scholarly journals Management and outcomes of paediatric ileocolic intussusception at a paediatric tertiary care hospital: A retrospective cohort study

2020 ◽  
Author(s):  
Esli Osmanlliu ◽  
Antonio D’Angelo ◽  
Marie-Claude Miron ◽  
Marianne Beaudin ◽  
Nathalie Gaucher ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Hemodynamic Instability ◽  
Time Of Day ◽  
Care Hospital ◽  
Ileocolic Intussusception ◽  
Rapid Reduction ◽  
Intravenous Access ◽  
Paediatric Hospital ◽  
Pneumatic Reduction ◽  
Transferred Patients

Abstract Background Rapid reduction of ileocolic intussusception is important to minimize the compromise in blood flow to the affected bowel segment. This study aimed to quantify the potentially modifiable time between diagnosis and initiation of pneumatic reduction, identify factors associated with delays, and characterize the outcomes of pneumatic reduction in a recent cohort. Methods This retrospective observational study occurred at a tertiary care paediatric hospital with a consecutive sample of all children with ileocolic intussusception September 2015 through September 2018. The primary outcome was the time between ultrasound diagnosis of intussusception and the beginning of pneumatic reduction. Independent variables were age of the patient, time of day of arrival, transfer from another facility, and intravenous access prior to ultrasound. Outcomes of pneumatic reduction were expressed as proportions. Results There were 103 cases of ileocolic intussusception (among 257,282 visits) during the study period. The median time between diagnostic confirmation and initiation of reduction was 36 minutes. This was shorter for transferred patients and children with intravenous access prior to ultrasound. One perforation was identified at the beginning of reduction, without hemodynamic instability. Six children (5.8%) underwent either open (n=4) or laparoscopic surgery (n=2) for reduction failure. Conclusion The median delay between diagnosis and initiation of reduction at this paediatric hospital was short, especially among patients transferred with a suspicion of intussusception and children with intravenous access prior to diagnosis. Complications from pneumatic reduction were infrequent.

scholarly journals Blunt abdominal trauma: a tertiary care experience

2018 ◽  
Vol 5 (3) ◽  
pp. 975
Author(s):  
Vikram Trehan ◽  
Sukumar S. Kumar
Keyword(s):  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Tertiary Care ◽  
Hemodynamic Instability ◽  
Morbidity And Mortality ◽  
Organ Injury ◽  
Solid Organ ◽  
Care Hospital ◽  
Management Options ◽  
Solid Organ Injury

Background: Blunt abdominal trauma (BAT) is one of the common causes of admission in surgical ward in any hospital. It requires high level of suspicion, urgent evaluation and timely management to decrease morbidity and mortality. Aim of present study was to find out demographic details, causes of injury, management options and treatment outcomes of BAT.Methods: Retrospective study of cases of BAT was carried out at a tertiary care hospital of India spanning five years, between June 2012 to June 2017. Authors analyzed the demographic profile of the trauma victims, etiological factors of BAT, the abdominal organs involved, the treatment modalities adopted and the final outcome.Results: There were 231 cases of BAT. Most common age group was 11 to 30 years which accounted for 42.42% of the total. The study had 181 (78.35%) males and 50 (21.64%) females. Road traffic accident was the most common cause of BAT and it accounted for 67.97%. Liver (34.20%) was the most commonly involved organ followed by spleen (22.51%), bowel (15.58%), mesentery (8.23%), kidney (7.36%), pancreaticoduodenal injuries (3.46%) and diaphragm (3.46%). 56.71% underwent non-operative management (NOM), 3.90% underwent angio-embolization and 39.39% eventually required operative treatment. Mortality occurred in 31 patients (13.41%) because of septicemia, renal failure, shock, acute coronary event or respiratory complications.Conclusions: NOM for BAT was found to be successful in haemodynamically stable patient with solid organ injury. Along with sophisticated infrastructure like ultrasound or CT Scan, close supervision with repeated examination by a treating surgeon were the sheet anchors of NOM. Angio-embolization is a feasible modality of treatment in solid organ injury and can avoid surgery in an appropriate patient. Definitive indications for laparotomy were hemodynamic instability and perforation-peritonitis. Initial hemodynamic instability, haemorrhagic shock, and associated injuries influenced morbidity and mortality in BAT. 

