University-affiliated Tertiary Teaching Hospital Research Articles

Time-driven activity-based costing for patients with multiple chronic conditions: a mixed-method study to cost care in a multidisciplinary and integrated care delivery centre at a university-affiliated tertiary teaching hospital in Stockholm, Sweden.

ObjectiveThis study can be applied to cost the complex non-standardised processes used to treat patients with multiple chronic conditions.DesignA mixed-method approach to cost analysis, following a modified healthcare-specific version of the seven-step Time-Driven Activity-Based Costing (TDABC) approach.SettingA multidisciplinary integrated and person-centred care delivery centre at a university-affiliated tertiary teaching hospital in Stockholm, Sweden, designed to improve care coordination for patients with multiple chronic conditions, specifically diabetes, cardiovascular disease and kidney disease.Participants314 patients (248 men and 66 women) fit inclusion criteria. Average age was 80 years.ResultsThis modified TDABC analysis costed outpatient care for patients with multiple chronic conditions. The approach accounted for the difficulty of conceptualising care cycles. The estimated total cost, stratified by resources, can be reviewed together with existing managerial accounting statements to inform management decisions regarding the multidisciplinary centre.ConclusionsThis article demonstrates that the healthcare-specific seven-step approach to TDABC can be applied to cost care for patients with multiple chronic conditions, where pathways are not yet discernable. It became clear that there was a need for slight methodological adaptations for this particular patient group to make it possible to cost these pathways, stratified by activity and resource. The value of this approach can be discerned from the way management incorporated the results of this analysis into the development of their hospital strategy. In the absence of integrated data infrastructures that can link patients and resources across financial, clinical and process data sets, the scalability of this method will be difficult.

Sandwich compression with rubbery tourniquet sheets and cotton balls for auricular pseudocyst.

Pseudocyst of the auricle is a benign, noninflammatory cystic disease that is more common in Asians than in Caucasians. When managed conservatively, the results are often unsatisfactory and recurrences are common. We aimed to introduce a novel modified surgical method that involves a deroofing technique followed by a sandwich compression suture using two rubber tourniquet sheets and an iodine-soaked cotton ball for the treatment of auricular pseudocysts and to ascertain its effectiveness. Case series with or without comparison. The charts of 100 patients with auricular pseudocysts who were treated with this new method from 2004 to 2016 in a university-affiliated tertiary teaching hospital were retrospectively reviewed and analyzed. The mean patient age was 37.7 years, and 84% were male. All of the patients had unilateral lesions, with right-side lesions (53.0%) being slightly predominant. The cymba concha (44.1%) was the most common site. Seven patients (7.0%) had trauma to the ear within 3 months before presentation. Previous aspiration or drainage had been performed for the cysts in 35 patients (35.0%), and the recurrences had been treated conservatively. In comparison, 98 of the 100 patients recovered smoothly from surgery without further recurrence or complications after follow-up for at least 1 year. Based on our experience, not only does this surgical procedure yield reliable results in the treatment of pseudocysts of auricles, but it also has advantages such as using readily available materials, being simple to perform, improving efficacy, and lowering recurrence rates. 4. Laryngoscope, 128:1653-1657, 2018.

Evaluation of in vitro fertilization outcomes using interleukin-8 in culture medium of human preimplantation embryos

To investigate whether selected cytokines are detectable in the embryo culture medium (EM) of human preimplantation embryos (HPE) and what the relationship is of the cytokines with clinical outcomes. Cross-sectional study. University-affiliated tertiary teaching hospital. Three-hundred and thirty infertile women who underwent fresh cycle invitro fertilization (IVF) between January and December2014. Collection on the day of transfer of the EM of each embryo that was transferred in all patients for measurement of cytokine levels. Measurement of 13 selected cytokines in the EM of day-3 HPE to analyze the relationship of the cytokine with embryo quality and clinical outcome. Of the cytokines measured, only interleukin-8 (IL-8) was statistically significantly associated with clinical outcome. The rate of detectable IL-8 in the EM was 32.42%, and the pregnancy rate, implantation rate, and number of live births per invitro fertilization (IVF) or intracytoplasmic sperm injection patient (N LBPP) were higher, and 0 IR was lower in patients for whom the medium from transferred embryos was positive for IL-8 (IL-8 positive group) compared with the patients for whom the medium tested negative for IL-8 (IL-8 negative group). Compared with the IL-8 negative group, a higher pregnancy rate was observed in the IL-8 positive group when the patients received equal good-ordinary quality embryos. In the EM from HPE, IL-8 is associated with higher pregnancy rates, higher IRs, and higher N LBPP, so IL-8 may be an independent predictor for pretransfer assessment of the embryo development potential in IVF patients.

