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.

Intraluminal Volume Dose Alteplase for the Clearance of Occluded Peripherally Inserted Central Catheter Lines at a Long-Term Acute Care Hospital: Efficacy and Economic Impact

Abstract: Purpose: To evaluate the efficacy and economic impact of a maximum of 2 doses of intraluminal volume 1 mg/1 mL dose alteplase for the clearance of occluded peripherally inserted central cath- eter (PICC) lines at a long-term acute care hospital (LTACH) Methods: Open-label, nonrandomized quasi-experimental trial taking place over a 3-month period from December 2013 to March 2014 Patients had a standing order of either standard (2 mg/2 mL) or intraluminal volume (1 mg/1 mL) dose alteplase entered for any potential occlu- sions The primary efficacy outcome was restored line patency after a maximum of 2 doses of alteplase Secondary efficacy outcomes included restored patency after 1 dose of alteplase, reocclu - sion rate, mean time to reocclusion, and mean number of occlusions per patient Results: A total of 168 patients were enrolled into the study (intraluminal volume, n = 54; stand- ard, n = 114) and a total of 270 occlusions were recorded; 90 received intraluminal volume dose alteplase and 180 received the standard dose The primary efficacy endpoint was 933% for the intraluminal volume dose group and 944% for the standard dose group Secondary outcomes were similar between groups The average cost per dose was $12377 and $6062 for the standard and intraluminal volume dose alteplase groups, respectively Conclusion: For the clearance of occluded PICC lines at our LTACH, there was no statistical differ- ence in the efficacy of a maximum of 2 doses of intraluminal volume dose alteplase versus the stand - ard dose Use of intraluminal volume dose alteplase was found to be significantly more cost-effective

Effects of Video-Guided Group vs. Solitary Meditation on Mindfulness and Social Connectivity: A Pilot Study.

Abstract: Interest in mindfulness meditation continues to grow as accumulating evidence suggests mindfulness training encourages more positive functioning. However, basic questions about the conditions best suited for realizing mindful states remain unanswered. Prominent among these is whether a group mindfulness practice setting is more effective for novice meditators than a solitary practice setting. Answering this question has assumed new urgency due to the imposition of physical distancing measures designed to stop the spread of COVID-19. In a time of limited social contact, is a simulated group practice setting better than practicing alone? This preliminary study investigated whether environmental setting impacted mindfulness practice experience by examining the effects of three simulated meditation practice environments (1. group practice, 2. nature practice, and 3. solitary practice) on state mindfulness and perceived social connectivity in a sample of novice meditators. Significant differences emerged across the three simulated practice settings. Findings suggest watching others meditate while meditating appears to most effectively induce a state of mindfulness and strengthen feelings of social connectivity. This study supports traditional beliefs about the benefits of group mindfulness practice. These findings also have implications for social workers struggling to stretch limited resources to address growing mental health demands, especially during times of heightened social isolation due to COVID-19. If a simulated group practice confers the same cognitive benefits as solitary practice while also conferring social benefits, simulated group instruction may be preferable for therapeutic and economic reasons.

Adenomyosis: diagnostics and treatment

Abstract: Adenomyosis is a frequent additional condition in patients with endometriosis and should be included in diagnostic and treatment concepts. Description of diagnostic and therapeutic approaches in patients with adenomyosis in relation to patient age, family planning status, peritoneal and/or deep endometriosis and symptoms. The current literature on adenomyosis including case reports was analyzed. Due to the lack of evidenced-based approaches the most probable trends in diagnostics and treatment are discussed. Adenomyosis plays an important role in fertile patients with dysmenorrhea, dyspareunia and pelvic pain, with or without additional peritoneal or deep endometriosis. It has a negative impact on fertility and can cause a variety of symptoms. The disease can be diagnosed by a skilled examiner and treatment concepts exist. Adenomyosis can be diagnosed by a combination of clinical history, gynecological examination, transvaginal ultrasound and magnetic resonance imaging. Various medical and surgical treatment approaches are available to reduce symptoms and to increase fertility. The course of action depends on the family planning status of the patient.

Giant cell arteritis followed by idiopathic retroperitoneal fibrosis in the same patient—an unexpected positron emission tomography finding

Abstract: A 78-year-old male patient was diagnosed with GCA, confirmed by positive histology of the temporal artery. Treatment with prednisone 1 mg/kg of body weight was initiated, tapered and stopped after 2 years. Two years later, with unremarkable regular controls, the patient presented with lumbar pain, elevated ESR (41 mm/h) and CRP (27 mg/l). PET CT scan (Fig. 1A) was performed, showing moderately elevated fluoro-deoxy-glucose (FDG) uptake in both femoral arteries and a retroperitoneal metabolically active mass partially obstructing the left urether. MRI scans of the abdomen (Fig. 1B) were consistent with the diagnosis of idiopathic retroperitoneal fibrosis (IRF) with left-sided grade I hydronephrosis. IgG4 was initially elevated to 2.00 g/l (normal range 0.08 1.4 g/l) subsiding to 0.62 g/l under treatment with prednisone (1 mg/kg body weight). With 5 mg of prednisone per day, both diseases have remained inactive for the past 6 months. This case describes a patient suffering from both GCA and IRF, an IgG4-related sclerosing disease often associated with elevation of the IgG4 subclass. IRF has not yet been described in patients with GCA. However, similarities in histopathology with inflammation in the medial and adventitial layers of the aorta suggest common yet unproven pathogenetic mechanisms for IRF and GCA.

Diagnostic Errors Induced by a Wrong a Priori Diagnosis: A Prospective Randomized Simulator-Based Trial.

Abstract: Preventive strategies against diagnostic errors require the knowledge of underlying mechanisms. We examined the effects of a wrong a priori diagnosis on diagnostic accuracy of a focussed assessment in an acute myocardial infarction scenario. One-hundred-and-fifty-six medical students (cohort 1) were randomized to three study arms differing in the a priori diagnosis revealed: no diagnosis (control group), myocardial infarction (correct diagnosis group), and pulmonary embolism (wrong diagnosis group). Forty-four physicians (cohort 2) were randomized to the control group and the wrong diagnosis group. Primary endpoint was the participants' final presumptive diagnosis. Among students, the correct diagnosis of an acute myocardial infarction was made by 48/52 (92%) in the control group, 49/52 (94%) in the correct diagnosis group, and 14/52 (27%) in the wrong diagnosis group (p < 0.001 vs. both other groups). Among physicians, the correct diagnosis was made by 20/21 (95%) in the control group and 15/23 (65%) in the wrong diagnosis group (p = 0.023). In the wrong diagnosis group, 31/52 (60%) students and 6/23 (19%) physicians indicated their initially given wrong a priori diagnosis pulmonary embolism as final diagnosis. A wrong a priori diagnosis significantly increases the likelihood of a diagnostic error during a subsequent patient encounter.