scholarly journals Perspective of asylum-seeking caregivers on the quality of care provided by a Swiss paediatric hospital: a qualitative study

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e029385
Author(s):  
Julia Brandenberger ◽  
Katrin Sontag ◽  
Cédric Duchêne-Lacroix ◽  
Fabienne Nicole Jaeger ◽  
Bernadette Peterhans ◽  
...  
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Healthcare Delivery ◽  
Healthcare Providers ◽  
Social Background ◽  
Quality Of Healthcare ◽  
Care Hospital ◽  
Paediatric Hospital ◽  
Personal Competencies

ObjectivesThis study investigated the perspective of asylum-seeking caregivers on the quality of healthcare delivered to their children in a qualitative in-depth interview study. The health of asylum-seeking children is of key interest for healthcare providers, yet knowledge of the perspective of asylum-seeking caregivers when accessing healthcare is limited.SettingThe study took place in a paediatric tertiary care hospital in Basel, Switzerland.ParticipantsInterviews were done with 13 asylum-seeking caregivers who had presented with their children at the paediatric tertiary care hospital. Nine female and four male caregivers from Tibet, Eritrea, Afghanistan, Syria, Iraq, Albania and Macedonia were included. A diverse sample was chosen regarding cultural and social background, years of residence in Switzerland and reasons for seeking care. A previously developed and pilot-tested interview guide was used for semistructured in-depth interviews between 36 and 92 min in duration. Data analysis and reporting was done according to Consolidated Criteria for Reporting Qualitative Research. The number of interviews was determined by saturation of data.ResultsThe interviewees described a mismatch of personal competencies and external challenges. Communication barriers and unfamiliarity with new health concepts were reported as challenges. These were aggravated by isolation and concerns about their child’s health. The following factors were reported to strongly contribute to satisfaction of healthcare delivery: a respectful and trusting caregiver–provider relationship, the presence of interpreters and immediate availability of treatment.ConclusionsA mismatch of personal competencies and external challenges importantly influences the caregiver–provider relationship. To overcome this mismatch establishment of confidence was identified as a key factor. This can be achieved by availability of interpreter services, sufficient consultation time and transcultural trainings for healthcare workers. Coordination between the family, the government’s asylum system and the medical system is required to facilitate this process.

scholarly journals Image Guided Percutaneous Cholecystostomy–A Single Center Experience

2020 ◽  
Vol 4 (01) ◽  
pp. 20-26
Author(s):  
Sathya Narayanan ◽  
Shyamkumar N. Keshava ◽  
Vinu Moses ◽  
Munawwar Ahmed ◽  
Aswin Padmanabhan ◽  
...  
Keyword(s):  
High Risk ◽  
Acute Cholecystitis ◽  
Tertiary Care ◽  
Hemodynamic Instability ◽  
Care Hospital ◽  
Percutaneous Cholecystostomy ◽  
Image Guided ◽  
Single Center Experience ◽  
Risk Patients ◽  
Emergency Cholecystectomy

Abstract Purpose To assess the technical feasibility of percutaneous cholecystostomy (PCC) for acute cholecystitis and formulate an algorithm for PCC. Materials and methods This is a retrospective study of 35 patients (28 male and 7 female; mean age 60 years) who underwent image-guided PCC from 2008 to 2018 at a tertiary care hospital in South India. Descriptive summary statistics and frequencies were used to assess the technical success and complications. Results The patients (35/35) presented with fever, abdominal pain, and a few of them had severe sepsis. All these patients were high risk for surgery considering the comorbidities (17/35) and hemodynamic instability (18/35). PCC was performed under ultrasoundguidance, through transhepatic approach, and using single puncture and modified single puncture techniques. The procedure was technically successful in all 35 patients (100%). Two patients (2/35) did not improve clinically after PCC; hence, they were taken up for emergency cholecystectomy with high-risk consent. One patient required a repeat procedure after 3 days due to tube dislodgement. There were no major procedure-related complications. Conclusion Image-guided PCC can be performed safely and is effective for treating high-risk patients with acute cholecystitis.

