Public Hospital Experience Research Articles

Poor outcome of myasthenia gravis in COVID-19: A tertiary public hospital experience

The COVID-19 Pandemic has caused a great concern worldwide. Myasthenia Gravis is known to be a challenging disease on its own. Most of the time the management of MG would include immunosuppression which could lead us to think that these patients may be at higher risk of contracting an infection or experience severe manifestations of COVID-19 [3]. Current data might be biased toward poor outcome of patients with myasthenia gravis with COVID-19; more likely to be hospitalized, have disease exacerbations, and have a higher risk for mortality than the general population with COVID-19. This case series will present how a concurrent COVID 19 infection affected the outcomes of patients with Myasthenia gravis. In our observation, other factors that may contribute to a poorer outcome are pregnancy and presence of other co-morbidities. The first case was pregnant. The second patient was undergoing treatment for pulmonary tuberculosis. The third case had more than two chronic illnesses and risk factors. In our setting, additional factors like accessibility to a health facility, proper patient education and availability of medications and equipment need to be considered. Despite improvement of myasthenic symptoms, there was progression of respiratory infection leading to poor outcome of the patients. For third-world countries like the Philippines, patient education and monitoring is very important for the prevention of hospitalization due to myasthenic crisis or COVID-19 infection. Further studies are recommended to establish the effects of pregnancy and other co-morbidities in the poor outcome of MG in COVID-19.

Impact of COVID-19 pandemic on non-COVID patient\u2019s management in urology: a public hospital experience in Mumbai

BackgroundTo evaluate the impact of COVID-19 lockdown on non-COVID urological patient’s management in tertiary care urology centres.MethodsThis is an observational study in which data of patients visiting the urology department of all the MCGM run tertiary care hospitals were recorded for the duration of 1 April 2020 to 31 July 2020 and were compared to data of pre-COVID-19 period of similar duration.ResultsThere was a decrease of 93.86% in indoor admissions of urology patients during the COVID-19 lockdown. Indoor admissions for stone disease, haematuria, malignancy accounted for 53.65%, 15.85%, 9.75%, respectively. Elective surgeries had the highest percentage decrease followed by emergency and semi-emergency procedures. There was a reduction of more than 80% in patients attending outpatient clinics. Stone disease and its consequences were the main reasons for visiting outdoor clinics (39%). A substantial number of patients presented with flank and abdominal pain (14.8%) and benign enlargement of the prostate (10.23%). Malignancy accounted for a very small number of patients visiting outdoor clinics (1.58%).ConclusionsCOVID-19 pandemic has a profound impact on patient care and education in Urology. There was more than ninety percent reduction in indoor admissions, operative procedures, and outpatient clinics attendance. Once the pandemic is controlled, there will be a large number of patients seeking consultation and management for urological conditions and we should be prepared for it. Surgical training of urology residents needs to be compensated in near future. Long-term impact on urological patient outcome remains to be defined.

Clinical Outcomes in Critically Ill Coronavirus Disease 2019 Patients: A Unique New York City Public Hospital Experience.

Retrospective cohort study. Data were collected from a large tertiary care public hospital ICU that is part of the largest public healthcare network in the United States. One-hundred thirty-seven adult (≥ 18 yr old) ICU patients admitted between March 10, 2020, and April 7, 2020, with follow-up collected through May 18, 2020. None. Demographic, clinical, laboratory, treatment, and outcome data extracted from electronic medical records. The majority of patients were male (99/137; 72.3%) and older than 50 years old (108/137; 78.9%). The most reported ethnicity and race were Hispanic (61/137; 44.5%) and Black (23/137; 16.7%). One-hundred six of 137 patients had at least one comorbidity (77.4%). One-hundred twenty-one of 137 (78.1%) required mechanical ventilation of whom 30 (24.8%) moved to tracheostomy and 46 of 137 (33.6%) required new onset renal replacement therapy. Eighty-two of 137 patients (59.9%) died after a median of 8 days (interquartile range 5-15 d) in the ICU. Male sex had a trend toward a higher hazard of death (hazard ratio, 2.1 [1.1-4.0]) in the multivariable Cox model. We report a mortality rate of 59.9% in a predominantly Hispanic and Black patient population. A significant association between comorbidities and mortality was not found in multivariable regression, and further research is needed to study factors that impact mortality in critical coronavirus disease 2019 patients. We also describe how a public hospital developed innovative approaches to safely manage a large volume of interhospital transfers and admitted patients.

