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Search Results: 1 - 10 of 223 matches for " Hariharan Seetharaman "
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A Safe Surgical Approach to a Giant Intrarenal Arteriovenous Fistula and Aneurysm
Vijay Naraynsingh,Patrick Harnarayan,Seetharaman Hariharan
Urology Journal , 2009,
Evaluation of the utilization of the preanaesthetic clinics in a University teaching hospital
Seetharaman Hariharan, Deryk Chen, Lorna Merritt-Charles
BMC Health Services Research , 2006, DOI: 10.1186/1472-6963-6-59
Abstract: All patients scheduled to have elective surgery during the period of twelve weeks were enrolled for prospective collection of data including demographics, the admitting diagnoses, surgical procedure, category of surgery and specialty, and the patients' attendance to preanaesthetic clinics. Cancellations on the day of surgery along with reasons were recorded. The difference between patients who attended and did not attend the clinic was analysed.Of 424 patients scheduled for procedures during the study period, 213 were adults and 211 were children. Overall 39% of adults and 46% of the children scheduled for surgery had previously attended the preanaesthetic clinic. Among adults, general surgery patients were the largest majority to attend the preanaesthetic clinic. The paediatric preanaesthetic clinic was mostly utilized by paediatric general surgery. Overall 30% of procedures in adults and 26% of those in children were cancelled. There was a statistically significant difference in cancellations between patients who attended and did not attend the preanaesthetic clinic (p = 0.004). There was a 52% more chance of the procedure getting cancelled if the patient did not attend the clinic.The study highlights the inadequate use of the preanaesthetic clinics and the impact of the clinics on last-minute cancellations.Preanaesthetic assessment of a surgical patient is done differently in various settings. In an outpatient setting this may be done by administering a questionnaire by the nursing or medical staff, or assessing the patient in a dedicated preanaesthetic out-patient clinic. In an in-patient setting the patient on the ward may be referred to the anaesthetist preoperatively for preoperative evaluation and optimization. Although in many institutions the anaesthetists get to see the patient on the day of the procedure in the patient-waiting room, there is evidence that a preanaesthetic assessment well before the procedure plays a vital role in avoiding last-minute can
Knowledge, attitudes and practice of healthcare ethics and law among doctors and nurses in Barbados
Seetharaman Hariharan, Ramesh Jonnalagadda, Errol Walrond, Harley Moseley
BMC Medical Ethics , 2006, DOI: 10.1186/1472-6939-7-7
Abstract: A self-administered structured questionnaire about knowledge of healthcare ethics, law and the role of an Ethics Committee in the healthcare system was devised, tested and distributed to all levels of staff at the Queen Elizabeth Hospital in Barbados (a tertiary care teaching hospital) during April and May 2003.The paper analyses 159 responses from doctors and nurses comprising junior doctors, consultants, staff nurses and sisters-in-charge. The frequency with which the respondents encountered ethical or legal problems varied widely from 'daily' to 'yearly'. 52% of senior medical staff and 20% of senior nursing staff knew little of the law pertinent to their work. 11% of the doctors did not know the contents of the Hippocratic Oath whilst a quarter of nurses did not know the Nurses Code. Nuremberg Code and Helsinki Code were known only to a few individuals. 29% of doctors and 37% of nurses had no knowledge of an existing hospital ethics committee. Physicians had a stronger opinion than nurses regarding practice of ethics such as adherence to patients' wishes, confidentiality, paternalism, consent for procedures and treating violent/non-compliant patients (p = 0.01)The study highlights the need to identify professionals in the workforce who appear to be indifferent to ethical and legal issues, to devise means to sensitize them to these issues and appropriately training them.There has been growing public concern regarding the ethical conduct of healthcare professionals. This is often reflected as complaints about poor ethical conduct and an increasing use of litigation against healthcare practitioners.Although ethics as applied to medical practice dates back to the ancient civilization by the symbolic adherence to the Hippocratic Oath, codes of conduct and laws regulating the profession are devised and updated from time to time [1]. These codes have been included in the health professionals' training curriculum in many countries, and there has been a growth in the num
Portal vein thrombosis following laparoscopic cholecystectomy complicated by dengue viral infection: a case report
Dilip Dan, Kevin King, Shiva Seetahal, Vijay Naraynsingh, Seetharaman Hariharan
Journal of Medical Case Reports , 2011, DOI: 10.1186/1752-1947-5-126