MODELING AND ANALYSIS OF OCCUPANCY DATA: A HEALTHCARE CAPACITY PLANNING APPLICATION

2002 ◽  
Vol 01 (04) ◽  
pp. 707-729 ◽  
Author(s):  
MARK W. ISKEN
Keyword(s):  
Capacity Planning ◽  
Tertiary Care ◽  
Software Tool ◽  
Time Of Day ◽  
Care Hospital ◽  
Healthcare Operations ◽  
Managerial Decision ◽  
Modeling And Analysis ◽  
Related Data ◽  
Large Tertiary Care

Managerial decision making problems in the healthcare industry often involve considerations of customer occupancy by time of day and day of week. Through a case study at a large tertiary care hospital, we discuss a number of issues that arise in analyzing occupancy data which have implications for design of healthcare operations oriented data warehouses and analysis tools. We offer practical solutions to these problems including a transaction oriented database design, a general database framework and software tool for analysis of occupancy related data and a method for simulating entity flow from the data mart.

scholarly journals Predictors of Mortality among Inter-Hospital Transferred Patients in a Middle-Income Country: a Retrospective Cohort Study

2021 ◽  
Vol 73 (5) ◽  
Author(s):  
Parin Rattananon ◽  
Isara Yenyuwadee ◽  
Thanchanok Dheeradilok ◽  
Parichaya Boonsoong ◽  
Nintita Sripaiboonkij Thokanit ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Community Hospital ◽  
Tertiary Care Hospital ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Medication Use ◽  
Care Hospital ◽  
Middle Income ◽  
Vasoactive Medication ◽  
Transferred Patients

Objective: To identify predictors for hospital mortality among inter-hospital transferred patients in low-resource settings of rural hospitals in Thailand.Methods: We conducted a retrospective cohort study of patients transferred from emergency room(ER) of a community hospital to its designated tertiary care hospital in a western province of Thailand. During March 2018 and February 2019, medical records of 412 patients were reviewed and extracted for potential predictor variables and outcomes. We defined deaths within 72 hrs after a transfer as primary outcome and overall hospital mortality as secondary outcome. Multivariate logistic regression analysis was performed to identify predictors of the outcomes adjusted for potential confounders.Results: Out of 412 patients, a total of 37 patients (9.0%) died during the stay in receiving hospital and 18 (4.4%) of them died within 72 hrs after transfer. Top ten primary diagnostic categories included road traffic injuries (19.7%), acute appendicitis (9.7%), and acute myocardial infarction (5.1%). Univariate analysis revealed early mortality (<72 hrs) was associated with NEWS2, Emergency Severity Index (ESI), cardiac arrest prior to transfer, use of vasoactive agents, endotracheal intubation and admitting service. Using multiple logistic regression model  adjusted for  the predictors identified by univariate analysis, we found early mortality was independently associated with NEWS2 ≥ 9 (compared to NEWS2 0-6) with OR= 17.51(95%CI 3.16-97.00)  and vasoactive medication use (OR= 5.46, 95%CI 1.39-21.46). Similarly, overall mortality was also independently associated with NEWS2 ≥ 9(OR= 4.76, 95%CI 1.31–17.36)  and  vasoactive medication use (OR= 7.51,95%CI  2.76–20.45).Conclusion: This study identified predictors of early (<72 hrs) hospital mortality and overall hospital mortality among ER patients transferred from a rural community hospital to its designated tertiary care hospital in Thailand, a middle-income country with universal healthcare coverage. The findings might be helpful to inform decision-making dealing with the inter-hospital transfer of ER patients in resource-poor rural settings with similar case-mix.

scholarly journals Demographic Profile of Liver Injury Managed at a Tertiary Care Hospital in Central Nepal -A Retrospective Study

2018 ◽  
Vol 14 (1) ◽  
pp. 32-38
Author(s):  
Narayan Prasad Belbase ◽  
Aditya Kumar Jalan ◽  
Hari Upadhyay ◽  
Rohit Mishra ◽  
Mukesh Karki ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Liver Injury ◽  
Tertiary Care ◽  
Operative Management ◽  
Hemodynamic Instability ◽  
Solid Organ ◽  
Care Hospital ◽  
Demographic Profile ◽  
Liver Injuries ◽  
The Mean