MEASURING HEALTHCARE SERVICE QUALITY FOR INPATIENT AT THE NATIONAL HEART INSTITUTE AT BACHMAI HOSPITAL IN VIETNAM

Objective: A survey was conducted for measuring healthcare service quality for inpatient at national public general hospital in Hanoi, Vietnam using the Tools of both in the SERVQUAL model and John E. Ware model. Methods: Cross-Sectional study. The study obtained feedbacks from inpatients over one month from January 2014 to February 2014; after inpatients finished their inpatient care at the hospital, they were asked 30 questions following the tool of both in functional and technical quality, using the five generic dimensions (the original 22 scores) of SERVQUAL instrument to combinate with the one dimensions (8 scores) of John E. Ware model, each question can score from 1-5. Results: In total, 325 patients were interviewed and completed the survey. Levels of inpatient satisfaction about service quality is influenced by the tool with 6 items (30 score), All dimension (6 dimension) have reliability coefficient > 0.05; and Cronbach alpha coefficient of the model’s 0.932: Including the first is Reliability (5 score), the second is Responsiveness (4 score), the third is Assurance (4 score), the fourth is Empathy (4 score), the fifth is Tangible (5 score), and the sixth is Technical quality (8 score) with highly Corrected Item-Total Correlation of four construct of patient satisfaction in healthcare service quality (from 0.646 to 0.837). Overall, the level of highly inpatient satisfaction about quality of healthcare in the hospital was explained almost 73.954% what could be achieved. Conclusions: Adjusted research model for the hospital has six contruct from levels of inpatient satisfaction about healthcare service quality is influenced by the tool with 6 factors (30 score). The tool provides feedback on the service quality for medical examination and treatment process of a public hospital experience from the adult inpatient’s perspective at the developing nation as Vietnam. Keywords: Measuring healthcare service quality, inpatient, SERVQUAL, John E. Ware model.

MEASURING INPATIENT SATISFACTION FOR TREATMENT PROCESS AT THE NATIONAL HEART INSTITUTE AT BACHMAI HOSPITAL IN VIETNAM BY TOOLS OF VICTORIAN PATIENT SATISFACTION MONITOR

Background: A survey was conducted for inpatient satisfaction about medical examination and treatment process in Vietnam National Heart Institute at Bachmai Hospital using the Tools of Victorian Patient Satisfaction Monitor (VPSM) 2012. Methods: The study obtained feedback from adult inpatients over a period of one month, during a middle of January to middle of February 2014. We were finished interviewed immediately before inpatients leave hospital, the attendant, a modified version of the PS by the VPSM with 6 items (25 score) was used in the hospital. Results: In total, 325 inpatients were interviewed and completed the survey. Levels of inpatient satisfaction about medical examination and treatment process were influenced by the VPSM with 6 items (25 score) and Cronbach alpha coefficient’s 0.928, Including the Access and Admission, General Patient information, Treatment and Related information, Complaints Management, Physical Environment, Discharge and Follow. Overall, the level of highly inpatient satisfaction in the hospital was explained almost 74.621% what could be archieved. There is no difference in the assessment of the inpatient satisfaction for medical examination and treatment process between level of education; there is difference in the assessment of the inpatient satisfaction for medical examination and treatment process under the Gender, and the monthly income level with the model of research. Conclusion: The levels of inpatient satisfaction about medical examination and treatment process is influenced by the VPSM with 6 items (25 score). The VPSM provides feedback on the PS for medical examination and treatment process of a public hospital experience from the adult inpatient's perspective. Keywords: Medical examination and treatment process, inpatient, patient satisfaction, VPSM

Frequency of Acute Kidney Injury in tetanus patients of Paedriatic Intensive Care Unit: A Public Hospital Experience.

