scholarly journals Action Plans in Asthma

2006 ◽  
Vol 13 (6) ◽  
pp. 306-310 ◽  
Author(s):  
Marie-France Beauchesne ◽  
Valérie Levert ◽  
Miray El Tawil ◽  
Manon Labrecque ◽  
Lucie Blais
Keyword(s):  
Action Plan ◽  
Tertiary Care ◽  
Persistent Asthma ◽  
Action Plans ◽  
Tertiary Care Centre ◽  
Perceived Efficacy ◽  
Asthmatic Patients ◽  
Level Of Confidence ◽  
Respiratory Physician

BACKGROUND: Action plans are recommended for most patients with persistent asthma to reduce the morbidity associated with this chronic disease. Unfortunately, despite these recommendations, this tool remains underused.METHODS: The authors conducted a descriptive study at the asthma clinic of a tertiary care centre to determine the number of asthmatic patients presenting to a respiratory physician (new reference or follow-up visit) who possessed an individualized, written action plan, and to evaluate the patients’ level of confidence and perceived efficacy toward their plans. In addition, for all patients in the study, the level of confidence in and the perceived efficacy of three different action plans (two traditional tools versus a simplified tool) were compared.RESULTS: A total of 92 asthmatic patients were included in the study. Overall, 46% of the patients possessed an action plan. The patients’ average level of confidence and perceived efficacy toward their action plans were high (4.1 out of five and 3.3 out of four, respectively). When the three different action plans were compared, the level of confidence in and perceived efficacy of the traditional tools were similar, both being superior to the simplified tool.CONCLUSION: The number of asthmatic patients who presented to the asthma clinic and who possessed an action plan was higher than the reported Canadian mean of 10%; however, most of the patients were treated by specialized respiratory physicians, which may explain this improvement. Considering that most patients with persistent asthma should have an individualized, written action plan, the present study confirms that this tool is still not used for all asthmatic patients.

scholarly journals IsHelicobacter pyloriBeing Treated Appropriately? A Study of Inpatients and Outpatients in a Tertiary Care Centre

2007 ◽  
Vol 21 (5) ◽  
pp. 285-288 ◽  
Author(s):  
Jose Nazareno ◽  
David K Driman ◽  
Paul Adams
Keyword(s):  
Tertiary Care ◽  
Gastric Biopsy ◽  
Pathology Report ◽  
Tertiary Care Centre ◽  
Delivery Of Care ◽  
Ulcer Disease ◽  
Appropriate Treatment ◽  
Significant Difference ◽  
H Pylori

BACKGROUND:Helicobacter pyloriis causally associated with peptic ulcer disease and gastric cancer. Although effective treatment is available, studies have shown that patients withH pyloriare often not well managed. Recently, there has also been increasing awareness of patient safety concerns arising from missed follow-up of abnormal test results.OBJECTIVE: To examine whether inpatients and outpatients diagnosed withH pylorireceive appropriate treatment.PATIENTS AND METHODS: All patients who were diagnosed withH pyloriby gastric biopsy in London, Ontario between January 1, 2004, and December 31, 2004, were identified. The hospital charts of these patients were reviewed. Outpatient office charts, clinic notes, pathology reports and endoscopy reports were also reviewed.RESULTS: One hundred ninety-three patients were diagnosed withH pyloriby gastric biopsy in 2004. Of the 193 patients, 143 (74%) were outpatients and 50 (26%) were inpatients. Overall, 89% of patients received treatment forH pylori. Ninety-two per cent of outpatients were treated, while only 60% of inpatients received treatment (P<0.001). Among the inpatients, the pathology report was available in 40% of the cases before the patient was discharged from the hospital. After discharge from the hospital, 30% of inpatients received appropriate treatment and follow-up. There was no significant difference in treatment whether the patient was admitted to a medical or a nonmedical service.CONCLUSION:H pyloriis treated relatively poorly in inpatients compared with outpatients. Results of the present study reveal opportunities to improve delivery of care for inpatients on a number of different levels. More research is needed to ensure safety, effectiveness and timeliness in the test result management process.