Abstract: We report a case of a 63-year-old woman of Asian Indian ethnicity who developed portal vein thrombosis following an uneventful laparoscopic cholecystectomy for symptomatic gallstones. Her condition was further complicated by dengue viral infection in the post-operative period, with thrombocytopenia immediately preceding the diagnosis of portal vein thrombosis. The etiological connections between dengue viral infection with thrombocytopenia, laparoscopic cholecystectomy, portal vein thrombosis as well as the treatment dilemmas posed in treating a patient with portal vein thrombosis with a bleeding diathesis are discussed.When portal vein thrombosis occurs in patients with contraindications to anticoagulation, there is a role for initial conservative management without aggressive anticoagulation therapy and such patients must be approached on an individualized basis.Portal vein thrombosis (PVT) is one of the recognized complications in the post-operative period following abdominal surgeries, although it is uncommonly reported in the literature. PVT may usually manifest in a patient who is in a hypercoagulable state, but to the best of our knowledge, has never been reported in a patient with thrombocytopenic hemorrhagic disorder. We report a patient who presented with PVT, five days after an uneventful laparoscopic cholecystectomy. She was simultaneously diagnosed with thrombocytopenia secondary to dengue virus infection. This case is noteworthy in that it represents an unusual constellation of diseases and poses interesting challenges regarding the seemingly contradictory fundamentals of management.A 63-year-old woman of Asian Indian ethnicity presented with complaints of biliary colic, which was worsening over a period of six months. She denied jaundice, fevers or weight loss. She had a past medical history of hypertension, diabetes mellitus and ischemic heart disease; she had received coronary angioplasty and stenting two years prior to the presentation. She was on
The utilities of the therapeutic intervention scoring system (TISS-28)
Hariharan Seetharaman,Chen Deryk,Merritt-Charles Lorna,Bobb Nahmorah
Indian Journal of Critical Care Medicine , 2007,
Abstract: Background and Aims: The study evaluates the utility of therapeutic intervention scoring system (TISS-28) in quantifying the resource utilization, costs and predicting outcome of critically ill patients. Materials and Methods: TISS-28 was prospectively applied to patients consecutively admitted to the intensive care units (ICU) of three public teaching hospitals and two private hospitals in Trinidad on a daily basis for a period of eight weeks. Demographic data, diagnoses on admission, nurse-patient ratio, ICU length of stay and hospital outcomes were recorded. Simplified acute physiology score (SAPS)-II was applied for all adult patients. Costs were calculated from data collected from the public hospitals in relation to TISS-28 score. Results : TISS-28 scores of five hundred and ninety-five patient-days were analyzed. The median daily TISS-28 per patient was 27 [24.5, 30.6 quartiles (IQR)]; the median day-1 TISS-28 score was 29 (25, 33 IQR) and the median last day TISS-28 score was 25 (21, 30 IQR). The overall average TISS per nurse was 26.2 per day. The mean cost per patient per day was 414 US dollars. The discriminatory function of day-1 TISS-28 as a prognostic scoring system was less compared to SAPS II as shown by the area under the receiver operating characteristic curve (0.65 compared to 0.71). Conclusions: TISS-28 is useful for evaluating the resource utilization and costs and may not be useful as a prognostic scoring system
Bariatric Surgery in the Caribbean: Is It Safe in a Low-Volume, Third World Setting?
Dilip Dan,Yardesh Singh,Vijay Naraynsingh,Seetharaman Hariharan,Ravi Maharaj,Surujpal Teelucksingh
Minimally Invasive Surgery , 2012, DOI: 10.1155/2012/427803
Abstract: Bariatric surgery is a well-recognized modality of management of obesity. In addition to obesity, it effectively controls diabetes mellitus, and hypertension. It has been recommended that bariatric surgery should be done in “designated centers” of excellence where there is a high volume of case turnover. Caribbean nations are not spared from the global spread of the obesity epidemic; however, not many patients get the benefits of bariatric surgery. This study aimed to establish that bariatric surgery could be safely and efficiently undertaken in a low-volume center outside the “designated centers” with comparable patient outcomes even in a third world setting. Though “patient numbers” generally imply better outcome, in an environment where these numbers cannot be achieved, patients should not be denied the access to surgery once good outcomes are achieved. 1. Introduction Obesity has reached epidemic levels in many countries around the world [1]. The prevalence of obesity has steadily increased over the years irrespective of demographic factors such as age, sex, race, ethnicity, or educational level [2]. It is also increasing rapidly in both industrialized and developing countries [3]. Worldwide, nearly 250 million people are obese, and the WHO has estimated that in 2025, 300 million people will be obese [4]. It is a well-known fact that obesity is associated with increased morbidity and mortality. There have been many published reports from several Caribbean nations such as Jamaica, Barbados, Trinidad & Tobago, and St. Lucia concerning the steady rise in the prevalence of obesity from primary school age through adolescence and adulthood [5–8]. A recent PAHO/WHO report suggests that more than half of the population in Trinidad & Tobago fall within the parameters of being either overweight or obese, which is indeed quite alarming [9]. The medical management of obesity has a poor track record, but bariatric surgery has demonstrated superior weight loss and dramatic improvement in comorbidities in the postoperative period. In the developed world, bariatric surgery is usually performed at designated centers of excellence on the basis that this leads to better outcomes. However, it is debatable if bariatric surgery should be limited to such high-volume centers [10]. In addition to control of obesity, bariatric surgery is also very effective in the management of diabetes mellitus and hypertension, which commonly afflicts this population. Since the prevalence of diabetes mellitus and hypertension is also very high in the Caribbean nations, it may well be