Background and Objective:Tetanus is a potentially fatal but preventable disease. Mortality is related to severity of the disease, cardiovascular, pulmonary and renal complications. Acute kidney injury (AKI) is a frequent and lethal complication of tetanus. The objective was to determine the frequency of AKI in tetanus patients managed in a public hospital.Methods:Children aged 1-12 years admitted in Paediatric Intensive Care Unit (PICU) with the clinical diagnosis of tetanus over three and half years were recruited for the retrospective study. pRIFLE (Pediatric Risk, Injury, Failure, Loss, End) criteria was applied to all cases of tetanus to categorize them as having AKI or not, on the basis of estimated creatinine clearance (ECCL). Comparison was done between AKI and non-AKI cases, as well as between AKI survivors and AKI non-survivors. The study was conducted at PICU of Dr. Ruth K.M. PFau Civil Hospital Karachi for tetanus cases admitted during July 2013 to December 2016Results:During the study period, 44 patients of tetanus were enrolled. Nearly 32 % of tetanus patients developed acute renal dysfunction according to PRIFLE criteria. There were overall 15 (34.09%) expiries among tetanus patients among which nine (60%) had AKI. Oliguria was observed in five (35.71%) cases. All the AKI non-survivors had ECCL below 50% and all had autonomic instability. AKI developed towards the end of first week in three cases, mid of second week in four cases and third week in seven cases. Renal replacement therapy (RRT) i.e. peritoneal dialysis (PD) was done in four AKI cases but it did not improve the outcome. CRP was more than 50 in 24 (54.54%) cases. Ventilatory support was given to 85.71% with AKI as compared to 66.66% of non AKI patients.Conclusion:Development of AKI in tetanus is multifactorial. Major contributors are severity of the tetanus itself, presence of autonomic instability, ventilator dependency, and sepsis. Presence of AKI worsens the outcome of tetanus in terms of survival, length of stay, hospital cost and ventilator days.

(1198) - Heart Transplantation as an Option for End-Stage Chronic Chagas Heart Disease. A Public Hospital Experience

(1198) - Heart Transplantation as an Option for End-Stage Chronic Chagas Heart Disease. A Public Hospital Experience

Measuring Healthcare Quality in Big Public Hospital in Vietnam Country

Objective: Measuring healthcare quality of the big public hospital in developing countries by the functional quality by servQual instrument and technical quality of healthcare by eight dimensions Subject and Method: The study obtained feedback from patients, measure consumers’ perceptions of healthcare quality in both functional and technical quality including, using the SERVQUAL instrument with five generic dimensions (the original 22 item instruments) for functional quality to combination with the 8 dimensions for technical quality for General clinic department at Bachmai Hospital in Vietnam country. The study refers to the period from December 2013 to Jan 2014. Result: Altogether 550 persons were interviewed and 513 patients were identified by stratified random sampling. Most outpatients whose length of stay in general clinic department in the Bachmai hospital. Measuring healthcare quality by functional and technical quality. The functional quality by SERQUAL instrument with 5 items (22 score) and Technical quality item (8 score). Servqual instrument had 5 items are the “Tangible”, “Reliability”, “Responsiveness”, “Assurance”, “Empathy” including and Technical quality item’s Technical Quality; There items have highly patient satisfaction (PS) mean are 3.9196 ± 0.59615, 3.8104 ± 0.73355, 3.9532 ± 0.67188, 3.8998 ± 0.58325, 3.9513 ± 0.61043, 3.9671 ± 0.59481, respectively, and Cronbach alpha for the first construct of public are 0.824, 0.869, 0.860, 0.808, 0.847, and 0.927, respectively. After performing factor analysis, we have four elements are drawn: Factor 1 (Responsiveness) with 8 variables, factor 2 (Reliability) with 6 variables, factor 3 (Tangible) with 5 variables, factor 4 (Technical quality) with 8 variables with highly Corrected Item-Total Correlation of PS and reliability coefficient. Conclusion: Adjusted research model for the public hospital have four construct from levels of customer satisfaction about service quality is influenced by the SERVQUAL (3 items are responsivenes, reliability and tangibles with 19 scores) and Technical Quality instrument (8 scores) with total of 27 scores. The model provides feedback on the quality of a public hospital experience from the adult outpatient’s perspective at the developing nation as Vietnam country.

