Bellevue Hospital (officially NYC Health + Hospitals/Bellevue and formerly known as Bellevue Hospital Center) is a hospital in New York City and the oldest public hospital in the United States. One of the largest hospitals in the United States by number of beds, it is located at 462 First Avenue in the Kips Bay neighborhood of Manhattan, New York City. Bellevue is also home to FDNY EMS Station 08, formerly NYC EMS Station 13. The facility offers comprehensive healthcare services, including outpatient, specialty, and skilled nursing care, as well as emergency and inpatient services. The hospital contains a 25-story patient care facility and has an attending physician staff of 1,200 and an in-house staff of about 5,500. Bellevue is a safety net hospital, providing healthcare for individuals regardless of their insurance status or ability to pay. It handles over half a million patient visits each year.In 2014 Bellevue was ranked 40th overall best hospital in the New York metro area and 29th in New York City by U.S. News and World Report. Though Bellevue is a full-service hospital, it was once popularly associated with its treatment of mentally ill patients who required psychiatric commitment. The name "Bellevue" became a pejorative slang term for a psychiatric hospital.
Abstract Background Antithrombotic therapy with a P2Y12 inhibitor ± aspirin/oral anticoagulant after percutaneous coronary intervention (PCI) is critical to prevent stent thrombosis. The three oral P2Y12 inhibitors vary in potency, bleed risk, dosing regimen, place in guideline recommendations, and cost. Known disparities in access to medications, adherence, and use of first-line agents among minority groups increase the risk of stent thrombosis and recurrent MI after PCI. At our large, urban, safety-net hospital, the majority of the patients that we serve are uninsured or underinsured and belong to minority groups that are vulnerable to factors that reduce medication adherence. In order to provide equitable care, we implemented interventions aimed at improving adherence by making care both accessible and acceptable for patients’ individual circumstance. Purpose To compare one-year ischemic and bleeding outcomes after percutaneous coronary intervention between clopidogrel responders and non-responders treated with ticagrelor or prasugrel as part of a tailored antiplatelet strategy. Methods In this quality improvement project, adults underwent platelet function testing (PFT) after clopidogrel initiation for ACS and/or PCI and were classified as responders (ADP inhibition <40% on light transmission aggregometry) or non-responders. Responders remained on clopidogrel and non-responders were switched to ticagrelor or prasugrel. The primary outcome was a one-year composite of stent thrombosis, cardiac death, and bleeding. Concurrently, all PCI patients received at least a 30-day supply of antithrombotic therapy via bedside delivery and a follow-up call to support adherence during the period of greatest thrombotic risk. Results As part of the guided antiplatelet program, 455 patients (mean age 64.9 years, 32% women, 90% non-White) were followed for one year to assess differences in outcomes between clopidogrel responders and non-responders that were switched to another agent. No differences were observed in the primary outcome (composite of stent thrombosis, cardiac death, and bleeding events) at one year (7% vs 6%, log-rank p=0.67) between the groups, nor were there differences in the individual components of the primary outcome. In the Meds-to-Beds program, a 95% (1175/1243) delivery rate was achieved over two years, where previously no bedside delivery option existed. Conclusion The use of clopidogrel in patients confirmed to be responders was as safe and effective as ticagrelor or prasugrel at one year. Clopidogrel remains widely used and its advantages (once-daily dosing, lower bleed risk, and lower cost) make it a viable option despite guideline preference for ticagrelor and prasugrel. Combining tailored therapy with bedside medication delivery can reduce costs and expand the ability to provide optimal post-PCI care in vulnerable populations.
INTRODUCTION:Inguinal hernia repair is one of the most commonly performed surgical procedures worldwide, yet limited large-scale data exist comparing open and laparoscopic approaches in the Indian population. This study aimed to compare outcomes between these surgical techniques across multiple centres in India. PATIENTS AND METHODS:This multi-centric prospective observational study was conducted by Sir Ganga Ram Hospital in collaboration with the Indian Association of Gastrointestinal Endo Surgeons. Data on all groin hernia surgeries performed over 3 months were collected, with patient outcomes assessed at 30 and 90 days postoperatively using the Clavien-Dindo classification system. RESULTS:A total of 2679 patients underwent inguinal hernia repair: 1592 underwent open surgery and 1087 underwent laparoscopic surgery. The laparoscopic group was significantly older with higher body mass index, and bilateral hernias were more common. Laparoscopic repair demonstrated significantly lower post-operative day-one pain scores, reduced major medical complications and lower surgical site infection rates at 30 days. Chronic groin pain at 90 days was significantly less common in the laparoscopic group. No significant differences in recurrence rates were observed at 90 days. CONCLUSION:This large-scale Indian study demonstrates that laparoscopic inguinal hernia repair offers significant advantages, including reduced post-operative pain, lower complication rates and decreased chronic groin pain compared to open repair. The findings support selective laparoscopic application for bilateral hernias, obese patients and those with metabolic comorbidities while highlighting the need for standardised protocols in Indian healthcare settings.