scholarly journals Limited adequacy of thyroid cancer patient follow-up at a Canadian tertiary care centre

2013 ◽  
Vol 56 (6) ◽  
pp. 385-392 ◽  
Author(s):  
Elaine Lam ◽  
Scott S. Strugnell ◽  
Chris Bajdik ◽  
Daniel Holmes ◽  
Sam M. Wiseman
Keyword(s):  
Thyroid Cancer ◽  
Cancer Patient ◽  
Tertiary Care ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Thyroid Cancer Patient

scholarly journals PHARMACOINVASIVE VERSUS THROMBOLYSIS IN STEMI COHORT – OUTCOMES FROM A TERTIARY CARE CENTRE OF NORTH INDIA

2020 ◽  
pp. 1-3
Author(s):  
Richa Sharma ◽  
Ajeet Jain ◽  
Praveen Singh ◽  
Bhushan Shah
Keyword(s):  
Myocardial Ischemia ◽  
Tertiary Care ◽  
Myocardial Necrosis ◽  
North India ◽  
Registry Study ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Promising Strategy ◽  
Cardiology Department

STEMI is an event where transmural myocardial ischemia induces myocardial necrosis. PI strategy is a promising strategy in the management of STEMI. It is prospective registry study conducted in Cardiology Department, KGMU between January-June 2016 to know 30 day outcome of thrombolysis alone or thrombolysis followed by PCI in north India.At 30 day follow up, patients undergoing PI strategy,complained less of angina and dyspnea compared to thrombolysis arm.

scholarly journals URETHRAL CATHETERIZATION

2011 ◽  
Vol 18 (02) ◽  
pp. 246-250
Author(s):  
SHAHID MEHMOOD ◽  
KHALID FAROUK ◽  
ZEESHAN QADEER ◽  
Iram Batool Nadeem
Keyword(s):  
Practical Knowledge ◽  
Tertiary Care ◽  
Senior Resident ◽  
Teaching Hospitals ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Urethral Catheterization ◽  
Care Teaching ◽  
Level Of Confidence ◽  
Tertiary Care Centers

Objectives: (1) To assess the theoretical and practical knowledge of young doctors about urethral catheterization. (2) To evaluate the experience and level of confidence of young doctors regarding the urethral catheterization in various tertiary care centers of Rawalpindi and Islamabad. Period: Sep 2009 to Feb 2010. Setting: Tertiary Care Centre, Fauji Foundation Hospital, Rawalpindi. Subjects and methods: A questionnaire was distributed among 400 young doctors working as interns in various tertiary care teaching hospitals of Rawalpindi and Islamabad. We obtained the information about observation, assistance, performance and knowledge of young doctors about urethral catheterization. Results: Questionnaire was distributed to about 400 young doctors working as interns in different teaching hospitals of Rawalpindi and Islamabad. Among the 400 doctors, 20 (5%) doctors never observed the male urethral catheterization and 35 (8.75%) doctors never observed female urethral catheterization. While among these 400 doctors 159 (38.75%) doctors never assisted male urethral catheterization and 175 (43.75%) doctors never assisted female urethral catheterization. Moreover 205 (51.25%) doctors never performed the male urethral catheterization and 185 (46.25%) doctors never performed female urethral catheterization. Conclusions: Training of young doctors about UC is not adequate. There is a need to train the young interns properly on this aspect. A senior resident or registrar of department should demonstrate the procedure in front of young interns before they are allowed to practice and first few catheterizations should be supervised by senior residents. Other alternate is the use of manikens for training of house officers.

scholarly journals Efficacy and Safety of Rituximab in Immunobullous Diseases: A Retrospective Study from a Tertiary Care Centre of Nepal