Implementation of a small bowel obstruction protocol at an urban public hospital

AimThe purpose of this study is to describe our experience with the implementation of a protocol for small bowel obstruction (SBO).MethodologyA retrospective review of patients who presented with SBO between 1 March 2012 and 30 November 2014 were reviewed.ResultsBetween 1 March 2012 and 30 November 2014, the protocol was administered to 49 patients with SBO and 49 patients were treated conventionally. Operative rates for the protocol group and the non‐protocol group were 6% and 18%, respectively (P = 0.06). Patients who received the protocol had an average hospital stay of 5.2 days. The non‐protocol group had an average stay of 7.2 days (P = 0.34). Time from admission to operating room (OR) was 35.2 h for the protocol group and 161.2 h for those who did not receive the protocol (P = 0.57). Mean OR time was 2.6 h for the protocol group and 2.3 h for the non‐protocol group (P = 0.68).ConclusionThis study describes an urban public hospital's experience with a protocol for SBO. These findings suggest that an SBO protocol can be successfully implemented to decrease operative rates, length of stay, and time from admission to OR.

Malleable Penile Prosthesis is a Cost-Effective Treatment for Refractory Ischemic Priapism

Refractory ischemic priapism (RIP) can be difficult to treat, consuming significant healthcare-related resources. Acute insertion of a malleable penile prosthesis (MPP) has been reported as an effective therapy that treats the priapism and restores sexual function. We report our 6-year, urban public hospital experience with acute insertion of MPP in patients with RIP. We retrospectively reviewed the records of patients receiving MPPs for RIP from 2007 to 2013. Data analyzed included duration of erection, number of emergency room (ER) visits, hospital admissions, days of hospitalization, and postoperative course. Costs were estimated using standard Medicare reimbursement rates. Healthcare-related costs of treatment of RIP episodes in men presenting to our institution. During the study period, 14 men underwent MPP placement acutely for refractory priapism. Thirteen presented with RIP, and one had stuttering priapism over a 14-day hospitalization. Etiologies included sickle cell anemia (4/13, 29%), medication-induced (3/14, 21%), and idiopathic (7/14, 50%). Average preoperative duration of RIP was 82 hours with considerable consumption of health-care resources (average US $83,818 estimated cost, 4 ER visits [range 1-27], 2 hospital admissions [range 1-5], 1.5 shunt procedures [range 1-3], 5 irrigation and drainage procedures using phenylephrine injection [range 2-20], and 5 hospital admission days [range 2-14]). All patients were discharged within 24 hours of MPP surgery. The management of RIP is associated with multiple ER visits, prolonged hospital admissions, and significant resource utilization. MPP insertion is efficacious for the immediate resolution of refractory priapism, with potential cost and resource benefits.

Use of a Prescription-Assistance Program for Medically Uninsured Patients With Cancer: Case Study of a Public Hospital Experience in New York State.