Novel mutations and polymorphisms in the CFTR gene associated with three subtypes of congenital absence of vas deferens

To study the new genotypes in congenital absence of vas deferens (CAVD) and the correlation with different phenotypes, and to investigate the pathogenesis of the disease based on bioinformatics analysis. Case-control study. University-affiliated tertiary teaching hospital. Nineteen patients with CAVD and azoospermia. The time period of the study was from May 2013 to April 2014. None. Sanger sequencing was performed in the coding regions and intron-exon boundaries of the cystic fibrosis transmembrane regulator CFTR gene on the polymerase chain reaction (PCR) products. Mutations/variations were identified and compared with the control subjects, and bioinformatics analysis searched in the dbSNP and 1000 Genomes Project. Functional effects of the novel mutations were predicted. Structural modeling of the wild and mutant proteins was also performed. A total of 8 mutations were identified in 12 patients, 4 of which were novel (c.4433C>G, c.3469-3C>A, c.1357delT, and c.3407C>T). The mutation c.4433C>G occurred in the PSD-95/DLG/ZO-1 (PDZ)-binding motif in the CFTR protein, which was predicted to disrupt the interaction between CFTR and CFTR-associated ligand (CAL). Another missense mutation, c.3407C>T, was predicted to damage and destroy the transmembrane adenosine triphosphate (ATP)-binding cassette domain. The splicing mutation, c.3469-3C>A, was predicted to truncate exon 22 by Human Splicing Finder. The frameshift mutation, c.1357delT, was predicted to introduce a premature stop codon at position 453 and lead to 1,012 amino acids truncation at the carboxyl terminus of the CFTR protein. This study illustrates the significance of whole exon sequencing of the CFTR gene in patients with CAVD. It is essential for determining the pathogenesis of novel mutations using bioinformatics analysis and to identify correlation between new genotypes and phenotypes.

Effect of sperm DNA fragmentation on the clinical outcomes for in vitro fertilization and intracytoplasmic sperm injection in women with different ovarian reserves

To investigate effect of sperm DNA fragmentation (SDF) on clinical outcomes of assisted reproductive technology in women with normal ovarian reserve (NOR) versus reduced ovarian reserve (ROR). Retrospective clinical study. University-affiliated tertiary teaching hospital. A total of 2,865 consecutive couples undergoing their first in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) cycle. SDF assessed using sperm chromatin dispersion in sperm samples 1-2 months before treatment. SDF, IVF, and ICSI outcomes. The grouping criteria were [1] basal follicle stimulating hormone >10 IU/L, [2] antral follicle count <6, and [3] female age ≥38 years. Women fulfilling two of the three criteria were considered to have ROR, and those not meeting any criteria were considered to have NOR. The area under the receiver operating characteristic curve was 0.594 (0.539-0.648) for the ROR group and 0.510 (0.491-0.530) for the NOR group. A cutoff value for SDF to predict the clinical pregnancy rate (CPR) in the ROR group was 27.3%. When the SDF exceeded 27.3%, the live-birth and implantation rates in the ROR group were statistically significantly decreased, but the clinical pregnancy, live-birth, and implantation rates were not affected in the NOR group. The risk of early abortion increased significantly in the NOR group when the SDF exceeded 27.3%. Sperm DNA fragmentation has a greater impact on IVF and ICSI outcomes among women with ROR, so SDF testing may be of particular clinical significance for these couples.

Chest radiograph heterogeneity predicts functional improvement with volume reduction surgery

Background. Using a historical cohort study model, we tested the hypothesis that heterogeneity of emphysematous changes on the preoperative chest radiograph correlated with favorable outcome of lung volume reduction surgery. Methods. The test population consisted of 21 patients with severe emphysema who were being treated at a 1,000-bed university-affiliated tertiary teaching hospital. A simple but quantitative index of heterogeneity has been devised, whereby the preoperative posteroanterior chest radiographic lung fields are divided into four geometric quadrants. Each quadrant is scored (0 to 4) for emphysematous changes by two radiologists blinded as to subsequent patient management and outcome. Criteria for determining presence of emphysema were hyperlucency, decreased vascular markings, and parenchymal crowding indicating compressed lung. Heterogeneity index is the sum of the two highest scores minus the two lowest, with a maximum index of 8 and a minimum of 0. Preoperative chest radiographs and postoperative changes in forced expiratory volume in 1 second were examined. Results. The heterogeneity index was positively correlated with change in forced expiratory volume in 1 second after operation with an r 2 of 0.31 and an average increase of 117 mL per unit increase in heterogeneity index ( p < 0.009). Conclusions. This simple index of heterogeneity may be useful as a predictor of improved pulmonary function after lung volume reduction surgery.