2020 ◽  
Author(s):  
Sudip Parajuli ◽  
Jyoti Vidhan ◽  
Dinesh Binod Pokhrel ◽  
Upama Paudel
Keyword(s):  
Retrospective Study ◽  
Adverse Effects ◽  
Tertiary Care ◽  
Data Entry ◽  
Pemphigus Vulgaris ◽  
University Teaching ◽  
Efficacy And Safety ◽  
Tertiary Care Centre ◽  
Cutaneous Lesions

Introduction: Rituximab is effective and safe treatment of immunobullous disorders. There are variations in doses of drugs used in different studies and uncertainties on when to use it along with use of adjuvant therapies. Efficacy and safety of this drug has not been described in Nepalese population till date. Dermatologists have hesitation in starting this drug in immunobullous diseases because of lack of data on efficacy and safety. Aim: To assess the efficacy and side effects of Rituximab therapy in treating immunobullous disorders in Nepalese patients. Materials and Methods: This was a retrospective study of patients with immunobullous diseases treated with Rituximab in Dermatological ward of Tribhuvan University Teaching Hospital, Kathmandu, Nepal from May 2018 to August 2019. Data were analysed for duration of disease and treatment received before Rituximab therapy, duration of steroid used before Rituximab, adverse effects due to prolonged steroid use, time to remission from 1st Rituximab pulse, duration of remission, relapse, duration of steroid and adjuvant drug used post 1st pulse and adverse effects associated with Rituximab. SPSS version 20 was used for data entry and descriptive statistics was used for analysis of the data. Results: Nine patients (Pemphigus Vulgaris-8 (PV-8), Bullous Pemphigoid-1 (BP-1) were treated with Rituximab. Seven were treated for refractory disease not controlled by conventional therapy and two received Rituximab as first-line therapy. The patients were under follow-up for 15-60 weeks (mean 31.89±15.62 weeks). Out of these nine patients, eight were free of lesions in one to eight weeks (mean 5.125±2 weeks) of first pulse. One patient with Oral Pemphigus had persistence of old lesions, however there were no new cutaneous lesions after first pulse. Adverse effects were seen in four patients that included infusion reaction in one and infection in three. There was relapse in one patient at last follow-up. Conclusion: Rituximab is efficacious and is safe in treating immunobullous disorders in Nepalese Population.

scholarly journals Retrospective analysis of paediatric tracheostomy in Indian tertiary care centre

2020 ◽  
Vol 6 (3) ◽  
pp. 533
Author(s):  
Digant Patni ◽  
Vishal R. Munjal
Keyword(s):  
Retrospective Analysis ◽  
Tertiary Care ◽  
Care Facility ◽  
Tertiary Care Centre ◽  
Prolonged Intubation ◽  
Changing Trend ◽  
Lost To Follow Up ◽  
Neurological Infection ◽  
Related Mortality

<p class="abstract"><strong>Background:</strong> Tracheostomy is frequently performed surgical procedure. The present study was carried out to assess data on various indications, surgical issues if any, complications and outcomes of paediatric tracheostomy.</p><p class="abstract"><strong>Methods:</strong> This study is a retrospective analysis of 32 paediatric patients between 1 to 12 years of age, who underwent tracheostomy at SAIMS, Indore between June 2015 to June 2019. Data was analysed in terms of patient age, sex, emergency or planned procedure, any surgical challenge, complications and post-operative follow up.  </p><p class="abstract"><strong>Results:</strong> Majority of patients were of prolonged intubation due to respiratory and laryngotracheobronchitis (15.6%) each, neuromuscular disease (15.6%), seizure disorder (9.4%), metabolic disease (9.4%) and neurological infection (6.3%). Obstructive causes included head injury (9.4%), sub-glottic stenosis (6.3%), malignancy (6.3%) and craniofacial anomaly (3.1%). Common complication encountered were partial blockage of tube, peri-stomal granulation and accidental decannulation. There was no tracheostomy related mortality in this study. Out of 32 patients, 16 were successfully decannulated, 6 were lost to follow up, 6 could not be decannulated and 4 expired due to worsening of primary disease.</p><p class="abstract"><strong>Conclusions:</strong> There is a changing trend in indications of tracheostomy and overall complications have reduced due to trained team and better care facility.</p>