With the advances in early detection, prevention, and treatment of some cancers, mortality rates in the United States have been consistently falling. However, with these successes have come substantial increases in the cost of cancer care. Antineoplastics are the leading class in hospital drug expenditures. Cancer treatments are causing a serious financial burden for patients, families, hospitals, and society at large, especially for those who are uninsured. Prescription assistance programs (PAPs) are offered by pharmaceutical manufacturers to provide medications at no out-of-pocket cost to medically indigent patients. To assist the Cancer Care Center at Nassau University Medical Center (NUMC) with drug costs for chemotherapies, a clinical pharmacist-managed PAP was implemented to procure chemotherapy medications from pharmaceutical manufacturers. NUMC is a safety-net teaching hospital in suburban New York. It serves mostly an indigent population, and its Level I trauma center has more than 77,000 emergency department visits per year. We observed all patients requiring assistance with chemotherapy who enrolled in PAPs from January 1, 2011, through December 31, 2012. The total number of visits in the clinic over 24 months was 9,405. Individuals potentially eligible for the PAP were identified by oncologists. Patients received a referral to the PAP when they mentioned to office personnel that they had difficulty obtaining medications or expressed financial concerns related to management. The clinical pharmacist spent the majority of his time assisting uninsured individuals, working with charity pools from the drug manufacturers, and obtaining medications through the PAP. The program served 341 patients in 2011 and 579 patients in 2012. Medications obtained for these patients included both oral and parenteral chemotherapy drugs and antiemetics. The total cost savings of the medications was $908,944.11 in 2011 and $1,715,538.37 in 2012. In 2012, a total of 783 prescriptions were processed, and 775 were approved by the manufacturers (98.9%). PAPs provide a valuable safety net to ensure that uninsured patients with cancer receive needed prescription medications. The rising cost of health care and the high proportion of indigent patients have financially burdened the hospital. For the pharmacy department, this has resulted in a lack of compensation for pharmaceuticals dispensed to indigent patients. A pharmacy-based program to procure free medications for uninsured patients with cancer has helped to defray the expenses of the Cancer Care Center in providing care at NUMC, increased patient compliance with chemotherapy protocols, and allowed many patients to receive the treatments they otherwise would not have been able to afford.

Who leaves the emergency department without being seen? A public hospital experience in Georgetown, Guyana

BackgroundLeft without being seen (LWBS) proportions are commonly used as quality control indicators, but little data is available on LWBS proportions in the developing world. This study sought to determine the proportion and characteristics of patients who LWBS from the emergency department (ED) of the main public hospital in Georgetown, Guyana.MethodsThis is a retrospective cross-sectional analysis of an ED quality assurance database. Registration personnel collected demographic information on patients presenting to the ED over a 2-week period in July 2010. Both univariate and multivariate analysis were conducted to determine patient characteristics associated with LWBS.ResultsThe LWBS proportion was 5.7%. In univariate analysis, patients 18 or older (OR 1.48, 95%CI 1.03-2.12), presenting during the 4PM-12AM shift (OR 2.15, 95%CI 1.53-3.01), with non-urgent triage classification (OR 1.88, 95%CI 1.76-4.66), with non-traumatic chief complaints (OR 1.70, 95%CI 1.14-2.55), or who were not transferred (OR 2.13, 95%CI 1.00-4.55) had significantly higher odds of LWBS. On multivariate analysis, only patients 18 or older (OR 1.54, 95%CI 1.02-2.33), presenting during the 4PM-12AM shift (OR 2.29, 95%CI 1.54-3.40), and with non-traumatic chief complaints (OR 2.39, 95%CI 1.43-4.02) were found to be significantly associated with LWBS. Sex, residence in the capital city, time to triage, transfer status, use of EMS, and triage classification were not statistically associated with LWBS.ConclusionsLWBS proportions are used as quality control indicators and this study determined the LWBS proportion at a public hospital in a developing country and some of the patient characteristics associated with LWBS. This can be helpful to develop strategies to decrease LWBS proportions and to assess progress over time.

Utilization of prescription-assistance program for medically uninsured cancer patients: A case study of a public hospital experience in New York state.