Background & Objectives:The liver is one of the commonly injured solid organ following abdominal trauma. The aim of this study was to determine the outcome of liver injuries managed operatively or non-operatively and predict factors affecting morbidity and mortality.Materials & Methods:This was a retrospective study of 40 liver injuries managed in the department of Surgical Gastroenterology at College of Medical Sciences over a period of 2 years. The liver injury was classified in accordance with the American Association for the Surgery of Trauma liver injury scoring scale. Patients were divided into two groups those managed operatively or non-operatively and were compared in terms of demographic profile and outcome.Results:Forty patients were analyzed. The mean age of the patients was 29.95years. Male predominance was seen with 72.5% of the cases. Road traffic accidents were the commonest mode of injury seen in 72.5% cases. The mean Revised Trauma Score (RTS) and Injury severity score (ISS)  were 7.11and 22.58. The mean systolic BP, hospital stay and ICU stay were 93.80 mm of mercury, 11.55 days and 3.55 days respectively. Twenty six patients (65%) were initially managed non-operatively and 14 patients were managed operatively. Five patients had to be converted to operative management for hemodynamic instability. Mortality was 7.6% in patient undergoing non-operative management and 21.43% in patients managed operatively. Low systolic BP at presentation, low RTS score, high ISS score, high AST, ALT and prothrombin time were significantly associated with operative management and mortality.Conclusion:Patients with hemodynamic instability, low RTS score, high ISS score, high liver enzymes have high likelihood of operative management.

scholarly journals Active screening and interfacility communication of carbapenem-resistant Enterobacteriaceae (CRE) in a tertiary-care hospital

2018 ◽  
Vol 39 (9) ◽  
pp. 1058-1062 ◽  
Author(s):  
Teppei Shimasaki ◽  
John Segreti ◽  
Alexander Tomich ◽  
Julie Kim ◽  
Mary K. Hayden ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Health Department ◽  
Care Hospital ◽  
Active Screening ◽  
Carbapenem Resistant ◽  
Period 2 ◽  
Admission Screening ◽  
Transferred Patients ◽  
General Wards ◽  
Carbapenem Resistant Enterobacteriaceae

BackgroundHospitals may implement admission screening cultures and may review transfer documentation to identify patients colonized with carbapenem-resistant Enterobacteriaceae (CRE) to implement isolation precautions; however, outcomes and logistical considerations have not been well described.MethodsAt an academic hospital in Chicago, we retrospectively studied the implementation and outcomes of CRE admission screening from 2013 to 2016 during 2 periods. During period 1, we implemented active CRE rectal culture screening for all adults patients admitted to intensive care units (ICUs) and for those transferred from outside facilities to general wards. During period 2, screening was restricted only to adults transferred from outside facilities. For a subset of transferred patients who were previously reported to the health department as CRE positive, we reviewed transfer paperwork for appropriate documentation of CRE.ResultsOverall, 11,757 patients qualified for screening; rectal cultures were performed for 8,569 patients (73%). Rates of CRE screen positivity differed by period, previous facility type (if transferred), and current inpatient location. A higher combined CRE positivity rate was detected in the medical and surgical ICUs among period 2 patients (3.3%) versus all other ward-period comparisons (P<.001). Among 13 transferred patients previously known to be CRE colonized, appropriate CRE transfer documentation was available for only 4 patients (31%).ConclusionsActive screening for CRE is feasible, and screening patients transferred from outside facilities to the medical or surgical ICU resulted in the highest screen positivity rate. Furthermore, CRE carriage was inconsistently documented in transfer paperwork, suggesting that admission screening or enhanced inter-facility communication are needed to improve the identification of CRE-colonized patients.

scholarly journals Epidemiology of in-hospital cardiac arrest in Abu Dhabi, United Arab Emirates, 2013–2015

Heart Asia ◽  
2018 ◽  
Vol 10 (2) ◽  
pp. e011029 ◽  
Author(s):  
Faisal Aziz ◽  
Marilia Silva Paulo ◽  
Emad H Dababneh ◽  
Tom Loney
Keyword(s):  
Cardiac Arrest ◽  
United Arab Emirates ◽  
Hospital Admissions ◽  
Tertiary Care ◽  
Time Of Day ◽  
Abu Dhabi ◽  
Survival Outcomes ◽  
Care Hospital ◽  
Shockable Rhythm ◽  
Hospital Cardiac Arrest

