawlik TM, Wolfgang CL, Weiss MJ. Neoadjuvant therapy prior to surgical resection for previously explored pancreatic cancer patients is associated with improved survival. Hepatobiliary Surg Nutr 2017; 6:144-153. [PMID: 28652997 DOI: 10.21037/hbsn.2016.08.06] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Patients with pancreatic ductal adenocarcinoma (PDAC) are frequently referred to tertiary centers after unsuccessful attempted resections at other institutions. The outcome of these patients who are ultimately resected is not well understood. METHODS We performed a retrospective review of patients with PDAC who underwent re-exploration between 1995 and 2013 at a single high volume tertiary care institution. We aimed to evaluate the association of neoadjuvant therapy prior to re-exploration on pathologic findings and clinical outcome in previously explored patients with PDAC. RESULTS Between 1995 and 2013, 50 of the 2,062 patients who were surgically explored underwent pancreatic resection following a previous exploration where they were deemed unresectable. The most common reason for unresectability at initial operation was vascular invasion (80%) and a presumed R2 resection. Thirty-seven (74%) patients received neoadjuvant therapy. Neoadjuvant therapy was associated with improved TNM stage (P=0.002), fewer positive lymph nodes (0 vs. 2, P=0.025), and improved median survival (24 vs. 13 months, P=0.044). Compared to R2 resected patients with PDAC who had not previously been explored, re-explored patients had significantly lower pathologic T and N stages (P<0.001) and a longer median survival (19 vs. 10 months, P<0.001). CONCLUSIONS Patients with PDAC deemed unresectable may warrant re-exploration. Treatment with neoadjuvant therapy between operations is associated with improved pathological stage and survival. In this highly selected group of patients, successful resection is associated with improved survival compared to R2 resections.
Collapse
Affiliation(s)
- Fengchun Lu
- Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Surgery, Union Hospital, Fujian Medical University, Fuzhou 350001, China
| | - Kevin C Soares
- Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jin He
- Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ammar A Javed
- Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John L Cameron
- Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Neda Rezaee
- Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Timothy M Pawlik
- Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christopher L Wolfgang
- Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthew J Weiss
- Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
20
|
El-Atem NA, Wojcik K, Horsfall L, Irvine KM, Johnson T, McPhail SM, Powell EE. Patterns of service utilisation within Australian hepatology clinics: high prevalence of advanced liver disease. Intern Med J 2017; 46:420-6. [PMID: 26762655 DOI: 10.1111/imj.13008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 12/20/2015] [Indexed: 01/18/2023]
Abstract
BACKGROUND Liver diseases in Australia are estimated to affect 6 million people with a societal cost of $51 billion annually. Information about utilisation of specialist hepatology care is critical in informing policy makers about the requirements for delivery of hepatology-related healthcare. AIMS This study examined the aetiology and severity of liver disease seen in a tertiary hospital hepatology clinic, as well as the resource utilisation patterns. METHODS A longitudinal cohort study included consecutive patients booked in hepatology outpatient clinics during a 3-month period. Subsequent outpatient appointments for these patients over the following 12 months were then recorded. RESULTS During the initial 3-month period, 1471 appointments were scheduled with a hepatologist, 1136 of which were attended. Twenty-one per cent of patients were 'new cases'. Hepatitis B virus (HBV) was the most common disease aetiology for new cases (37%). Advanced disease at presentation varied between aetiology; only 5% of HBV cases had advanced liver disease at presentation, in contrast with HCV, NAFLD and ALD, in which advanced disease was identified at presentation in 31%, 46% and 72% of cases, respectively. Most patients (83%) attended multiple hepatology appointments, and a range of referral patterns for procedures, investigations and other specialty assessments were observed. CONCLUSIONS There is a high prevalence of HBV in new case referrals. Patients with HCV infection, NAFLD and ALD have a high prevalence of advanced liver disease at referral, requiring ongoing surveillance for development of decompensated liver disease and liver cancer. These findings that describe the patterns of health service utilisation among patients with liver disease provide useful information for planning sustainable health service provision for this clinical population.