e17537 Background: With the advances in early detection, prevention, and treatment of some cancers, mortality rates in the United States have been consistently falling. However, with these successes have come substantial increases in the cost of cancer care. Antineoplastics are the leading therapeutic classes in hospital drug expenditures. Lack of insurance is associated with lower rates of cancer screening, later stage at diagnosis, and increased cancer mortality. Prescription assistance programs (PAPs) are offered by pharmaceutical manufacturers to provide medications at no out-of-pocket cost to medically indigent patients. To assist the Cancer Care Center at NUMC with drug costs for chemotherapies and maintain the quality care for patients, the Pharmacy department instituted a Patient Assistance Program (PAP) to obtain medication from the drug companies at no cost. NUMC is a “safety net” teaching hospital in suburban New York. It serves mostly an indigent population and is a Level 1 Trauma Center with over 77,000 emergency department visits per year. Methods: We followed all patients requiring assistance with chemotherapy who enrolled in our PAPs from January 1, 2011 to December 31, 2012. Individuals potentially eligible for PAPs were identified by Oncologists and by the pharmacy department. Medications included both oral and parenteral chemotherapy drugs and antiemetics. Results: The program served 341 patients in 2011 and 579 patients in 2012. The total number of visits in the clinic over 24 months was 9,405. The total cost savings of the medications was $908,944.11 in 2011 and $1,715,538.37 in 2012. Conclusions: PAPs provide a valuable safety net to ensure that cancer patients without insurance receive needed prescription medications. The rising cost of health care and the high proportion of indigent patients have financially burdened the hospital. A pharmacy-based program to procure free medications for uninsured cancer outpatients has helped to defray the Cancer Care Center’s expense of providing care at NUMC, increased patients’ compliance with chemo-protocols and allowed many patients to receive the treatment they otherwise would not be able to afford.

Effectiveness of capecitabine plus oxaliplatin for advanced colon cancer: A public hospital experience.

570 Background: Adjuvant chemotherapy has been shown to improve disease-free survival (DFS) and overall survival (OS) in advanced colon cancer (CC). 5-fluorouracil (5-FU)/leucovorin and oxaliplatin is the first line therapy for stage II and III CC. Due to systematic and financial constraints imposed by administering infusional 5-FU, this agent is not available at our institution. Capecitabine plus oxaliplatin (CAPOX) has been studied by others as a possible alternative. We report our experience with CAPOX in the adjuvant treatment of CC patients in a large, public hospital. Methods: A retrospective study of 142 patients with CC who received CAPOX from 2005 to 2011 was performed. Data on patient demographics, treatment, disease recurrence, and survival were analyzed. Survival was assessed by the Kaplan-Meier method. The Cox regression model was used for multivariate analysis. Results: There were 60 female and 82 male patients with a mean age of 54 years (range 21-80). 57 patients were diagnosed with stage II CC and 85 with stage III CC. All patients with stage II and stage III disease underwent curative-intent surgical resection, except for one patient, who refused surgery. 14/141 operations (10%) were performed emergently. Mean follow-up was 36 months (range 2-85 months). The 3-year OS rates were 91% and 81% for stages II and III, respectively. The 3-year DFS rate was 74% for stage II and 66% for stage III. By multivariate analysis, only cancer stage was predictive of overall survival. Conclusions: CAPOX is an effective treatment for stage II and III CC in the adjuvant setting. Our study supports recent evidence demonstrating the efficacy of CAPOX in CC. Ease of administration and improved utilization of resources make it an ideal regimen for public hospital facilities.

A public hospital experience with young gastric cancer patients.

30 Background: Recent literature has reported an increased incidence in the United States of node positive and metastatic disease in young patients with gastric adenocarcinoma. The purpose of this study was to investigate the effect of age (≤40 years) on patients with gastric adenocarcinoma at a large urban public institution. Methods: A total of 520 cases of gastric adenocarcinoma treated between 1995 and 2012 were identified. Information was gathered from the medical record including age at presentation, stage at presentation, pathological type of GC, treatment received, and mortality data. Descriptive statistics were used to analyze the data. Survival was analyzed using the Kaplan-Meier method. Comparisons were made using the log-rank test. Results: The mean age at diagnosis was 56 years. 64 patients (12%) were identified as ≤40 years old. 57 of 64 (89%) of the young age group presented with stage III or IV disease, compared with 75% of patients >40 years of age (p=0.014). For patients ≤40 years old, 38% underwent an operation with curative intent, which was comparable to 39% in patients >40 years old. Of patients who underwent surgery, only 33% (10 of 30) ≤40 years old received an R0 resection compared to 110 of 184 (60%) in those >40 years old (p=0.007). The overall median survival was 5 months with one-year survival of 24% for the young patients and a median of 7.8 months with 39% one-year survival for the older patients (p=0.016). Conclusions: There is a decreased awareness and therefore suspicion of the diagnosis of gastric cancer in young patients (≤40 years of age). For this reason, young patients with gastric adenocarcinoma may present with more advanced disease than older patients. Surgical exploration was often futile, and survival was especially poor in young patients likely due to the more advanced nature of their disease at diagnosis.