Percep??o dos pacientes a respeito da utilidade do Ambulatório de Avalia??o Pré-anestésica em um país caribenho em desenvolvimento
Hariharan, Seetharaman;Chen, Deryk;Jurai, Nicholas;Partap, Amanda;Ramnath, Rakesh;Singh, Dinesh;
Revista Brasileira de Anestesiologia , 2009, DOI: 10.1590/S0034-70942009000200007
Abstract: background and objectives: perception of the patients regarding the utility of the preanesthetic clinics and flow time in clinics has not been widely studied in the developing world. the present study aims to study this aspect. methods: a self-administered 15-item questionnaire survey was conducted among patients attending the preanesthetic clinics at a tertiary care teaching hospital in trinidad. the questionnaire was also distributed to the patients attending the general surgical clinic for comparison. another questionnaire was distributed among the staff of the preanesthetic clinic. patient demographics including age, gender, and educational status and american society of anesthesiologists physical status were noted. other data recorded were patient flow time and details of attending staff. results: of the 220 patients who attended the preanesthetic clinics, 92.7% participated in the study. the reliability of the questionnaire was supported by cronbach's alpha coefficient (0.67). the median time for referral from the surgical clinic to preanesthetic clinic was 50 days, median waiting time in the clinic was 2.7 hours, and the median waiting time for surgery after acceptance in the clinic was 13 days. the patients' opinions regarding the benefits of the clinic, length of the waiting time was independent of their age and educational status. patients felt that attending the preanesthetic clinic was beneficial and not costly to them, although the waiting times were found to be longer. conclusions: patients perceive that attending the preanesthetic clinic has been useful before the surgical procedure and the care they received in the clinic was satisfactory
Extrauterine leiomyomata presenting with sepsis requiring hemicolectomy
Dan, Dilip;Harnanan, Dave;Hariharan, Seetharaman;Maharaj, Ravi;Hosein, Ian;Naraynsingh, Vijay;
Revista Brasileira de Ginecologia e Obstetrícia , 2012, DOI: 10.1590/S0100-72032012000600008
Abstract: extrauterine leiomyomas are rare, benign, and may arise in any anatomic sites. their unusual growth pattern may even mimic malignancy and can result in a clinical dilemma. occasionally, uterine leiomyomas become adherent to surrounding structures. they also develop an auxiliary blood supply, and lose their original attachment to the uterus, thus becoming 'parasitic'. parasitic myomas may also be iatrogenically created after uterine fibroid surgery, particularly if morcellation is used. this report presented two cases of parasitic myomas with sepsis, both requiring right hemicolectomy. it reviewed the pertinent literature.
Near-Lossless Compression Based on a Full Range Gaussian Markov Random Field Model for 2D Monochrome Images  [PDF]
K. Seetharaman, V. Rekha
Journal of Signal and Information Processing (JSIP) , 2013, DOI: 10.4236/jsip.2013.41002

This paper proposes a Full Range Gaussian Markov Random Field (FRGMRF) model for monochrome image compression, where images are assumed to be Gaussian Markov Random Field. The parameters of the model are estimated based on Bayesian approach. The advantage of the proposed model is that it adapts itself according to the nature of the data (image) because it has infinite structure with a finite number of parameters, and so completely avoids the problem of order determination. The proposed model is fitted to reconstruct the image with the use of estimated parameters and seed values. The residual image is computed from the original and the reconstructed images. The proposed FRGMRF model is redefined as an error model to compress the residual image to obtain better quality of the reconstructed image. The parameters of the error model are estimated by employing the Metropolis-Hastings (M-H) algorithm. Then, the error model is fitted to reconstruct the compressed residual image. The Arithmetic coding is employed on seed values, average of the residuals and the model coefficients of both the input and residual images to achieve higher compression ratio. Different types of textured and structured images are considered for experiment to illustrate the efficiency of the proposed model. The results obtained by the FRGMRF model are compared to the JPEG2000. The proposed approach yields higher compression ratio than the JPEG whereas it produces Peak Signal to Noise Ratio (PSNR) with little higher than the JPEG, which is negligible.

Regression Testing in Developer Environment for Absence of Code Coverage  [PDF]
M. Thillaikarasi, K. Seetharaman
Journal of Software Engineering and Applications (JSEA) , 2014, DOI: 10.4236/jsea.2014.78057

The techniques of test case prioritization schedule the execution order of test cases to attain respective target, such as enhanced level of forecasting the fault. The requirement of the prioritization can be viewed as the en-route for deriving an order of relation on a given set of test cases which results from regression testing. Alteration of programs between the versions can cause more test cases which may respond differently to following versions of software. In this, a fixed approach to prioritizing test cases avoids the preceding drawbacks. The JUnit test case prioritization techniques operating in the absence of coverage information, differs from existing dynamic coverage-based test case prioritization techniques. Further, the prioritization test cases relying on coverage information were projected from fixed structures relatively other than gathered instrumentation and execution.

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