Bethesda Hospital

About: Bethesda Hospital is a healthcare organization based out in Ambur, Tamil Nadu, India. It is known for research contribution in the topics: Population & Helicobacter pylori. The organization has 386 authors who have published 472 publications receiving 15193 citations.

A study of medication reviews to identify drug‐related problems of polypharmacy patients in the Dutch nursing home setting

Abstract: Background: Little is known about the extent of drug-related problems of polypharmacy patients in Dutch nursing homes. Objectives: We investigated the feasibility of teams of hospital pharmacists and nursing home physicians carrying out medication reviews. We aimed to identify the number and nature of drug-related problems of nursing home patients receiving more than nine drugs (polypharmacy). Methods: The study was carried out in five Dutch nursing homes (n = 742 beds) between October 2005 and May 2006. Ninety-one polypharmacy patients, (average age 80 years) were included. A medication review was carried out by teams consisting of one hospital pharmacist and the patient's nursing home physician with a follow-up meeting of the same team 6 weeks later. Results: A total of 323 drug-related problems were identified (mean of 3.5 problems per patient). Sixty-two per cent of problems, in 87% of patients, were classified as 'unclear or not confirmed indication or need for review' of the prescribed drug. By the time of the follow-up, a mean of 1.7 (n = 159) problems per patient had been solved and the number of drugs per patient had decreased significantly from 13.5 to 12.7 (P <0.0001). Conclusions: The majority of patients had at least one drug prescribed for which the indication was unknown. The intervention was accompanied by a significant decrease in the number of drugs per patient, but half of the drug-related problems remained unsolved.

Reduced 5-FU clearance in a patient with low DPD activity due to heterozygosity for a mutant allele of the DPYD gene.

Abstract: Reduced 5-FU clearance in a patient with low DPD activity due to heterozygosity for a mutant allele of the DPYD gene

Limited destruction of renal nerves after catheter-based renal denervation: results of a human case study

Abstract: Renal denervation (RDN) is a promising novel treatment for resistant hypertension. Effectiveness of treatment is, however, highly variable and unpredictable. Incomplete denervation of the renal nerves is a plausible explanation for the variable blood pressure lowering effect of RDN. Here, we present for the first time a histopathological evaluation of the effects of RDN on perivascular nerves of the renal arteries in a human patient. Our findings potentially have important implications for future directions with RDN.

Comparison of eight prehospital stroke scales to detect intracranial large-vessel occlusion in suspected stroke (PRESTO): a prospective observational study

Abstract: Summary Background Due to the time-sensitive effect of endovascular treatment, rapid prehospital identification of large-vessel occlusion in individuals with suspected stroke is essential to optimise outcome. Interhospital transfers are an important cause of delay of endovascular treatment. Prehospital stroke scales have been proposed to select patients with large-vessel occlusion for direct transport to an endovascular-capable intervention centre. We aimed to prospectively validate eight prehospital stroke scales in the field. Methods We did a multicentre, prospective, observational cohort study of adults with suspected stroke (aged ≥18 years) who were transported by ambulance to one of eight hospitals in southwest Netherlands. Suspected stroke was defined by a positive Face-Arm-Speech-Time (FAST) test. We included individuals with blood glucose of at least 2·5 mmol/L. People who presented more than 6 h after symptom onset were excluded from the analysis. After structured training, paramedics used a mobile app to assess items from eight prehospital stroke scales: Rapid Arterial oCclusion Evaluation (RACE), Los Angeles Motor Scale (LAMS), Cincinnati Stroke Triage Assessment Tool (C-STAT), Gaze-Face-Arm-Speech-Time (G-FAST), Prehospital Acute Stroke Severity (PASS), Cincinnati Prehospital Stroke Scale (CPSS), Conveniently-Grasped Field Assessment Stroke Triage (CG-FAST), and the FAST-PLUS (Face-Arm-Speech-Time plus severe arm or leg motor deficit) test. The primary outcome was the clinical diagnosis of ischaemic stroke with a proximal intracranial large-vessel occlusion in the anterior circulation (aLVO) on CT angiography. Baseline neuroimaging was centrally assessed by neuroradiologists to validate the true occlusion status. Prehospital stroke scale performance was expressed as the area under the receiver operating characteristic curve (AUC) and was compared with National Institutes of Health Stroke Scale (NIHSS) scores assessed by clinicians at the emergency department. This study was registered at the Netherlands Trial Register, NL7387. Findings Between Aug 13, 2018, and Sept 2, 2019, 1039 people (median age 72 years [IQR 61–81]) with suspected stroke were identified by paramedics, of whom 120 (12%) were diagnosed with aLVO. Of all prehospital stroke scales, the AUC for RACE was highest (0·83, 95% CI 0·79–0·86), followed by the AUC for G-FAST (0·80, 0·76–0·84), CG-FAST (0·80, 0·76–0·84), LAMS (0·79, 0·75–0·83), CPSS (0·79, 0·75–0·83), PASS (0·76, 0·72–0·80), C-STAT (0·75, 0·71–0·80), and FAST-PLUS (0·72, 0·67–0·76). The NIHSS as assessed by a clinician in the emergency department did somewhat better than the prehospital stroke scales with an AUC of 0·86 (95% CI 0·83–0·89). Interpretation Prehospital stroke scales detect aLVO with acceptable-to-good accuracy. RACE, G-FAST, and CG-FAST are the best performing prehospital stroke scales out of the eight scales tested and approach the performance of the clinician-assessed NIHSS. Further studies are needed to investigate whether use of these scales in regional transportation strategies can optimise outcomes of patients with ischaemic stroke. Funding BeterKeten Collaboration and Theia Foundation (Zilveren Kruis).