First Results of the Free Flap Transfer for the Head and Neck Reconstruction: The Public Hospital Experience

ABSTRACTThe aim of the study is to assess our first results with the free flap transfer. Since October 2006 through April 2012, 58 operations were performed. The upper digestive tract was reconstructed in 46 cases, the soft tissues and skin of the head and neck region—in 12 cases. The primary plasty was performed in all but two cases. Eighteen first cases were performed with 2. 5 and 4x binocular loupes magnification only. The operating microscope was used in 40 cases. Fourty-two radial forearm fasciocutaneous flaps, five latissimus dorsi musculocutaneous flaps, nine anterolateral thigh flaps, one scapular osteocutaneous flap were used with the single case of the visceral flap— the jejunal flap. Death in early postoperative period occurred once. Complete flap loss occurred six times. Five radial and one latissimus dorsi free flaps were lost. The arterial thrombosis is considered as the primary cause of failure in one case, venous thrombosis—in two cases, postoperative infection—in one case with remaining two cases of the unknown primary cause of failure. There were three cases of the revision surgery with the attempts to reperform venous anastomosis, one of them was successful. The overall success rate in this series is 87.9%. Most of the failures occurred early in the series. The main cause of such a low rate of the success is a lack of experience. Even in a so small number of patients the results significantly improved from 72.2 to 94.4%.How to cite this articleKarpenko A, Roman L, Chumanikhina N, Kostyuk I, Sibgatullin R, Belova E, Evdokimova N, Dzhalilov First Results of the Free Flap Transfer for the Head and Neck Reconstruction: The Public Hospital Experience. Int J Head Neck Surg 2012;3(2):66-72.

P161 The changing face of eclampsia – A Chennai Public Hospital experience

International Journal of Gynecology & ObstetricsVolume 107, Issue S2 p. S457-S457 Poster presentations P161 The changing face of eclampsia – A Chennai Public Hospital experience D.M. Christe, D.M. ChristeSearch for more papers by this authorC.R. Anuradha, C.R. AnuradhaSearch for more papers by this authorM. Mohanambal, M. MohanambalSearch for more papers by this authorC. Alexander, C. AlexanderSearch for more papers by this authorA.P. Naliini, A.P. NaliiniSearch for more papers by this authorW.G. Sheelaa, W.G. SheelaaSearch for more papers by this author D.M. Christe, D.M. ChristeSearch for more papers by this authorC.R. Anuradha, C.R. AnuradhaSearch for more papers by this authorM. Mohanambal, M. MohanambalSearch for more papers by this authorC. Alexander, C. AlexanderSearch for more papers by this authorA.P. Naliini, A.P. NaliiniSearch for more papers by this authorW.G. Sheelaa, W.G. SheelaaSearch for more papers by this author First published: 20 November 2009 https://doi.org/10.1016/S0020-7292(09)61652-0AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume107, IssueS2Abstracts of XIX FIGO World Congress of Gynecology and ObstetricsOctober 2009Pages S457-S457 RelatedInformation

The Roles of Radiotherapy and Cytotoxic Drugs in the Management of Carcinoma of the Œsophagus

Cancer of the æsophagus is a most disappointing disease to manage. The public hospital experience in Victoria over the decade 1960‐69 was uniformly bleak, in that only 15 patients survived five years out of a total of 500 registered with the Anti‐Cancer Council of Victoria. No ten‐year survivors were seen. Only a few fortunate exceptions derived any benefit from any attempted therapy in a sample survey of the clinical material at the Peter MacCallum Clinic. However, there is an increasing awareness of the possibilities of relief in cases suitable for radical X‐ray therapy, thanks to the publications of Pearson and Nakayama. Cytotoxic therapy has not been tried adequately, but it has so far failed in this situation to be of much use at all. Suggestions are made as to possible improvements in a combined attack on the lesion.