Contact Dermatitis Mimickers: A Tertiary Care Center's Experience

2013 ◽  
Vol 17 (6) ◽  
pp. 429-432 ◽  
Author(s):  
Yuliya Velykoredko ◽  
Marie-Claude Houle ◽  
Sandy Skotnicki
Keyword(s):  
Contact Dermatitis ◽  
Tertiary Care ◽  
Final Diagnosis ◽  
Significant Delay ◽  
Tertiary Care Centre ◽  
Delay In Diagnosis ◽  
Pityriasis Rubra Pilaris ◽  
Appropriate Treatment ◽  
Specialized Program

Background: Contact dermatitis (CD) is very common but can be mimicked by numerous dermatologic conditions. Thus, a wide differential must be considered before a definitive diagnosis of CD is made to ensure the patient receives appropriate treatment and follow-up. Objective: To describe conditions that can present similarly to contact dermatitis. Methods: We retrospectively analyzed patients referred to the Occupational Disease Specialized Program at St. Michael's Hospital in Toronto between 2009 and 2011 for CD investigations but with a final diagnosis other than CD. Results: We report cases of 2 feet-1 hand syndrome, Dermatitis Herpetiformis, Sézary syndrome and two cases of Pityriasis Rubra Pilaris misdiagnosed as CD and referred for patch testing at our busy tertiary care centre. Failing to recognize these mimickers of CD resulted in a significant delay in diagnosis for the patients and resulting initiation of necessary intervention. Conclusions: It is important to consider numerous mimickers before making a diagnosis of CD to ensure optimal outcome for patients.

scholarly journals Tuberculosis Screening and Active Tuberculosis among HIV-Infected Persons in a Canadian Tertiary Care Centre

2009 ◽  
Vol 20 (2) ◽  
pp. 51-57 ◽  
Author(s):  
Paul Brassard ◽  
Travis Salway Hottes ◽  
Richard G Lalonde ◽  
Marina B Klein
Keyword(s):  
Highly Active Antiretroviral Therapy ◽  
Tertiary Care ◽  
Latent Tuberculosis ◽  
Clinic Visit ◽  
Skin Tests ◽  
Country Of Birth ◽  
Hiv Diagnosis ◽  
Tertiary Care Centre ◽  
Tuberculosis Screening

RATIONALE: HIV infection increases the risk of reactivation of latent tuberculosis (TB). The present study evaluates how latent TB is detected and treated to determine the effectiveness of screening in HIV-infected patients with diverse risk profiles.METHOD: A retrospective medical record database review (1988 to 2007) was conducted at a tertiary care HIV clinic. The proportion of patients receiving tuberculin skin tests (TSTs) and the rate of active TB at each stage of screening and prevention were estimated. Predictors of receiving a TST at baseline, testing positive by TST and developing active TB were evaluated.RESULTS: In the present study, 2123 patients were observed for a total of 9412 person-years. Four hundred seventy-six (22.4%) patients were tested by TST within 90 days of first clinic visit. Having a first clinic visit during the highly active antiretroviral therapy era (OR 3.64; 95% CI 2.66 to 4.99), country of birth (ORs: Africa 3.11, Asia 2.79, Haiti 3.14, and Latin America and the Caribbean 2.38), time between HIV diagnosis and first visit (OR per one-year change 0.97; 95% CI 0.94 to 0.99) and previous antiretroviral exposure (OR 0.61; 95% CI 0.45 to 0.81) were independent predictors of receiving a TST at baseline. Of the 17 patients who developed active TB during follow-up, nine (53%) had no documented TSTs at baseline or during follow-up. Forty-one per cent of all TB patients and 56% of TB patients who were not screened were born in Canada.CONCLUSION: The administration of TSTs to newly diagnosed HIV patients was inconsistent and differential according to country of birth, among other factors, resulting in missed opportunities for TB prevention.

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