ObjectiveEstimate the incidence and outcomes of in-hospital cardiac arrest (IHCA) in a tertiary-care hospital in Abu Dhabi emirate, United Arab Emirates (UAE).MethodsRetrospective data from 685 inpatients who experienced an IHCA at a hospital in Abu Dhabi (UAE) between 1 January 2013 and 31 December 2015 were analysed. Sociodemographic variables were age and gender, and IHCA event variables were shift, day, event location, initial cardiac rhythm and the total number of IHCA events. Outcome variables were the return of spontaneous circulation (ROSC) and survival to discharge (StD).ResultsThe incidence of IHCA was 11.7 (95% CI 10.8 to 12.6) per 1000 hospital admissions. Non-shockable rhythms were 91.1% of the cardiac rhythms at presentation. The majority of IHCA cases occurred in the intensive care unit (46.1%) and on weekdays (74.6%). More than a third (38.3%) of patients who experienced an IHCA achieved ROSC and 7.7% StD. Both ROSC and StD were significantly higher in patients who were younger and presenting with a shockable rhythm (all p’s≤0.05). Survival outcomes were not significantly different between dayshifts and nightshifts or weekdays and weekends.ConclusionsThe incidence of IHCA was higher and its outcomes were lower compared with other high-income/developed countries. Survival outcomes were better for patients who were younger and had a shockable rhythm, and similar between time of day and days of the week. These findings may help to inform health managers about the magnitude and quality of IHCA care in the UAE.

scholarly journals A prospective study of injury pattern and outcome of blunt trauma abdomen patients in a tertiary care hospital in eastern part of India

2020 ◽  
Vol 7 (8) ◽  
pp. 2557
Author(s):  
Vinod Kumar Pandey ◽  
Hanuman Prasad Shahi ◽  
Rahul Singh ◽  
Prakhar Pratap
Keyword(s):  
Blunt Trauma ◽  
Conservative Management ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Hemodynamic Instability ◽  
Blunt Injury ◽  
Trauma Patients ◽  
Care Hospital ◽  
Critical Components ◽  
A Prospective Study

Background: Abdominal trauma continues to account for a large number of trauma-related injuries and deaths. The evaluation and treatment of abdominal injuries are critical components in the management of severely injured trauma patients. The study was done to study pattern and outcome of BTA patients in a tertiary care hospital in eastern part of India as few studies exist in this part of the country.Methods: Prospective descriptive study conducted in in SRN Hospital, Prayagraj over a period of one year with all cases of blunt injury abdomen included with respect to inclusion criteria.Results: In our study mean age was 23.2±17.6 years. 92% were male and 8% were female RTA are responsible for most number of cases (78%). Conservative management done in 34 (68.0%) and Operative Intervention done in 16 (32.0%) cases. In our study, X-ray erect had 75% accuracy total subsets of 336 organ scans were performed on ultrasound specific injury was seen in total 50 cases and total 210 CT scans performed was able to pick up 59 injuries (p=0.0002). CECT forms the core investigation of choice in dealing with blunt injury abdomen cases. In our present study, paralytic ileus (prolonged) (31%) and pelvic intraabdominal abscess (31%) as postoperative complications.Conclusions: CECT abdomen is the investigation of the choice with RTA being the most common mode of BTA. So effort should be made to implement traffic rules. Hemodynamic instability with radiological findings useful in deciding operative versus conservative management of blunt trauma patients.

Confidence toward vaccination as reported by parents of children admitted to a tertiary care hospital in Riyadh, Saudi Arabia: A cross sectional study

Vacunas ◽  
2020 ◽  
Vol 21 (2) ◽  
pp. 95-104 ◽  
Author(s):  
Y.M. AlGoraini ◽  
N.N. AlDujayn ◽  
M.A. AlRasheed ◽  
Y.E. Bashawri ◽  
S.S. Alsubaie ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Care Hospital ◽  
Sectional Study ◽  
Cross Sectional
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