Collapse
Affiliation(s)
- N A El-Atem
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia.,Centre for Functioning and Health Research, Metro South Health, Brisbane, Queensland, Australia
| | - K Wojcik
- Centre for Liver Disease Research, The University of Queensland, Brisbane, Queensland, Australia
| | - L Horsfall
- Centre for Liver Disease Research, The University of Queensland, Brisbane, Queensland, Australia.,Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - K M Irvine
- Centre for Liver Disease Research, The University of Queensland, Brisbane, Queensland, Australia
| | - T Johnson
- Inala Primary Care, Brisbane, Queensland, Australia
| | - S M McPhail
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia.,Centre for Functioning and Health Research, Metro South Health, Brisbane, Queensland, Australia
| | - E E Powell
- Centre for Liver Disease Research, The University of Queensland, Brisbane, Queensland, Australia.,Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| |
Collapse
|
21
|
Abstract
PURPOSE Patients with congenital genitourinary abnormalities are growing into adulthood and their expectations, especially in the areas of sexual function and fertility are creating unforeseen challenges for health care providers. We review the incidence and management of pelvic organ prolapse at our Transitional Urology Clinic. MATERIALS AND METHODS This study is a retrospective chart review of the presentation and treatment of patients with clinically bothersome pelvic organ prolapse seen at our tertiary Transitional Urology Clinic during 2012 to 2015. RESULTS Seven patients with a mean age of 22.8 years presented to our clinic with clinically bothersome prolapse. Four patients had myelomeningocele, 2 had sacral agenesis and 1 had bladder exstrophy. All were on self-catheterization. Three patients were sexually active and 1 had an intact uterus and desired fertility. Bothersome symptoms included vaginal bulge in 6 cases, difficult vaginal intercourse in 1 and difficult catheterization in 1. For the leading edge of Bp (anterior compartment) prolapse the median POP-Q (Pelvic Organ Prolapse Quantification System) stage was 3 (range 1 to 3), for Bp (posterior compartment) prolapse it was 1 (range 0 to 3) and for C (vaginal vault or cervical) prolapse it was 2 (range 1 to 3). Management included pessary in 1 case, hysterectomy with bilateral uterosacral ligament suspension in 4, sacrocolpopexy in 1 and observation in 1. Mean followup was 17.6 months (range 1 to 92). One of the 5 patients treated with surgical intervention had recurrence in the anterior compartment and vaginal vault. CONCLUSIONS Females with congenital genitourinary anomalies present with pelvic organ prolapse at a much younger age and a more advanced stage. There is a paucity of literature on the epidemiology, presentation and management of pelvic organ prolapse in this patient population.
Collapse
|
22
|
Abstract
The 2001 Report of the Public Inquiry into children's heart surgery at the Bristol Royal Infirmary 1984-1995 stated that there must be standards for hospitals as a whole and that hospitals, which do not meet these standards, should not be able to offer services within the National Health Service (NHS). In 2013, agreed standards for pediatric neurosurgery were produced. Between 2001 and 2013 several key documents were published, which formed the background to the review that produced these standards:, the 'Safe and Sustainable' review. The process had the mission statement, 'Safe, sustainable and world class. Not ordinary, OK or just good enough.' In April 2013, the new commissioning structure of NHS England came into being. Clinical Reference Groups (reporting directly into the new structure) and pediatric neurosurgical operational delivery networks are taking the Safe and Sustainable pediatric neurosurgery standards and models of care into practice in England. Effective outcome data collection will allow us to assess whether these networks will improve equity of access for English children to world-class pediatric neurosurgical care and reduce the variation in outcomes seen at the present time.
Collapse
Affiliation(s)
- Amber E Young
- Department of Anaesthesia, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| |
Collapse
|